Effects of an integrated transitional care program for stroke survivors living in a rural community: a randomized controlled trial

Abstract

Objective: To evaluate the effect of an integrated transitional care program on health outcomes in stroke survivors based on an original community for healthcare. Design: A pilot randomized controlled trial with blinded assessment. Randomization by statistician using computer-generated, random numbers concealed in opaque envelopes. Setting: A tertiary hospital and participants’ home across Lishui, China. Subjects: A total of 98 people with acute cerebral hemorrhage or cerebral infarction, eight weeks following discharge from our hospital. Interventions: Each participant received stroke unit–based treatment including acute medical treatment, early rehabilitation and health education. Patients in the intervention group received ongoing rehabilitation at home through multidisciplinary team, while patients in the control group received secondary stroke prevention. Main measures: Short-Form Health Survey-36, Modified Barthel Index and Caregiver Strain Index at four and eight weeks, respectively, after discharged. Results: A total of 98 participants were recruited (intervention n = 49, control n = 49). Patients had an average age of 61.4 years (61.4 ± 18.3). Mean values of Physical Components Summary and Mental Components Summary, integral components of Short-Form Health Survey-36, were significantly better in the intervention group at four and eight weeks (40.2 ± 6.3 and 42.9 ± 3.7 for the former; 43.9 ± 2.6 and 46.1 ± 1.8 for the later). The same trend was observed in Modified Barthel Index (87.1 ± 9.2 and 92.5 ± 6.7 at four and eight weeks, respectively). But the significant improvement in Caregiver Strain Index was only observed at four weeks. There were significant differences between groups in these scores. Conclusion: The transitional care program has been proven to be feasible and improve health-related outcomes.

Early Supported Discharge and Transitional Care Management After Stroke: A Systematic Review and Meta-Analysis

“…This literature review finally examined 20 articles, of which 19 were RCTs and 1 was an RPT. Regarding international location, 85% of the studies were conducted in Europe [Norway ( 10 – 15 ): 6, Denmark ( 16 – 20 ): 5, Netherlands ( 21 ): 1, Sweden ( 22 , 23 ): 2, UK ( 24 , 25 ): 2, Portugal ( 26 ): 1], 10% were conducted in Asia [China ( 27 ): 1, Hong Kong ( 28 ): 1], and 5% were conducted in North America [USA ( 9 ): 1]. For the intervention types, seven studies provided type I intervention, whereas 13 studies provided type II intervention.…”

Effect of home-based interventions on basic activities of daily living for patients who had a stroke: a systematic review with meta-analysis

“…Twenty-one randomised controlled trials compared home-based rehabilitation with institution-based rehabilitation on an inpatient or outpatient basis 23–43. Fifteen randomised controlled trials compared home-based rehabilitation with usual care, which was provided according to routine practice without the involvement of the research team and might include no therapy, home care, instructions for home rehabilitation, inpatient therapy and outpatient therapy 32 38 44–56. Five randomised controlled trials evaluated the effect of specific home-based interventions by comparing with blank control or sham control 57–61.…”

“…There were various home-based interventions performed in the included studies. Twelve studies did not describe the details of treatment strategy 28 29 32 33 37 43 48 50 52 56 68 70. Among 37 studies which reported the details of treatment strategy, 19 studies provided physical exercise practice,23 26 27 31 34–36 45–47 49 53 57–59 61 63 64 71 20 studies provided training of daily activities,23–27 30 36 38 45 46 53–55 58–61 65 66 71 8 studies provided task/functional-specific training35 39–42 51 61 69 and 2 studies provided constraint-induced movement treatment 44 62.…”

Ações em saúde propostas em programas de transição do cuidado para idosos: revisão integrativa

“…No que diz respeito às ações em saúde aplicadas durante a internação, embora poucos estudos tenham implementado intervenções terapêuticas no ambiente intra-hospitalar, observou-se concordância entre os autores, acerca do papel de planos de alta especializados, que se constituem como o alicerce de Programas de Transição de Cuidados para idosos (Gilbert et al, 2021;Deng et al, 2020;Murphy et al, 2019;Aboumatar et al, 2018;Ballard et al, 2018;Low et al, 2017;Takahashi et al, 2016;Heim et al, 2016;Zhou et al, 2015;Wong et al, 2015;Naylor et al, 2013;Stauffer et al, 2011). Vale destacar que, para Hanan et al (2018), os planos de alta devem apresentar componentes como: orientações para paciente, familiares e/ou cuidador acerca do prognóstico e terapêutica medicamentosa e de reabilitação que será adotada em domicílio; agendamento de consulta de retorno, com média de até sete dias após alta hospitalar; orientações acerca de possíveis eventos adversos relacionados ao estado de saúde, orientações e encaminhamento para a equipe de Atenção Primária à Saúde sobre o caso.…”