Stroke is a leading cause of serious, long-term disability in the US. Half of all people living with stroke are dependent on others to perform thei activities of daily living (ADL) and two-thirds report participation restrictions at six months pos stroke. With shorter inpatient hospital stays, more time in rehabilitation is devoted to medical stabilization and less on skills to regain independence in daily activities. The transition home may be an opportunity for intervention focused on regaining independence. We propose an enhanced rehabilitation transition program called: Community Participation Transition after Stroke (COMPASS). Compass is a compensatory intervention consisting of 1 pre and 5 post-discharge home visits by an occupational therapist focused on resolving barriers to independence in daily activities and participation using environmental support and active practice of daily activities. This is a new combination of evidence-based compensatory treatments delivered in a novel treatment setting (transition to home). The long-term goal of this project is the development of an effective intervention for transition home designed to prevent excess disability for people living with stroke. The purpose of this study is to conduct a feasibilty trial of COMPASS. We will test the central hypothesis that COMPASS will be acceptable, feasible, and superior to control on measures of community participation and daily activity performance at 6 months post stroke. The rationale for this proposal is that long term participation outcomes for many persons with stroke are low because of incomplete treatment, not because of biological limits imposed by the stroke. Until a cure is discovered for cognitive and motor impairments after stroke, the use of environmental support is necessary to prevent disability and improve participation. It is important to know if this brief, enhanced rehabilitatio program can provide the missing link between inpatient rehabilitation and home. We will objectively test our central hypothesis by conducting a pilot randomized controlled trial of COMPASS among 40 patients undergoing rehabilitation for ischemic stroke to achieve the following aims: 1) determine the acceptability and feasibility of COMPASS;and 2) estimate the magnitude of efficacy of COMPASS on the primary outcome of community and on exploratory outcomes of daily activity performance, quality of life, and community mobility to select optimal endpoints for a definitive trial. We will test the hypotheses that COMPASS is superior to control at 6 months on the primary and secondary endpoints among people with ischemic stroke. We expect the outcome of this study will be new evidence about implementation and effectiveness of an enhanced transition program for people undergoing rehabilitation after an ischemic stroke. If this program is acceptable, feasible, and safe, we will be well positioned to conduct a definitive trial that has the potential to improve the delivery of rehabilitation services, positivly impacting functional and participation outcomes for people with stroke.

Public Health Relevance

Stroke is one of the most serious, disabling health conditions in the United States. Patients who undergo rehabilitation treatment for stroke have a high rate of disability. Poor outcomes for many persons with stroke may be low because of incomplete treatment. This study proposes to test the feasibility of a newly developed transition program: community participation after stroke, designed to bridge inpatient rehabilitation and the home to support the performance of everyday activities.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Small Research Grants (R03)
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Pediatrics Subcommittee (CHHD)
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Michel, Mary E
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Washington University
Other Health Professions
Schools of Medicine
Saint Louis
United States
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