title: Use of healthcare, impact on family caregivers and patient satisfaction of rehabilitation at home after stroke in southwest Stockholm.
abstract: We previously conducted a randomized controlled trial in which early supported discharge from the Department of Neurology at Huddinge Hospital in southwest Stockholm with continuity of rehabilitation at home (n = 41) was compared to routine rehabilitation services (n = 40) for moderately disabled selected stroke patients. No statistical significant differences were found in patient outcome at 3 or 6 months, but a moderately positive effect in the home rehabilitation group was suggested. In the present study we evaluated resource utilization of health and social care, impact on family caregivers during 6 months after acute stroke and patient satisfaction. A 50% reduction in total hospitalization (initial and recurrent) was observed, from 30 days in the routine rehabilitation group to 15 days in the home rehabilitation group (p < 0.001). After discharge, the mean number of home visits in the home rehabilitation group was 12. In total, the routine rehabilitation group had a higher frequency of therapy contacts and daycare in outpatient care. Seventy-eight percent received help from a family caregiver in activities of daily living, yet only 15% had formal home help service. No major differences were found in use of home help service or impact on family caregivers in the form of time devoted to helping the patient or subjective well-being of spouses as per Sickness Impact Profile. Patient satisfaction was in favour of the home rehabilitation group, but a significant difference was only found in active participation in rehabilitation programme planning. In conclusion, early supported discharge with continuity of rehabilitation at home, using goal-directed functional activities based on the patient's personal interests, should be the rehabilitation service of choice for moderately disabled stroke patients fulfilling certain criteria, provided that further evaluation during the first year after stroke reveals no great changes in outcome or resource use. More research into the effectiveness and cost implications of early supported discharge with continuity of rehabilitation at home is needed in other parts of Sweden and in other countries before it can be asserted that the conclusions drawn from this study are applicable elsewhere.
authors.affiliation: Department of Clinical Neuroscience, Occupational Therapy, and Elderly Care Research, Karolinska Institutet, Huddinge University Hospital, Sweden. lotwid@ki.se
authors.forename: L W
authors.initials: LW
authors.lastname: Holmqvist
authors.forename: L
authors.initials: L
authors.lastname: von Koch
authors.forename: J
authors.initials: J
authors.lastname: de Pedro-Cuesta
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D003266:Continuity of Patient Care; D017281:Cost of Illness; D005190:Family; D006699:Home Care Services / Q000706:statistics & numerical data*; D006701:Home Nursing / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D017060:Patient Satisfaction; D018434:Sickness Impact Profile; D000071939:Stroke Rehabilitation; D013548:Sweden