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

We wouldn't need much research like this if we solved and prevented the neuronal cascade of death.
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.