A client-centered ADL intervention after stroke

In LAS-II client-centred implies an intervention tailored to the client's ability and perceived needs and which takes the client's unique life-world experiences as the point of departure for the rehabilitation. Moreover, the client includes the significant others e.g. partners, sons or daughters or friends and ADL encompasses all everyday activities that a person wants and needs to perform. The CADL aims to enable participation in the activities people with stroke want and need to do on their own, or together with others in their everyday life.

The CADL will be compared to usual ADL intervention (UADL) after stroke with regard to perceived participation, independence in ADL and life-satisfaction at 3, 6 and 12 months after the inclusion in th study. In addition life-satisfaction and caregiver burden of the participants' significant others will be evaluated. The aim is also to describe how people with stroke and their significant others experience CADL and to explore how occupational therapists experience learning and delivering the CADL in clinical practice.

Design

A multicenter randomized controlld trial RCT of CADL compared to UADL. A randomization of 16 participating rehabilitation sites in Stockholm, Uppsala and Gävleborg counties has been applied based on knowledge gained from a preceding feasibility pilot study. Altogether 280 participants with stroke and 180 significant others have been included in the study. Eligible for inclusion in the study were people who were: a) treated for acute stroke in a stroke unit up to 3 months after stroke onset and, b) dependent in at least two ADL domains according to Katz Extended ADL Index, c) not diagnosed with dementia, d) able to understand and follow instructions, and e) referred for rehabilitation to one of the 16 participating sites.

Data collection is completed and data analysis is ongoing.

(ClinicalTrials.gov NCT01417585)

Financial support

The regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet, the Swedish Research Council (VR), the Swedish Council for Working Life and Social Welfare (FAS), RIKS-Strokeförbundet (The Swedish Stroke Association), Uppsala-Örebro Regional Research Council, the Doctoral School in Health Care Sciences at Karolinska Institutet, Strategic Research Program in Care Sciences and Funds at Karolinska Institutet.

ALF: grant number 20080156 and 20100107

Vetenskaprådet: grant number 2010-2943

Project leaders

Kerstin Tham

Lena von Koch

Researchers

Gunilla Eriksson, Mia Flink, Susanne Guidetti, Ulla Johansson, Malin Tistad och Charlotte Ytterberg

Doctoral students

Christina Eriksson

Publications

List of scientific publications from the LAS-II study.

Doctoral theses

Ann-Sofie Bertilsson 2015
Evaluation of a client-centred ADL intervention after stroke : perspectives of occupational therapists, clients with stroke and significant others

Maria Ranner 2016

Evaluation and experiences of a client-centred ADL intervention after stroke