A course of occupational therapy is being tested in a cluster randomised trial to see if it helps stroke survivors living in care homes regain independence in daily tasks like washing, dressing, and moving around. This matters because stroke is a leading cause of long-term disability, and many survivors end up in care homes where they may not receive targeted rehabilitation. Current care often lacks structured, repetitive training in activities of daily living, provision of adaptive equipment, and minor environmental adaptations—the three components of this intervention. The study fills a gap by testing whether a pragmatic, therapist-delivered programme can improve outcomes in a real-world care home setting, rather than in a controlled hospital environment. If the intervention works, it could change how care homes support stroke survivors, reducing dependence on staff for basic self-care and improving quality of life. The economic evaluation from both NHS and societal perspectives will show whether the programme offers value for money. Success could lead to a scalable model for occupational therapy in care homes across the UK, potentially reducing the burden on health services and improving residents’ mobility and mood.
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The purpose of the study is to conduct a Phase III RCT to evaluate the effects of a targeted course of occupational therapy (targeted repetitive training of activities of daily living, provision of adaptive equipment & minor environmental adaptations and staff training) for people living in a care home with a history of stroke or transient ischaemic attack (TIA) and who are not receiving end of life care. In particular, the effects on independence in self care activities of daily living AND Mobility. This will be a pragmatic stage III cluster randomised controlled trial with independent assessment based on a stage II exploratory study. Randomisation will be conducted by the CTU and only revealed to the treating occupational therapist. Homes will be identified randomly; using published care home lists within South and East Birmingham, Bangor, Devon, Portsmouth, Nottingham and Preston, including all funding models (private, charitable, not for profit and local authority). The homes will be approached for consent. Individual consent from residents and staff will also be gained. Baseline assessments will be completed prior to randomisation (to reduce possible bias once cluster allocation revealed). Control homes will receive free staff training once the study is completed to improve compliance and loss to follow up in the control group (again to reduce bias). Health technologies being assessed: Active intervention- Occupational therapy delivered by a qualified therapist will include i. Task-related ADL practice with an individual ii. Provision of adaptive equipment to an individual. iii Adaptations to the individual's environment, such as chair raises and bed levers, and small general adaptations to the home, such as raised toilet seats and grab rails. iii Care giver training. Individual and group sessions Control-Standard care. The primary outcome will be independence in ADL measured by the Barthel Index. Secondary outcomes will include mobility, mood and adverse events. Cognitive status will be assessed at baseline. Staff attitudes will be assessed using the Kogan's Old People Scale. Economic evaluation- The EQ5D will be recorded at each time point. The economic evaluation will take from the UK National Health Service perspective and a societal perspective. Outcomes will be measured as quality-adjusted life-years (QALYs).
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