Michigan Stroke Transitions Trial

Autor: Paul P. Freddolino, Mojdeh Nasiri, Mathew J. Reeves, Michele C. Fritz, Constantinos K. Coursaris, Amanda T. Woodward, Anne K. Hughes, Sarah J. Swierenga
Rok vydání: 2019
Předmět:
Zdroj: Circulation: Cardiovascular Quality and Outcomes. 12
ISSN: 1941-7705
1941-7713
DOI: 10.1161/circoutcomes.119.005493
Popis: Background: To test whether access to home-based social worker–led case management (SWCM) program or SWCM program combined with a website providing stroke-related information improves patient-reported outcomes in patients with stroke, relative to usual care. Methods and Results: The MISTT (Michigan Stroke Transitions Trial), an open (unblinded) 3-group parallel-design clinical trial, randomized 265 acute patients with stroke to 3 treatment groups: Usual Care (group-1), SWCM (group-2), and SWCM+MISTT website (group-3). Patients were discharged directly home or returned home within 4 weeks of discharge to a rehabilitation facility. The SWCM program provided in-home and phone-based case management services. The website provided patient-orientated information covering stroke education, prevention, recovery, and community resources. Both interventions were provided for up to 90 days. Outcomes data were collected by telephone at 7 and 90 days. Primary patient-reported outcomes included Patient-Reported Outcomes Measurement Information System Global-10 Quality-of-Life (Physical and Mental Health subscales) and the Patient Activation Measure. Treatment efficacy was determined by comparing the change in mean response (90 days minus 7 days) between the 3 treatment groups using a group-by-time interaction. Subjects were aged 66 years on average, 49% were female, 21% nonwhite, and 86% had ischemic stroke. There were statistically significant changes in Patient-Reported Outcomes Measurement Information System Physical Health ( P =0.003) and Patient Activation Measure ( P =0.042), but not Patient-Reported Outcomes Measurement Information System Mental Health ( P =0.56). The mean change in Patient-Reported Outcomes Measurement Information System Physical Health scores for group-3 (SWCM+MISTT Website) was significantly higher than both group-2 (SWCM; difference, +2.4; 95% CI, 0.46–4.34; P =0.02) and group-1 (usual care; difference, +3.4; 95% CI, 1.41–5.33; P P =0.02) and marginally higher than group-1 (+5.0; 95% CI, −0.47 to 10.52; P =0.07). Conclusions: An intervention that combined SWCM with access to online stroke-related information produced greater gains in patient-reported physical health and activation compared with usual care or case management alone. There was no intervention effect on mental health. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02653170.
Databáze: OpenAIRE
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