title: Usual Clinical Practice for Early Supported Discharge after Stroke with Continued Rehabilitation at Home: An Observational Comparative Study.
abstract: BACKGROUND
  Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke.
  
  
  METHODS
  This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke.
  
  
  RESULTS
  At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs.
  
  
  CONCLUSIONS
  ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.
authors.affiliation: Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Tistad
authors.affiliation: Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden; Division of Neurology, Department of Clinical Neuroscience, Karolinska University Hospital, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: von Koch
mesh_terms: D017028:Caregivers / Q000191:economics; D003710:Demography; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010045:Outpatients; D010351:Patient Discharge / Q000191:economics; D010818:Practice Patterns, Physicians'; D020521:Stroke / Q000191:economics; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome