title: Randomized controlled trial of home rehabilitation for patients with ischemic stroke: impact upon disability and elderly depression.
abstract: BACKGROUND
  Patients with major stroke are often left with disability and may have depression and dementia during the recovery phase. Rehabilitation programmes have been shown to improve short-term physical outcome, but their long-term effectiveness and impact on dementia and depression are uncertain.
  
  
  METHODS
  We performed a 6-month randomized controlled trial of a home rehabilitation programme and compared it with the standard care patients with recent ischemic stroke receive. The intervention group received home-based physical therapy once a month for 6 months, along with educational support, counselling and audiovisual materials. The control group received rehabilitation as prescribed by a physician and educational materials upon discharge from hospital. The primary measurement was a change in Barthel Index. Secondary measurements were the Hospital Anxiety and Depression Scale (HADS) and Thai Mini-Mental State Examination.
  
  
  RESULTS
  Of the 68 screened patients, 60 patients were enrolled. At baseline, there was no significant difference in patient characteristics between the two groups. Over 2 years, the mean Barthel Index and Hospital Anxiety and Depression Scale were significantly improved in the intervention group compared to the control group (Barthel Index mean: from 31.7 ± 5.9 to 97.2 ± 2.8 vs from 33.2 ± 4.8 to 76.4 ± 9.4, P < 0.001; Hospital Anxiety and Depression Scale mean: from 16.1 ± 7.6 to 9.1 ± 0.3 vs 16.4 ± 4.9 to 9.1 ± 0.3, P= 0.003). Depression was strongly associated with being dependent on others. However, the Thai Mini-Mental State Examination in both groups did not significantly differ (Thai Mini-Mental State Examination mean: from 24.4 ± 2.0 to 24.6 vs 23.8 ± 1.9 to 24.1 ± 0.3, P= 0.068). There was no significant interaction between baseline characteristics and treatment outcome.
  
  
  CONCLUSIONS
  At 2 years follow-up, it was evident that a 6-month home rehabilitation programme after ischemic stroke improved functional outcome and reduced incidence of depression, but not dementia.
authors.affiliation: Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.
authors.forename: Pakaratee
authors.initials: P
authors.lastname: Chaiyawat
authors.forename: Kongkiat
authors.initials: K
authors.lastname: Kulkantrakorn
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D003704:Dementia / Q000150:complications / Q000523:psychology*; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology*; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000523:psychology* / Q000706:statistics & numerical data; D015397:Program Evaluation / Q000379:methods / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D013785:Thailand; D016896:Treatment Outcome