Value and efficacy of early supported discharge from stroke units.

OBJECTIVES: The goal of early supported discharge (ESD) is to reduce the duration of in-patient care in stroke units (SUs) and to optimize the management of pre- and post-discharge rehabilitation. Here, we report on and discuss ESD's effects on various outcome parameters in stroke patients.
METHODS: Analysis of randomized, controlled studies and meta-analyses identified in the Medline and Cochrane databases.
RESULTS: ESD interventions have been evaluated in more than 10 studies. Most of the included patients had suffered from mild or moderate strokes. Meta-analyses have shown that when compared with standard care, ESD has a positive effect on the risk of death or institutionalisation, death or dependence and participation in instrumental activities of daily living (iADL). In-patient hospitalization in the SU and the overall cost of care were significantly lower. Individual studies showed variability in the inclusion criteria, type of care, comparisons performed and conclusions drawn. ESD's superiority in terms of the risk of death or dependency was mainly reported in a Norwegian study and that in terms of iADL was reported in a Swedish study. There was no specific effect on functional impairment and personal ADL (pADL). DISCUSSION: This technique reduces the length of the in-patient stay and the overall cost of care while lowering the risk of death or institutionalisation and promoting participation in iADL. However, studies on this topic are heterogeneous.