IMPACT OF AGE AND FRAILTY ON THE EFFECT OF A MULTIMODAL INDIVIDUALIZED LONG-TERM INTERVENTION AFTER STROKE: THE LAST-LONG TRIAL

Abstract

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 randomized controlled trial 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 (standard deviation 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