Interdisciplinary Team Approach to Stroke Rehabilitation in Home Care

Completed

Phase 1 Results

Trial Description

As the population ages and the number of stroke survivors increases, information is needed to determine the best way of providing home care services for rehabilitation to stroke survivors and their caregivers while containing health care costs. This project will address this area by developing and testing the effects and costs of a collaborative and specialized team approach to stroke rehabilitation by health professionals, in a home care setting, compared to usual home care services. The overall goal of this way of providing home care services is to improve the quality of life and function of stroke survivors and their caregivers and prevent future strokes, which will reduce the overall cost to the health care system.

Detailed Description

Stroke is the third leading cause of death in Canada, and is considered to be the most common disabling chronic condition. Approximately 40,000 to 50,000 people in Canada experience a stroke each year and about 80% of these people survive. Many of these people who survive a stroke never fully recover and are left with significant impairments and disabilities, and 12% to 25% will have another stroke within the first year. This results in a significant burden to individuals, families, and society as a whole. Of every 100 people who are hospitalized for a stroke, 15-40 return home and require home care services for rehabilitation. Stroke rehabilitation is one of the key components of stroke care. The goal of rehabilitation is to assist stroke survivors to reach his or her optimal level of physical, social, and emotional function.
Information gained from this study will be used to inform home care practice, policy decisions and the allocation of home care resources and make a national contribution to health care delivery reform.

Conditions

Interventions

  • Interdisciplinary (or team) Stroke Rehab Behavioral
    Intervention Desc: Participants in the experimental group will receive home care services from a team of professional service providers (CCAC Care Coordinator, Registered Nurse, Occupational therapist, Physiotherapist, Speech language pathologist, Nutritionist) and non-professional service providers (personal support workers) with experience and training in stroke care. The team will provide a comprehensive, coordinated and evidence-based approach to stroke rehabilitation through weekly case conferencing, a written interdisciplinary care plan, and joint visits.
  • Interprofessional Team Approach Other
    Other Names: Interdisciplinary Stroke Rehabilitation Team
    Intervention Desc: Subject in the second group will receive home care services from a team of professional service providers (CCAC Care Coordinator, Registered Nurse, Occupational therapist, Physiotherapist, Speech language pathologist, Nutritionist) and non-professional service providers (personal support workers) with experience and training in stroke care. The team will provide a comprehensive, coordinated and evidence-based approach to stroke rehabilitation through weekly case conferencing, a written interdisciplinary care plan, and joint visits.
    ARM 1: Kind: Experimental
    Label: Interprofessional Team Approach
    Description: Participants in the experimental group will receive home care services from a team of professional service providers [Community Care Access Centre (CCAC) Care Coordinator, Registered Nurse, Occupational therapist, Physiotherapist, Speech language pathologist, Nutritionist] and non-professional service providers (personal support workers) with experience and training in stroke care. The team will provide a comprehensive, coordinated and evidence-based approach to stroke rehabilitation through weekly case conferencing, a written interdisciplinary care plan, and joint visits.

Trial Design

  • Allocation: Randomized
  • Masking: Double Blind (Investigator, Outcomes Assessor)
  • Purpose: Treatment
  • Endpoint: Efficacy Study
  • Intervention: Parallel Assignment

Patient Involvement

Subjects will take baseline, 6-months and 12-months: Stroke Impact Scale - 16; Reintegration to Normal Living Index; Short Portable Mental Status Questionnaire; Centre for Epidemiological Studies in Depression Scale; Personal Resource Questionnaire; Health and Social Services Utilization Inventory; Kessler - 10Caregivers in study(measures taken at baseline and 12-months except the falls calendar): SF-36 health survey Centre for Epidemiological Studies in Depression Scale SPMSQ; Caregiver Reaction Assessment ScaleExperimental arm: Participants in the experimental group will receive home care services from a team of professional service providers (CCAC Care Coordinator, Registered Nurse, Occupational therapist, Physiotherapist, Speech language pathologist, Nutritionist) and non-professional service providers (personal support workers) with experience and training in stroke care.Interdisciplinary (or team) Stroke Rehab arm: Subject in the second group will receive home care services from a team of professional service providers (CCAC Care Coordinator, Registered Nurse, Occupational therapist, Physiotherapist, Speech language pathologist, Nutritionist) and non-professional service providers (personal support workers) with experience and training in stroke care.

Outcomes

Type Measure Time Frame Safety Issue
Primary For stroke survivors (measures taken at baseline, 6-months, and 12-months); Neurobehavioral Functioning Inventory.
Secondary For stroke survivors (measures taken at baseline, 6-months, and 12-months): Stroke Impact Scale - 16; Reintegration to Normal Living Index; Short Portable Mental Status Questionnaire; Centre for Epidemiological Studies in Depression Scale; Personal Resource Questionnaire; Health and Social Services Utilization Inventory; Kessler - 10. For Caregivers (measures taken at baseline and 12-months except the falls calendar): SF-36 health survey Centre for Epidemiological Studies in Depression Scale SPMSQ; Caregiver Reaction Assessment Scale
Primary SF-36 Physical Function Score to Measure the Change in Health-related Quality of Life and Function From Baseline (Pre-randomization)to 12 Months. Baseline (pre-randomization) and 12 months No
Secondary Stroke Impact Scale - 16 Baseline (pre-randomization) and 12 months No
Secondary Reintegration to Normal Living Index Baseline (pre-randomization) and 12 months No
Secondary Short Portable Mental Status Questionnaire. Baseline (pre-randomization) and 12 months No
Secondary Centre for Epidemiological Studies in Depression Scale (CES-D) 10 minutes No
Secondary Caregiver Reaction Assessment Scale. Baseline (pre-randomization) and 12 months No
Secondary Personal Resource Questionnaire (PRQ85-Part Two) Baseline (pre-randomization) and 12 months No
Secondary Health and Social Services Utilization Inventory Baseline (pre-randomization) and 12 months No
Secondary Kessler - 10 Baseline (pre-randomization) and 12 months No

Sponsors