C D Wolfe1, K Tilling, A G Rudd. 1. Division of Public Health Sciences, Guy's and St Thomas' Hospital, London, UK. charles.wolfe@kcl.ac.uk
Abstract
OBJECTIVE: To assess the effectiveness of community-based rehabilitation for stroke patients who were not admitted to hospital in South London. DESIGN: Randomized controlled trial. SETTING:Patients' homes in South London. SUBJECTS:Stroke patients not admitted to hospital after a stroke. INTERVENTION: Rehabilitation at home by rehabilitation team for up to three months or usual care. MAIN OUTCOME MEASURES: The primary outcome measure was the Barthel score. Secondary measures included the Motricity Index, Rivermead ADL, Hospital Anxiety and Depression score and Nottingham Health Profile. RESULTS:Forty-three patients who remained at home were randomized to rehabilitation team (23) or 'usual' care (20). The mean number of physiotherapy sessions was three (range 1-14) for the rehabilitation team group and two for the usual care group. Patients (with a deficit) in the rehabilitation arm of the trial were more likely to receive occupational, physical and speech therapy than those in the control arm (p = 0.03, 0.01 and 0.008, respectively). For those patients actually receiving therapy, there was no evidence that the amount received differed between the groups. However, the number of patients in each of these comparisons was very small. The outcome for patients in the rehabilitation team arm of the trial was nonsignificantly higher (0.05 < p < 0.2) than for those in the control arm for the areas of Nottingham Health Profile, anxiety, depression, caregiver strain and the proportion of patients living at home. Based on the data observed here, a trial with approximately 150 patients in each arm would be needed to have adequate power to detect a 33% difference between intervention and control groups in these outcomes. CONCLUSION: Community therapy support for patients not admitted to hospital is feasible but to determine whether it is cost- or clinically effective would require trials of adequate size.
RCT Entities:
OBJECTIVE: To assess the effectiveness of community-based rehabilitation for strokepatients who were not admitted to hospital in South London. DESIGN: Randomized controlled trial. SETTING:Patients' homes in South London. SUBJECTS:Strokepatients not admitted to hospital after a stroke. INTERVENTION: Rehabilitation at home by rehabilitation team for up to three months or usual care. MAIN OUTCOME MEASURES: The primary outcome measure was the Barthel score. Secondary measures included the Motricity Index, Rivermead ADL, Hospital Anxiety and Depression score and Nottingham Health Profile. RESULTS: Forty-three patients who remained at home were randomized to rehabilitation team (23) or 'usual' care (20). The mean number of physiotherapy sessions was three (range 1-14) for the rehabilitation team group and two for the usual care group. Patients (with a deficit) in the rehabilitation arm of the trial were more likely to receive occupational, physical and speech therapy than those in the control arm (p = 0.03, 0.01 and 0.008, respectively). For those patients actually receiving therapy, there was no evidence that the amount received differed between the groups. However, the number of patients in each of these comparisons was very small. The outcome for patients in the rehabilitation team arm of the trial was nonsignificantly higher (0.05 < p < 0.2) than for those in the control arm for the areas of Nottingham Health Profile, anxiety, depression, caregiver strain and the proportion of patients living at home. Based on the data observed here, a trial with approximately 150 patients in each arm would be needed to have adequate power to detect a 33% difference between intervention and control groups in these outcomes. CONCLUSION: Community therapy support for patients not admitted to hospital is feasible but to determine whether it is cost- or clinically effective would require trials of adequate size.
Authors: Sasha Shepperd; Steve Iliffe; Helen A Doll; Mike J Clarke; Lalit Kalra; Andrew D Wilson; Daniela C Gonçalves-Bradley Journal: Cochrane Database Syst Rev Date: 2016-09-01
Authors: David H Saunders; Mark Sanderson; Sara Hayes; Maeve Kilrane; Carolyn A Greig; Miriam Brazzelli; Gillian E Mead Journal: Cochrane Database Syst Rev Date: 2016-03-24
Authors: Cecilie Røe; Erik Bautz-Holter; Nada Andelic; Helene Lundgaard Søberg; Boya Nugraha; Christoph Gutenbrunner; Andrea Boekel; Marit Kirkevold; Grace Engen; Juan Lu Journal: Arch Rehabil Res Clin Transl Date: 2022-04-13
Authors: Sasha Shepperd; Helen Doll; Robert M Angus; Mike J Clarke; Steve Iliffe; Lalit Kalra; Nicoletta Aimonio Ricauda; Vittoria Tibaldi; Andrew D Wilson Journal: CMAJ Date: 2009-01-20 Impact factor: 8.262
Authors: Sasha Shepperd; Helen Doll; Robert M Angus; Mike J Clarke; Steve Iliffe; Lalit Kalra; Nicoletta Aimonino Ricauda; Andrew D Wilson Journal: Cochrane Database Syst Rev Date: 2008-10-08