The overall goal of this project is to improve patients? function following stroke. The project will pilot test an innovative Stroke Homehealth Aide Recovery Program (SHARP) designed to improve mobility and reduce falls in post-acute homebound stroke patients. SHARP would accomplish this by expanding the home-based rehabilitation team to include a corps of advanced home health aides (HHAs) specially trained as stroke ?coaches.? The coaches will in turn employ a ?train-the-trainer? approach to train and support generalist HHAs as they collaborate with patients and families to implement the therapeutic regimens prescribed by patients? physicians and rehabilitation therapists. The pilot study will engage and train 10 experienced home health aides to become SHARP coaches and will randomly assign 60 consented, eligible patients to the SHARP intervention (30) or a control group (30) receiving usual care.
The specific aims of the study are to: ? Aim 1: Test SHARP recruitment and randomization procedures, specifically the ability to identify, recruit and complete training of 10 SHARP coaches and the ability to identify, recruit and complete intervention and data collection activities with 60 post-stroke patients. ? Aim 2: Assess the acceptability of the SHARP coaching program to coaches/direct care HHAs/patients/ rehabilitation therapists and solicit feedback to determine adjustments that may be needed in a future trial through interviews or focus group with members of each of the participating groups. ? Aim 3: Assess implementation fidelity to the SHARP program intervention components through monitoring the timeliness and completion of expected coach visits, exercise log maintenance, and other protocol activities. ? Aim 4: Examine patient response burden and psychometric properties of selected baseline, primary and secondary outcome measures through baseline and 60 day follow-up interviews for consideration of a subsequent larger scale study of SHARP effectiveness. SHARP is a potential workforce development solution for addressing the national priority of maximizing stroke patients? abilities and likelihood of returning to a full and independent life. SHARP would create a new category of culturally competent advanced HHAs specially prepared in post-stroke rehabilitation and adult learning to enhance home-based rehabilitation. The model would expand the HHAs? role in promoting patients? functional mobility, reducing risk of falls, improving recognition of possible post-stroke depression and improving patients? quality of life. The SHARP model has the potential to be a high impact approach to enhancing home-based post-stroke rehabilitation and improving functional mobility, defined as individuals? capacity to move within their environment to achieve activities of daily living.
To be most effective, home-based rehabilitation regimens require motivation and practice on the part of patients and reinforcement by their caregivers. Home health aides spend more time with stroke patients than any other care provider during the early post-stroke period, making aides a strategic intervention point in the care delivery system. This initiative will pilot test an innovative, culturally tailored Stroke Homehealth Aide Recovery Program (SHARP) that expands the care team to include a corps of advanced home health aides specially trained as stroke ?coaches,? and will assess the viability of this avenue of research to improve functional outcomes following stroke.
