Objective: To evaluate a day service for people aged 18–55 years who had a stroke. Design: A randomized cross-over study design was used, randomly allocating individuals to attend the service for six months followed by a period of no attendance for six months. Setting: A day service pilot project was launched in Cardiff in July 1995 for people who were aged between 18 and 55 years and had a stroke. It met one day a week. Subjects: Twenty-six participants were recruited to the study between June 1998 and February 2000. Their mean age was 48 years (SD = 7). Interventions: The service aimed to offer participants the opportunity to identify and pursue meaningful and realistic opportunities within the community. A range of activities occurred at the service including creative activities and social outings. Main outcome measures: The Barthel ADL Index, Extended ADL Scale, Nottingham Leisure Questionnaire, Short Form 36, the Hospital Anxiety and Depression Scale, the Canadian Occupational Performance Measure, the Role Checklist and the Semantic Differential Self Concept Scale were used to assess the outcomes from the service. Results: Attending the service increased occupational performance and satisfaction with performance but there was no evidence that depression and anxiety were reduced or that quality of life and self-concept were improved. Conclusion: Although there were some gains from attending the service there were also many unmet needs. Further research is required to continue to identify how best to meet the needs of individuals post stroke under retirement age.