Volunteer Facilitated Discharge Assistance and Supports at Home (DASH) for People With Stroke

Official title

Volunteer Facilitated Discharge Assistance and Supports at Home (DASH) for People With Stroke: An Effectiveness-implementation Hybrid Trial.

Overview

The goal of this clinical trial is to learn if a home visit by a trained volunteer can improve stroke recovery after a stroke survivor is discharged home from the hospital. The main questions it aims to answer are: 1. After 3 months of being discharged from the hospital, does this additional volunteer support at home improve coping skills for stroke survivors? 2. Does the effects of the volunteer support last over 3 to 6 months after being discharged home? Researchers will compare between a group who will receive the volunteer support and a group who will not to see if the additional support can improve stroke recovery. Participants will: * Either receive volunteer support over an 8-week time period OR receive no additional volunteer support * Continue with their usual care plan and receive educational resources from the research team during the study * Complete online surveys during study enrollment, at 3 months, and at 6 months after hospital discharge

Detailed description

Acute stroke often leads to adult disability in Canada, and about 108,707 Canadians experience a stroke each year. While most people survive stroke (80 percent) and return home, some survivors are left with ongoing challenges that require them to seek help in the community. These challenges can lead to stress for the individual and their caregiver. Research on volunteer-supported home-to-hospital programs has shown positive outcomes. However, despite the growing evidence that supports volunteer engagement in care transitions, we have yet to determine the impact of a complex psychosocial volunteer-delivered care transition intervention for stroke survivors. This study will assess whether a volunteer-delivered transitional care intervention, designed by Bruyère Health Research Institute in partnership with March of Dimes Canada (MODC), for adults discharged home from a stroke rehabilitation unit following an acute stroke can improve coping compared to usual care. MODC will implement the volunteer-support transition program across two Ontario regions for stroke rehabilitation sites. Those allocated to the intervention group will receive an initial visit from the Volunteer Coordinator and then weekly one-on-one visits by a trained volunteer for eight weeks. The volunteer may assist the study participant with instrumental daily living activities and psychosocial and informational support. Those not receiving the intervention will receive educational material at 4- and 8-week time points in addition to their usual care. All study participants will complete validated patient-reported outcome measures at 3- and 6-months post-hospital discharge.

Interventions

• Behavioral Discharge Assistance and Supports at Home (DASH)
  One-on-one weekly visits in the stroke survivor participants' residence by a trained volunteer for approximately 8 weeks (about 2 months). Volunteer support could span three types: i) instrumental activities of daily living assistance (e.g., assistance with meal preparation, light house duties, and transportation), ii) psychosocial support (e.g., befriending visits), and iii) informational supports (signposting to other community services).

Primary outcome measures

• Coping at Time 1 as assessed by Post-Discharge Coping Difficulty Scale (PDCDS) [Time frame: Measured at 3 months post-hospital discharge]

Secondary outcome measures (4)

• Change in coping as assessed by Post-Discharge Coping Difficulty Scale (PDCDS) [Time frame: Measured at 3 months and 6 months post-hospital discharge]
• Change in quality of life as assessed by Stroke-Specific Quality of Life (SS-QOL) [Time frame: Measured at 3 months and 6 months post-hospital discharge]
• Change in symptoms of depression as assessed by Patient Health Questionnaire-9 (PHQ-9) [Time frame: Measured at 3 months and 6 months post-hospital discharge]
• Change in social isolation and loneliness indicators as assessed by UCLA Loneliness Scale (Version 3) [Time frame: Measured at 3 months and 6 months post-hospital discharge]

Eligibility criteria

Inclusion criteria

• Confirmed diagnosis of stroke
• Either undergoing or recently completed in-patient rehabilitation within the last 3 weeks
• Lived at home pre-stroke
• Discharged directly home (to own residence or that of a family member)
• Live in one of the program implementation areas (i.e., Toronto, Ottawa)

Exclusion criteria

• Discharged to additional hospital inpatient care, nursing home, or other long-term care
• Inability to communicate in English
• Inability to provide informed consent due to cognitive deficits

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Canada · 6 centers

• Bruyère Health Élisabeth-Bruyère Hospital — Ottawa
• Hennick Bridgepoint Hospital — Toronto
• Providence Healthcare (Unity Health Toronto) — Toronto
• Sunnybrook Health Sciences Centre — Toronto
• Toronto Rehabilitation Institute (UHN) — Toronto
• West Park Healthcare Centre (UHN) — Toronto

Identifiers

NCT: NCT07590076 · 191308 · 5161

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗