A Randomized Controlled Trial of Rehabilitation at Home After Stroke in Southwest Stockholm

Abstract

Background and Purpose —This study describes the methodology, patient outcome, and use of hospital and rehabilitation services at 3 months of a population-based randomized controlled trial. The purpose was to evaluate rehabilitation at home after early supported discharge from the Department of Neurology, Huddinge Hospital, for moderately disabled stroke patients in southwest Stockholm. Methods —The patients were eligible if they were continent, independent in feeding, had mental function within normal limits, and had impaired motor function and/or aphasia 1 week after stroke. Patients were randomized either to early supported discharge with continuity of rehabilitation at home for 3 to 4 months or to routine rehabilitation service in a hospital, day care, and/or outpatient care. The home rehabilitation team consisted of two physical therapists, two occupational therapists, and one speech therapist; one of the therapists was assigned as case manager for the patient. The rehabilitation program at home emphasized a task- and context-oriented approach. The activities were chosen on the basis of the patient’s personal interests. Spouses were offered education and individual counseling. A total of 81 patients were followed up for a minimum of 3 months. Patient outcome was assessed by the Frenchay Social Activity Index, Extended Katz Index, Barthel Index, Lindmark Motor Capacity Assessment, Nine-Hole Peg Test, walking speed over 10 m, reported falls, and subjective dysfunction according to the Sickness Impact Profile. Patient use of hospital and home rehabilitation service and patient satisfaction with care were studied. Results —Overall there were no statistical significant differences in outcome. Multivariate logistic regression analysis suggested a systematic positive effect for the home rehabilitation group in social activity, activities of daily living, motor capacity, manual dexterity, and walking. A considerable difference in resource use during such a 3-month period was seen. A 52% reduction in hospitalization was observed: from 29 days in the routine rehabilitation group to 14 days in the home rehabilitation group. Patient satisfaction was in favor of the latter group. Conclusions —Early supported discharge with continuity of home rehabilitation services for the majority of moderately disabled stroke patients during the first 3-month period after acute stroke is not less beneficial than routine rehabilitation and can be a rehabilitation service of choice if follow-up at 6 and 12 months confirms the suggested effectiveness and considerable reduction in use of health care.

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

“…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).…”

“…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.…”

Buying Time for Better Decision-Making: The Impact of Home Based Rehabilitation on Frail Older People

“…In addition, the service appears to improve decision making about the future care needs of older people by helping them to achieve maximum functioning before decisions about heir long-term care are made. Collectively this evaluation and other studies (Audit Commission, 1997;Widen-Holmqvist et al, 1998;Miller et al, 2005) provide a growing evidence base to support this model of rehabilitation as a way of increasing client choice, reducing pressure on care management and, generally improving professional decision making and the quality of services provided to older people.…”

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.…”