Home or Hospital for Stroke Rehabilitation? Results of a Randomized Controlled Trial

Abstract

Background and Purpose-We wished to examine the effectiveness of an early hospital discharge and home-based rehabilitation scheme for patients with acute stroke. Methods-This was a randomized, controlled trial comparing early hospital discharge and home-based rehabilitation with usual inpatient rehabilitation and follow-up care. The trial was carried out in 2 affiliated teaching hospitals in Adelaide, South Australia. Participants were 86 patients with acute stroke (mean age, 75 years) who were admitted to hospital and required rehabilitation. Forty-two patients received early hospital discharge and home-based rehabilitation (median duration, 5 weeks), and 44 patients continued with conventional rehabilitation care after randomization. The primary end point was self-reported general health status (SF-36) at 6 months after randomization. A variety of secondary outcome measures were also assessed. Results-Overall, clinical outcomes for patients did not differ significantly between the groups at 6 months after randomization, but the total duration of hospital stay in the experimental group was significantly reduced (15 versus 30 days; PϽ0.001). Caregivers among the home-based rehabilitation group had significantly lower mental health SF-36 scores (mean difference, 7 points). Conclusions-A policy of early hospital discharge and home-based rehabilitation for patients with stroke can reduce the use of hospital rehabilitation beds without compromising clinical patient outcomes. However, there is a potential risk of poorer mental health on the part of caregivers. The choice of this management strategy may therefore depend on convenience and costs but also on further evaluations of the impact of stroke on caregivers.

A Synthesis of Peer-Reviewed Literature on Team-Coordinated and Delivered Early Supported Discharge After Stroke

“…Holmqvist et al explicitly used an MMSE score of 23 in their inclusion criteria 10 and two others reported average admission scores of 28 and 21, respectively. 6,15 In these three studies, the mean score on admission was 24/30. Similar to BI, the study with the widest dispersion of admission MMSE scores was Rudd et al, 15 in which 1 standard deviation from the mean ranged from 14 to 28.…”

“…In total, eight studies were included for further assessment. 6,[9][10][11][12][13][14][15] A summary of the programs explored in the studies of a team coordinated and delivered ESD program is provided in Table 1. All teams included a physiotherapist (PT) and occupational therapist (OT) and most included access to a speech language pathologist (SLP).…”

Activity limitations of patients with stroke attending out-patient facilities in the Western Cape, South Africa

“…Studies have indicated that an extended pro gramme in the community, provided by a dedicated team could result in patients being discharged earlier from hospital (Anderson et al 2000;Bautz Holter et al 2002;Donnelly et al 2004;Indredavik et al 2000;Mayo et al 2000). This approached was developed as the home setting, is conducive to relearning skills post stroke (Anderson et al 2000;Bautz Holter et al 2002;Donnelly et al 2004;Indredavik et al 2000;Mayo et al 2000). Unfortunately this type of extended ser vices is non existent in under resourced rehabilitation settings such as in the Western Cape.…”

Running a Complementary Stroke Rehabilitation and Aftercare Program: Experiences of Four European Centres

“…Several studies on different models for discharging and follow-up for stroke patients have been performed with varying effect, and there is still no consensus concerning care of stroke patients after discharge (Holmqvist et al, 1998;Anderson et al, 2000;Ytterberg et al,2000). "Early supported discharge'' is one of the settings studied in other countries.…”