BACKGROUND: This randomized controlled trial tested the effectiveness of comprehensive, interdisciplinary postdischarge care management in improving a profile of indicators of health recovery and secondary prevention (profile of health and prevention) in stroke and transient ischemic attack (TIA) patients. METHODS:Ninety-sixstroke/TIA patients were randomized to usual care or intervention at discharge from our acute stroke unit. The intervention group received an in-home biopsychosocial assessment by an advanced practice nurse at 1 month. A care plan was developed by an interdisciplinary team and implemented in collaboration with the patient's primary care physician. The profile of health and prevention, measured at 3 months, was comprised of 5 domains: (1) Neuromotor Function, (2) Severe Complications, (3) Quality of Life, (4) Management of Risk for common poststroke complications and recurrent stroke, and (5) Stroke Knowledge. A single global hypothesis test across multiple end points was used to compare the 2 groups. RESULTS: The intervention significantly improved the profile of health and prevention (P < .0001). In addition, each domain showed a positive effect of the intervention. Effect sizes (in standard deviation units) of the intervention on domains were .1 for Neuromotor Function (90% confidence interval [CI] = -.3 to .5); .4 for Severe Complications (90% CI = .1 to .8); .5 for Quality of Life (90% CI = .1 to .9); .6 for Management of Risk for common poststroke complications and recurrent stroke (90% CI = .3 to 1.); and 1.0 for Stroke Knowledge (90% CI = .6 to 1.4). CONCLUSIONS: This model of care management resulted in a significantly better profile of health and prevention for stroke/TIA patients 3 months postdischarge.
RCT Entities:
BACKGROUND: This randomized controlled trial tested the effectiveness of comprehensive, interdisciplinary postdischarge care management in improving a profile of indicators of health recovery and secondary prevention (profile of health and prevention) in stroke and transient ischemic attack (TIA) patients. METHODS: Ninety-six stroke/TIApatients were randomized to usual care or intervention at discharge from our acute stroke unit. The intervention group received an in-home biopsychosocial assessment by an advanced practice nurse at 1 month. A care plan was developed by an interdisciplinary team and implemented in collaboration with the patient's primary care physician. The profile of health and prevention, measured at 3 months, was comprised of 5 domains: (1) Neuromotor Function, (2) Severe Complications, (3) Quality of Life, (4) Management of Risk for common poststroke complications and recurrent stroke, and (5) Stroke Knowledge. A single global hypothesis test across multiple end points was used to compare the 2 groups. RESULTS: The intervention significantly improved the profile of health and prevention (P < .0001). In addition, each domain showed a positive effect of the intervention. Effect sizes (in standard deviation units) of the intervention on domains were .1 for Neuromotor Function (90% confidence interval [CI] = -.3 to .5); .4 for Severe Complications (90% CI = .1 to .8); .5 for Quality of Life (90% CI = .1 to .9); .6 for Management of Risk for common poststroke complications and recurrent stroke (90% CI = .3 to 1.); and 1.0 for Stroke Knowledge (90% CI = .6 to 1.4). CONCLUSIONS: This model of care management resulted in a significantly better profile of health and prevention for stroke/TIApatients 3 months postdischarge.
Authors: Alexander W Dromerick; Michael C Gibbons; Dorothy F Edwards; Deeonna E Farr; Margot L Giannetti; Brisa Sánchez; Nawar M Shara; Ali Fokar; Annapurni Jayam-Trouth; Bruce Ovbiagele; Chelsea S Kidwell Journal: Int J Stroke Date: 2011-10 Impact factor: 5.266
Authors: M Iosa; A Lupo; G Morone; A Baricich; A Picelli; G Panza; N Smania; C Cisari; G Sandrini; S Paolucci Journal: Neurol Sci Date: 2017-10-30 Impact factor: 3.307
Authors: Rebecca J Lank; Lynda D Lisabeth; Brisa N Sánchez; Darin B Zahuranec; Kevin A Kerber; Lesli E Skolarus; James F Burke; Deborah A Levine; Erin Case; Devin L Brown; Lewis B Morgenstern Journal: Neurology Date: 2019-01-04 Impact factor: 9.910