title: Taking charge after stroke: promoting self-directed rehabilitation to improve quality of life--a randomized controlled trial.
abstract: OBJECTIVE
  Few community interventions following stroke enhance activity, participation or quality of life. We tested two novel community interventions designed to promote self-directed rehabilitation following stroke.
  
  
  METHODS
  This was a randomized, controlled parallel group 2×2 trial.
  
  
  METHODS
  Community.
  
  
  METHODS
  Maori and Pacific New Zealanders, >15 years old, randomized within three months of a new stroke.
  
  
  METHODS
  A DVD of four inspirational stories by Maori and Pacific people with stroke and a 'Take Charge Session'--a single structured risk factor and activities of daily living assessment, designed to facilitate self-directed rehabilitation.
  
  
  METHODS
  Primary outcomes were Health-related Quality of Life (Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Short Form 36 (SF-36)) 12 months from randomization. Secondary outcomes were Barthel Index, Frenchay Activities Index, Carer Strain Index and modified Rankin score.
  
  
  RESULTS
  One hundred and seventy-two people were randomized with 139 (80.8%) followed up at 12 months post randomization. The effect of the Take Charge Session on SF-36 PCS at 12 months was 6.0 (95% confidence interval (CI) 2.0 to 10.0) and of the DVD was 0.9 (95% CI -3.1 to 4.9). Participants allocated to the Take Charge Session were less likely to have a modified Rankin score of >2 (odds ratio (OR) 0.42, 95% CI 0.2 to 0.89) and their carers had lower (better) Carer Strain Index scores (-1.5, 95% CI -2.8 to -0.1).
  
  
  CONCLUSIONS
  A simple, low-cost intervention in the community phase of stroke recovery aiming to promote self-directed rehabilitation improved outcomes.
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand.
authors.forename: Matire
authors.initials: M
authors.lastname: Harwood
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
authors.forename: Api
authors.initials: A
authors.lastname: Talemaitoga
authors.forename: P Alan
authors.initials: PA
authors.lastname: Barber
authors.forename: John
authors.initials: J
authors.lastname: Gommans
authors.forename: William
authors.initials: W
authors.lastname: Taylor
authors.forename: Kathryn
authors.initials: K
authors.lastname: McPherson
authors.forename: Harry
authors.initials: H
authors.lastname: McNaughton
mesh_terms: D017028:Caregivers; D004185:Disability Evaluation; D005006:Ethnicity; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009520:New Zealand; D011446:Prospective Studies; D011788:Quality of Life; D020377:Self Efficacy; D000071939:Stroke Rehabilitation