title: Stroke unit care combined with early supported discharge improves 5-year outcome: a randomized controlled trial.
abstract: OBJECTIVE
  Early supported discharge (ESD) seems to be a promising alternative to conventional follow-up care after acute stroke. We have previously shown that stroke unit care combined with ESD has beneficial effects on functional outcome and the use of resources for up to 1 year. The aim of this trial was to evaluate outcome after 5 years.
  
  
  METHODS
  We performed a randomized controlled trial with 320 acute stroke patients allocated to ordinary stroke unit care (160 patients) or stroke unit care with ESD (160 patients). The ESD service consisted of a mobile team that co-coordinated hospital discharge and further rehabilitation during 1 month of follow-up in cooperation with the primary health care. Mortality, residence, and functional outcome including modified Rankin scale were registered after 5 years. All assessments were blinded.
  
  
  RESULTS
  There was no difference between the groups with modified Rankin scale score ≤2 (P=0.213), but there was a trend toward greater improvement in modified Rankin scale score in the ESD group from onset of stroke (38% versus 30%; P=0.106). More patients were dead or institutionalized in the ordinary stroke unit care group (P=0.032); 158 patients were alive, 84 were in ESD, and 74 were in ordinary stroke unit care. Of the 158 patients alive, a greater proportion were living at home in ESD (86%/70%; P=0.019).
  
  
  CONCLUSIONS
  Stroke unit care combined with ESD seems to reduce death and institutional care and to improve patients' chances of living at home 5 years after stroke compared to traditional stroke care. There is a trend toward improved functional outcome in the ESD group.
authors.affiliation: The Stroke Unit, St. Olavs Hospital, Trondheim University Hospital, Medisinsk klinikk, Pb. 3250, 7006 Trondheim, Norway. hild.fjaertoft@stolav.no
authors.forename: Hild
authors.initials: H
authors.lastname: Fjærtoft
authors.forename: Gitta
authors.initials: G
authors.lastname: Rohweder
authors.forename: Bent
authors.initials: B
authors.lastname: Indredavik
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006699:Home Care Services; D006757:Hospital Units; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009664:Norway; D010351:Patient Discharge; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome