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Cited by 31Stroke Rehabilitation and RecoveryAcute Ischemic Stroke ManagementMedical Practices and Rehabilitation

Gothenburg Very Early Supported Discharge study (GOTVED): a randomised controlled trial investigating anxiety and overall disability in the first year after stroke

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Rafsten, Lena, Danielsson, Anna, Nordin, Asa, Björkdahl, Ann, Lundgren-Nilsson, Asa, Larsson, Maria E. H., Sunnerhagen, Katharina S.·2019·BMC Neurology
DOI 10.1186/s12883-019-1503-3PMC PMC6878692
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Abstract

Background and purpose: Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine. Methods: A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients’ degree of overall disability, measured by the modified Rankin Scale (mRS). Results: No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke. Conclusions: The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit. Trial registration: Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).

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  • Some studies include the occupational therapist as part of multidisciplinary services facilitated by an Early Supported Discharge (ESD) or Very Early Supported Discharge (VESD) model, which has been proven to reduce long-term dependency and admission to institutional care.

    “Some studies include the occupational therapist as part of the multidisciplinary services facilitated by an Early Supported Discharge (ESD) or a Very Early Supported Discharge (VESD) model, which has been proven to reduce long-term dependency and admission to institutional care [3, 56].”

    From Early Occupational Therapy Intervention post-stroke (EOTIPS): A randomized controlled trial (2024) · cites this paper as [3]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Decision on evaluations and intervention duration was made after reviewing recent and similar published papers showing main changes between groups 3 months after discharge, and Barthel Index and mRS were the most widely used evaluations.

    “Decision on evaluations and intervention duration was made after reviewing recent and similar published papers, as showing main changes between groups 3 months after discharge [3, 4, 49, 53, 58] and being Barthel Index and the mRS the most widely used evaluations [3, 4, 53, 59].”

    From Early Occupational Therapy Intervention post-stroke (EOTIPS): A randomized controlled trial (2024) · cites this paper as [3]

    The Results (Table 3; page unavailable) report a between-group difference in mRS at three months post-stroke, and Methods > Outcome measures (Table 1; page unavailable) shows that both the Barthel Index and mRS were assessed. The paper does not establish that these were the most widely used evaluations, and its three-month time point is measured from stroke onset, not discharge. (LLM, conf=0.85)

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  • Stroke discharges and rehabilitation plans are usually carried out in a multidisciplinary manner, making it difficult to evaluate the extent OT contributes to patients' recovery.

    “Stroke discharges and rehabilitation plans are usually carried out in a multidisciplinary manner, making it difficult to evaluate the extent OT contributes to the patients’ recovery [3–5, 54].”

    From Early Occupational Therapy Intervention post-stroke (EOTIPS): A randomized controlled trial (2024) · cites this paper as [3]

    The Methods (Intervention in the very early supported discharge group; page unavailable) describe rehabilitation by a team including occupational therapists, physiotherapists and a stroke nurse. But the Methods (Control group) say usual-care patients were not followed by that multidisciplinary team, and the Background says this discharge model was not standard in Sweden. The paper does not state that team-based care makes occupational therapy’s contribution to recovery difficult to evaluate. (LLM, conf=0.85)

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Research works printed but not linked: 1

  1. [14]Swedish Council on Health Technology A SBU Systematic Review Summaries Rehabilitation at Home After Early Supported Discharge (ESD) for Elderly Patients After Stroke 2015 Stockholm Swedish Council on Health Technology Assessment (SBU) Copyright (c) 2015 by the Swedish Council on Health Technology Assessment 26803854

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Authors
Rafsten, L., Danielsson, A., Nordin, A., Björkdahl, A., Lundgren-Nilsson, A., Larsson, M. E. H., & Sunnerhagen, K. S.
Affiliations
  • Sahlgrenska University Hospital (SE)
  • University of Gothenburg (SE)
  • Marie Cederschiöld University (SE)
  • Region Västra Götaland (SE)
Corresponding author
Rafsten, Lena
ORCID
Venue
BMC Neurology
Publisher
Springer Science and Business Media LLC
Published
2019-11-09
Volume
19
Issue
1
Pages
277-277
ISSN
1471-2377 (ISSN-L)
DOI
10.1186/s12883-019-1503-3
PMC
PMC6878692
OpenAlex
W2988261757
Cited by
31
References
39
Citations by year
2026: 5 · 2025: 3 · 2024: 7 · 2023: 6 · 2022: 4 · 2021: 3 · 2020: 3
FWCI
1.75
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Neurology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Swedish Science Council (VR2012-3523)
  • Health & Medical Care Committee of the Regional Executive Board of the Region Västra Götaland
  • King Gustaf V’s and Queen Victoria’s Freemasons´ Foundation
  • Swedish National Stroke Association
  • Local Research and Development Board for Gothenburg and Södra Bohuslän
  • Agneta Prytz-Folke’s Gösta Folke’s Foundation
  • Wilhelm & Martina Lundgrens Foundation
  • Felix Neubergh´s Foundation
  • Hjalmar Svensson´s Research Foundation
  • Rune and Ulla Amlöv´s Foundation
  • John and Berit Wennerström´s Foundation
Topics
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords
stroke, anxiety, disability, home-based rehabilitation, multidisciplinary team, stroke unit, early discharge, modified Rankin Scale, Hospital Anxiety and Depression Scale
MeSH terms
Stroke Rehabilitation, Aged, Anxiety, Female, Home Care Services, Humans, Male, Middle Aged, Patient Discharge, Recovery of Function, Stroke

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