title: Early home-supported discharge for patients with stroke in Portugal: a randomised controlled trial.
abstract: OBJECTIVE
  To evaluate an early home-supported discharge service for stroke patients.
  
  
  METHODS
  We carried out a prospective, randomised, open-label, blinded-endpoint trial (allocation ratio of 1:1) with patients assigned to either an early home-supported discharge service or usual care.
  
  
  METHODS
  The study was undertaken in Aveiro, Portugal, between April 2009 and April 2013.
  
  
  METHODS
  We included stroke patients aged 25-85 years admitted to the stroke unit with an initial Functional Independence Measure of up to 100, who gave informed consent.
  
  
  METHODS
  Patients in the early home-supported discharge group began their rehabilitation intervention in the stroke unit and the early home-supported discharge team worked with them at home for a maximum of one month. Patients in the control group received usual services.
  
  
  METHODS
  The primary outcome measure was the Functional Independence Measure at six months after stroke.
  
  
  RESULTS
  We randomised 190 patients of whom 34 were lost to follow-up. There were no significant differences (p > 0.5) in the average scores of Functional Independence Measure between the early home-supported discharge (69 ±22; mean ±SD) and the control groups (71 ±17) measured at baseline; and between the early home-supported discharge (107 ±20) and the control groups (107 ±25) measured at six months. The number of individuals with a low Functional Independence Measure score (<60) in the early home-supported discharge group compared with the control group was higher at admission (34/95 vs. 26/95) and lower at follow-up (2/74 vs. 5/78).
  
  
  CONCLUSIONS
  It was feasible to implement early home-supported discharge procedures in a Southern European setting, but we have not shown convincing differences in disability at six months.
authors.affiliation: 1 University of Aveiro, Aveiro, Portugal.
authors.forename: Silvina
authors.initials: S
authors.lastname: Santana
authors.affiliation: 2 Hospital Infante D. Pedro Stroke Unit, Aveiro, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Rente
authors.affiliation: 2 Hospital Infante D. Pedro Stroke Unit, Aveiro, Portugal.
authors.forename: Conceição
authors.initials: C
authors.lastname: Neves
authors.affiliation: 1 University of Aveiro, Aveiro, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Redondo
authors.affiliation: 1 University of Aveiro, Aveiro, Portugal.
authors.forename: Nina
authors.initials: N
authors.lastname: Szczygiel
authors.affiliation: 3 University of Southern Denmark, Odense, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Larsen
authors.affiliation: 4 Ringe Neurorehabilitation Unit, University Hospital of Odense, Odense, Denmark.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Jepsen
authors.affiliation: 5 University of Glasgow, Glasgow, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Langhorne
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation / Q000379:methods*
keywords: Functional Independence Measure; Portugal; Stroke; care continuity; clinical effectiveness; early home-supported discharge; home rehabilitation; randomised controlled trial
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