Rebecca J Fisher1, Christine S Cobley2, Iskra Potgieter3, Amy Moody3, Fiona Nouri4, Catherine Gaynor5, Adrian Byrne6, Marion F Walker3. 1. School of Medicine, University of Nottingham, UK rebecca.fisher@nottingham.ac.uk. 2. Clinical Psychology Unit, University of Sheffield, UK. 3. School of Medicine, University of Nottingham, UK. 4. School of Health Sciences, University of Nottingham, UK. 5. Nottingham University Hospitals NHS Trust, UK. 6. School of Social Sciences, University of Manchester, UK.
Abstract
OBJECTIVE: Randomised controlled trials have shown the benefits of Early Supported Discharge (ESD) of stroke survivors. Our aim was to evaluate whether ESD is still beneficial when operating in the complex context of frontline healthcare provision. DESIGN: We conducted a cohort study with quasi experimental design. A total of 293 stroke survivors (transfer independently or with assistance of one, identified rehabilitation goals) within two naturally formed groups were recruited from two acute stroke units: 'ESD' n=135 and 'Non ESD' n=158 and 84 caregivers. The 'ESD' group accessed either of two ESD services operating in Nottinghamshire, UK. The 'Non ESD' group experienced standard practices for discharge and onward referral. Outcome measures (primary: Barthel Index) were administered at baseline, 6 weeks, 6 months and 12 months. RESULTS: The ESD group had a significantly shorter length of hospital stay (P=0.029) and reported significantly higher levels of satisfaction with services received (P<0.001). Following adjustment for age differences at baseline, participants in the ESD group (n=71) had significantly higher odds (compared to the Non ESD group, n=85) of being in the ⩾90 Barthel Index category at 6 weeks (OR = 1.557, 95% CI 2.579 to 8.733), 6 months (OR = 1.541, 95% CI 2.617 to 8.340) and 12 months (OR 0.837, 95% CI 1.306 to 4.087) respectively in relation to baseline. Carers of patients accessing ESD services showed significant improvement in mental health scores (P<0.01). CONCLUSION: The health benefits of ESD are still evident when evidence based models of these services are implemented in practice.
OBJECTIVE: Randomised controlled trials have shown the benefits of Early Supported Discharge (ESD) of stroke survivors. Our aim was to evaluate whether ESD is still beneficial when operating in the complex context of frontline healthcare provision. DESIGN: We conducted a cohort study with quasi experimental design. A total of 293 stroke survivors (transfer independently or with assistance of one, identified rehabilitation goals) within two naturally formed groups were recruited from two acute stroke units: 'ESD' n=135 and 'Non ESD' n=158 and 84 caregivers. The 'ESD' group accessed either of two ESD services operating in Nottinghamshire, UK. The 'Non ESD' group experienced standard practices for discharge and onward referral. Outcome measures (primary: Barthel Index) were administered at baseline, 6 weeks, 6 months and 12 months. RESULTS: The ESD group had a significantly shorter length of hospital stay (P=0.029) and reported significantly higher levels of satisfaction with services received (P<0.001). Following adjustment for age differences at baseline, participants in the ESD group (n=71) had significantly higher odds (compared to the Non ESD group, n=85) of being in the ⩾90 Barthel Index category at 6 weeks (OR = 1.557, 95% CI 2.579 to 8.733), 6 months (OR = 1.541, 95% CI 2.617 to 8.340) and 12 months (OR 0.837, 95% CI 1.306 to 4.087) respectively in relation to baseline. Carers of patients accessing ESD services showed significant improvement in mental health scores (P<0.01). CONCLUSION: The health benefits of ESD are still evident when evidence based models of these services are implemented in practice.
Authors: Lena Rafsten; Anna Danielsson; Asa Nordin; Ann Björkdahl; Asa Lundgren-Nilsson; Maria E H Larsson; Katharina S Sunnerhagen Journal: BMC Neurol Date: 2019-11-09 Impact factor: 2.474
Authors: Rebecca J Fisher; Adrian Byrne; Niki Chouliara; Sarah Lewis; Lizz Paley; Alex Hoffman; Anthony Rudd; Thompson Robinson; Peter Langhorne; Marion Walker Journal: BMJ Open Date: 2021-01-20 Impact factor: 2.692
Authors: Rebecca J Fisher; Adrian Byrne; Niki Chouliara; Sarah Lewis; Lizz Paley; Alex Hoffman; Anthony Rudd; Thompson Robinson; Peter Langhorne; Marion F Walker Journal: Circ Cardiovasc Qual Outcomes Date: 2020-07-17
Authors: S Broussy; F Rouanet; E Lesaine; S Domecq; M Kret; M Maugeais; F Aly; P Dehail; A Bénard; J Wittwer; R Salamon; I Sibon; F Saillour-Glenisson Journal: BMC Health Serv Res Date: 2019-10-29 Impact factor: 2.655