A RANDOMIZED CONTROLLED TRIAL OF REHABILITATION AT HOME AFTER STROKE IN SOUTHWEST STOCKHOLM: OUTCOME AT SIX MONTHS
Lena von Koch, Lotta Wide ́n Holmqvist, Vasilios Kostulas, Javier Almaza ́n and Jesus de Pedro-Cuesta
A 6-month follow-up of a single-blind, randomized, con- trolled trial in Southwest Stockholm was performed in order to evaluate the effect of early supported discharge and continued rehabilitation at home after stroke. Eighty-three stroke patients with moderate neurological impairments, continent, independent in feeding, and mental function within normal limits one week after onset were included in the study. The patients were allocated 1:1 to early supported discharge and continued rehabilitation at home by a specialized team, versus routine rehabilitation. Patient out- comes measured were motor capacity, dysphasia, activities of daily living, social activities, perceived dysfunction, mortality and reported falls. Data on length of stay in hospital; initial and recurrent during 6 months were com- pared. The 6-month follow-up of 78 patients showed no statistically significant differences in patient outcome. The results of multivariate logistic regression analysis suggest a positive effect of home rehabilitation on activities of daily living. At 3–6 months the frequency of significant improve- ments was higher in the intervention group. Death or depen- dency in activities of daily living was 24% in the intervention group compared with 44% in the control group. The mean initial hospitalization was 29 days in routine rehabilitation group versus 14 days in the home rehabilitation group. We conclude that for moderately disabled stroke patients with mental function within normal limits, early supported discharge and continued rehabilitation at home had no less a beneficial effect on patient outcome than routine rehabi- litation, reduced initial hospitalization significantly and had no adverse effects on mortality and number of falls
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