Published online before print December 23, 2004, doi: 10.1161/01.STR.0000152288.42701.a6
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(Stroke. 2005;36:297.)
© 2005 American Heart Association, Inc.
Original Contributions |
A Randomized Controlled Trial of Early Supported Discharge and Continued Rehabilitation at Home After Stroke
Five-Year Follow-Up of Patient Outcome
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.
Correspondence to Dr Lena von Koch, Karolinska Institutet, Neurotec Department, Division of Neurology, R54, Karolinska University Hospital, Huddinge, S-141 86 Stockholm, Sweden. 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.
Key Words: cerebrovascular accident • home care services • outcome assessment • randomized controlled trials • rehabilitation
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