Researchers at Washington University School of Medicine in St. Louis found that safety measures such as walkers, grab bars, ramps and other home modifications may allow many stroke patients to continue living independently at home and reduce their risk of death.
Every 40 seconds, someone in the United States suffers a stroke, a condition that blocks blood flow to the brain. Even for those who survive, residual brain damage can leave them with lifelong disabilities that make everyday tasks like using the toilet or showering dangerous.
One in eight people who survive a stroke die within a year of being discharged from the hospital. But a clinical trial led by researchers at Washington University School of Medicine in St. Louis found that modifications to stroke patients' homes, such as grab bars, shower seats, ramps, and other safety features, reduced their risk of dying within a year or so of being discharged from the hospital and allowed many to continue living independently at home.
The transition period is crucial for stroke patients returning home after several weeks of inpatient rehabilitation. The home environment is different and more challenging than in a well-equipped facility. Occupational therapy can make a big contribution by creating a safe space where stroke patients can live independently at home.”
Susan Stark, PhD, senior author and professor of occupational therapy, neurology and social work
The study can be found online in the Archives of Physical Medicine and Rehabilitation.
The research team tested a new program in St. Louis in which occupational therapists visited stroke patients in their homes to identify environmental barriers — such as stairs without handrails, low-hanging toilets or dark hallways — and make adjustments to address their specific needs. The therapists also provided self-management training, including building problem-solving skills, such as how to access accessible transportation.
The recovery process after a stroke depends on the severity of the blockage and how quickly treatment is administered. People with mild cognitive or motor impairments are typically discharged to outpatient rehabilitation. Severe stroke patients are more likely to be transferred to a skilled nursing facility for ongoing care and treatment.
But another group of stroke patients, about 25 percent of them, have moderate cognitive and motor impairments. These patients, who are the focus of the clinical trial, typically can be discharged from the hospital to an inpatient rehabilitation facility and potentially live independently again, Stark explained.
But life at home looks different for these survivors: Even pulling a shirt out of a drawer strains muscles weakened by the stroke. Using the toilet tests a weakened sense of balance. Climbing stairs feels like an obstacle course, stunting socializing and connecting with others.
Stark said stroke patients have high rates of depression. “When they don't reintegrate into the community, people become even more depressed,” he said.
The trial involved 183 people aged 50 and older returning home from an inpatient rehabilitation facility. Participants were randomly assigned to one of two groups: one that received home modification and self-management skills, and the other that received stroke prevention education over four occupational therapy sessions.
Researchers have found that removing barriers and teaching problem-solving skills can save lives.
Compared with the control group, individuals in the intervention group were more likely to survive: 10 people who received education alone died during the study period, compared with none in the intervention group. Similarly, people who received home modifications and self-management training were less likely to move into skilled nursing facilities.
Dr. Donna C. Jones is one of the intervention group who benefited from this study. After suffering a stroke in the summer of 2021, Jones underwent home modifications that put her on the road to recovery, helping her regain her balance and gaining the confidence to function independently while mastering new skills.
“Remodeling my bathroom has given me hope that my life is moving in the right direction,” said Jones, who earned her doctorate in ethical leadership and workforce development just three months before her stroke. “The practical tools and services I received are the foundation for my new journey. I have a new life. It's very different, but I love it.”
Jones enjoys event planning, traveling and community volunteering. A year later, she suffered a stroke and had to have her lower right leg amputated, but that didn't stop her from living her passion. “Today, I find creative ways to continue my quest to impact our global society through ethical leadership development, education, programs and service. I am grateful for my studies for giving me the foundation that has enabled me to approach the future with a positive attitude.”
Stark said the small clinical trial focused on a single geographic area, and the transition program needs to be tested more broadly. She also aims to conduct an economic analysis to determine how much money could be saved by implementing the home modifications.
“The biggest hurdle to implementing this program is getting insurance to cover the cost of home modifications,” Stark says. “These interventions are not very expensive, but there's no system in place to cover the costs. If a $500 home modification can keep people out of the hospital or a nursing home, it's a no-brainer. That's why we're doing an economic analysis to look at the health care savings of these interventions.”
sauce:
University of Washington School of Medicine
Journal References:
Krauss, MJ, et al. (2024). The Community Engagement Transition After Stroke (COMPASS) Randomized Controlled Trial: Impact on Adverse Health Events. Archives of Physical Medicine and Rehabilitation. doi.org/10.1016/j.apmr.2024.05.015
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