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Evid Based Nurs 12:84 doi:10.1136/ebn.12.3.84
  • Treatment

Hospital and home rehabilitation did not differ for functional competence in activities of daily living

QUESTION

In patients discharged from hospital and referred for rehabilitation, how does home rehabilitation compare with hospital rehabilitation?

METHODS

Design:

randomised controlled trial. ACTRN 12605000638639.

Allocation:

concealed.

Blinding:

blinded (occupational therapist, {data collectors, outcome assessors, and data analysts}*).

Follow-up period:

6 months.

Setting:

patients’ homes or day hospitals in Adelaide, Australia.

Patients:

229 patients (mean age 72 y, 52% women) who were medically stable, ready to be discharged from hospital, and required ⩾12 rehabilitation sessions. Patients were excluded if they lived outside of the health region or were judged by the referring physician to be unsuitable for rehabilitation.

Intervention:

rehabilitation in a day hospital (n = 113) or at home (n = 116). Hospital rehabilitation consisted of 3-hour high-intensity individual or group sessions, 3–5 times/week for 4–6 weeks. Home rehabilitation consisted of 3–5 one-on-one sessions/week. Sessions comprised physiotherapy, occupational therapy, speech therapy, social work, psychology, dietetics, nursing, and access to a rehabilitation medicine doctor.

Outcomes:

included functional competence in activities of daily living (Assessment of Motor and Process Skills [AMPS]) and hospital readmission. The study had 80% power to detect a clinically significant change of 0.5 points on the AMPS logit scale.

Patient follow-up:

95% (intention-to-treat analysis).

MAIN RESULTS

Hospital and home rehabilitation did not differ for change in AMPS scores (table). Hospital rehabilitation increased readmission rates compared with home rehabilitation (table).

CONCLUSIONS

Hospital and home rehabilitation did not differ for functional competence in activities of daily living. Hospital rehabilitation increased risk of readmission compared with home rehabilitation.

*Information provided by author.

ABSTRACTED FROM

Crotty M, Giles LC, Halbert J, et al. Home versus day rehabilitation: a randomised controlled trial. Age Ageing 2008;37:628–33.

Rehabilitation in day hospital v at home in patients discharged from hospital*

Clinical impact ratings: Elderly care 6/7; Family/general practice 5/7; General/internal medicine 6/7; Rehabilitation 6/7

Footnotes

  • Source of funding: South Australian Department of Health.

Commentary

In the study by Crotty et al, patients receiving home rehabilitation performed equally well in terms of functional measures but received fewer sessions and were less likely to be readmitted to hospital. This could be construed as good news as such care is generally assumed to be less expensive, and preventing hospital admission is a major policy goal. However, in an otherwise well-designed study, the authors point to the absence of an economic analysis as a limitation. Obtaining valid measures of costs for care delivered in part by informal carers is difficult.

The authors also point to the availability of medical services in the day-hospital group as a possible cause of increased admissions. With much still to be learnt about the health trajectories of old elderly people (⩾75 y of age), it is difficult to judge the appropriateness of such admissions since another study found that readmissions were entirely warranted on medical grounds.1 Appropriateness of admission is also difficult to establish because primary care and acute care staff do not always agree.2

Counter-intuitively, carers of patients in the day hospital reported higher levels of strain. A qualitative study of hospital-at-home reported strain on some carers imposed by hospital visiting.3 Meeting hospital transport deadlines may potentially have accounted for increased strain among carers in the day hospital group. Since the 2 groups did not differ for outcomes, the challenge lies in the appropriate selection of patients for day hospital or home care. A recent Cochrane review of hospital avoidance suggests that different modalities of care may suit different patient groups.4 The heterogeneity of the sample in the study by Crotty et al may be masking groups for whom day-hospital care is appropriate.

References

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