title: Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial.
abstract: OBJECTIVE
  To evaluate if home-based rehabilitation of inpatients improved outcome compared to standard care.
  
  
  METHODS
  Interventional, randomised, safety/efficacy open-label trial.
  
  
  METHODS
  University hospital stroke unit in collaboration with three municipalities.
  
  
  METHODS
  Seventy-one eligible stroke patients (41 women) with focal neurological deficits hospitalised in a stroke unit for more than three days and in need of rehabilitation.
  
  
  METHODS
  Thirty-eight patients were randomised to home-based rehabilitation during hospitalization and for up to four weeks after discharge to replace part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients.
  
  
  METHODS
  Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome measures were the modified Barthel-100 Index, Motor Assessment Scale, CT-50 Cognitive Test, EuroQol-5D, Body Mass Index and treatment-associated economy.
  
  
  RESULTS
  Thirty-one intervention and 30 control patients completed the study. Patients in the intervention group achieved better modified Rankin Scale score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2-4; P=0.04). EuroQol-5D quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66-0.79; Control median = 0.66, IQR = 0.56 - 0.72; P=0.03). The total amount of home-based training in minutes highly correlated with mRS, Barthel, Motor Assessment Scale and EuroQol-5D™ scores (P-values ranging from P<0.00001 to P=0.01). Economical estimations of intervention costs were lower than total costs of standard treatment.
  
  
  CONCLUSIONS
  Early home-based rehabilitation reduced disability and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective.
authors.affiliation: Department of Neurology N108, Copenhagen University Hospital Herlev, Herlev, Denmark RSR@sund.ku.dk.
authors.forename: Rune Skovgaard
authors.initials: RS
authors.lastname: Rasmussen
authors.affiliation: Medical Department C, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Ann
authors.initials: A
authors.lastname: Østergaard
authors.affiliation: Medical Department C, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Pia
authors.initials: P
authors.lastname: Kjær
authors.affiliation: Medical Department C, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Skerris
authors.affiliation: Medical Department C, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Christina
authors.initials: C
authors.lastname: Skou
authors.affiliation: Medical Department C, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Jane
authors.initials: J
authors.lastname: Christoffersen
authors.affiliation: Medical Department C, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Line Skou
authors.initials: LS
authors.lastname: Seest
authors.affiliation: Department of Neurology N108, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Mai Bang
authors.initials: MB
authors.lastname: Poulsen
authors.affiliation: Medical Department O, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Finn
authors.initials: F
authors.lastname: Rønholt
authors.affiliation: Department of Neurology N108, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Karsten
authors.initials: K
authors.lastname: Overgaard
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D011788:Quality of Life; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome
keywords: Stroke; domiciliary rehabilitation; quality of life