Early supported discharge after stroke in Bergen (ESD Stroke Bergen): three and six months results of a randomised controlled trial comparing two early supported discharge schemes with treatment as usual

Abstract

BackgroundStroke causes lasting disability and the burden of stroke is expected to increase substantially during the next decades. Optimal rehabilitation is therefore mandatory. Early supported discharge (ESD) has previously shown beneficial, but all major studies were carried out more than ten years ago. We wanted to implement and study the results of ESD in our community today with comparisons between ESD and treatment as usual, as well as between two different ESD models.MethodsPatients with acute stroke were included during a three year period (2008–11) in a randomised controlled study comparing two different ESD models to treatment as usual. The two ESD models differed by the location of treatment: either in a day unit or in the patients’ homes. Patients in the ESD groups were followed by a multi-disciplinary ambulatory team in the stroke unit and discharged home as early as possible. The ESD models also comprised treatment by a multi-disciplinary community health team for up to five weeks and follow-up controls after 3 and 6 months. Primary outcome was modified Rankin Scale (mRS) at six months.ResultsThree-hundred-and-six patients were included. mRS scores and change scores were non-significantly better in the two ESD groups at 3 and 6 months. Within-group improvement from baseline to 3 months was significant in the ESD 1 (p = 0.042) and ESD 2 (p = 0.001) groups, but not in the controls. More patients in the pooled ESD groups were independent at 3 (p = 0.086) and 6 months (p = 0.122) compared to controls and there also was a significant difference in 3 month change score between them (p = 0.049). There were no differences between the two ESD groups. Length of stay in the stroke unit was 11 days in all groups.ConclusionsPatients in the ESD groups tended to be more independent than controls at 3 and 6 months, but no clear statistically significant differences were found. The added effect of supported discharge and improved follow-up seems to be rather modest. The improved stroke treatment of today may necessitate larger patient samples to demonstrate additional benefit of ESD.Clinical trial registrationUnique identifier: NCT00771771

Subjective health complaints predict functional outcome six months after stroke

“…Regarding sex, previous researchers have generally reported a negative effect of female sex on functional outcome 5, 19, 20, 21, 22, 23, 24, 25, 26, 27. This is seen also in the present study (for details, see11). However, when corrected for subjective health complaints, the predictive value of sex disappeared completely, as seen in Table 4.…”

“…In our study, subjective health complaints also are much more common in females than in males, and the poorer functional prognosis in females may therefore be related to their degree of subjective health complaints rather than to their sex alone. The women in our study were on average 6 years older than the males,11 but the significant relationship between subjective health complaints and functional outcome still holds adjusted for age (results not shown).…”

The Postural Assessment Scale for Stroke Patients: translation into Norwegian, cultural adaptation, and examination of reliability

“…In addition, the scoring criteria have been clarified, where 'much help' is defined as 'support of two persons' and 'little help' as 'support of one person'. These modifications and clarifications are in accordance with our clinical experience and in line with a previous study (19).…”

Acquired brain injury rehabilitation: dilemmas in neurological physiotherapy across healthcare settings

“…These results somewhat contrast with the promising results from studies on early supported discharge (ESD) and home rehabilitation programs, which show similar or better outcomes of patient treatment when the length of specialist health care stay is reduced (23,(42)(43)(44)(45)(46). However, particular ESD studies presuppose extra SpHC effort in patient transition, performed in the PrHC setting, offering close collaboration and support in the homecoming phase (21,22).…”

“…Studies on health care pathways and smooth care setting transitions are increasing (19,20), and several studies have focused more specifically upon neurological rehabilitation and collaboration across health care settings for PwABI (21)(22)(23)(24)(25). However, knowledge on physiotherapists' perceptions of service delivery to PwABI in transition from SpHC to PrHC is sparse.…”