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Frailty modifies effectiveness of psychosocial intervention in recovery from stroke

Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA

M.M. Glymour

Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA

T.A. Glass

Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA

L.F. Berkman

Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA, lberkman{at}hsph.harvard.edu

Objective : To evaluate the impact of a psychosocial intervention on instrumental activities of daily living, physical performance, cognition and mortality after stroke.

Design : A randomized clinical trial.

Setting : Patients were recruited from hospitals and rehabilitation centres; the intervention took place in subjects' homes.

Subjects : Two-hundred and ninety-one stroke survivors over age 45. One-hundred and forty-six subjects were assigned to the intervention and 145 subjects were assigned to usual care.

Intervention : Up to 16 meetings conducted over six months in the patient's home (approximately weekly for 12 weeks, followed by tri-weekly sessions for another 12 weeks). Sessions lasted approximately 1 hour and included, when possible, the entire support system (stroke survivor, primary caregiver, additional family and friends, and professional caregivers).

Main outcome measures : Instrumental activities of daily living, physical performance, and cognition were assessed six months post stroke; mortality was assessed at an average of 47 months post stroke.

Results : No significant differences in outcomes were observed between the intervention and usual care groups when analysing the total study population. Among non-frail participants (n = 156), subjects randomized to treatment had better scores on instrumental activities of daily living (mean score among treated = 12.4 (standard deviation (SD) = 2.1), mean score among usual care subjects = 11.3 (SD = 2.9), P-value for difference in means = 0.01) and reduced risk of mortality (P = 0.03) than subjects randomized to usual care.

Conclusion : While there is evidence that the treatment benefited healthier subgroups, results also show evidence that the treatment was not effective, and possibly harmful, in frail subgroups.

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