Benefit of an Extended Stroke Unit Service With Early Supported Discharge

Indredavik, Bent; Fjærtoft, Hild; Ekeberg, Gun; Løge, Anne D.; Mørch, Birgitte

doi:10.1161/01.str.31.12.2989

Cited by 141 publications

(120 citation statements)

References 42 publications

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“…11 As part of this service, all patients received an outpatient follow-up medical evaluation 4 weeks after discharge. At 90 days, a home-visit and functional assessment using modified Rankin Scale (mRS) scores 15 were performed by a staff-member unfamiliar with the patient.…”

Section: Methodsmentioning

confidence: 99%

Functional Outcome After Common Poststroke Complications Occurring in the First 90 Days

Rohweder

Ellekjær

Salvesen

et al. 2015

Stroke

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Background and Purpose-The aim of this study was to explore the associations of common medical complications with functional outcome at 90 days post stroke. Methods-Patients with unselected acute stroke were included and observed for 16 predefined complications during the first week. Fifty percent (244 patients) were allocated to follow-up of 13 complications until 90 days and then assessed with the modified Rankin Scale 90.

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Section: Methodsmentioning

confidence: 99%

Functional Outcome After Common Poststroke Complications Occurring in the First 90 Days

Rohweder

Ellekjær

Salvesen

et al. 2015

Stroke

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“…Details regarding the study design, the method of randomization, the inclusion criteria, and the intervention have been reported previously. [5][6][7][8] The Regional Committee for Medical Research approved the study protocol.…”

Section: Methodsmentioning

confidence: 99%

“…Randomized controlled trials of early supported discharge (ESD) and further rehabilitation at home have documented great benefits, mostly in reduced length of hospital stay (8 days). 3,4 Some trials also have documented improved functional outcome, improved quality of life, and reduced costs [3][4][5][6][7][8] up to 1 year after stroke. The current recommendation from the ESD trialists group, based on a meta-analysis on 12 randomized controlled trials, 3,4,9 is an ESD service consisting of a coordinating multidisciplinary team, because this is the most effective form of organization in follow-up and rehabilitation.…”

mentioning

confidence: 99%

Stroke Unit Care Combined With Early Supported Discharge Improves 5-Year Outcome

Fjærtoft

Rohweder

Indredavik

2011

Stroke

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Background and Purpose-Early supported discharge (ESD) seems to be a promising alternative to conventional follow-up care after acute stroke. We have previously shown that stroke unit care combined with ESD has beneficial effects on functional outcome and the use of resources for up to 1 year. The aim of this trial was to evaluate outcome after 5 years. Methods-We performed a randomized controlled trial with 320 acute stroke patients allocated to ordinary stroke unit care (160 patients) or stroke unit care with ESD (160 patients). The ESD service consisted of a mobile team that co-coordinated hospital discharge and further rehabilitation during 1 month of follow-up in cooperation with the primary health care. Mortality, residence, and functional outcome including modified Rankin scale were registered after 5 years. All assessments were blinded. Results-There was no difference between the groups with modified Rankin scale score Յ2 (Pϭ0.213), but there was a trend toward greater improvement in modified Rankin scale score in the ESD group from onset of stroke (38% versus 30%; Pϭ0.106). More patients were dead or institutionalized in the ordinary stroke unit care group (Pϭ0.032); 158 patients were alive, 84 were in ESD, and 74 were in ordinary stroke unit care. Of the 158 patients alive, a greater proportion were living at home in ESD (86%/70%; Pϭ0.019). Conclusions-Stroke unit care combined with ESD seems to reduce death and institutional care and to improve patients' chances of living at home 5 years after stroke compared to traditional stroke care. There is a trend toward improved functional outcome in the ESD group. (Stroke. 2011;42:1707-1711.)

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“…2,3 It is likely that the physical and social home environment creates a better arena for relearning skills. This may enable both patient and carers to become more fully involved in decision making and provide greater insight and motivation.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study exploring patients’ and carers’ experiences of Early Supported Discharge services after stroke

et al. 2013

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Objective: To investigate patients' and carers' experiences of Early Supported Discharge services and inform future Early Supported Discharge service development and provision. Design and subjects: Semi-structured interviews were completed with 27 stroke patients and 15 carers in the Nottinghamshire region who met evidence-based Early Supported Discharge service eligibility criteria. Participants were either receiving Early Supported Discharge or conventional services. Setting: Community stroke services in Nottinghamshire, UK. Results: A thematic analysis process was applied to identify similarities and differences across datasets. Themes specific to participants receiving Early Supported Discharge services were: the home-based form of rehabilitation; speed of response; intensity and duration of therapy; respite time for the carer; rehabilitation exercises and provision of technical equipment; disjointed transition between Early Supported Discharge and ongoing rehabilitation services. Participants receiving Early Supported Discharge or conventional community services experienced difficulties related to: limited support in dealing with carer strain; lack of education and training of carers; inadequate provision and delivery of stroke-related information; disjointed transition between Early Supported Discharge and ongoing rehabilitation services. Conclusions: Accelerated hospital discharge and home-based rehabilitation was perceived positively by service users. The study findings highlight the need for Early Supported Discharge teams to address information and support needs of patients and carers and to monitor their impact on carers in addition to patients, using robust outcome measures.

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Benefit of an Extended Stroke Unit Service With Early Supported Discharge

Cited by 141 publications

References 42 publications

Functional Outcome After Common Poststroke Complications Occurring in the First 90 Days

Functional Outcome After Common Poststroke Complications Occurring in the First 90 Days

Stroke Unit Care Combined With Early Supported Discharge Improves 5-Year Outcome

A qualitative study exploring patients’ and carers’ experiences of Early Supported Discharge services after stroke

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