ObjectiveTo investigate the available evidence on early supported discharge (ESD) and transitional care (TC) delivery service in patients with cerebrovascular disease.MethodsA systematic literature search was conducted to collect all available evidence on the use of ESD and TC services. We included cluster-randomized pragmatic trials or randomized controlled trials (RCTs) that recruited patients with stroke or transient ischemic attack to receive either conventional care or any care service intervention that included rehabilitation or support provided by professional medical personnel with the aim of accelerating and supporting home discharge. Relevant data were electronically searched through international databases (Cochrane Library, EMBASE, and PubMed) and incorporated into a summary grid to investigate research outcomes and provide a narrative synthesis. Furthermore, we compared the outcomes in terms of length of hospital stay, patient and caregiver outcomes, and mortality through meta-analysis.ResultsWe identified and included a total of 20 publications of various original randomized studies. There were 18 studies conducted in western countries and 2 in eastern countries. The meta-analysis revealed a tendency that ESD or TC could decrease the length of hospital stay more than the usual care [standardized mean difference (SMD) −0.13; 95% confidence interval (CI) −0.31 to 0.04 days; P = 0.14]. Moreover, there was a tendency that ESD resulted in better activities of daily living (ADL) than usual care (SMD 0.29; 95% CI −0.04 to 0.61; P = 0.08). Patient outcome based on modified Rankin scale (mRS) score (SMD −0.11; 95% CI −0.38 to 0.17; P = 0.45] and mortality (odds ratio 0.80; 95% CI 0.56–1.17; P = 0.25) did not reveal any significant difference. The Caregiver Strain Index revealed no difference.ConclusionWe did not find a large effect size for the use of TC and ESD. When implementing the TC and ESD model from western to Asian countries, services should be prepared and implemented in accordance with national medical rehabilitation pathways for cerebrovascular disease.

Background Rotator cuff injury (RCI) and adhesive capsulitis of the shoulder (ACS) are musculoskeletal disorders (MSDs) characterized by limited motion of the shoulder. As symptoms of MSDs worsen over time, constant management and exercise are necessary. We hypothesized that shoulder pain can be managed through full-cycle rehabilitation exercises. Therefore, the purpose of this study is to confirm the effect of full-cycle rehabilitation exercises by providing exercise education in the community after hospital exercise intervention in subjects with RCI and ACS. Methods This is the protocol for a prospective, randomized controlled trial. Sixty subjects with shoulder pain will be recruited from the rehabilitation clinics of an urban medical hospital. Then, subjects will be randomly allocated into two groups. The intervention group will underwent 12 weeks of rehabilitation exercises in both the hospital and community, while the control group will conduct home exercises for 4 weeks using videos provided by the researchers. The main outcomes will be the change in shoulder pain and score of activities of daily living from initial evaluation to 3 months. The secondary outcomes will be functional measurements, such as ROM and the Manual Muscle Test (MMT), Timed Up and Go test (TUG), 10-meter walk test (10MWT), and Berg Balance Scale (BBS) scores, and will include subject-reported outcomes at multi-time points up to 3 months after the intervention. Discussion This is a randomized controlled trial to study the effectiveness of full-cycle rehabilitation exercises for shoulder pain. The results of this study will determine whether exercise from the hospital to the community is effective in subjects with RCI or ACS and will present evidence for the proper community connection guidelines for sustainable rehabilitation. Trial registration: