Evaluation of an Extended Stroke Rehabilitation Service (EXTRAS)

Rodgers, Helen; Howel, Denise; Bhattarai, Nawaraj; Cant, Robin; Drummond, Avril; Ford, Gary A.; Forster, Anne; Francis, Richard; Hills, K; Laverty, Annie; McKevitt, Christopher; McMeekin, Peter; Price, Chris; Stamp, Elaine; Stevens, Eleanor; Vale, Luke; Shaw, Lisa

doi:10.1161/strokeaha.119.024876

Cited by 24 publications

(38 citation statements)

References 23 publications

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“…Effects of the intervention analyzed in each study were measured through different outcome variables according to the type of analysis, type of intervention, pathology of the participants and the objectives of the study. Consequently, QALY was measured in all the studies conducting cost-utility analysis [ 13 , 14 , 17 , 18 , 20 , 21 , 22 , 27 , 28 , 31 , 32 , 34 , 39 , 40 , 41 , 42 , 43 , 46 , 49 , 50 , 51 , 54 ]. Other health outcomes were used including HRQL [ 14 , 27 , 28 , 31 ], daily life activities [ 22 , 52 ] or pain [ 13 ].…”

Section: Resultsmentioning

confidence: 99%

Economic Evaluation in Neurological Physiotherapy: A Systematic Review

2021

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This systematic review was carried out to compile and assess original studies that included economic evaluations of neurological physiotherapy interventions. A thorough search of PubMED, Cochrane and Embase was developed using keywords such as health economics, neurological physiotherapy and cost analysis, and studies published during the last six-year term were selected. A total of 3124 studies were analyzed, and 43 were eligible for inclusion. Among the studies analyzed, 48.8% were interventions for stroke patients, and 13.9% were focused on Parkinson’s disease. In terms of the countries involved, 46.5% of the studies included were developed in the UK, and 13.9% were from the USA. The economic analysis most frequently used was cost-utility, implemented in 22 of the studies. A cost-effectiveness analysis was also developed in nine of those studies. The distribution of studies including an economic evaluation in this discipline showed a clear geographic dominance in terms of the pathology. A clear upward trend was noted in the economic evaluation of interventions developed in neurological physiotherapy. However, these studies should be promoted for their use in evidence-based clinical practice and decision-making.

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Section: Resultsmentioning

confidence: 99%

Economic Evaluation in Neurological Physiotherapy: A Systematic Review

2021

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“…First, Table 17 shows whether any entry was reported as achieved or not, broken down across the domains. Reviewer a action(s) only 202 (9) Both reviewer a and patient/carer actions 155 (7) Reviewer advice, signposting or information only 29 (1) No action plan 54 (2) a Includes liaise with health and social care professional, referral to make, referral to follow-up and provide aid.…”

Section: Goal and Action Point Achievementmentioning

confidence: 99%

An extended stroke rehabilitation service for people who have had a stroke: the EXTRAS RCT

Shaw

Bhattarai

Cant

et al. 2020

Health Technol Assess

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Background There is limited evidence about the effectiveness of rehabilitation in meeting the longer-term needs of stroke patients and their carers. Objective To determine the clinical effectiveness and cost-effectiveness of an extended stroke rehabilitation service (EXTRAS). Design A pragmatic, observer-blind, parallel-group, multicentre randomised controlled trial with embedded health economic and process evaluations. Participants were randomised (1 : 1) to receive EXTRAS or usual care. Setting Nineteen NHS study centres. Participants Patients with a new stroke who received early supported discharge and their informal carers. Interventions Five EXTRAS reviews provided by an early supported discharge team member between 1 and 18 months post early supported discharge, usually over the telephone. Reviewers assessed rehabilitation needs, with goal-setting and action-planning. Control treatment was usual care post early supported discharge. Main outcome measures The primary outcome was performance in extended activities of daily living (Nottingham Extended Activities of Daily Living Scale) at 24 months post randomisation. Secondary outcomes at 12 and 24 months included patient mood (Hospital Anxiety and Depression Scale), health status (Oxford Handicap Scale), experience of services and adverse events. For carers, secondary outcomes included carers’ strain (Caregiver Strain Index) and experience of services. Cost-effectiveness was estimated using resource utilisation costs (adaptation of the Client Service Receipt Inventory) and quality-adjusted life-years. Results A total of 573 patients (EXTRAS, n = 285; usual care, n = 288) with 194 carers (EXTRAS, n = 103; usual care, n = 91) were randomised. Mean 24-month Nottingham Extended Activities of Daily Living Scale scores were 40.0 (standard deviation 18.1) for EXTRAS (n = 219) and 37.2 (standard deviation 18.5) for usual care (n = 231), giving an adjusted mean difference of 1.8 (95% confidence interval –0.7 to 4.2). The mean intervention group Hospital Anxiety and Depression Scale scores were not significantly different at 12 and 24 months. The intervention did not improve patient health status or carer strain. EXTRAS patients and carers reported greater satisfaction with some aspects of care. The mean cost of resource utilisation was lower in the intervention group: –£311 (95% confidence interval –£3292 to £2787), with a 68% chance of EXTRAS being cost-saving. EXTRAS was associated with 0.07 (95% confidence interval 0.01 to 0.12) additional quality-adjusted life-years. At current conventional thresholds of willingness to pay for a quality-adjusted life-year, there is a 90% chance that EXTRAS is cost-effective. Conclusions EXTRAS did not improve stroke survivors’ performance in extended activities of daily living but did improve their overall satisfaction with services. Given the impact on costs and quality-adjusted life-years, there is a high chance that EXTRAS could be considered cost-effective. Future work Further research is required to identify whether or not community-based interventions can improve performance of extended activities of daily living, and to understand the improvements in health-related quality of life and costs seen by provision of intermittent longer-term specialist review. Trial registration Current Controlled Trials ISRCTN45203373. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 24. See the NIHR Journals Library website for further project information.

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“…The PN definition was not met in eight studies [21][22][23][24][25][26][27][28][29], and two studies did not present cost-effectiveness results [14,30]. Hence, two studies were included in this review [31,32]. Fig 1 displays the PRISMA flowchart to illustrate the article identification and selection process.…”

Section: Study Selectionmentioning

confidence: 99%

Cost-effectiveness of patient navigation programs for stroke patients–A systematic review

et al. 2021

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Objective Stroke remains a leading cause of premature death, impairment and reduced quality of life. Its aftercare is performed by numerous different health care service providers, resulting in a high need for coordination. Personally delivered patient navigation (PN) is a promising approach for managing pathways through health care systems and for improving patient outcomes. Although PN in stroke care is evolving, no summarized information on its cost-effectiveness in stroke survivors is available. Hence, the aim of this systematic review is to analyze the level of evidence on the cost-effectiveness of PN for stroke survivors. Methods A systematic literature search without time limitations was carried out in PubMed, EMBASE, CENTRAL, CINAHL as well as PsycINFO and supplemented by a manual search. Randomized controlled trials published prior to April 2020 in English or German were considered eligible if any results regarding the cost-effectiveness of PN for stroke survivors were reported. The review was conducted according to PRISMA guidelines. Quality of included studies was assessed with the RoB2 tool. Main study characteristics and cost-effectiveness results were summarized and discussed. Results The search identified 1442 records, and two studies met the inclusion criteria. Quality of included studies was rated moderate and high. Programs, settings and cost-effectiveness results were heterogeneous, with one study showing a 90% probability of being cost-effective at a willingness to pay of $25600 per QALY (health/social care perspective) and the other showing similar QALYs and higher costs. Conclusions Since only two studies were eligible, this review reveals a large gap in knowledge regarding the cost-effectiveness of PN for stroke survivors. Furthermore, no conclusive statement about the cost-effectiveness can be made. Future attempts to evaluate PN for stroke survivors are necessary and should also involve cost-effectiveness issues.

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Evaluation of an Extended Stroke Rehabilitation Service (EXTRAS)

Cited by 24 publications

References 23 publications

Economic Evaluation in Neurological Physiotherapy: A Systematic Review

Economic Evaluation in Neurological Physiotherapy: A Systematic Review

An extended stroke rehabilitation service for people who have had a stroke: the EXTRAS RCT

Cost-effectiveness of patient navigation programs for stroke patients–A systematic review

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