Abstract TP313: Early Supported Discharge after Stroke in Bergen, Norway: No Significant Difference from In-Patient Treatment, but Home Rehabilitation may be Better
Background: Both incidence and prevalence of stroke will increase in the coming decades, due to demographic changes with a more aged population and increased stroke survival. An optimized rehabilitation outcome is therefore essential from both the individual and societal point of view. Early discharge from hospital is cost-effective. In Early Supported Discharge (ESD) stroke patients are discharged home as soon as possible, but with support from a multidisciplinary team and rehabilitative treatment in the community. Studies conducted 10-15 years ago indicate that this is equal to or better than traditional in-hospital treatment, but the essential components are mostly unclarified.
Methods: We conducted an RCT with 306 acute stroke patients randomized into one of two different ESD arms or a control arm. The ESD arms differed in the location for the rehabilitative treatment after discharge: either in a day unit or in the patients’ homes. The control patients were treated according to ordinary procedures. The main outcome was modified Rankin Scale (mRS), in addition to several secondary outcomes. Patient data were collected at 0, 3 and 6 months after stroke and analysed using regression statistics.
Results: Baseline characteristics were not different between the groups. 55.2 % of the patients were male and 44.8 % female, with a mean age of 69.8 years (males) and 75.5 years (females). On follow-up all the groups performed well with mean mRS of 2.36/2.32 (3/6 months), mean Barthel Index of 86.7/87.5, and mean NIHSS of 3.05/2.55. There were only minor differences between the groups, but the home treatment-group did a little better at both time points. Detailed results will be presented at the conference.
Interpretation: Although differences between groups did not reach statistical significance, ESD performed at least as well as ordinary treatment and best with the home rehabilitation group. This demonstrates that early discharge is safe in the present context. Most previous studies were conducted 1-2 decades ago when thrombolysis had not been introduced and prophylactic treatment was less developed than today, and this may partly explain the more uniformly good results now.
- © 2012 by American Heart Association, Inc.