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

Abstract

ObjectiveTo investigate the available evidence on early supported discharge (ESD) and transitional care (TC) delivery service in patients with cerebrovascular disease.MethodsA systematic literature search was conducted to collect all available evidence on the use of ESD and TC services. We included cluster-randomized pragmatic trials or randomized controlled trials (RCTs) that recruited patients with stroke or transient ischemic attack to receive either conventional care or any care service intervention that included rehabilitation or support provided by professional medical personnel with the aim of accelerating and supporting home discharge. Relevant data were electronically searched through international databases (Cochrane Library, EMBASE, and PubMed) and incorporated into a summary grid to investigate research outcomes and provide a narrative synthesis. Furthermore, we compared the outcomes in terms of length of hospital stay, patient and caregiver outcomes, and mortality through meta-analysis.ResultsWe identified and included a total of 20 publications of various original randomized studies. There were 18 studies conducted in western countries and 2 in eastern countries. The meta-analysis revealed a tendency that ESD or TC could decrease the length of hospital stay more than the usual care [standardized mean difference (SMD) −0.13; 95% confidence interval (CI) −0.31 to 0.04 days; P = 0.14]. Moreover, there was a tendency that ESD resulted in better activities of daily living (ADL) than usual care (SMD 0.29; 95% CI −0.04 to 0.61; P = 0.08). Patient outcome based on modified Rankin scale (mRS) score (SMD −0.11; 95% CI −0.38 to 0.17; P = 0.45] and mortality (odds ratio 0.80; 95% CI 0.56–1.17; P = 0.25) did not reveal any significant difference. The Caregiver Strain Index revealed no difference.ConclusionWe did not find a large effect size for the use of TC and ESD. When implementing the TC and ESD model from western to Asian countries, services should be prepared and implemented in accordance with national medical rehabilitation pathways for cerebrovascular disease.

A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals’ experiences of early supported discharge (ESD) after stroke

“…This aligns with findings from the Riksstroke registry in Sweden which showed that those with first ever stroke who received ESD (n = 1495) were more satisfied with rehabilitation after discharge, reported less depression and better function compared to controls (n = 28,737) [ 55 ]. Our findings on important improvements reported by people after stroke following ESD such as improved mobility and the ability to resume valued activities also mirrors findings from systematic reviews of the effectiveness of ESD after stroke which have found improvements in participants’ activities of daily living [ADL] scores [ 18 ] and extended activities of daily living scores [ 17 ] in favour of ESD when compared to usual care.…”

“…A Cochrane review of ESD for people after stroke demonstrated a reduction in the length of hospital stay by 6 days [CI -3 to -8 days] and a reduction in long term dependency and admission to long term care [17]. A more recent review also demonstrated improved activities of daily living (ADL) scores for those receiving ESD compared to those receiving usual care [18]. ESD has also been proven to be cost effective [19][20][21].…”

The beneficial effects of transitional care for patients with stroke: A meta‐analysis

“…For instance, in the case of ADL outcomes, neutral findings or small effect sizes can be attributed to a ceiling effect. As underlined by similar studies, most participants started the experiment with an already high level of ADL functioning (Jee et al, 2022;Langhorne & Baylan, 2017). In some studies, transitional care programmes did not sufficiently target patients with stroke-related deficits or potential complications (Sit et al, 2016).…”

“…Previous studies have added to the body of knowledge on the potential benefits of transitional care programmes in improving the motor performance, walking speed, and ADL performance of patients with stroke; however, their findings are inconclusive. Moreover, previous systematic reviews and meta‐analyses have also highlighted transitional care techniques that emphasize continuous rehabilitation through multidisciplinary teams and therapy‐based home rehabilitation, with patients receiving diverse stroke recovery care (Jee et al, 2022; Lin et al, 2020). However, it is unclear how the services should be planned and coordinated, as well as the intensity and duration of rehabilitation based on the outcome needs and preferences of patients and caregivers (Joo & Liu, 2021).…”

“…However, it is unclear how the services should be planned and coordinated, as well as the intensity and duration of rehabilitation based on the outcome needs and preferences of patients and caregivers (Joo & Liu, 2021). Only a few studies have examined the impacts of the frequency and duration of the intervention on physical function (Jee et al, 2022; Lin et al, 2020; Wang et al, 2017).…”