Age, but not frailty, modified the response to the LAST-long multimodal, stroke coordinator-led intervention, with participants aged 80 or older less likely to have a favourable mRS outcome with intervention than with standard care.
Age modified the effect of the intervention on the primary outcome (mRS at 18 months), with worse outcomes for those aged ≥80 in the intervention group.
Frailty did not modify the intervention effect.
The intervention improved executive function (Trail Making Test B) in younger participants, with a significant age-intervention interaction.
The study population was mostly relatively young with mild stroke symptoms, with a sizable minority of older and frail participants.
The parent LAST-long trial found no overall functional benefit of the intervention, and this subgroup analysis was designed to see whether older or frailer participants benefited.
This study looked more closely at a Norwegian trial in which stroke survivors either received monthly meetings with a stroke coordinator for 18 months or got usual care. The coordinators did structured risk assessments and set individual goals. The main trial found no overall benefit for everyday function. Because most participants had mild strokes, the researchers asked whether the program helped some groups, such as older or frailer people, more than others. The results suggest that age mattered, but frailty did not. Among people aged 80 or older, a favourable functional outcome was less common in the intervention group (23.4%) than in the usual care group (57.0%). In younger participants, the intervention was linked to better performance on a thinking-speed and flexibility test (Trail Making Test B) by about 32 seconds. Frailty level made no measurable difference in how people responded. These findings suggest that a single long-term, multi-part follow-up program may not suit everyone equally, and that it could be less helpful, or possibly less well suited, for the oldest stroke survivors. The analysis looked at subgroups within a trial that had no overall benefit, so the results should be confirmed in further research before drawing firm conclusions.
Ihle-Hansen H, Thommessen B, Langlo S, Bergh E, Hokstad A, Lydersen S, et al.. (2026). Impact of age and frailty on the effect of a multimodal individualized long-term intervention after stroke: the last-long trial.. Journal of rehabilitation medicine. https://doi.org/10.2340/jrm.v58.46250