Community Health Worker-Assisted Task-Specific Training and Cognitive Behavioral Therapy at Home with Exposure After Stroke (CATCHES): A Pilot Feasibility Trial
Seyyedreza Ebadi1, Kevin Strobino2, Keri Fisher3, Stephanie Assuras1, Yuzhu Huang1, Juan Meyreles1, Adriana Arcia4, Clare Bassile5, Olajide Williams1, Lori Quinn3, Imama Naqvi1
1Columbia University, Department of Neurology, 2Weill Cornell Medicine, 3Teachers College, Columbia University, 4Columbia University School of Nursing, 5Columbia University - Programs in Physical Therapy
Objective:
(1) Determine the feasibility of recruiting > 0.5/week and retaining >70% patients with recent mild stroke to participate in CATCHES with > 70% adherence. (2) Explore the effect on fear of falling (FOF) and on physical function measures including Timed Up and Go (TUG), PROMIS-Physical Function, and step count.
Background:
Up to two-thirds of stroke survivors, including those with mild strokes, experience FOF and, in turn, avoidance of physical activity (PA). CATCHES seeks to safely increase PA in this population by reducing FOF and increasing balance self-efficacy. Key components include community health worker (CHW)-delivered task-specific training (TST) in the home environment, aspects of cognitive behavioral therapy (CBT) with graded exposure to PA, and PA monitoring.
Design/Methods:
Using pre-post design, patients with modified Rankin Scale (mRS ≤2) were recruited and screened for low Activity-specific Balance Confidence (ABC <80) upon hospital discharge. During a three-month period, they received an initial physical therapist (PT) home visit, psychologist tele-visit, and 5 biweekly CHW-led visits combining TST, cognitive strategies, and Fitbit feedback.
Results:
Among 30 recruited, 22 screened in with mean age 64 ± 11 years, 32% female, 50% Black, and 27% Hispanic. Feasibility measures exceeded targets with 0.73±1.10 recruitment rate and 86% retention rate. Nearly all (95%) adhered to ≥ one study visit. ABC improved 27.3 points (p<0.001), TUG improved 7.3 seconds (p=0.04), and PROMIS-PF improved 7.9 points (p<0.001). During the study period, median daily steps were 4678 with an average increase of 16.7 steps per day (p=0.027) from baseline with ≥ 5000 steps achieved on 48% of study-days. For each additional study-day, the odds of achieving ≥ 5000 steps increased by 0.8% (p < .001).
Conclusions:
A CHW-led transdisciplinary-, home-based behavioral intervention targeting FOF was feasible in an underserved urban community. Improved balance confidence may be a key behavioral target to enhance functional mobility and sustained engagement.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.