From the Unit of Neuroepidemiology and Health Services Research, Division
of Neurology, Karolinska Institute, Huddinge University Hospital (L.W.H., L.
von K., V.K., K.J., J. de P.-C.), the Department of Physical Therapy,
Karolinska Institute (L.W.H., L. von K.), and Departments of Physical Therapy
(M.H.), Occupational Therapy (G.W.), Geriatric Medicine, Huddinge University
Hospital (H.T.), Stockholm, Sweden, and the Department of Applied
Epidemiology, National Centre for Epidemiology, Carlos III Institute of Health
(J.A., J. de P.-C.), Madrid, Spain.
Correspondence to Lotta Widén Holmqvist, Unit of Neuroepidemiology and Health Services Research, Division of Neurology, Karolinska Institute, Huddinge University Hospital, S-141 86 Huddinge, Sweden. E-mail lotwid{at}ki.se
Background and Purpose—This
study describes the methodology, patient outcome, and use of hospital
and rehabilitation services at 3 months of a population-based
randomized controlled trial. The purpose was to evaluate rehabilitation
at home after early supported discharge from the Department of
Neurology, Huddinge Hospital, for moderately disabled stroke patients
in southwest Stockholm.
Methods—The patients were eligible if they were continent,
independent in feeding, had mental function within normal limits, and
had impaired motor function and/or aphasia 1 week after stroke.
Patients were randomized either to early supported discharge with
continuity of rehabilitation at home for 3 to 4 months or to routine
rehabilitation service in a hospital, day care, and/or outpatient care.
The home rehabilitation team consisted of two physical therapists, two
occupational therapists, and one speech therapist; one of the
therapists was assigned as case manager for the patient. The
rehabilitation program at home emphasized a task- and context-oriented
approach. The activities were chosen on the basis of the patient's
personal interests. Spouses were offered education and individual
counseling. A total of 81 patients were followed up for a minimum of 3
months. Patient outcome was assessed by the Frenchay Social Activity
Index, Extended Katz Index, Barthel Index, Lindmark Motor Capacity
Assessment, Nine-Hole Peg Test, walking speed over 10 m, reported
falls, and subjective dysfunction according to the Sickness Impact
Profile. Patient use of hospital and home rehabilitation service and
patient satisfaction with care were studied.
Results—Overall there were no statistical significant
differences in outcome. Multivariate logistic
regression analysis suggested a systematic positive effect for
the home rehabilitation group in social activity, activities of daily
living, motor capacity, manual dexterity, and walking. A considerable
difference in resource use during such a 3-month period was seen. A
52% reduction in hospitalization was observed: from 29 days in the
routine rehabilitation group to 14 days in the home rehabilitation
group. Patient satisfaction was in favor of the latter group.
Conclusions—Early supported discharge with continuity of
home rehabilitation services for the majority of moderately disabled
stroke patients during the first 3-month period after acute stroke is
not less beneficial than routine rehabilitation and can be a
rehabilitation service of choice if follow-up at 6 and 12 months
confirms the suggested effectiveness and considerable reduction in use
of health care.
© 1998 American Heart Association, Inc.
Original Contributions
A Randomized Controlled Trial of Rehabilitation at Home After Stroke in Southwest Stockholm
Key Words: clinical trials • stroke management • stroke outcome • stroke rehabilitation
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