A randomized controlled trial of early supported discharge and continued rehabilitation at home after stroke: five-year follow-up of patient outcome.
OBJECTIVE
The optimal organization of rehabilitation services after discharge from a stroke unit has not been determined. This study sought to evaluate the effect of early supported discharge and continued rehabilitation at home (ESD), in terms of patient outcome 5 years after stroke and changes in selected data over time.


METHODS
Eighty-three patients from Southwest Stockholm, mildly or moderately impaired 5 to 7 days after acute stroke, were enrolled in a randomized controlled trial. The core components of the ESD service were initial treatment in a stroke unit and the involvement of an outreach team to deliver and coordinate home-based rehabilitation in partnership with the patient. At the 5-year follow-up, measures used to assess patient outcome included survival, motor capacity, dysphasia, activities of daily living (ADL), social activities, subjective dysfunction, and self-reported falls.


RESULTS
Fifty-four patients (30 in the intervention group and 24 in the control group) were evaluated 5 years after stroke, at which time a significantly larger proportion of patients in the intervention group were independent in extended ADL and active in household activities.


CONCLUSIONS
This ESD service has a beneficial effect on extended ADL 5 years after stroke for mildly to moderately impaired patients.
Thorsén
Ann-Mari
AM
Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
Holmqvist
Lotta Widés
LW
de Pedro-Cuesta
Jesús
J
von Koch
Lena
L
D000203:Activities of Daily Living; D000368:Aged; D001037:Aphasia / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services; D006699:Home Care Services; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D012046:Rehabilitation; D020521:Stroke / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome