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Study protocol of the YOU CALL--WE CALL TRIAL: impact of a multimodal support intervention after a "mild" stroke.

Rochette A, Korner-Bitensky N, Bishop D, Teasell R, White C, Bravo G, Côté R, Lachaine J, Green T, Lebrun LH, Lanthier S, Kapral M, Wood-Dauphinee S - BMC Neurol (2010)

Bottom Line: Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar).If effective, this multimodal intervention could be delivered in both urban and rural environments.ISRCTN95662526.

View Article: PubMed Central - HTML - PubMed

Affiliation: Montreal University, Montreal, Quebec, Canada. annie.rochette@umontreal.ca

ABSTRACT

Background: More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization.The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support)--"WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to)--"YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life.

Method/design: We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up.

Discussion: If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable.

Trial registration: ISRCTN95662526.

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Related in: MedlinePlus

Study plan. 1. Informed consent, baseline assessment (primary and secondary outcomes) and randomisation; 2. Three-month primary outcomes assessment time; 3. Post- intervention assessment time (primary & secondary outcomes); 4. Self- reported use of health services assessment (from month #6 to #9); 5. Follow- up assessment (primary & secondary outcomes).
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Figure 1: Study plan. 1. Informed consent, baseline assessment (primary and secondary outcomes) and randomisation; 2. Three-month primary outcomes assessment time; 3. Post- intervention assessment time (primary & secondary outcomes); 4. Self- reported use of health services assessment (from month #6 to #9); 5. Follow- up assessment (primary & secondary outcomes).

Mentions: We are conducting a randomized clinical trial, over the first six months post-stroke, with a follow-up at one year (see figure 1). Multi-site recruitment across three Canadian provinces, Québec (Montréal), Ontario (Brantford, Chatham and Kitchener-Waterloo) and Alberta (Calgary), allows a representative sample of participants exposed to different levels of services post stroke such as differing access to Secondary Stroke Prevention Clinics. The target population for this study is all individuals/adults who sustained a first "mild" stroke and who are discharged home within three weeks of being admitted to an acute care hospital. Daily chart reviews of all new stroke admissions are being performed by a site-designated-research-nurse (who is not the treating clinician) to identify potential first mild stroke patients. Potential participants are then approached for further screening. Eligible and interested patients are requested to provide informed consent, and receive a copy of the consent form. Participants are being assessed at baseline (quality of life, participation and depression) in the first month post-stroke by way of a telephone interview. Phone interviews were shown to be as reliable as face-to-face interviews when measuring variables as complex as functional status [36]. They are then being allocated randomly, using stratified block randomization, to one of two groups: 1) "WE CALL" or 2) "YOU CALL". Stratification is done according to level of comorbidity (no or low comorbidity versus high as indicated by a score ≥ 4 on the Comorbidity Index [37]) as this variable is important to the primary outcomes: unplanned-use of health services for negative events and quality of life. Furthermore, to consider the potential effect on outcomes of availability of secondary prevention clinic and urban versus rural areas, parallel randomization (separate randomization) occurs for each province.


Study protocol of the YOU CALL--WE CALL TRIAL: impact of a multimodal support intervention after a "mild" stroke.

Rochette A, Korner-Bitensky N, Bishop D, Teasell R, White C, Bravo G, Côté R, Lachaine J, Green T, Lebrun LH, Lanthier S, Kapral M, Wood-Dauphinee S - BMC Neurol (2010)

Study plan. 1. Informed consent, baseline assessment (primary and secondary outcomes) and randomisation; 2. Three-month primary outcomes assessment time; 3. Post- intervention assessment time (primary & secondary outcomes); 4. Self- reported use of health services assessment (from month #6 to #9); 5. Follow- up assessment (primary & secondary outcomes).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2818655&req=5

Figure 1: Study plan. 1. Informed consent, baseline assessment (primary and secondary outcomes) and randomisation; 2. Three-month primary outcomes assessment time; 3. Post- intervention assessment time (primary & secondary outcomes); 4. Self- reported use of health services assessment (from month #6 to #9); 5. Follow- up assessment (primary & secondary outcomes).
Mentions: We are conducting a randomized clinical trial, over the first six months post-stroke, with a follow-up at one year (see figure 1). Multi-site recruitment across three Canadian provinces, Québec (Montréal), Ontario (Brantford, Chatham and Kitchener-Waterloo) and Alberta (Calgary), allows a representative sample of participants exposed to different levels of services post stroke such as differing access to Secondary Stroke Prevention Clinics. The target population for this study is all individuals/adults who sustained a first "mild" stroke and who are discharged home within three weeks of being admitted to an acute care hospital. Daily chart reviews of all new stroke admissions are being performed by a site-designated-research-nurse (who is not the treating clinician) to identify potential first mild stroke patients. Potential participants are then approached for further screening. Eligible and interested patients are requested to provide informed consent, and receive a copy of the consent form. Participants are being assessed at baseline (quality of life, participation and depression) in the first month post-stroke by way of a telephone interview. Phone interviews were shown to be as reliable as face-to-face interviews when measuring variables as complex as functional status [36]. They are then being allocated randomly, using stratified block randomization, to one of two groups: 1) "WE CALL" or 2) "YOU CALL". Stratification is done according to level of comorbidity (no or low comorbidity versus high as indicated by a score ≥ 4 on the Comorbidity Index [37]) as this variable is important to the primary outcomes: unplanned-use of health services for negative events and quality of life. Furthermore, to consider the potential effect on outcomes of availability of secondary prevention clinic and urban versus rural areas, parallel randomization (separate randomization) occurs for each province.

Bottom Line: Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar).If effective, this multimodal intervention could be delivered in both urban and rural environments.ISRCTN95662526.

View Article: PubMed Central - HTML - PubMed

Affiliation: Montreal University, Montreal, Quebec, Canada. annie.rochette@umontreal.ca

ABSTRACT

Background: More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization.The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support)--"WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to)--"YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life.

Method/design: We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up.

Discussion: If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable.

Trial registration: ISRCTN95662526.

Show MeSH
Related in: MedlinePlus