Early discharge plus home based rehabilitation reduced length of initial hospital stay but did not improve health related quality of life in patients with acute stroke
QUESTION: Does early discharge plus home based rehabilitation improve health related quality of life in patients with acute stroke?
Randomised (allocation concealed), blinded (outcome assessor) controlled trial with follow up at 6 months.
2 affiliated acute care public teaching hospitals in Adelaide, South Australia.
86 patients (mean age 75 y, 56% men) with a clinical diagnosis of first ever or recurrent stroke (but not subarachnoid haemorrhage) who were medically stable and suitable for early discharge from hospital to community rehabilitation, had sufficient physical and cognitive function, and had a home environment suitable for simple modifications; the patient's general practitioner and the community rehabilitation team had to be available to provide care. Follow up at 6 months was 98%.
42 patients were allocated to early discharge plus home based rehabilitation. Adaptations to the home and arrangements for care were organised so that discharge could occur within 48 hours of randomisation. Individually tailored treatment sessions were conducted in the patient's home. Self learning, adjustment to disability, and structured practice sessions between visits were encouraged. A community rehabilitation team, which included a full time coordinator, a rehabilitation consultant, physiotherapists, occupational therapists, social workers, speech therapists, and rehabilitation nurses, was contracted to provide care and met weekly to discuss the patient's progress. 44 patients were allocated to usual care, with in hospital rehabilitation on an acute care medical/geriatric ward or in a multidisciplinary stroke …