Controlled Trial of a Home-Care Service for Acute Stroke Patients

155

Background and Purpose-Organized acute stroke treatment reduces mortality, functional deficits, and the need of institutionalization after stroke. It is largely unknown whether the effects of treatment are due to early or subacute efforts. The aim of this randomized, controlled study was to test the hypothesis that rehabilitation of stroke patients in the subacute phase in a hospital rehabilitation unit is beneficial in reducing death and dependency and increasing health-related quality of life. Methods-251 patients initially treated in the hospital were randomized to subacute rehabilitation in a hospital rehabilitation unit (nϭ127) or to the health services in the municipality (nϭ124) and were followed up for 7 months. Results-The combined outcome of patients being dead or dependent (Barthel Index score of Ͻ75) was 23% in the hospital group and 38% in the municipality group (Pϭ.01). Seven-month survival rates were 90.6% and 83.9% (Pϭ.11), respectively. Dependency in activities of daily living was 12.6% in the hospital group and 25.0% in the municipality group (Pϭ.07). Patients with a BI score of Ͻ50 before rehabilitation had significantly better outcome in the hospital rehabilitation unit, with fewer patients becoming dependent (Pϭ.005) and patients having higher Scandinavian Stroke Scale (Pϭ.026) and BI scores (Pϭ.005). No significant differences in health-related quality of life were found. Many patients treated in the municipalities (30%) did not receive any organized rehabilitation in this study. Conclusions-Subacute rehabilitation of stroke patients in a hospital-based rehabilitation unit improves outcome. Patients with moderate or severe stroke appear to benefit most. (Stroke. 1998;29:779-784.)

Section: Allocation Of Stroke Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

Outcome of Subacute Stroke Rehabilitation

Rønning

Guldvog

1998

155

“…In a recent trial of home-care services for patients with acute stroke, Wade et al 62 noted functional recovery equal to that of patients who received hospital care. There did not appear to be greater stress on families, despite severe initial disability in 27% of the patients managed at home.…”

Section: Type Of Programmentioning

confidence: 99%

Rehabilitation for stroke: a review.

Dombovy¹,

Sandok²,

Basford³

1986

225

SUMMARY Survivors of stroke are often left with severe mental and physical disabilities, which create a major social and economic burden. Many investigators have attempted to assess the role of rehabilitation in reducing such disability. Few controlled studies provide accurate assessment and documentation of benefit. Because of the presence of multiple variables and inadequate measures of outcome, it is difficult to design studies evaluating the effectiveness of rehabilitation for stroke. It is unclear bow early rehabilitation should begin and what aspects of rehabilitation are important. Intensive rehabilitation is an expensive and limited resource; thus, the ability to identify the subgroup of patients with stroke who are likely to benefit is a critical issue. Although preliminary guidelines for the selection of patients who are appropriate for rehabilitation are given, no uniform criteria reliably differentiate patients who need rehabilitation from those who will recover spontaneously or do poorly. Controlled studies in the practice of rehabilitation for stroke will provide much useful information for patient management.

“…2 In randomized controlled studies, 3,4 specialized rehabilitation units have been shown to achieve faster and better functional outcome than general medical wards. Several authors 5,6 have suggested that there should be more emphasis on home rehabilitation. However, the rationale of this proposal is still unclear.…”

mentioning

confidence: 99%

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

Holmqvist

Koch

Kostulas

et al. 1998

193

130

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.