Effects of a 4-week transitional care programme for discharged stroke survivors in Hong Kong: a randomised controlled trial

Abstract

Stroke rehabilitation involves care issues concerning the physical, psychosocial and spiritual aspects. Hospital-based rehabilitation has its limitations because many of the care issues only emerge when patients return home. Transitional care models supporting patients after discharge from the hospital have proved to be effective among chronically ill patients, but limited studies were conducted among stroke survivors. This study was a randomised controlled trial conducted to test the effectiveness of a transitional care programme (TCP) which was a nurse-led 4-week programme designed based on the assessment-intervention-evaluation Omaha System framework. Between August 2010 and October 2011, 108 stroke patients who were discharged home, able to communicate, and had slight to moderate neurological deficits and disability were randomised into control (n = 54) and intervention groups (n = 54). Data on the patient-related and clinical outcomes were collected at baseline, 4 weeks when the TCP was completed and 8 weeks after discharge from hospital. Repeated measures analysis of variance with intention-to-treat strategy was used to examine the outcomes. There were significant between-group differences in quality of life, the primary outcome measure of this study, in both physical (F(1, 104) = 10.15, P = 0.002) and mental (F(1, 104) = 8.41, P = 0.005) domains, but only the physical domain achieved a significant time × intervention interaction effect (F(1, 103) = 7.73, P = 0.006). The intervention group had better spiritual-religion-personal measures, higher satisfaction, higher Modified Barthel Index scores and lower depression scores when compared with the control group. They also had lower hospital readmission and use of emergency room rates, but only the use of emergency room had significant difference when compared to control. This study is original in testing a transitional model among stroke patients discharged from hospital. The TCP shares common features that have been proved to be effective when applied to chronically ill patients, and the duration of 4 weeks seems to be adequate to bring about immediate effects.

What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis

“…Overall, 13 studies (41.9%) involved an intervention group of more than 100 participants, but only 4 of the 31 studies reported underpinning theories for their interventions [23,24,28,29]. Besides mortality and ADL (measured by BI), more than 30 unique outcome measures were reported at varying time points.…”

“…Eight RCTs described in nine publications compared home-visiting programs with the usual care [14,21,24,25,34,35,36,37]. Two studies compared an early support discharge (ESD) with home-visiting programs to the conventional hospital care [14,19].…”

“…Subgroup analyses were completed by the type of intervention and duration of follow-up. ADL was assessed using the Barthel Index (BI) (which is the most common used to evaluate ADL) in the following three different ways: cutting BI scores at 95 to create a dichotomous variable, so as to report an independence rate (BI scores ≥95 were considered to be independent) [12,16,17,18,19,20,21,22], using BI scores as continuous variables (ranging from 0 to 100) [10,23,24,25,26,27], or using a short version of the Barthel Index with scores ranging from 0 to 20 [28,29,30]. The three ways of assessing ADL were discriminated in the meta-analysis.…”

Use of health services by elderly people post-stroke: a randomized controlled trial

“…A structured program of care transition from hospital to home reduces the length of hospital stay of the elderly and their readmissions, and increases their satisfaction with care (7) . In the international context, studies have explored the effects of care transition programs on the use of health services by dependent or stroke elderly patients (8)(9)(10)(11)(12) .…”

Chinese family caregivers of stroke survivors: Determinants of caregiving burden within the first six months

“…() also reported that 69% of the people who suffer a stroke are in low‐income and middle‐income countries. In Hong Kong, the incidence of stroke among people aged 65 years and older comprised of 14% of the population and 50% of them remained dependent 6 months after the stroke (Lau, Tang, Wong, Mok, & Ungvari, ; Wong & Yeung, ). Korea and Taiwan also reported similar stroke incidences and stroke as the third leading cause of death and the main cause of chronic disability (Lee, Yoo, & Jung, ; Shyu, Kuo, Chen, & Chen, ).…”