Prompt hospital discharge with home care improved physical health and community reintegration and reduced initial length of hospital stay after acute stroke
QUESTION: Is a programme of prompt discharge from hospital and home based rehabilitation as effective as usual care (discharge planning and referral for follow up services) for patients with acute stroke?
Randomised (allocation concealed), blinded (outcome assessors), controlled trial with follow up at 3 months.
5 acute care hospitals in Montreal, Quebec, Canada.
114 patients (mean age 70 y, 68% men) who were admitted for acute stroke, had persistent motor deficits after stroke, and had caregivers who were able to provide live in care for 4 weeks after discharge from hospital. Exclusion criteria were need for assistance of >1 person to walk at 28 days after stroke, cognitive impairment, or co-existing conditions that affected ability to function independently (eg, dialysis or paraplegia). Follow up at 3 months was 84%.
58 patients were allocated to early discharge and home based rehabilitation, which comprised prompt discharge from hospital with immediate provision of follow up nursing care, physical therapy, occupational therapy, speech therapy, and dietary consultation services by a multidisciplinary team. Services were provided for 4 weeks. Rehabilitation care was individualised to patient needs and provided at home. All patients received ≥1 nurse home visit; subsequent home visits were arranged as needed and supplemented with telephone monitoring. 56 patients were allocated to usual care for discharge planning and provider referral to follow up services, including physical, occupational, and speech therapy, which were offered through …