Effectiveness of home rehabilitation program for ischemic stroke upon disability and quality of life: a randomized controlled trial.
BACKGROUND
To develop and examine the effectiveness of individual 6-month home rehabilitation program in ischemic stroke patients upon disability and quality of life at 2 years.


METHODS
This is a prospective randomized controlled trial (RCT) in 60 patients with recent ischemic stroke. They were randomly assigned to receive either home rehabilitation program once a month for 6 months with audiovisual materials (intervention group) or usual care (control group). We collected outcome data after discharge from the hospital until 2 years. The Barthel index (BI), the modified Rankin Scale (mRS) and utility index (EQ-5D) were measured for function, disability and quality of life respectively.


RESULTS
At 2 years, the BI was significantly improved in the intervention group more than the control group: 97.2±2.8 vs. 76.4±9.4, p<0.001. The good outcome, defined as BI 95-100, or mRS 0 or 1. For BI, there were 29 patients (96.7%) in intervention group vs 12 patients (42.9%) in usual care group (95% CI, 42.0, 85.0, p=0.03). For mRS, there were 28 patients (93.3%) in intervention group vs 9 patients (32.1%) in usual care group (95% CI, 38.2, 87.0, p=0.02). Number needed to treat for good outcome in mRS was 2.0 (95% CI: 1.0, 1.3). The mean (SD) of utility index in intervention group and control group were 0.9±0.02 and 0.7±0.04 respectively (p=0.03). There was no significant interaction in baseline characteristics and treatment outcome.


CONCLUSIONS
Early home rehabilitation program in the first 6 months period after ischemic stroke leads to more rapid improvement in function, reducing disability and increase quality of life than usual care.
Faculty of Physical Therapy, Mahidol University, Nakhon Pathom 73170, Thailand.
Pakaratee
P
Chaiyawat
Kongkiat
K
Kulkantrakorn
D000203:Activities of Daily Living; D000368:Aged; D002545:Brain Ischemia / Q000523:psychology / Q000534:rehabilitation*; D003704:Dementia / Q000150:complications / Q000523:psychology; D003863:Depression / Q000209:etiology / Q000523:psychology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000523:psychology / Q000534:rehabilitation; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D018401:Sample Size; D020521:Stroke / Q000523:psychology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome