Objective:To evaluate an early home-supported discharge service for stroke patients.Design:We carried out a prospective, randomised, open-label, blinded-endpoint trial (allocation ratio of 1:1) with patients assigned to either an early home-supported discharge service or usual care.Setting:The study was undertaken in Aveiro, Portugal, between April 2009 and April 2013.Subjects:We included stroke patients aged 25–85 years admitted to the stroke unit with an initial Functional Independence Measure of up to 100, who gave informed consent.Interventions:Patients in the early home-supported discharge group began their rehabilitation intervention in the stroke unit and the early home-supported discharge team worked with them at home for a maximum of one month. Patients in the control group received usual services.Main measures:The primary outcome measure was the Functional Independence Measure at six months after stroke.Results:We randomised 190 patients of whom 34 were lost to follow-up. There were no significant differences (p > 0.5) in the average scores of Functional Independence Measure between the early home-supported discharge (69 ±22; mean ±SD) and the control groups (71 ±17) measured at baseline; and between the early home-supported discharge (107 ±20) and the control groups (107 ±25) measured at six months. The number of individuals with a low Functional Independence Measure score (<60) in the early home-supported discharge group compared with the control group was higher at admission (34/95 vs. 26/95) and lower at follow-up (2/74 vs. 5/78).Conclusions:It was feasible to implement early home-supported discharge procedures in a Southern European setting, but we have not shown convincing differences in disability at six months.

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ResumoEnquadramento: A esclerose múltipla (EM) é uma doença crónica que interfere na qualidade de vida (QV) das pessoas com EM e dos cuidadores. Objetivos: Avaliar a perceção da QV das pessoas com EM e dos cuidadores. Avaliar a perceção da QV das pessoas com EM e dos cuidadores segundo o sexo. Comparar a QV das pessoas com EM com a dos cuidadores. Metodologia: Aplicou-se um questionário sobre perfil sociodemográfico e QV (WHOQOL-Bref ) nos 2 grupos, e perfil clínico nas pessoas com EM. Resultados: As pessoas com EM e os cuidadores percecionam melhor QV no domínio das Relações sociais e pior no Físico. As mulheres com EM têm melhor QV, enquanto que nos cuidadores são os homens. A QV das pessoas com EM é diferente da dos cuidadores, sendo estatisticamente significativa nos domínios QV geral-saúde (p=0,039), Físico (p=0,001) e Ambiente (p=0,012). Conclusão: Os resultados sugerem que as pessoas com EM têm pior QV que os cuidadores. É fundamental o planeamento de uma intervenção de enfermagem dirigida por forma a melhorar a QV de ambos. Palavras Conclusion:The results suggest that people with MS have worse QoL than caregivers. A nursing intervention should be planned to improve the QoL of both patients and caregivers.

Resumo Resumen R E S E A R C H P A P E R ( O R I G I N A L ) Living and Caring After a StrokeMethodology: Quantitative, descriptive and cross-sectional study, with a non-probability convenience sample.Results: The socio-demographic and clinical variables influence the quality of life. Two months after the stroke, both the patients and the caregivers have worse quality of life. Conclusion: When comparing patients' and caregivers' quality of life at the time of hospitalization and at the 2-month follow-up (after discharge), we concluded that both have worse quality of life two months after the stroke. We also concluded that the caregivers have better quality of life than the patients, although this difference was not statistically significant.

PurposeTo systematize the content of home-care interventions for stroke patients in Portugal and assess their relevance, feasibility and acceptability from the perspective of care professionals.TheoryResearch seems to show that Integrated Home Care (IHC) is an excellent form of rehabilitation as the domicile is the place where the patient feels safe, participate most and have direct feedback from ADL training [1]. Moreover, recent results show that IHC has the potential to lower the costs of post-stroke rehabilitation [2]. Cost-effectiveness analysis would then be an important tool for decision-makers regarding alternative IHC interventions. However, in practice the realization of the potential benefits of IHC has to overcome serious barriers and the dissemination of IHC in the European Union will depend “on the upgrade of health professionals from a defensive kind of monodisciplinary professionalism towards an open-ended multidisciplinary professionalism” [1]. Therefore, it is fundamental to assess health professionals’ perceptions and experiences regarding the relevance, feasibility and acceptability of home-based rehabilitation and their willingness to participate.MethodsIn Portugal, the home rehabilitation teams include a gerontologist which is the case manager, a physiotherapist, an occupational therapist and a psychologist. A mixed method was used to analyse the teams’ interventions at home. Information about each session was recorded by all professionals in a standardized form. Additionally, case managers have written qualitative reports, according to a pre-defined minimum structure and the psychologist has written patient specific psychology reports. We analysed the sessions’ reports of 80 patients who have received rehabilitation services at home. This information was coded, keyed into a database and analyzed with PASW Statistics 18. In the qualitative phase, we have explored health professional’s perceptions on experiences with home-care rehabilitation process. Data were collected within a focus group composed by two physiotherapists, two occupational therapists, a psychologist and two gerontologists. A group of three researchers with specific roles joined the focus group, namely a moderator, a recorder and a coordinator. The session’s content was recorded, transcript and analyzed with NVivo 9.Results and conclusionsQuantitative results consist on the average number of sessions at home per specialty, the duration of sessions, the reasons for therapeutic rehabilitation, the type of intervention executed by the professionals, the specific content of treatments in home care and strategies used by professionals in this type of rehabilitation. Qualitative results include health professionals individual and collective understanding of patients’ achievements and effort required from the professionals and their assessment of the measures used to evaluate the results.