Evaluation of the Impact of an Individual Peer Support Intervention for Stroke Patients When Returning Home: a Mixed Methods Pilot Study

Not Applicable

Recruiting

Brief Summary: Going back home following a stroke is a key step for the patient and his or her relatives. Due to the brutality of stroke and increasingly shorter in-hospital lengths of stay, patients and their families must adapt quickly to the patient's new health functioning and the new caregiving and support role for family members.

Peer support could be an innovative and inexpensive approach to addressing these issues. Peer-helpers are patient-partners who put their experiential knowledge from life with the disease at the disposal of other patients to offer them social and emotional support in the management of the disease in connection with care, social and community structures. Group peer support programs face organizational challenges and fail to address the full range of patient needs for stroke home visits. Individualized and more flexible support could better meet the needs of patients. Our hypothesis is that individual peer support improves quality of life and patient empowerment during the discharge period compared to usual practice.

Recruitment & Eligibility

Inclusion Criteria

Adult patient,
Having had a first confirmed, ischemic or hemorrhagic stroke
Managed in the participating rehabilitation center
Whose discharge to home directly from the rehabilitation center is planned
Presenting a modified Rankin score of 1 to 3 when deciding to leave the stroke center
Having given its written consent
Whose main residence is located in the Rhône department
Aphasic patients may be included if a caregiver can follow up with the case manager

Exclusion Criteria

Patient living in an institution prior to stroke
included in a gerontological network before stroke
Patient unable to understand quality of life questionnaires
Patient with unstable medical or psychological conditions who, in the opinion of the investigator, could lead the subject to be non-compliant or uncooperative during the study or could compromise patient safety or participation in the study
Patient under guardianship or curatorship
Patient not affiliated to a social health insurance

Arm && Interventions

Group	Intervention	Description
intervention group	Peer support	For 6 months after discharge, patients in the intervention group will benefit from peer support by a trained patient (number and frequency of contacts defined according to the patient's needs). The intervention aims to improve the patient's ability to manage his or her situation and meet his or her needs upon discharge at home, including identifying and seeking for the necessary health or social resources

Primary Outcome Measures

Name	Time	Method
Feasibility measure	6 months	The feasibility of the intervention will be evaluated as success with a combined criteria including: * Recruitment and training of 2 peer helpers, * Support offered to 20 patients by the peer helpers during the intervention period defined by at least one meeting before and one contact after discharge per patient included in period after, * Good acceptability by patients, carers and peer helpers. These data will be collected by a qualitative approach associating semi-directive interviews, focus groups and participant observation.

Secondary Outcome Measures

Name	Time	Method
Disability	6 months	proportion of patients with disabilities at 6 months evaluated by the Modified Rankin Scale (no disability corresponding to mRs\<3)
Adherence	6 months	proportion of adherent patients at 6 months evaluated by the Medication Adherence Rating Scale (MARS)
Human, material and financial assistance provided at home	6 months	Human, material and financial assistance provided at home collected by interviewing the patient
Quality of life between the discharge from hospital and 6 months	6 months	Evolution of the dimensions of the SIS at hospital discharge and 6 months: global recovery
Anxiety and depression scores between discharge and 6 months	6 months	Evolution of anxiety and depression scores between discharge and 6 months after discharge, measured by the Hospital Anxiety and Depression scale (HADS) score
Patient activation Measure	6 months	Evolution of patient activation between discharge and 6 months after discharge, measured by the Patient activation Measure (PAM) score
Satisfaction measure	6 months	Perceived satisfaction of the support received on during the discharge period will be collected by interviewing the patient
Caregiver burden	6 months	Evolution of caregiver burden between discharge and 6 months after discharge, measured by the Zarit burden scale
Caregiver satisfaction	6 months	Perceived caregiver satisfaction of the support during the patient's discharge period will be collected by interviewing caregiver