on December 23, 2004
Published online before print December 23, 2004, doi: 10.1161/01.STR.0000152288.42701.a6
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Submitted on June 22, 2004
From the Division of Physiotherapy (A.-M.T., L.W.H., L.v.K.) and the Unit of Neuroepidemiology and Health Services Research (A.-M.T., L.W.H., J.d.P.-C., L.v.K.), Division of Neurology, Neurotec Department, Karolinska Institutet, Stockholm, Sweden; and the National Center for Epidemiology (J.d.P.-C.), Carlos III Institute of Health, Madrid, Spain. * To whom correspondence should be addressed. E-mail: Lena.von.Koch{at}neurotec.ki.se.
Background and Purpose--The optimal organization of rehabilitation services after discharge from a stroke unit has not been determined. This study sought to evaluate the effect of early supported discharge and continued rehabilitation at home (ESD), in terms of patient outcome 5 years after stroke and changes in selected data over time. Methods--Eighty-three patients from Southwest Stockholm, mildly or moderately impaired 5 to 7 days after acute stroke, were enrolled in a randomized controlled trial. The core components of the ESD service were initial treatment in a stroke unit and the involvement of an outreach team to deliver and coordinate home-based rehabilitation in partnership with the patient. At the 5-year follow-up, measures used to assess patient outcome included survival, motor capacity, dysphasia, activities of daily living (ADL), social activities, subjective dysfunction, and self-reported falls. Results--Fifty-four patients (30 in the intervention group and 24 in the control group) were evaluated 5 years after stroke, at which time a significantly larger proportion of patients in the intervention group were independent in extended ADL and active in household activities. Conclusions--This ESD service has a beneficial effect on extended ADL 5 years after stroke for mildly to moderately impaired patients.
Revised on October 20, 2004
Accepted on November 3, 2004
A Randomized Controlled Trial of Early Supported Discharge and Continued Rehabilitation at Home After Stroke. Five-Year Follow-Up of Patient Outcome
Ann-Mari Thorsén RPT, BSc;
Key words: cerebrovascular accident • home care services • outcome assessment • randomized controlled trials • rehabilitation
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