Effectiveness of home rehabilitation for ischemic stroke

Abstract

The objective of this study was to develop and examine the effectiveness of an individual home rehabilitation program for patients with ischemic stroke. This was a randomized controlled trial in 60 patients with recent middle cerebral artery infarction. After hospital discharge for acute stroke care, they were randomly assigned to receive either a home rehabilitation program for three months (intervention group) or usual care (control group). We collected outcome data over three months after their discharge from the hospital. The Barthel Index (BI), the Modified Rankin Scale (MRS), the health-related quality-of-life index (EQ-5D), the Hospital Anxiety and Depression score (HADs), and the Thai Mental State Examination (TMSE) were used to analyze the outcomes. In the intervention group, all outcomes were significantly better (p<0.05) than in the control group, except in the case of TMSE. A favorable outcome, which was defined as minimal or no disability as measured by BI (score 95–100), was achieved by 93.33% of patients in the intervention group, and 90% had favorable scores (0 or 1) on the MRS. This showed a benefit in reducing disability, with two being the number of patients considered as needed-to-treat (NNT) (95% CI, 1.0–1.2). All dimensions of EQ-5D in the intervention group were significantly better for quality of life and generic health status than in the control group (p=0.001). Depression was found in one patient (3.33%) in the intervention group and in two patients (6.67%) in the control group. Dementia was found in three patients (10%) in the intervention group and in four patients (13.33%) in the control group. We concluded that an early home rehabilitation program for patients with ischemic stroke in the first three-month period provides significantly better outcomes in improving function, reducing disability, increasing quality of life, and reducing depression than a program of usual care does.

First-Year Outcomes after Stroke Rehabilitation: A Multicenter Study in Thailand

“…[6]. The result from rehabilitation affects not only longer survival period but also the quality of life of stroke patients for functional independence [6][7][8].…”

Comparison of Two Post-Stroke Rehabilitation Programs: A Follow-Up Study among Primary versus Specialized Health Care

“…Recent studies [6, 9, 30] have reached the conclusion that early at-home rehabilitation programs after a stroke provided significantly better results in terms of physical function, decreased disability, increased quality of life, and reduced depression, in comparison with other typical care programs. One clinical trial [31] compared the changes in perceived health after 5 years of disease between patients who received rehabilitation at home and those who received conventional rehabilitation.…”

Randomized controlled trial of home rehabilitation for patients with ischemic stroke: impact upon disability and elderly depression

“…With 30 patients in each group, this study had an 80% probability of achieving a statistically significant result at a two‐sided 5% level if the mean differences in the Barthel Index (BI) scores between the groups and the standard deviation were 4.8 and 6.7, respectively 11 …”

“…A novel rehabilitation programme may be required to maximize patients' function to overcome their disabilities, depression and dementia. Several studies have been conducted to examine rehabilitation of stroke patients, but the results have been inconsistent 9–15 …”

“…It is therefore important to not only consider the patient but that individual's social environment as well 16,17 . Our previous study showed that early home rehabilitation in the first three months for patients with ischemic stroke provides a significantly better outcome in improved function, reduced disability, increased quality of life, and reduced depression compared to those who received standard rehabilitation 11 …”