The Families In Recovery From Stroke Trial (FIRST): primary study results.
OBJECTIVE
Social support and family ties are strong predictors of functional recovery after stroke; however, development of successful psychosocial intervention programs has been difficult. This study examined whether a family-systems intervention designed to influence social support and self-efficacy affects functional outcome in older stroke patients.


METHODS
Two hundred ninety-one community-residing survivors of ischemic stroke or nontraumatic cerebral hemorrhage from eight acute-care hospitals and rehabilitation centers were randomized to either psychosocial intervention (PSI) or usual care (UC). PSI involved up to 16 sessions conducted in the home by a mental health worker. Functional recovery (measured by the Barthel Index [BI] at 6 months postrandomization, inability to assess functioning because of illness or death) was the primary end point.


RESULTS
Functional recovery did not differ between UC and PSI in intention-to-treat analyses. In adjusted logistic regression, the odds of being functionally independent at 6 months was 60% higher in the intervention group, but this difference was not statistically significant (p = .31). Subgroup analyses revealed that PSI may be more effective in subjects with better psychologic and cognitive functioning and who required less inpatient rehabilitation.


CONCLUSIONS
This study does not provide evidence for the efficacy of psychosocial intervention to improve functional recovery in stroke. Although PSI showed greater improvement than UC, the differences were not statistically significant.
Glass
Thomas A
TA
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. tglass@jhsph.edu
Berkman
Lisa F
LF
Hiltunen
Elizabeth F
EF
Furie
Karen
K
Glymour
M Maria
MM
Fay
Martha E
ME
Ware
James
J
D017028:Caregivers / Q000193:education; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005192:Family Health; D005195:Family Relations; D005196:Family Therapy / Q000379:methods; D006801:Humans; D017063:Outcome Assessment, Health Care; D010808:Physical Examination; D020127:Recovery of Function; D020377:Self Efficacy; D012720:Severity of Illness Index; D012944:Social Support; D020521:Stroke / Q000523:psychology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome