Metrics details. This pragmatic randomized controlled trial RCT included older adults discharged from hospital to community with stroke and multimorbidity using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized to usual care control group or usual care plus the 6-month TCSI intervention group. The primary outcome was risk of hospital readmission all cause after six-months. Secondary outcomes included physical and mental functioning, stroke self-management, patient experience, and health and social service use costs.
The intention-to-treat principle was used to conduct the primary and secondary analyses. No significant between-group differences were seen for baseline to six-month risk of hospital readmission. Differences favouring the intervention group were seen in the following secondary outcomes: physical functioning SF PCS mean difference: 5. No between-group differences were found in total healthcare costs or other secondary outcomes.
Although participation in the TCSI did not impact hospital readmissions, there were improvements in physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs. Challenges associated with the COVID pandemic, including the shift from in-person to virtual delivery, and re-deployment of interventionists could have influenced the results.
A larger pragmatic RCT is needed to determine intervention effectiveness in diverse geographic settings and ethno-cultural populations and examine intervention scalability. Registered May 2, Peer Review reports. Stroke-related mortality in Canada during the year period β decreased by A slight decline in stroke incidence has also been reported globally for high-income countries [ 3 ]. Raised awareness and better management of risk factors have undoubtedly contributed to this reduced incidence [ 1 ].
The development and delivery of reperfusion-based treatments have led to increasing survival rates following acute stroke [ 4 ], as has the reconfiguration of acute stroke care services focused on providing rapid access to multidisciplinary stroke teams with state-of-the-art diagnostic and monitoring equipment [ 5 ]. MSUs provide rapid access to diagnostic and treatment services via a specialized ambulance equipped with CT scanner, stroke-specific medications, point-of-care laboratory testing, and other supplies and capabilities needed to treat ischemic stroke patients.
