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Peer-reviewedCC BY 4.0Journal of Rehabilitation Medicine

Impact of age and frailty on the effect of a multimodal individualized long-term intervention after stroke: the last-long trial

  • Håkon Ihle-Hansen1
  • Bente Thommessen2
  • Sara Rise Langlo3
  • Elin Bergh2
  • Anne Hokstad3
  • Stian Lydersen4
  • Yngve Seljeseth5
  • Ingvild Saltvedt6
  • Torunn Askim7
7 affiliations
  1. 1Medical department, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway
  2. 2Department of Neurology, Division of Medicine, Akershus University Hospital, Akershus, Norway
  3. 3Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  4. 4Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
  5. 5Department of Medicine, Ålesund Hospital, Helse Møre and Romsdal Hospital Trust, Ålesund, Norway.
  6. 6Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  7. 7Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Internal Medicine, Department of Stroke, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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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 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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Cite

BibTeXRIS
BibTeX
@article{ihlehansen2026impact,
  title = {{Impact of age and frailty on the effect of a multimodal individualized long-term intervention after stroke: the last-long trial}},
  author = {Håkon Ihle-Hansen and Bente Thommessen and Sara Rise Langlo and Elin Bergh and Anne Hokstad and Stian Lydersen and Yngve Seljeseth and Ingvild Saltvedt and Torunn Askim},
  journal = {Journal of Rehabilitation Medicine},
  year = {2026},
  month = oct,
  doi = {10.2340/jrm.v58.46250},
  url = {https://doi.org/10.2340/jrm.v58.46250},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Impact of age and frailty on the effect of a multimodal individualized long-term intervention after stroke: the last-long trial
AU  - Håkon Ihle-Hansen
AU  - Bente Thommessen
AU  - Sara Rise Langlo
AU  - Elin Bergh
AU  - Anne Hokstad
AU  - Stian Lydersen
AU  - Yngve Seljeseth
AU  - Ingvild Saltvedt
AU  - Torunn Askim
PY  - 2026
DA  - 2026/10/26
JO  - Journal of Rehabilitation Medicine
DO  - 10.2340/jrm.v58.46250
UR  - https://doi.org/10.2340/jrm.v58.46250
AB  - 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
SN  - 1651-2081
SN  - 1650-1977
ER  -