Supporting Stroke Survivors at Home: The Key Role of Occupational Therapists in Home Modifications

Transitioning from inpatient rehabilitation to home is a critical—and often challenging—phase for stroke survivors. Many encounter new barriers in their home and community environments, which can impact recovery and daily life. Recent research offers valuable lessons for occupational therapists seeking to make a meaningful difference in the lives of these individuals.

What the Latest Evidence Shows

A 2024 randomized clinical trial investigated an enhanced rehabilitation transition program (COMPASS), led by occupational therapists and focused on home modifications and strategy training for stroke survivors. The findings are clear:

• Both intervention and control groups improved their community participation after returning home, but those who received the COMPASS program experienced greater gains in daily activity performance and satisfaction.
• The COMPASS group saw the largest reductions in environmental barriers, with significant differences appearing as early as six months post-discharge.
• Occupational therapy-led interventions that address environmental challenges lead to measurably better outcomes in clients’ ability to perform—and feel satisfied with—their daily tasks.

Why Home Modifications Matter After Stroke

Stroke survivors often confront:

• Physical barriers, such as stairs and inaccessible bathrooms
• Difficulties with tasks due to changes in strength, coordination, or cognition
• A mismatch between abilities and the demands of their environments

Occupational therapists excel at identifying and addressing these barriers, supporting stroke survivors’ independence and participation at home and in the community.

Actionable Strategies for Occupational Therapists

Occupational therapists can amplify their impact in home and community reintegration by:

• Incorporating comprehensive home and community access evaluations into their post-discharge plans
• Implementing evidence-based home modifications—such as adaptive equipment, grab bars, ramps, or lighting improvements—to directly reduce barriers
• Providing strategy training to help clients adapt and problem-solve within their specific home environments
• Using standardized tools—like the In-Home Occupational Performance Evaluation (I-HOPE)—to assess performance, satisfaction, and environmental barriers, and to measure improvement over time

Call to Action: Bringing Evidence to Your Community

This trial confirms the power of occupational therapy-led home modification in improving stroke survivors’ daily functioning and satisfaction. To foster this change in your own practice and community:

• Partner with local hospitals and rehabilitation centers to offer targeted transition programs for stroke survivors.
• Advocate for funding and policy support that values home evaluations and modifications as an essential part of rehabilitation.
• Share outcome data with community partners and decision-makers to demonstrate value and secure resources.
• Educate clients and caregivers about the transformational impact that addressing home barriers can have on independence and quality of life.

Take the next step: Reach out to your community hospital or stroke care team to discuss integrating OT-led home modification programs into discharge planning. Your expertise can bridge the gap from hospital to home—empowering stroke survivors to participate fully in daily life.

REFERENCES:

Bollinger, R. M., Krauss, M. J., Somerville, E. K., Holden, B. M., Blenden, G., Hollingsworth, H., Keleman, A. A., Carter, A., McBride, T. D., Barker, A. R., Yan, Y., & Stark, S. L. (2024). Rehabilitation Transition Program to Improve Community Participation Among Stroke Survivors: A Randomized Clinical Trial. JAMA network open, 7(10), e2437758. https://doi.org/10.1001/jamanetworkopen.2024.37758