Occupational therapy predischarge home visits for patients with a stroke (HOVIS): results of a feasibility randomized controlled trial

Abstract

Objective: To assess the feasibility of conducting a randomized controlled trial of occupational therapy predischarge home visits for people after stroke. Design: Randomized controlled trial and cohort study. We randomized eligible patients for whom there was clinical uncertainty about the need to conduct a home visit to a randomized controlled trial; patients for whom a visit was judged 'essential' were enrolled into a cohort study. Setting: Stroke rehabilitation unit of teaching hospital. Participants: One hundred and twenty-six participants hospitalized following recent stroke. Interventions: Predischarge home visit or structured, hospital-based interview. Main outcome measures:The primary objective was to collect information on the feasibility of a randomized controlled trial, including eligibility, control intervention and outcome assessments. The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale at one month after discharge from hospital. Secondary outcomes included mood, quality of life and costs at one week and one month following discharge. Results: Ninety-three people were allocated to the randomized controlled trial; 47 were randomized to intervention and 46 to control. Thirty-three were enrolled into the cohort study. More people were allocated to the randomized controlled trial as the study progressed. One hundred and thirteen people (90%) received the proposed intervention, although there was a need for stricter protocol adherence. Follow-up was good: at one month 114 (90%) were assessed. There were no significant differences Clinical Rehabilitation 27(5) between the groups in the randomized controlled trial for the primary outcome measure at one month. The average cost of a home visit was £208. Conclusion: A trial is feasible and warranted given the resource implications of predischarge occupational therapy home visits.

An Introduction to Economic Evaluation in Occupational Therapy: Cost-Effectiveness of Pre-Discharge Home Visits after Stroke (HOVIS)

“…A feasibility randomised controlled trial of occupational therapy pre-discharge home visits for patients with a stroke was completed, and has been reported elsewhere (Drummond et al, 2013). Approval was given by the Research Ethics Committee (Berkshire Research Ethics Committee ref 10/H0505/41).…”

“…Data were included in the analyses up to the point of withdrawal. Drummond et al (2013) primarily describe the feasibility of the trial, but also report various outcome measures and intervention costs. The treatment group received a pre-discharge home assessment visit with an occupational therapist.…”

“…It is important to note that hospital-based interviews are not currently standard practice, and that current practice varies (Drummond et al, 2012). However, the use of this control intervention was necessary to ensure acceptability of the trial (Drummond et al, 2013). The trial also included a non-randomised cohort group, for whom clinicians believed a home visit was essential.…”

“…Economic evaluations can be carried out alongside randomised controlled trials or can combine existing information from a number of sources to provide estimates. The Home Visits after Stroke (HOVIS) study (Drummond et al, 2013) comprised a feasibility randomised controlled trial and a cohort study, and included an economic evaluation estimating the cost-effectiveness of home visits compared with a hospital-based interview. This paper reports on the HOVIS economic evaluation.…”

Who should have a pre-discharge home assessment visit after a stroke? A qualitative study of occupational therapists' views

“…This study was part of The Home Visit after Stroke (HOVIS) study, in which qualitative methods were used concurrently to underpin a feasibility randomised controlled trial (RCT) which has been reported in detail elsewhere (Drummond et al, 2013). In combining qualitative approaches with the feasibility trial the objective was to identify factors which could affect the uptake of the RCT findings into clinical practice.…”