title: Protocol of a cluster randomized trial evaluation of a patient and carer-centered system of longer-term stroke care (LoTS care).
abstract: BACKGROUND
  Despite recognition of the importance of the longer-term consequences of stroke, services addressing these needs remain poorly developed. There are persuasive arguments that a community-based orientation to poststroke care, to assess, support, and coordinate relevant services, might be more helpful in minimizing longer-term stroke morbidity. To address this, an evidence-based system of care has been developed that aims to meet the longer-term needs for stroke survivors and their carers living at home in the community.
  
  
  OBJECTIVE
  The study aims to evaluate the clinical and cost-effectiveness of a purposely developed system of care for stroke patients and their carers living in the community.
  
  
  METHODS
  This is a cluster randomized, controlled trial. The trial aimed to recruit 800 patients (and their carers, if appropriate) in 32 stroke services across the United Kingdom. The system of care is delivered by health professionals undertaking a community-based liaison or coordinating role for stroke patients (termed 'stroke care coordinators'). Stroke care coordinators in stroke services randomized to the intervention group were trained to deliver the system of care, while those randomised to the control group continued to deliver current practice.
  
  
  RESULTS
  The primary outcome is patient emotional health measured using the General Health Questionnaire 12 at six-months after recruitment. Secondary outcomes include cost-effectiveness, patient functional health and carer emotional health, with final follow-up at 12 months.
  
  
  RESULTS
  Thirty-two stroke services were randomized and 800 patients and 208 carers were recruited from 29 services. Follow-up is ongoing, and trial results are expected in early 2013.
authors: Academic Unit of Elderly Care and Rehabilitation, University of Leeds and Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors: Anne
authors: A
authors: Forster
authors: John
authors: J
authors: Young
authors: Jane
authors: J
authors: Nixon
authors: Katie
authors: K
authors: Chapman
authors: Jenni
authors: J
authors: Murray
authors: Anita
authors: A
authors: Patel
authors: Martin
authors: M
authors: Knapp
authors: Shamaila
authors: S
authors: Anwar
authors: Rachel
authors: R
authors: Breen
authors: Kirste
authors: K
authors: Mellish
authors: Ivana
authors: I
authors: Holloway
authors: Amanda
authors: A
authors: Farrin
mesh_terms: D017028:Caregivers; D003150:Community Health Workers; D003362:Cost-Benefit Analysis; D006801:Humans; D008134:Long-Term Care / Q000191:economics* / Q000379:methods; D018802:Patient-Centered Care / Q000191:economics* / Q000379:methods; D012107:Research Design; D020521:Stroke / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D006113:United Kingdom
keywords: community; longer-term; rehabilitation; stroke