Objective Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals. Method A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden’s three step approach for thematic synthesis. Results Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD. Conclusion The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.

Background Early supported discharge (ESD) facilitates people with a stroke to be discharged from the hospital environment earlier than conventional care to continue their rehabilitation within the home with a multi-disciplinary team. Known benefits of ESD from Randomised Controlled Trials conducted include reducing the length of a hospital stay, long term dependency, and cost savings. There is limited qualitative evidence available on ESD. This systematic review and qualitative synthesis explored the experiences of those involved in ESD including people with stroke, family members, caregivers as well as healthcare professionals. Method A literature search was completed in 11 databases which generated 3,425 articles. Qualitative or mixed Method studies that included qualitative data on the experiences of people with stroke, family members, caregivers and healthcare professionals of an ESD service were included. The Critical Appraisal Skills Programme checklist was used to appraise the methodological quality of the papers. The findings were synthesised using the three step process for thematic synthesis. Results A total of fourteen studies were included with the methodological quality of the studies deemed good overall. Four key themes emerged: 1) ESD is experienced by people with stroke as a goal-focused and supportive process leading to positive outcomes, 2) ESD eases the transition from the hospital to the home environment but the transition from ESD to social and community services is often problematic, 3) Organisational, logistical and inter-professional factors are critical to the success of ESD and 4) The home environment enhances rehabilitation. Conclusion The findings of this qualitative evidence synthesis highlight the importance of the home environment in the rehabilitation process post stroke. Key practice implications point to the need for increased attention to periods where care transitions occur from ESD to community services.

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