Randomized controlled trial of rehabilitation at home after stroke: one-year follow-up of patient outcome, resource use and cost.
OBJECTIVE
This study sought to evaluate early supported discharge and continued rehabilitation at home after stroke, at a minimum of 6 months after the intervention, in terms of patient outcome, resource use and health care cost.


METHODS
Eighty-three patients, moderately impaired 5-7 days after acute stroke, were included in a randomized controlled trial, 42 being allocated to the intervention and 41 to routine rehabilitation. One-year follow-up of patient outcome included mortality, motor capacity, dysphasia, activities of daily living, social activities, perceived dysfunction, and self-reported falls. Resource use over 12 months included inpatient hospital care, outpatient health care, use of health-related services, informal care, and cost of health care.


RESULTS
On univariate analysis there was no difference in patient outcome. Multivariate regression analysis showed that intervention had a significant effect on independence in activities of daily living. A significant difference in inpatient hospital care, initial and recurrent, was observed, with a mean of 18 (intervention) versus 33 days (control) (p = 0.002). Further significant differences were that the control group registered more outpatient visits to hospital occupational therapists (p = 0.02), private physical therapists (p = 0.03) and day-hospital attendance (p = <0.001), while the intervention group registered more visits to nurses in primary care (p = 0.03) and home rehabilitation (p = <0.001). Other differences in outcomes or resource utilization were nonsignificant.


CONCLUSIONS
In Sweden, early supported discharge with continued rehabilitation at home proved no less beneficial as a rehabilitation service, and provided care and rehabilitation for 5 moderately disabled stroke patients over 12 months after stroke onset for the cost of 4 in routine rehabilitation.
von Koch
L
L
Unit of Neuroepidemiology and Health Service Research, Division of Neurology, Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institutet, Stockholm, Sweden. lenkoc@ki.se
de Pedro-Cuesta
J
J
Kostulas
V
V
Almazán
J
J
Widén Holmqvist
L
L
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010351:Patient Discharge / Q000191:economics; D020521:Stroke / Q000191:economics*; D000071939:Stroke Rehabilitation; D013997:Time Factors