Key result
Monthly stroke-coordinator meetings reduce favorable 18-month mRS outcomes by ~34 percentage points in patients ≥80.
Why the study?
The LAST-long randomized trial of a multidimensional, stroke coordinator-led, community-based intervention found no overall functional benefit among participants with mostly mild stroke symptoms, leaving uncertain whether older or frailer subgroups benefited.
Does a monthly stroke-coordinator-led multimodal intervention improve 18-month modified Rankin Scale outcomes in older or frailer post-stroke patients compared to standard care?
RCT (n=301)
Single-blind
1:1
Yes
Does a monthly stroke-coordinator-led multimodal intervention improve 18-month modified Rankin Scale outcomes in older or frailer post-stroke patients compared to standard care?
In post-stroke patients, age (>= 80 years) but not frailty modified the response to a long-term stroke coordinator-led intervention, with older patients experiencing less favorable functional outcomes with the intervention while younger patients showed cognitive benefits on the Trail Making Test B.
BACKGROUND: The LAST-long randomized trial tested a multidimensional, stroke coordinator-led, community-based intervention and found no overall functional benefit. Because most participants had mild stroke symptoms, whether older or frailer subgroups benefited was examined. METHODS: In this single-blinded RCT at 4 Norwegian hospitals (2019-2022), 301 participants were randomized 1:1 to monthly stroke-coordinator meetings for 18 months (structured risk assessment and individualized goals) or to standard care. PRIMARY OUTCOME: modified Rankin Scale (mRS) at 18 months. SECONDARY OUTCOMES: mortality, cognition, ADLs, physical function, fatigue, and quality of life. Older age: ≥ 80 years; frailty: Frailty Index ≥ 0.2. Linear and logistic regression tested age- and frailty-intervention interactions. RESULTS: mRS data were available for 268 participants (136 intervention, 132 control). Mean age 71.1 (SD 12.4); 66 (24.6%) ≥ 80; 89 (33.2%) frail. Age modified the intervention effect on mRS: among participants ≥ 80, favourable outcome was less likely with intervention vs control (23.4% vs 57.0%, p = 0.004). For secondary outcomes, the intervention improved Trail Making Test B in younger participants (-32.2 s, 95% CI -58.0 to -6.4, p = 0.015) with a significant age-intervention interaction (p = 0.019). No frailty-intervention interaction was found. CONCLUSIONS: Age - but not frailty - modified response to the intervention, indicating differential effects in older participants. CLINICAL TRIALS: gov identifier: NCT03859063.
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Lund-Hanssen et al. (2026) conducted an RCT in Stroke (n=301). Multimodal individualized stroke-coordinator-led intervention vs. Standard care was evaluated on Modified Rankin Scale (mRS) at 18 months (favourable outcome in subgroup ≥80 years) (p=0.004). Monthly stroke-coordinator meetings led to fewer favourable 18-month mRS outcomes than standard care in patients aged ≥80 years (23.4% vs 57.0%, p=0.004), with no frailty interaction.
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