title: Changes in perceived health between one and five years after stroke: a randomized controlled trial of early supported discharge with continued rehabilitation at home versus conventional rehabilitation.
abstract: BACKGROUND
  Early supported discharge with continued rehabilitation at home (ESD) for patients with mild to moderate impairments has been compared to conventional rehabilitation in a randomized controlled trial. The aim of this study was to explore changes over time in perceived health status over the five years after stroke onset.
  
  
  METHODS
  Of 83 patients enrolled in a randomized controlled trial of ESD compared to conventional rehabilitation, 50 (home rehabilitation group, n=28, conventional rehabilitation group, n=22) were followed up at one and five years after stroke with regard to perceived health using the Sickness Impact Profile. The Mann Whitney U-test was employed for statistical analysis of differences between the groups at one and five years, and the Wilcoxon sign test for differences within each group between one and five years.
  
  
  RESULTS
  There was no difference in perceived health between the groups at one or five years after stroke with regard to SIP total and the physical and psychosocial dimensions. Perceived health did not change significantly between one and five years in the home rehabilitation group whereas it had deteriorated significantly in the conventional rehabilitation group (p=0.05).
  
  
  CONCLUSIONS
  We conclude that the long term outcome with regard to perceived health status is more favourable after ESD than after conventional rehabilitation. Our results suggest that the environment is a key component to be considered in the rehabilitation process of stroke patients.
authors.affiliation: Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Fack 23 100, 141 83 Huddinge, Sweden. charlotte.ytterberg@ki.se
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ytterberg
authors.forename: Ann-Mari
authors.initials: AM
authors.lastname: Thorsén
authors.forename: Marianne
authors.initials: M
authors.lastname: Liljedahl
authors.forename: Lotta Widén
authors.initials: LW
authors.lastname: Holmqvist
authors.forename: Lena
authors.initials: L
authors.lastname: von Koch
mesh_terms: D000368:Aged; D001294:Attitude to Health; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D020521:Stroke / Q000523:psychology* / Q000628:therapy; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome