This study evaluates a program designed to help individuals transition from inpatient rehabilitation to home following an ischemic or hemorrhagic stroke. Half of the participants will receive a stroke education program while the other half will receive an environmental modifications program.

A gap in care exists at the point of transition from inpatient rehabilitation (IR) to home, when survivors encounter new environmental barriers due to the cognitive and sensorimotor sequelae of stroke. Resolving these barriers and improving independence in the community have potential to significantly improve stroke survivors' long-term morbidity.

Investigators will conduct a randomized, controlled multi-center trial (RCT) and concurrent implementation evaluation and review of process data to examine therapeutic efficacy, cost-effectiveness and implementation potential of a compensatory intervention (COMPASS) designed to improve daily activity performance and participation outcomes in persons transitioning home from inpatient rehabilitation (IR) following a stroke.

Inclusion Criteria:

• Aged ≥55 years at the time of screening
• Acute stroke diagnosis (IS or ICH) verified by the stroke team or medical record
• Independent in activities of daily living (ADLs) prior to stroke (premorbid Modified Rankin Scale score ≤2)
• Plan to discharge to home from an IR
• Capable of giving informed consent which includes compliance with the requirements and duration of participation as listed in the Informed Consent Form (ICF).

Exclusion Criteria:

• Life expectancy <6 months
• Cognitive impairment that the participant's stroke team or a research team member believes impairs their ability to provide informed consent or make reasoned choice including the interpretation of the self-rated scales
• Any communication problem that would prevent study completion
• Residence in a congregate living facility
• Not eligible for a therapeutic pass
• Residence outside of the designated catchment area (specific catchment distance to be determined by each site)
• Site investigator's judgment that the participant would not be able to complete research procedures or interventions
• Participation in another research study that in the site investigator's judgment could interfere or conflict with this research study's assessments or interventions

Final de-identified data will be preserved and shared with the public via WashU Research Data, an institutional repository managed by the Washington University in St. Louis Libraries. Datasets submitted to the data repository undergo curation prior to publication to ensure that the data are functioning, in the appropriate format, and well documented to facilitate long-term FAIRness (findable, accessible, interoperable and reusable). Submissions receive digital object identifiers minted with DataCite, and the library will retain the deposits for a minimum of 10 years.