title: Getting on with the rest of your life following stroke: a randomized trial of a complex intervention aimed at enhancing life participation post stroke.
abstract: OBJECTIVE
  To enhance participation post stroke through a structured, community-based program.
  
  
  METHODS
  A controlled trial with random allocation to immediate or four-month delayed entry.
  
  
  METHODS
  Eleven community sites in seven Canadian cities.
  
  
  METHODS
  Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently.
  
  
  METHODS
  Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups.
  
  
  METHODS
  Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months.
  
  
  RESULTS
  A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combined and a within-person analysis was carried out at three time points. There were statistically significant increases in all study outcomes on average over all persons. Over 45% of people met or exceeded the pre-specified target of a three hour per week increase in meaningful activity and this most often took a full year of intervention to achieve. Greatest gains were in satisfaction with community integration (mean 4.78; 95% CI: 2.01 to 7.55) and stroke-specific health-related quality of life (mean 4.14; 95% CI: 2.31 to 5.97).
  
  
  CONCLUSIONS
  Community-based programs targeting participation are feasible and effective, but stroke survivors require time to achieve meaningful gains.
authors: Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada nancy.mayo@mcgill.ca.
authors: Nancy E
authors: NE
authors: Mayo
authors: Department of Human Ecology, University of Alberta, Alberta, Canada.
authors: Sharon
authors: S
authors: Anderson
authors: Department of Physical Therapy, University of Manitoba, Manitoba, Canada.
authors: Ruth
authors: R
authors: Barclay
authors: Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
authors: Jill I
authors: JI
authors: Cameron
authors: School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.
authors: Johanne
authors: J
authors: Desrosiers
authors: Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
authors: Janice J
authors: JJ
authors: Eng
authors: Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
authors: Maria
authors: M
authors: Huijbregts
authors: Education and Applied Research, Aphasia Institute - The Pat Arato Aphasia Centre, Toronto, ON, Canada.
authors: Aura
authors: A
authors: Kagan
authors: School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
authors: Marilyn
authors: M
authors: MacKay-Lyons
authors: McGill University Health Center (MUHC), MUHC Research Institute, Montreal, QC, Canada.
authors: Carolina
authors: C
authors: Moriello
authors: Department of Rehabilitation and Center for Interdisciplinary Research in Rehabilitation and Social Integration, Laval University, Quebec, Canada.
authors: Carol L
authors: CL
authors: Richards
authors: Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
authors: Nancy M
authors: NM
authors: Salbach
authors: Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada.
authors: Susan C
authors: SC
authors: Scott
authors: Department of Physical Medicine and Rehabilitation, Western University, London, UK.
authors: Robert
authors: R
authors: Teasell
authors: Brain and Spinal Cord Rehab Program, UHN-Toronto Rehabilitation Institute, Toronto, ON, Canada.
authors: Mark
authors: M
authors: Bayley
mesh_terms: D000368:Aged; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D058992:Social Participation; D000071939:Stroke Rehabilitation
keywords: Stroke; participation (WHO ICF); randomized controlled trial; rehabilitation interventions