Related Experiment Videos
Recovery-focused community support to avoid readmissions and improve participation after stroke: A multicenter
Dominique Cadilhac1,2, Jan Cameron1, Monique F Kilkenny1,2
1Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton VIC, Australia.
Background:
Evidence is lacking on whether support and education programs, facilitated by mobile technology, benefit people with stroke.
Aims:
The primary aim was to determine the effectiveness of a co-designed, eHealth self-management intervention for reducing unplanned hospital presentations.
Methods:
Prospective, multicenter randomized controlled trial with blinded outcome assessment and intention-to-treat analysis. Randomization (1:1, stratified by age and level of disability at baseline) within 2 weeks of hospital discharge. Participants aged ⩾18 years with modified Rankin Scale (mRS) score 0-4 were recruited from 11 Australian hospitals. To maintain blinding, all participants co-developed three to five self-management goals with a trained clinician-researcher, using a standardized approach. Following randomization, participants were allocated to receive personalized, goal-centered electronic messages (intervention) or administrative messages (active control) over 12 weeks via text or email. The groups were not informed about the number of messages they would receive and were unaware that only the intervention group had their messages tailored to their goals. The primary outcome was unplanned hospital presentations (emergency department/admission) within 90 days post-randomization. Secondary outcomes included goal attainment, self-efficacy, and various health outcomes. We used generalized mixed-effects regression model with a logistic link for categorical outcomes and Cohen's d (0.2 considered small effect, 0.5 moderate-1.0 large) to assess within-group change.
Results:
The trial was impacted by COVID-19 and ceased with 556/890 planned participants; 465 were randomized (n = 234 control, n = 231 experimental), a median of 10 days post-discharge (median age 67.2 years, 67.1% male, median 3 goals/participant). Primary outcome assessments for 222 control and 218 experimental participants showed no between-group differences for unplanned hospital presentations (odds ratio (OR): 1.32; 95% confidence interval (CI): 0.52-3.34). Compared to controls at 90 days, a larger proportion of the experimental group had >3 unmet needs and slight to severe disability (both <8% difference). Both groups showed non-significant improvements in goal attainment at 90 days post-randomization; overall attainment was stronger among intervention participants (within-group change Cohen's d intervention 0.76 vs 0.61).
Conclusion:
We found no evidence that tailored, electronic messaging over 12 weeks, in addition to structured goal-setting reduced unplanned hospital presentations. Future research is needed to understand the role of disability and unmet needs, and factors that influence goal attainment.
Trial Registration:
ACTRN12618001468213, U1111-1206-7237.
