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

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.