Balance and walking after three different models of stroke rehabilitation: early supported discharge in a day unit or at home, and traditional treatment (control).
OBJECTIVE
To compare the effects on balance and walking of three models of stroke rehabilitation: early supported discharge with rehabilitation in a day unit or at home, and traditional uncoordinated treatment (control).


METHODS
Group comparison study within a randomised controlled trial.


METHODS
Hospital stroke unit and primary healthcare.


METHODS



METHODS
a score of 2-26 on National Institutes of Health Stroke Scale, assessed with Postural Assessment Scale for Stroke (PASS), and discharge directly home from the hospital stroke unit.


METHODS
Two intervention groups were given early supported discharge with treatment in either a day unit or the patient's own home. The controls were offered traditional, uncoordinated treatment.


METHODS
Primary: PASS. Secondary: Trunk Impairment Scale-modified Norwegian version; timed Up-and-Go; 5 m timed walk; self-reports on problems with walking, balance, ADL, physical activity, pain and tiredness. The patients were tested before randomisation and 3 months after inclusion.


RESULTS
From a total of 306 randomised patients, 167 were tested with PASS at baseline and discharged directly home. 105 were retested at 3 months: mean age 69 years, 63 men, 27 patients in day unit rehabilitation, 43 in home rehabilitation and 35 in a control group. There were no group differences, either at baseline for demographic and test data or for length of stroke unit stay. At 3 months, there was no group difference in change on PASS (p>0.05). Some secondary measures tended to show better outcome for the intervention groups, that is, trunk control, median (95% CI): day unit, 2 (0.28 to 2.31); home rehabilitation, 4 (1.80 to 3.78); control, 1 (0.56 to 2.53), p=0.044; and for self-report on walking, p=0.021 and ADL, p=0.016.


CONCLUSIONS
There was no difference in change between the groups for postural balance, but the secondary outcomes indicated that improvement of trunk control and walking was better in the intervention groups than in the control group.


BACKGROUND
This study is part of the Early Supported Discharge after Stroke in Bergen, ClinicalTrials.gov (NCT00771771).
Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Norway.
Bente Elisabeth Bassøe
BE
Gjelsvik
Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Norway Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
Håkon
H
Hofstad
Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway.
Tori
T
Smedal
Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
Geir Egil
GE
Eide
Department of Neurology, Haukeland University Hospital, Bergen, Norway Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.
Halvor
H
Næss
Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Norway Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
Jan Sture
JS
Skouen
Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway.
Bente
B
Frisk
Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway.
Silje
S
Daltveit
Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Norway.
Liv Inger
LI
Strand
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003631:Day Care, Medical; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D000066530:Neurological Rehabilitation / Q000379:methods*; D010351:Patient Discharge; D004856:Postural Balance; D016037:Single-Blind Method; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D016138:Walking
REHABILITATION MEDICINE