Feasibility of a Novel Intervention to Improve Participation after Stroke.
Susan Stark, Marian Keglovits, Emily Somerville and 3 others
PMID 29861533WHAT IT FOUND
A home-based occupational therapy program adding modifications and strategy training to usual stroke care was feasible and safe.
Participants in the intervention group showed large, clinically meaningful improvements in community participation and daily activity performance at six months compared to an education-only control group.
Key findings
01The intervention group showed a 17.4-point improvement in community participation at six months, compared to a 1.3-point improvement in the education control group.
02Participants receiving home modifications demonstrated a clinically meaningful average improvement of 17.3 points in daily activity performance on the Stroke Impact Scale ADL subscale.
03Adherence to the home modifications remained high at 84.9% three months post-intervention, with an average cost of $495 per participant.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The sample size was very small (N=15) and unbalanced, with the COMPASS group having more impaired participants at baseline (lower FIM scores, longer inpatient stays). The study was not powered to detect statistical differences between groups; findings are preliminary. Interventionists were not blinded to group allocation. Recruitment goals were not achieved, and the education control group may have received home modifications through other means. Results may not generalize to patients with hemorrhagic stroke or aphasia, who were excluded.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the large point differences as proof of efficacy. The study was a small pilot not powered for statistical significance, and the COMPASS group started with more severe impairments than the control group, meaning the observed improvements could be influenced by baseline differences or chance rather than the intervention alone.