目的:比较卒中后社区参与过渡试验中干预组和对照组参与者的不良健康事件,以减少社区居住的卒中幸存者的独立生活障碍。
方法:随机对照试验。
方法:住院康复(IR)向家庭和社区过渡。
方法:年龄≥50岁的卒中幸存者在卒中前独立于日常生活活动的IR出院(n=183)。
方法:随机接受干预的参与者(n=85)在家中接受了来自职业治疗师的家庭改造和自我管理培训超过4次。随机分为对照组的参与者(n=98)接受了相同数量的卒中教育。
方法:死亡,熟练护理机构(SNF)入院,再住院30天,从IR放电后的下降率。
结果:时间至事件分析显示,干预措施减少了SNF入院(累积生存率87.8%,95%置信区间[CI]78.6%至96.6%)和死亡(累积生存率100%)与对照组相比(SNF累积生存率78.9%,95%CI70.4%~87.4%;P=0.039;死亡累积生存率87.3%,95%CI79.9%至94.7%,P=0.001)。在干预参与者中,30天的再住院时间也较低(累积生存率95.1%,95%CI90.5%至99.8%)与对照组参与者相比(累积生存率86.3%,95%CI79.4%至93.2%,P=0.050),但无统计学意义。干预组之间的跌倒率没有显着差异(每1000名参与者天跌倒5.6次,95%CI4.7至6.5)和对照组(每1000名参与者天跌倒7.2次,95%CI6.2至8.3;发生率比[IRR]0.78,95%CI0.46至1.33,P=0.361)。
结论:以家庭为基础的OT为主导的干预措施通过减少家庭障碍和改善自我管理来帮助卒中幸存者回家,可以降低康复出院后的死亡率和SNF入院风险。
OBJECTIVE: To compare adverse health events in intervention versus control group participants in the Community Participation Transition After Stroke
trial to reduce barriers to independent living for community-dwelling stroke survivors.
METHODS: Randomized controlled
trial.
METHODS: Inpatient rehabilitation (IR) to home and community transition.
METHODS: Stroke survivors aged ≥50 years being discharged from IR who had been independent in activities of daily living prestroke (N=183).
METHODS: Participants randomized to intervention group (n=85) received home modifications and self-management training from an occupational therapist over 4 visits in the home. Participants randomized to control group (n=98) received the same number of visits consisting of stroke education.
METHODS: Death, skilled nursing facility (SNF) admission, 30-day rehospitalization, and fall rates after discharge from IR.
RESULTS: Time-to-event analysis revealed that the intervention reduced SNF admission (cumulative survival, 87.8%; 95% confidence interval [CI], 78.6%-96.6%) and death (cumulative survival, 100%) compared with the control group (SNF cumulative survival, 78.9%; 95% CI, 70.4%-87.4%; P=.039; death cumulative survival, 87.3%; 95% CI, 79.9%-94.7%; P=.001). Thirty-day rehospitalization also appeared to be lower among intervention participants (cumulative survival, 95.1%; 95% CI, 90.5%-99.8%) than among control participants (cumulative survival, 86.3%; 95% CI, 79.4%-93.2%; P=.050) but was not statistically significant. Fall rates did not significantly differ between the intervention group (5.6 falls per 1000 participant-days; 95% CI, 4.7-6.5) and the control group (7.2 falls per 1000 participant-days; 95% CI, 6.2-8.3; incidence rate ratio, 0.78; 95% CI, 0.46-1.33; P=.361).
CONCLUSIONS: A home-based occupational therapist-led intervention that helps stroke survivors transition to home by reducing barriers in the home and improving self-management could decrease the risk of mortality and SNF admission after discharge from rehabilitation.