There’s No Place Like Home: An Evaluation of Early Supported Discharge for Stroke
Abstract
Background and Purpose—Because stroke management is aimed at facilitating community reintegration, it would be logical that the sooner the patient can be discharged home, the sooner reintegration can commence. The purpose of this study was to determine the effectiveness of prompt discharge combined with home rehabilitation on function, community reintegration, and health-related quality of life during the first 3 months after stroke. Methods—A randomized trial was carried out involving patients who required rehabilitation services and who had a caregiver at home. When medically ready for discharge, persons with stroke were randomized to either the home intervention group (n=58) or the usual care group (n=56). The home group received a 4-week, tailor-made home program of rehabilitation and nursing services; persons randomized to the usual care group received services provided through a variety of mechanisms, depending on institutional, care provider, and personal preference. The main outcome measure was the Physical Health component of the Measuring Outcomes Study Short-Form-36 (SF-36). Associated outcomes measures included the Timed Up & Go (TUG), Barthel Index (BI), the Older Americans Resource Scale for instrumental activities of daily living (OARS-IADL), Reintegration to Normal Living (RNL), and the SF-36 Mental Health component. Results—The total length of stay for the home group was, on average, 10 days, 6 days shorter than that for the usual care group. There were no differences between the 2 groups on the BI or on the TUG at either 1 or 3 months after stroke; however, there was a significantly beneficial impact of the home intervention on IADL and reintegration (RNL). By 3 months after stroke, the home intervention group showed a significantly higher score on the SF-36 Physical Health component than the usual care group. The total number of services received by the home group was actually lower than that received by the usual care group. Conclusions—Prompt discharge combined with home rehabilitation appeared to translate motor and functional gains that occur through natural recovery and rehabilitation into a greater degree of higher-level function and satisfaction with community reintegration, and these in turn were translated into a better physical health.
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Literature addressing OT interventions for stroke survivors going home on discharge shows that most are effective in terms of patients' functional recovery and caregivers' improvements in self-efficacy and fatigue reduction, but heterogeneity of the interventions precludes drawing specific conclusions.
“Overall, literature addressing OT interventions for stroke survivors going home on discharge shows that, although most of them are effective in terms of patients’ functional recovery, as well as caregivers’ improvements in self-efficacy and fatigue reduction, the heterogeneity of the interventions precludes to draw specific conclusions [11–13].”
From Early Occupational Therapy Intervention post-stroke (EOTIPS): A randomized controlled trial (2024) · cites this paper as [11]
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References 31 · Cited by 395
Research works printed but not linked: 2
- Paveza GJ, Cohen D, Blaser CJ, Hagopian M. A brief form of the Mini-Mental State Examination for use in community care settings. Behav Health Aging. 1990;1:133-139.
- Daley K, Mayo N, Wood Dauphinee S, Danys I, Cabot R. Verification of the Stroke Rehabilitation Assessment of Movement (STREAM). Phys- iother Can. 1997;49:269 -278.
- Authors
- Mayo, N. E., Wood-Dauphinee, S., Côté, R., Gayton, D., Carlton, J., Buttery, J., & Tamblyn, R.
- Affiliations
- University of British Columbia (CA)
- From the Division of Clinical Epidemiology, Royal Victoria Hospital (N.E.M., S.W.-D., R.T.), Montreal; Department of Medicine (N.E.M., S.W.-D., R.C., D.G., R.T.), Department of Epidemiology and Biostatistics (N.E.M., S.W.-D., R.T.), and School of Physical and Occupational Therapy (N.E.M., S.W.-D.), McGill University, Montreal; Departments of Neurology (R.C.) and Nursing (J.B.), Montreal General Hospital, Montreal; and the Department of Neurology, Jewish General Hospital (J.C.), Montreal, Quebec,...
- Venue
- Stroke
- Published
- 2000-05
- Volume
- 31
- Issue
- 5
- Pages
- 1016-1023
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2113980807
- Cited by
- 395
- References
- 31
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 9 · 2019: 12 · 2018: 9 · 2017: 15 · 2016: 10 · 2015: 10 · 2014: 24 · 2013: 22 · 2012: 28
- FWCI
- 24.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- home-based rehabilitation, early discharge, community reintegration, health-related quality of life, instrumental activities of daily living, length of hospital stay, nursing services, functional recovery, caregiver support
- MeSH terms
- Stroke Rehabilitation, Aged, Aged, 80 and over, Family, Female, Follow-Up Studies, Health Personnel, Humans, Male, Middle Aged, Quality of Life, Stroke
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