Promoting community and social participation in chronic stroke: A pilot study of the ENGAGE intervention.

BACKGROUND

Survivors of stroke report low levels of community and social participation, even years after stroke. ENGAGE is a community-based intervention that merges social learning, guided problem solving, and supervised practice to collaboratively identify, generate, and apply solutions to challenges with community and social participation after stroke.

OBJECTIVE

We examined the feasibility, acceptability, and safety of ENGAGE and characterized within group changes in community and social participation outcomes.

METHODS

Community-dwelling survivors of stroke, occupational therapy providers, and occupational therapy scientists partnered to co-design the essential and structural elements of ENGAGE, as well as to evaluate ENGAGE using a multi-site single-arm community-based phase 2a clinical trial design. The 6-week ENGAGE program was co-facilitated by survivors of stroke acting as peer mentors and occupational therapy provider through in-person (Phase I, 12 sessions) or virtual web conference meetings (Phase II, 9 sessions). Feasibility was assessed through participant retention, engagement, acceptability, satisfaction, and safety. Within group change was assessed through the PROMIS Ability to Participation in Social Roles and Activities Scale.

RESULTS

Of the 42 participants providing consent, 38 were eligible, and 30 started the intervention program. Retention in the ENGAGE program was 90 % (n = 27). Of these, 85 % engaged actively, 87 % indicated very high satisfaction, and 0 % reported injuries or injurious falls. Participants achieved a medium within group effect size of change in community and social participation (d = 0.38, 95 % CI = -0.11, 0.94).

CONCLUSIONS

ENGAGE appears to be a feasible and promising intervention to promote improvements in community and social participation in community-dwelling survivors of stroke.