Effect of occupational therapy home visit discharge planning on participation after stroke: protocol for the HOME Rehab trial

Natasha A Lannin; Lindy Clemson; Avril Drummond; Mandy Stanley; Leonid Churilov; Kate Laver; Sophie O'Keefe; Ian Cameron; Maria Crotty; Tim Usherwood; Nadine E Andrew; Laura Jolliffe; Dominique A Cadilhac

doi:10.1136/bmjopen-2020-044573

Effect of occupational therapy home visit discharge planning on participation after stroke: protocol for the HOME Rehab trial

BMJ Open. 2021 Jul 5;11(7):e044573. doi: 10.1136/bmjopen-2020-044573.

Authors

Natasha A Lannin^{1

2}, Lindy Clemson³, Avril Drummond⁴, Mandy Stanley⁵, Leonid Churilov^{6

7}, Kate Laver⁸, Sophie O'Keefe⁹, Ian Cameron¹⁰, Maria Crotty^{8

11}, Tim Usherwood^{12

13}, Nadine E Andrew^{14

15}, Laura Jolliffe^{2

16}, Dominique A Cadilhac^{15

17}

Affiliations

¹ Department of Neuroscience, Monash University, Melbourne, Victoria, Australia Natasha.Lannin@monash.edu.
² Alfred Health, Melbourne, Victoria, Australia.
³ Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
⁴ School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK.
⁵ School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
⁶ Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
⁷ Melbourne Brain Centre at Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
⁸ Department of Rehabilitation, Aged and Extended Aged Care, College of Medicine and Public Heath, Flinders University, Adelaide, South Australia, Australia.
⁹ Occupational Therapy, School of Allied Heath, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.
¹⁰ John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, New South Wales, Australia.
¹¹ Flinders Clinical Effectiveness, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
¹² The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
¹³ Department of General Practice, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia.
¹⁵ Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
¹⁶ Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia.
¹⁷ Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia.

Abstract

Introduction: After first stroke, the transition from rehabilitation to home can be confronting and fraught with challenges. Although stroke clinical practice guidelines recommend predischarge occupational therapy home visits to ensure safe discharge and provision of appropriate equipment, there is currently limited evidence to support this recommendation.

Methods and analysis: The HOME Rehab trial is a national, multicentre, phase III randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis being conducted in Australia. The trial aim is to determine the effect and potential cost-effectiveness of an enhanced occupational therapy discharge planning intervention that involves pre and postdischarge home visits, goal setting and occupational therapy in the home (the HOME programme) in comparison to an in-hospital predischarge planning intervention. Stroke survivors aged ≥45 years, admitted to a rehabilitation ward, expected to return to a community (private) dwelling after discharge, with no significant prestroke disability will be randomly allocated 1:1 to receive a standardised discharge planning intervention and the HOME programme or the standardised discharge planning intervention alone. The primary outcome is participation measured using the Nottingham Extended Activities of Daily Living. Secondary outcome areas include hospital readmission, disability, performance of instrumental activities of daily living, health-related quality of life, quality of care transition and carer burden. Resources used/costs will be collected for the cost-effectiveness analysis and hospital readmission. Recruitment commenced in 2019. Allowing for potential attrition, 360 participants will be recruited to detect a clinically important treatment difference with 80% power at a two-tailed significance level of 0.05.

Ethics and dissemination: This study is approved by the Alfred Health Human Research Ethics Committee and site-specific ethics approval has been obtained at all participating sites. Results of the main trial and the secondary endpoint of cost-effectiveness will be submitted for publication in peer-reviewed journalsTrial registration numberACTRN12618001360202.

Keywords: rehabilitation medicine; stroke; stroke medicine.

Publication types

Clinical Trial Protocol
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aftercare
Australia
House Calls
Humans
Middle Aged
Multicenter Studies as Topic
Occupational Therapy*
Patient Discharge
Quality of Life
Randomized Controlled Trials as Topic
Stroke Rehabilitation*
Stroke* / therapy

Associated data

ANZCTR/ACTRN12618001360202