ORIGINAL RESEARCH Effectiveness of Client-Centered “Tune-Ups” on Community Reintegration, Mobility, and Quality of Life After Stroke: A Randomized Controlled Trial Brenda Brouwer, PhD, a Dianne Bryant, PhD, b S. Jayne Garland, PhD b,c From the a School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario; b School of Physical Therapy, Western University, London, Ontario; and c Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada. Abstract Objective: To explore the effectiveness of a 2-week client-centered rehabilitation intervention (tune-up) delivered 6 months after inpatient discharge on community reintegration at 1 year in people with stroke. Design: A multicenter randomized controlled trial with 2 groups: an intervention (“tune-up”) group and a control group having the same exposure to assessment. Setting: Three research laboratories. Participants: Participants (NZ103) with hemiparetic stroke recruited from inpatient rehabilitation units at the time of discharge. Interventions: Participants randomized to the tune-up group received 1-hour therapy sessions in their home 3times/wk for 2 weeks at 6 months postdischarge focusing on identified mobility-related goals. A second tune-up was provided at 12 months. Main Outcome Measures: Community reintegration measured by the Subjective Index of Physical and Social Outcome at 12 months and secondary outcomes included the Berg Balance Scale and measures of mobility and health-related quality of life up to 15 months. Results: At 12 months, both groups showed significant improvement in community reintegration (P< .05), a trend evident at all time points, with no difference between groups (mean difference, 0.5; 95% confidence interval, 1.8 to 2.7; PZ.68). Similarly, a main effect of time reflected improvement in mobility-related and quality of life outcomes for both groups (P .0.5), but no group differences (P .30). Conclusions: All participants in the tune-up group met or exceeded at least 1 mobility-related goal; however, the intervention did not differ- entially improve community reintegration. The improvements in mobility and quality of life over the 15-month postdischarge period may be secondary to high activity levels in both study groups and exposure to regular assessment. Archives of Physical Medicine and Rehabilitation 2018;-:------- Crown Copyright ª 2018 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine More than 85% of those with moderate to severe stroke and almost all who survive mild strokes live in the community. 1 Most people with stroke regain the ability to walk to some degree in a controlled environment, 2 though impaired gait and poor walking endurance are important contributors to disability, loss of independence, and restricted participation in society. 3-5 Being able to participate in community activities and social roles to the extent desired is the ultimate rehabilitation goal. 6 Restoration of mobility is considered instrumental to facilitating community (re)integration 3,5,7 and is a primary goal of early rehabilitation intervention. Indeed, longitu- dinal data on disability in the first year poststroke among persons who were ambulatory within 3 weeks of stroke onset indicate marked improvements in walking ability by discharge and within the first month, with further modest gains evident up to 3 months later. 4 Another study 8 involving community-dwelling survivors of stroke reported that discharge mobility status was maintained at 6 months but had declined by 12 months, with fewer individuals able to negotiate stairs or walk outdoors independently. This is consistent with reports 9,10 that people with stroke describe their level of function to be poor 1 year after inpatient rehabilitation. We specu- lated that a decline in mobility might lead to social isolation, re- strictions in social participation, and disengagement, which are critical to successful community integration. 6 Supported by the Heart and Stroke Foundation of Ontario (grant no. SRA 5974). Clinical Trial Registration No.: NCT00400712. Disclosures: none. 0003-9993/18/$36 - see front matter Crown Copyright ª 2018 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine https://doi.org/10.1016/j.apmr.2017.12.034 Archives of Physical Medicine and Rehabilitation journal homepage: www.archives-pmr.org Archives of Physical Medicine and Rehabilitation 2018;-:-------