| Sumario: | QUESTION: Does early discharge plus home based rehabilitation improve health related quality of life in patients with acute stroke? Design: Randomised (allocation concealed), blinded (outcome assessor) controlled trial with follow up at 6 months. Setting: 2 affiliated acute care public teaching hospitals in Adelaide, South Australia. Patients: 86 patients (mean age 75 y, 56% men) with a clinical diagnosis of first ever or recurrent stroke (but not subarachnoid haemorrhage) who were medically stable and suitable for early discharge from hospital to community rehabilitation, had sufficient physical and cognitive function, and had a home environment suitable for simple modifications; the patient's general practitioner and the community rehabilitation team had to be available to provide care. Follow up at 6 months was 98%. Intervention: 42 patients were allocated to early discharge plus home based rehabilitation. Adaptations to the home and arrangements for care were organised so that discharge could occur within 48 hours of randomisation. Individually tailored treatment sessions were conducted in the patient's home. Self learning, adjustment to disability, and structured practice sessions between visits were encouraged. A community rehabilitation team, which included a full time coordinator, a rehabilitation consultant, physiotherapists, occupational therapists, social workers, speech therapists, and rehabilitation nurses, was contracted to provide care and met weekly to discuss the patient's progress. 44 patients were allocated to usual care, with in hospital rehabilitation on an acute care medical/geriatric ward or in a multidisciplinary stroke rehabilitation unit, discharge planning, and outpatient or community based follow up. Main outcome measures: Main outcome was health related quality of life, assessed by the self report, Medical Outcomes Study Short Form questionnaire (SF-36). Secondary outcomes included general health, physical function, social activities, family dynamics, mental state, hospital readmissions, use of community services, falls, place of residence, and patient satisfaction. Main results: Analysis was by intention to treat At 6 months, the groups did not differ for health related quality of life, general health, physical function, social activities, family dynamics, emotional state, hospital readmissions, use of community services, falls, admissions to residential care, or patient satisfaction. The early discharge group had a shorter length of hospital stay after randomisation than the usual care group (median 2 v 11.5 d, p < 0.001) and a shorter total time in hospital at initial admission (median 15 v 30 d, p < 0.001). Conclusion: A programme of early discharge and home based rehabilitation reduced length of initial hospital stay among patients with acute stroke, but did not improve (or worsen) health related quality of life or general health outcomes. [Original article accession number: 2000047059 (clinical trial, research, tables/charts)]
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