Effectiveness of An Integrated Multidisciplinary Geriatric Rehabilitation Programme for Older Persons with Stroke: A Multicentre Randomised Controlled Trial

Abstract

Background: Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate ambulatory aftercare in the community. Therefore, we developed an integrated multidisciplinary rehabilitation programme that includes aftercare for older persons with stroke. We evaluated the effectiveness of this newly developed rehabilitation programme in comparison to usual care. Methods: A multicentre randomised controlled trial was conducted in eight geriatric rehabilitation stroke units and their collaborating partners in primary care. The study population involved stroke patients and their informal caregivers who were aged 65 or over, living in the community before admission to geriatric rehabilitation, and expected to be able to return home after discharge. The programme consisted of three modules: inpatient neurorehabilitation, home-based self-management training, and stroke education. For patients, daily activity (FAI) was assessed as primary outcome and functional dependence (Katz-15), perceived quality of life (SSQoL) and social participation (IPA) as secondary outcomes. Additionally, among informal caregivers perceived care burden (self-rated burden VAS), objective care burden (Erasmus iBMG), and quality of life (CarerQol), were assessed as secondary outcomes.Results: In total 189 patients and 170 informal caregivers were included. Mean age of the patients in the intervention group was 78.8 years (SD= 6.3) and in the usual care group 78.8 years (SD=7.0). Significant favourable effects for the programme were observed for the subscale autonomy outdoors of the IPA (-2.15, P=.047, and for the informal caregivers perceived care burden (1.23, P=.048. For the primary outcome daily activity and the other secondary outcomes, no significant effects were observed.Conclusion: The integrated multidisciplinary programme had no effect on daily activity of older stroke patients. However, patients participating in the programme had a higher level of perceived autonomy of outdoor activities and their informal caregivers perceived a lower care burden. The programme might be promising in providing adequate (after)care, although adaptation of the programme is recommended to increase its feasibility and improve its effects.