Stroke unit care combined with early supported discharge: long-term follow-up of a randomized controlled trial.
OBJECTIVE
Early supported discharge from a stroke unit reduces the length of hospital stay. Evidence of a benefit for the patients is still unknown. The aim of this trial was to evaluate the long-term effects of an extended stroke unit service (ESUS), characterized by early supported discharge. The short-term effects were published previously.


METHODS
We performed a randomized controlled trial in which 320 acute stroke patients were allocated to either ordinary stroke unit service (OSUS) (160 patients) or stroke unit care with early supported discharge (160 patients). The ESUS consists of a mobile team that coordinates early supported discharge and further rehabilitation. Primary outcome was the proportion of patients who were independent as assessed by modified Rankin Scale (RS) (RS < or =2=global independence). Secondary outcomes measured at 52 weeks were performance on the Barthel Index (BI) (BI > or =95=independent in activities of daily living), differences in final residence, and analyses to identify patients who benefited most from an early supported discharge service. All assessments were blinded.


RESULTS
We found that 56.3% of the patients in the ESUS versus 45.0% in the OSUS were independent (RS < or =2) (P=0.045). The number needed to treat to achieve 1 independent patient in ESUS versus OSUS was 9. The odds ratio for independence was 1.56 (95% CI, 1.01 to 2.44). There were no significant differences in BI score and final residence. Patients with moderate to severe stroke benefited most from the ESUS.


CONCLUSIONS
Stroke service based on treatment in a stroke unit combined with early supported discharge appears to improve the long-term clinical outcome compared with ordinary stroke unit care. Patients with moderate to severe stroke benefit most.
Fjaertoft
Hild
H
Department of Neuroscience and Motion, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. hild.fjartoft@medisin.ntnu.no
Indredavik
Bent
B
Lydersen
Stian
S
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D009664:Norway; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010351:Patient Discharge; D011383:Progressive Patient Care; D012720:Severity of Illness Index; D012944:Social Support; D000071939:Stroke Rehabilitation; D013995:Time