Effect of occupational therapy home visit discharge planning on participation after stroke: protocol for the HOME Rehab trial

Abstract

Introduction After first stroke, the transition from rehabilitation to home can be confronting and fraught with challenges. Although stroke clinical practice guidelines recommend predischarge occupational therapy home visits to ensure safe discharge and provision of appropriate equipment, there is currently limited evidence to support this recommendation. Methods and analysis The HOME Rehab trial is a national, multicentre, phase III randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis being conducted in Australia. The trial aim is to determine the effect and potential cost-effectiveness of an enhanced occupational therapy discharge planning intervention that involves pre and postdischarge home visits, goal setting and occupational therapy in the home (the HOME programme) in comparison to an in-hospital predischarge planning intervention. Stroke survivors aged ≥45 years, admitted to a rehabilitation ward, expected to return to a community (private) dwelling after discharge, with no significant prestroke disability will be randomly allocated 1:1 to receive a standardised discharge planning intervention and the HOME programme or the standardised discharge planning intervention alone. The primary outcome is participation measured using the Nottingham Extended Activities of Daily Living. Secondary outcome areas include hospital readmission, disability, performance of instrumental activities of daily living, health-related quality of life, quality of care transition and carer burden. Resources used/costs will be collected for the cost-effectiveness analysis and hospital readmission. Recruitment commenced in 2019. Allowing for potential attrition, 360 participants will be recruited to detect a clinically important treatment difference with 80% power at a two-tailed significance level of 0.05. Ethics and dissemination This study is approved by the Alfred Health Human Research Ethics Committee and site-specific ethics approval has been obtained at all participating sites. Results of the main trial and the secondary endpoint of cost-effectiveness will be submitted for publication in peer-reviewed journals Trial registration number NCT12618001360202

Differences in Daily Activity Performance Between Inpatient Rehabilitation Facility and Home Among Stroke Survivors

“…Although home visits prior to discharge have been recommended, 30 they are still not standard practice at many IRFs because of lack of time, productivity standards, and limited evidence supporting their effectiveness in improving discharge outcomes. 31 There is currently only low-to-moderate evidence that predischarge home visits improve patient outcomes, [32][33][34] but it is possible that addressing barriers in the environment during home visits could be instrumental in adequately preparing stroke survivors for a successful transition home after stroke and lead to greater independence, fewer falls, and less reliance on caregivers. [35][36][37] However, additional rigorous trials among stroke survivors are needed to examine whether home visits can in fact improve safety, participation, and independence after discharge from an IRF.…”

A retrospective study on return to living alone of stroke patients who were living alone before stroke

“…Recently, it has been reported that not only ADL ability but also social factors such as family structure 1 , 2 , 3 , 4 , 5 , 29 ) , economic issues 30 , 31 , 32 ) , and coordination of social resources such as long-term care insurance services and the community 33 , 34 , 35 ) are involved in the return home of stroke patients. Sawamura et al 17 ) found that the following factors inhibited the return to living alone of stroke patients who had lived alone before the illness: patient’s abilities such as higher brain dysfunction, motor paralysis, and ADL ability; human resources such as family and supporters; financial problems; adjustment of long-term care insurance; difference between the patient’s wishes and reality.…”

The Readiness of Discharge planning in Aspects of Caregiver Involvement among Caring for the Elderly with Stroke

“…Lama pasien stroke yang dirawat juga berbagai macam mulai dari 4 hari, 7 hari sampai 1 bulan. Selain itu, beberapa penelitian memperlihatkan tingginya angka ketergantungan pasien stroke yang dirawat di rumah sakit [7]. Ketergantungan terhadap keluarga juga ditunjukkan oleh pasien stroke dalam menghadapi transisi kehidupan dan perawatannya [8].…”