A coordinator every month, alongside usual care
Conducted at four Norwegian hospitals between 2019 and 2022, the trial randomly assigned 301 people who had experienced a stroke to two groups. The first received monthly meetings with a coordinator for 18 months, including a structured risk assessment and individualized goals. The second received usual care.
The primary outcome was disability level at 18 months, measured using the modified Rankin Scale. The researchers also examined mortality, cognition, daily activities, physical abilities, fatigue and quality of life. Most participants had mild symptoms after their stroke.
An unfavorable signal among the oldest participants
Primary outcome data were available for 268 participants, including 66 aged at least 80. In this subgroup, a favorable outcome was reported in 23.4% of those receiving the intervention, compared with 57.0% receiving usual care. The abstract does not specify the threshold used to define this favorable outcome.
The statistical analysis indicates that the intervention's effect differed by age. This finding deserves attention, but it comes from a small subgroup and is not enough to conclude that all extended support would be unfavorable for older people after a stroke. The abstract reviewed does not explain this difference.
A cognitive finding limited to one test
Among younger participants, the intervention improved completion time on the Trail Making Test B, with a reported difference of 32.2 seconds in favor of personalized follow-up. This finding concerns one specific secondary outcome, not a demonstrated improvement in overall cognitive abilities or independence.
The researchers found no evidence that frailty modified the intervention's effect. However, this absence of a detected interaction does not demonstrate that frail and non-frail people respond in exactly the same way.
What this trial calls into question
LAST-long questions the value of routinely adding this particular program to usual care. It does not evaluate all forms of rehabilitation after a stroke and does not justify stopping them. Its main contribution is to show that individualized, extended follow-up must also demonstrate a benefit rather than simply being assumed effective.
Limitations to keep in mind
Only the PubMed abstract was reviewed, not the full text. The age-based analysis relies on a small subgroup, and the excerpt does not indicate whether it was prespecified. Functional outcome data are not available for all randomized participants. The details of usual care, funding and conflicts of interest were not verified.
What we can take away
This 18-month coordination program did not improve overall functional outcomes after a stroke. The unfavorable signal among participants aged 80 or older calls for in-depth analysis, not generalization to all rehabilitation.
Sources and provenance
- Impact of age and frailty on the effect of a multimodal individualized long-term intervention after stroke: the last-long trial.
Source date: 2026-10-26.
Journal Article, Randomized Controlled Trial, Multicenter Study · Résumé PubMed uniquement, texte intégral non consulté