Efficacy and safety of individualized coaching after stroke: the LAST Study (Life After Stroke): a pragmatic randomized controlled trial

Askim, T. et al. (2018) Efficacy and safety of individualized coaching after stroke: the LAST Study (Life After Stroke): a pragmatic randomized controlled trial. Stroke, 49(2), pp. 426-432. (doi: 10.1161/STROKEAHA.117.018827) (PMID:29284737)

Abstract

Background and Purpose: The evidence for interventions to prevent functional decline in the long term after stroke is lacking. The aim of this trial was to evaluate the efficacy and safety of an 18-month follow-up program of individualized regular coaching on physical activity and exercise. Methods: This was a multicentre, pragmatic, single-blinded, randomized controlled trial. Adults (age ≥18 years) with first-ever or recurrent stroke, community dwelling, with modified Rankin Scale <5, and no serious comorbidities were included 10 to 16 weeks poststroke. The intervention group received individualized regular coaching on physical activity and exercise every month for 18 consecutive months. The control group received standard care. Primary outcome was the Motor Assessment Scale at end of intervention (18-month follow-up). Secondary measures were Barthel index, modified Rankin Scale, item 14 from Berg Balance Scale, Timed Up and Go test, gait speed, 6-minute walk test, and Stroke Impact Scale. Other outcomes were adverse events and compliance to the intervention assessed by training diaries and the International Physical Activity Questionnaire. Results: Three hundred and eighty consenting participants were randomly assigned to individualized coaching (n=186) or standard care (n=194). The mean estimated difference on Motor Assessment Scale in favor of control group was −0.70 points (95% confidence interval, −2.80, 1.39), P=0.512. There were no differences between the groups on Barthel index, modified Rankin Scale, or Berg Balance Scale. The frequency of adverse events was low in both groups. Results from International Physical Activity Questionnaire and training diaries showed increased activity levels but low intensity of the exercise in the intervention group. Conclusions: The regular individualized coaching did not improve maintenance of motor function or the secondary outcomes compared with standard care. The intervention should be regarded as safe. Despite the neutral results, the health costs related to the intervention should be investigated.

• Item Type: Articles
• Additional Information: The LAST study was funded by Norwegian Research Council, Liaison Committee between Central Norway Regional Health Authority and Norwegian University of Science and Technology (NTNU), Joint Research Committee between St. Olavs Hospital and NTNU, Norwegian Fund for Postgraduate Training in Physiotherapy, and Stroke Unit Research Fund at St. Olavs Hospital.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Langhorne, Professor Peter
• Authors: Askim, T., Langhammer, B., Ihle-Hansen, H., Gunnes, M., Lydersen, S., Indredavik, B., Engstad, T., Magnussen, J., Hansen, A., Schjørlien, R., Engen, S., Osmundnes, R. M., Olerud, A.-B., Knudsen, C., Hansen, T., Schroeter, W., Fjelldal, G. S., Hovde, K., Reneflot, K. H., Wennberg, L., Norvang, O. P., Phan, A., Storvoll, J. B., Ørjaset, B., Syvertsen, M., Berger, I., Dahl, A. E., Sandø, C. L., Kjølstad, V., Hansen, A., Vileid, H. K., Giddal, M. H., Bernhardt, J., and Langhorne, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Stroke
• Publisher: American Heart Association
• ISSN: 0039-2499
• ISSN (Online): 1524-4628
• Published Online: 28 December 2017