Long term follow-up of participants in the Taking Charge after Stroke randomised controlled trial

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Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Long term follow-up of participants in the Taking Charge after Stroke randomised controlled trial Alexander Martin , View ORCID Profile Vivian Fu , Zamir Joya , Sajida Joya , Allie Eathorne , Mark Weatherall , Gabrielle Shortt , Alex Semprini , View ORCID Profile John Gommans , View ORCID Profile Harry McNaughton doi: https://doi.org/10.1101/2025.06.10.25329381 Alexander Martin 1 Medical Research Institute of New Zealand , Wellington, New Zealand BSc (Hons) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Vivian Fu 1 Medical Research Institute of New Zealand , Wellington, New Zealand 2 University of Calgary , Ontario, Canada PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Vivian Fu Zamir Joya 1 Medical Research Institute of New Zealand , Wellington, New Zealand DipPharm Find this author on Google Scholar Find this author on PubMed Search for this author on this site Sajida Joya 1 Medical Research Institute of New Zealand , Wellington, New Zealand Find this author on Google Scholar Find this author on PubMed Search for this author on this site Allie Eathorne 1 Medical Research Institute of New Zealand , Wellington, New Zealand MAppStat Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mark Weatherall 3 University of Otago , Wellington, New Zealand FRACP Find this author on Google Scholar Find this author on PubMed Search for this author on this site Gabrielle Shortt 1 Medical Research Institute of New Zealand , Wellington, New Zealand 5 Victoria University of Wellington , Wellington, New Zealand PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Alex Semprini 1 Medical Research Institute of New Zealand , Wellington, New Zealand PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site John Gommans 4 Hawkes Bay Hospital , Hastings, New Zealand FRACP Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for John Gommans Harry McNaughton 1 Medical Research Institute of New Zealand , Wellington, New Zealand PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Harry McNaughton For correspondence: Harry.mcnaughton{at}mrinz.ac.nz Abstract Full Text Info/History Metrics Data/Code Preview PDF ABSTRACT Background The Take Charge intervention – a conversation-based, community intervention to improve motivation, improved independence and physical health 12 months after stroke in two randomised controlled trials with 572 participants. This paper reports long term outcomes for the 400 participants in the Taking Charge After Stroke (TaCAS) study. Method A follow-up study, of a multicentre, randomised, controlled, parallel-group trial. Outcome measures were collected by postal questionnaire or by telephone call. The TaCAS study recruited 400 participants discharged after stroke, randomised within 16 weeks to one of three groups: one session of the Take Charge intervention, two sessions six weeks apart or no sessions (control). This study is of participants still alive and willing to answer a questionnaire between 5 and 6 years after their index stroke. The primary outcome was the Physical Component Summary (PCS) of the Short Form 36. Secondary outcomes were: Frenchay Activities Index; modified Rankin Score (mRS); survival; and stroke recurrence. Results Mortality data were available for all 400 participants and functional data for 204/296 (69%) of survivors. The mean difference (95% CI) in PCS between Take Charge and control groups was 2.8 (−0.8 to 6.5) units, p = 0.12, and for independence (mRS 0-2) the odds ratio (95% CI) was 0.56 (0.28 to 1.16) p = 0.11, both favouring Take Charge with similar point estimates to those after 12 months. Point estimates for other outcomes also favoured Take Charge but were not statistically significant. Conclusions Differences in physical health and independence observed at 12 months, were sustained 5-6 years after stroke, but were not statistically significant. Introduction The Take Charge intervention, a conversation-based intervention designed to improve intrinsic motivation, delivered in the early community phase of stroke rehabilitation, improves independence, advanced activities of daily living and physical health at 12 months. Two randomised controlled trials of size 172 and 400 participants, and an individual participant meta-analysis of all 572 participants, provide strong evidence of benefit with a large effect size. The number needed to treat (NNT) to have one extra person independent at 12 months after stroke is eight.[ 1 , 2 ] This is of a similar magnitude to that for intravenous thrombolysis with alteplase in the first 3 hours after stroke.[ 3 ] Take Charge is the only intervention that has been shown to affect these outcomes in people discharged from hospital after stroke. It is also very cost-effective, saving $US2,000 for every patient treated when assessed directly over a 12-month horizon following stroke.[ 4 ] The Take Charge intervention is now a strong recommendation in recent stroke rehabilitation guidelines [ 5 ] and, to our knowledge, is being used in clinical services in the U.S., Canada, Australia, New Zealand, U.K., Germany and other countries. Materials are free to download and available in seven languages.[ 6 ] Long term stroke follow-up studies (>2 years after randomisation) of randomised controlled trials (RCT) are rare. This reflects the difficulties in maintaining contact with participants over long periods. Nevertheless, these follow-up data are important, to assess whether established medium-term benefits of an intervention are sustained in the longer term. To our knowledge only one other study has assessed functional outcomes in participants who received a randomised intervention multiple years after the initial trial. That study report five and 10-year survival and functional outcomes for survivors of the original 220 participants in a randomised trial of stroke unit versus general medical ward care. In that study, beneficial survival and functional outcome observed after 12 months were sustained at both five and 10 years.[ 7 - 9 ]. This study aimed to assess independence, physical health, and advanced activities of daily living, between five and six years after the initial stroke to explore if the positive outcomes for Take Charge participants after 12 months in the Taking Charge after Stroke (TaCAS) study were sustained. Methods This is a cross-sectional follow-up study of the 400 participants enrolled in the TaCAS Study, a multicentre randomised controlled parallel-group trial in people discharged to a community setting following hospital admission with acute stroke.[ 2 , 10 ]. The study protocol was approved by the Health and Disability Ethics Committee. Participants in the initial study were not masked as to treatment allocation. Outcomes for this study were collected remotely, by investigators masked to the original treatment allocation. Questionnaires were administered either by pen and paper through the post, or by telephone with an investigator. Participants In the TaCAS study, 400 non-Māori, non-Pacific adults (>16 years) discharged to a community setting after acute stroke, and randomised between two and 16 weeks after that event, were recruited over 2016/2017 from seven centers across New Zealand, four tertiary and three non-tertiary centres. Of the initial 400 participants recruited, 2 withdrew and 10 died before the final visit at 12 months, with a 12-month follow-up rate for functional outcomes of 97%. Participants in this follow-up study were survivors who could be contacted and consented to complete a questionnaire. Sample Size This was a convenience sample, determined by the original study size and the proportion of survivors willing to participate. Interventions No new intervention occurred as part of this follow-up study. The original interventions are described in detail in the TaCAS study main report.[ 2 ] In the initial study participants were randomly allocated to one of three treatment groups, one Take Charge Session (TCS), two TCS, 6 weeks apart and no TCS in a 1:1:1 ratio. All participants received usual community rehabilitation. Outcome variables The primary outcome was the Physical Component Summary (PCS) of the Short Form 36 (SF-36) adapted to New Zealand norms.[ 11 ] Secondary outcomes were the Frenchay Activities Index, the modified Rankin Score dichotomised to independent (mRS 0-2) and dependent (mRS >2), survival and stroke recurrence. All outcome measures were used in the TaCAS study (see Supplementary Table 1 for list of measures and timepoints for the original and current study). All outcome measures have been validated for use in stroke. [ 12 - 14 ] Data collection Data were collected from March to August of 2022, between 5 and 6 years after the initial stroke. Death was established by accessing medical records. Any participants who were not listed as deceased were sent a consent form and questionnaire which they could complete and return by post. Alternatively, participants could choose a telephone call from an investigator during which informed consent and study questionnaires were completed. If a participant was unable to provide the necessary information, a carer or family member could complete the mRS alone, either in writing or by telephone on behalf of the participant. If there was no response from a participant, they were contacted by telephone between 14 and 21 days after their study pack was posted. If uncontactable, participants were subsequently contacted a second and final time between 14 and 21 days after the first follow-up. Failing this contact the participant was classified as lost to follow-up. Data management and missing data Source data from paper questionnaires were transcribed by an investigator into a secure REDCap [ 15 ] database and electronic copies of the source data were uploaded alongside. Verbally collected data were input directly into this database. The REDCap database was hosted on Medical Research Institute of New Zealand (MRINZ) servers. Statistical analysis Statistical analyses were prespecified in the study protocol and were intended to match the analyses of the initial study. All analyses were intention to treat. The primary outcome measure was the Physical Component Summary (PCS) of the SF-36. The primary analysis of the primary outcome was ANOVA; all Take Charge vs control. The number of Take Charge sessions was used in a sensitivity analysis to explore a dose-response relationship with the outcome. The secondary analysis of the PCS of the SF-36 was ANCOVA, adjusted for the following baseline variables: Barthel Index score three days post stroke; PCS of the Short Form 12; age; gender; living alone. The two pre-specified comparisons were: all TCS vs control; and two sessions TCS vs one session TCS. The analysis of the FAI was ANOVA. mRS, survival and stroke recurrence were analysed by logistic regression. SAS version 9.4 was used. Results The mean (SD) time between initial stroke and consent for this follow-up was 5.7 (0.4) years. Mortality data were available for all the original 400 participants of the TaCAS trial. Of these, two withdrew, and 10 died by the 12-month follow-up. Of the 388 participants who completed the final visit of the original study, a further 91 died before the 5 to 6 years follow-up (25% mortality overall). Of the remaining 297 participants, 47 chose not to participate and 46 were lost to follow-up, leaving 204 (69%) of the surviving participants, who provided functional outcome data, with 191 (64%) able to complete the PCS. Loss to follow-up was similar across the three arms of the trial. The participant flow is shown in Figure 1 . Baseline characteristics of participants at the 5-to-6-year follow-up were broadly similar across the intervention groups, shown in Table 1 . View this table: View inline View popup Download powerpoint Table 1: Baseline characteristics of follow-up study participants Download figure Open in new tab Figure 1: Flow of participants in Taking Charge after Stroke (TaCAS) trial, completed after 12 month follow-up, and Taking Charge after Stroke Follow up (TaCAS-FU) trial. TC1 = one Take Charge session only, TC2 = 2 Take Charge sessions Download figure Open in new tab Figure 2: Difference between Take Charge and control group in PCS and FAI score at 12 months and 5-6 years post stroke, shown using point estimates of the mean difference in units (for PCS and FAI) and 95% confidence intervals. Download figure Open in new tab Figure 3: Odds ratios and 95% confidence intervals of being dependent (modified Rankin Score >2), Take Charge vs control 12 months, and between 5 and 6 years post stroke. An odds ratio below 1.0 favours Take Charge. For the entire cohort, physical health declined from a mean PCS of 45.4 units at 12 months to 40.3 units after between 5 and 6 years of follow-up. Similarly, rates of independence (mRS 0-2) fell from 86% at 12 months to 78% after between 5 and 6 years. There were 21/189 (11%) respondents reporting a recurrent stroke. Outcomes by treatment allocation are summarised in Table 2 . Participants who received any Take Charge sessions had mean (95% CI) PCS score 2.8 units (−0.8 to 6.5), p = 0.12, higher (better) at prolonged follow-up after stroke than participants who received no Take Charge sessions. This point estimate of the mean difference after between 5 and 6 years is almost identical to that observed at 12-months after stroke, although no longer statistically significant. Similarly, the odds ratio (95% CI) for dependency (mRS >2) for Take Charge participants compared to control was 0.56 (0.28 to 1.16), p=0.11, at the prolonged follow-up, as compared to an odds ratio of 0.55 (0.31 to 0.99), p = 0.045, on the same measure 12 months after stroke. An odds ratio less than one favours the Take Charge intervention. The mean difference (95% CI) between groups in the FAI was 0.8 (−2.0 to 3.7) p = 0.57, favouring Take Charge. Fewer participants in the Take Charge groups than control were dead or reported recurrent stroke by 5 to 6 years, however the differences were small and not statistically significant. Mean (95% CI) PCS scores increased 1.6 units (−0.4 to 3.6), p = 0.11, for each extra TC session received. This is a similar estimate of change to that measured at 12 months, which showed an increase of 1.9 (0.8 to 3.1), p<0.001, units per extra session received. View this table: View inline View popup Download powerpoint Table 2: Outcomes between 5 and 6 years compared to outcomes 12 months after stroke Discussion In this long term follow-up of a randomised trial after stroke, we were able to assess mortality for all the original participants, and data regarding functional outcomes for 69% of survivors, a mean 5.7 years after the original stroke. The main finding was that the differences in physical health outcomes and independence, favouring the Take Charge intervention, measured at 12 months after stroke, were sustained at almost 6 years of follow-up. However, these differences were no longer statistically significant, reflecting participant attrition from mortality and loss to follow-up. The measured 2.8 units difference in physical health, approximates the 2.5-3 unit minimal clinically important difference (MCID) for the PCS in people with stroke.[ 16 ] A dose-response effect was again observed, with higher PCS scores for participants receiving two sessions compared to one. To our knowledge this is the largest long-term follow-up study of a randomised intervention for stroke. Our results show a similar pattern to the stroke unit studies of Indredavik et al (7-9) where a difference observed at 12 months persisted to 5 (and 10) years. Those studies were numerically smaller than ours with functional outcomes limited to a simple activity of daily living measure, the Barthel Index (treated as a dichotomous variable), obtained from 58 participants at 5 years and 41 participants at 10 years. Our functional data were based on responses from 204 individuals and measured physical health, advanced activities of daily living and independence giving a broader picture of outcomes at International Classification of Functioning levels more appropriate for people living in the community.[ 17 ] The confirmation that significant changes at 12 months could be sustained long-term is important for at least two reasons. Firstly, it should encourage attempts to maximise outcomes in the first year after stroke and secondly, the information can be used in longer term modelling of outcomes and cost effectiveness of interventions after stroke. The most significant limitation of the study was loss to follow-up which resulted in a smaller achieved sample size and possible Type II error. Nevertheless, we were able to obtain complete survival data and functional data were obtained from over two-thirds of survivors. Participants in the initial study were not masked to treatment allocation and participants with more favourable outcomes may have been more likely to respond to the request for follow-up. However, loss to follow-up was distributed evenly between groups and the similarity in the differences at 12 months and 5-6 years between the groups is compelling. That a low intensity (one or two sessions) conversation-based intervention delivered in the first four months after stroke could have a significant effect on independence and physical health 12 months after stroke may be surprising but is supported by sound theory and experimental evidence.[ 18 ]. That the effect could be sustained past 5 years of follow-up seems remarkable. We hypothesise that the Take Charge intervention influences intrinsic motivation of the individual leading to permanent behaviour change, with the person with stroke taking more responsibility for achieving the outcomes that matter most to them.[ 18 - 20 ] These results strengthen the case for widespread implementation of the Take Charge intervention for people discharged home after stroke. They also underline the potential for psychological interventions in general after stroke to have an important impact on long term recovery, when combined with usual therapy-based approaches.[ 18 ] Data Availability Data are available on reasonable request from the corresponding author Source of funding This study was funded by a grant from the Hawkes Bay Hospital Clinical Trials Unit – Stroke Fund. The Taking Charge after Stroke (TaCAS) trial was funded by a grant from the Health Research Council of New Zealand. Disclosures None of the authors have any disclosures to report. None of the authors have any financial interest in the Take Charge intervention which is free to download and use. Acknowledgements Thanks to the participants in the original Taking Charge after Stroke study and the large number who also agreed to participate in this follow up study. Footnotes Trial Registration: UTN: U1111-1273-6693, ANZCTRN: ACTRN12622000311752 References 1. ↵ Harwood M , Weatherall M , Talemaitoga A , Barber PA , Gommans J , Taylor W , et al. Taking charge after stroke: promoting self-directed rehabilitation to improve quality of life – a randomized controlled trial . Clin Rehabil . 2012 ; 26 : 493 – 501 . OpenUrl CrossRef PubMed 2. ↵ Fu V , Weatherall M , McPherson K , Taylor W , McRae A , Thomson T , et al. Taking Charge after Stroke: A randomized controlled trial of a person-centered, self-directed rehabilitation intervention . Int J Stroke 2020 ; 15 : 954 – 64 . OpenUrl PubMed 3. ↵ Emberson J , Lees KR , Lyden P , Blackwell L , Albers G , Bluhmki E , et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials . Lancet . 2014 ; 384 : 1929 – 35 . OpenUrl CrossRef PubMed Web of Science 4. ↵ Te Ao B , Harwood M , Fu V , et al. Economic analysis of the ‘Take Charge’ intervention for people following stroke: Results from a randomised trial . Clinical Rehabilitation . 2021 ; 36 : 240 – 250 . OpenUrl PubMed 5. ↵ Stroke Foundation of Australia . Australian and New Zealand Living Clinical Guidelines for Stroke Management - Chapter 8 of 8: Community participation and long-term care . Available at: https://app.magicapp.org/#/guideline/6nYJxE (Accessed 2 June 2025 ) 6. ↵ McNaughton , H. ( 2025 ) Take Charge, a whole-person intervention that improves outcomes (Website) . Available at: http://www.xn--boutdesouffle-odb.net/HarryMcNaughton/ (Accessed 2 June 2025 ) 7. ↵ Indredavik B , Bakke F , Solberg R , Rokseth R , Haaheim LL , Holme I. Benefit of a stroke unit: a randomized controlled trial . Stroke . 1991 ; 22 : 1026 – 31 . OpenUrl Abstract / FREE Full Text 8. Indredavik B , Slørdahl SA , Bakke F , Rokseth R , Håheim LL . Stroke unit treatment . Long-term effects. Stroke . 1997 ; 28 : 1861 – 6 . OpenUrl PubMed 9. ↵ Indredavik B , Bakke F , Slørdahl SA , Rokseth R , Håheim LL . Stroke Unit Treatment: 10-year follow-up . Stroke . 1999 ; 30 : 1524 – 7 . OpenUrl Abstract / FREE Full Text 10. ↵ Fu VWY , Weatherall M , McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Māori, non-Pacific adult New Zealanders discharged to community living BMJ Open 2017 ; 7 : e016512 . OpenUrl Abstract / FREE Full Text 11. ↵ Frieling MA , Davis WR , Chiang G. The SF-36v2 and SF-12v2 health surveys in New Zealand: norms, scoring coefficients and cross-country comparisons . Aust N Z J Public Health . 2013 ; 37 : 24 – 31 . OpenUrl CrossRef PubMed 12. ↵ Anderson C , Laubscher S , Burns R. Validation of the Short Form 36 (SF-36) health survey questionnaire among stroke patients . Stroke . 1996 ; 27 : 1812 – 6 . OpenUrl Abstract / FREE Full Text 13. Schuling J , de Haan R , Limburg M , Groenier KH . The Frenchay Activities Index. Assessment of functional status in stroke patients . Stroke . 1993 ; 24 : 1173 – 7 . OpenUrl Abstract / FREE Full Text 14. ↵ Banks JL , Marotta CA . Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis . Stroke . 2007 ; 38 : 1091 – 6 . OpenUrl Abstract / FREE Full Text 15. ↵ Harris PA , Taylor R , Thielke R , Payne J , Gonzalez N , Conde JG . Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support . J Biomed Inform . 2009 ; 42 : 377 – 81 . OpenUrl CrossRef PubMed Web of Science 16. ↵ Fu V , Weatherall M , McNaughton H. Estimating the minimal clinically important difference for the Physical Component Summary of the Short Form 36 for patients with stroke . J Int Med Res . 2021 ; 49 ( 12 ):03000605211067902. 17. ↵ International Classification of Functioning, Disability and Health (ICF) . ( 2001 ). World Health Organisation, Geneva . Available at: https://www.who.int/classifications/icf/en/ (Accessed 2 June 2025 ). 18. ↵ McNaughton H , Gommans J , McPherson K , Harwood M , Fu V. A cohesive, person-centric evidence-based model for successful rehabilitation after stroke and other disabling conditions . Clin Rehabil . 2023 ; 37 : 975 – 985 . OpenUrl PubMed 19. McNaughton H , Weatherall M , McPherson K , Fu V , Taylor WJ , McRae A , et al. The effect of the Take Charge intervention on mood, motivation, activation and risk factor management: Analysis of secondary data from the Taking Charge after Stroke (TaCAS) trial . Clin Rehabil . 2021 ; 35 : 1021 – 31 . OpenUrl PubMed 20. ↵ McNaughton H , Fu V. Intrinsic motivation . Pract Neurol . 2023 ; 23 : 489 – 92 . OpenUrl Abstract / FREE Full Text View the discussion thread. Back to top Previous Next Posted June 11, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. 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Share Long term follow-up of participants in the Taking Charge after Stroke randomised controlled trial Alexander Martin , Vivian Fu , Zamir Joya , Sajida Joya , Allie Eathorne , Mark Weatherall , Gabrielle Shortt , Alex Semprini , John Gommans , Harry McNaughton medRxiv 2025.06.10.25329381; doi: https://doi.org/10.1101/2025.06.10.25329381 Share This Article: Copy Citation Tools Long term follow-up of participants in the Taking Charge after Stroke randomised controlled trial Alexander Martin , Vivian Fu , Zamir Joya , Sajida Joya , Allie Eathorne , Mark Weatherall , Gabrielle Shortt , Alex Semprini , John Gommans , Harry McNaughton medRxiv 2025.06.10.25329381; doi: https://doi.org/10.1101/2025.06.10.25329381 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Rehabilitation Medicine and Physical Therapy Subject Areas All Articles Addiction Medicine (567) Allergy and Immunology (863) Anesthesia (297) Cardiovascular Medicine (4411) Dentistry and Oral Medicine (443) Dermatology (380) Emergency Medicine (606) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1505) Epidemiology (15205) Forensic Medicine (30) Gastroenterology (1119) Genetic and Genomic Medicine (6574) Geriatric Medicine (666) Health Economics (994) Health Informatics (4511) Health Policy (1365) Health Systems and Quality Improvement (1608) Hematology (537) HIV/AIDS (1263) Infectious Diseases (except HIV/AIDS) (15903) Intensive Care and Critical Care Medicine (1103) Medical Education (620) Medical Ethics (144) Nephrology (665) Neurology (6573) Nursing (345) Nutrition (998) Obstetrics and Gynecology (1139) Occupational and Environmental Health (954) Oncology (3319) Ophthalmology (967) Orthopedics (369) Otolaryngology (420) Pain Medicine (435) Palliative Medicine (129) Pathology (662) Pediatrics (1689) Pharmacology and Therapeutics (691) Primary Care Research (710) Psychiatry and Clinical Psychology (5421) Public and Global Health (9205) Radiology and Imaging (2191) Rehabilitation Medicine and Physical Therapy (1367) Respiratory Medicine (1191) Rheumatology (593) Sexual and Reproductive Health (709) Sports Medicine (529) Surgery (709) Toxicology (99) Transplantation (288) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9fe8d7c28a103fe2',t:'MTc3OTI1MzkwOA=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();