Hild Fjærtoft1, Gitta Rohweder, Bent Indredavik. 1. The Stroke Unit, St. Olavs Hospital, Trondheim University Hospital, Medisinsk klinikk, Pb. 3250, 7006 Trondheim, Norway. hild.fjaertoft@stolav.no
Abstract
BACKGROUND AND PURPOSE: Early supported discharge (ESD) seems to be a promising alternative to conventional follow-up care after acute stroke. We have previously shown that stroke unit care combined with ESD has beneficial effects on functional outcome and the use of resources for up to 1 year. The aim of this trial was to evaluate outcome after 5 years. METHODS: We performed a randomized controlled trial with 320 acute stroke patients allocated to ordinary stroke unit care (160 patients) or stroke unit care with ESD (160 patients). The ESD service consisted of a mobile team that co-coordinated hospital discharge and further rehabilitation during 1 month of follow-up in cooperation with the primary health care. Mortality, residence, and functional outcome including modified Rankin scale were registered after 5 years. All assessments were blinded. RESULTS: There was no difference between the groups with modified Rankin scale score ≤2 (P=0.213), but there was a trend toward greater improvement in modified Rankin scale score in the ESD group from onset of stroke (38% versus 30%; P=0.106). More patients were dead or institutionalized in the ordinary stroke unit care group (P=0.032); 158 patients were alive, 84 were in ESD, and 74 were in ordinary stroke unit care. Of the 158 patients alive, a greater proportion were living at home in ESD (86%/70%; P=0.019). CONCLUSIONS: Stroke unit care combined with ESD seems to reduce death and institutional care and to improve patients' chances of living at home 5 years after stroke compared to traditional stroke care. There is a trend toward improved functional outcome in the ESD group.
RCT Entities:
BACKGROUND AND PURPOSE: Early supported discharge (ESD) seems to be a promising alternative to conventional follow-up care after acute stroke. We have previously shown that stroke unit care combined with ESD has beneficial effects on functional outcome and the use of resources for up to 1 year. The aim of this trial was to evaluate outcome after 5 years. METHODS: We performed a randomized controlled trial with 320 acute strokepatients allocated to ordinary stroke unit care (160 patients) or stroke unit care with ESD (160 patients). The ESD service consisted of a mobile team that co-coordinated hospital discharge and further rehabilitation during 1 month of follow-up in cooperation with the primary health care. Mortality, residence, and functional outcome including modified Rankin scale were registered after 5 years. All assessments were blinded. RESULTS: There was no difference between the groups with modified Rankin scale score ≤2 (P=0.213), but there was a trend toward greater improvement in modified Rankin scale score in the ESD group from onset of stroke (38% versus 30%; P=0.106). More patients were dead or institutionalized in the ordinary stroke unit care group (P=0.032); 158 patients were alive, 84 were in ESD, and 74 were in ordinary stroke unit care. Of the 158 patients alive, a greater proportion were living at home in ESD (86%/70%; P=0.019). CONCLUSIONS:Stroke unit care combined with ESD seems to reduce death and institutional care and to improve patients' chances of living at home 5 years after stroke compared to traditional stroke care. There is a trend toward improved functional outcome in the ESD group.
Authors: Daniela C Gonçalves-Bradley; Steve Iliffe; Helen A Doll; Joanna Broad; John Gladman; Peter Langhorne; Suzanne H Richards; Sasha Shepperd Journal: Cochrane Database Syst Rev Date: 2017-06-26
Authors: Ron Heijnen; Martien Limburg; Silvia Evers; George Beusmans; Trudy van der Weijden; Jos Schols Journal: Int J Integr Care Date: 2012-05-25 Impact factor: 5.120