Getting on with the rest of your life following stroke: a randomized trial of a complex intervention aimed at enhancing life participation post stroke

It wouldn't be so hard to resume regular life if our doctors would stop the neuronal cascade of death so survivors would have fewer dead and damaged neurons.
http://www.ncbi.nlm.nih.gov/pubmed/25627292

Mayo NE¹, Anderson S², Barclay R³, Cameron JI⁴, Desrosiers J⁵, Eng JJ⁶, Huijbregts M⁷, Kagan A⁸, MacKay-Lyons M⁹, Moriello C¹⁰, Richards CL¹¹, Salbach NM⁷, Scott SC¹², Teasell R¹³, Bayley M¹⁴.

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Abstract

OBJECTIVE:

To enhance participation post stroke through a structured, community-based program.

DESIGN:

A controlled trial with random allocation to immediate or four-month delayed entry.

SETTING:

Eleven community sites in seven Canadian cities.

SUBJECTS:

Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently.

INTERVENTIONS:

Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups.

MAIN MEASURES:

Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months.

RESULTS:

A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combined and a within-person analysis was carried out at three time points. There were statistically significant increases in all study outcomes on average over all persons. Over 45% of people met or exceeded the pre-specified target of a three hour per week increase in meaningful activity and this most often took a full year of intervention to achieve. Greatest gains were in satisfaction with community integration (mean 4.78; 95% CI: 2.01 to 7.55) and stroke-specific health-related quality of life (mean 4.14; 95% CI: 2.31 to 5.97).

CONCLUSIONS:

Community-based programs targeting participation are feasible and effective, but stroke survivors require time to achieve meaningful gains.