RESUMEN
OBJECTIVE: To evaluate an early home-supported discharge service for stroke patients. DESIGN: We carried out a prospective, randomised, open-label, blinded-endpoint trial (allocation ratio of 1:1) with patients assigned to either an early home-supported discharge service or usual care. SETTING: The study was undertaken in Aveiro, Portugal, between April 2009 and April 2013. SUBJECTS: We included stroke patients aged 25-85 years admitted to the stroke unit with an initial Functional Independence Measure of up to 100, who gave informed consent. INTERVENTIONS: Patients in the early home-supported discharge group began their rehabilitation intervention in the stroke unit and the early home-supported discharge team worked with them at home for a maximum of one month. Patients in the control group received usual services. MAIN MEASURES: The primary outcome measure was the Functional Independence Measure at six months after stroke. RESULTS: We randomised 190 patients of whom 34 were lost to follow-up. There were no significant differences (p > 0.5) in the average scores of Functional Independence Measure between the early home-supported discharge (69 ±22; mean ±SD) and the control groups (71 ±17) measured at baseline; and between the early home-supported discharge (107 ±20) and the control groups (107 ±25) measured at six months. The number of individuals with a low Functional Independence Measure score (<60) in the early home-supported discharge group compared with the control group was higher at admission (34/95 vs. 26/95) and lower at follow-up (2/74 vs. 5/78). CONCLUSIONS: It was feasible to implement early home-supported discharge procedures in a Southern European setting, but we have not shown convincing differences in disability at six months.
Asunto(s)
Continuidad de la Atención al Paciente/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Evaluación de Resultado en la Atención de Salud , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/diagnóstico , Actividades Cotidianas , Adulto , Anciano , Humanos , Persona de Mediana Edad , Alta del Paciente , Pronóstico , Estudios Prospectivos , Recuperación de la Función , Medición de Riesgo , Índice de Severidad de la Enfermedad , Método Simple CiegoRESUMEN
This report is a brief practical problem-based guide to support clinical management in the implementation of early home-supported discharge as an integrated part of stroke care. However, it is clear that skilled members of a multidisciplinary team are needed and they need to work in a coordinated manner. Services vary considerably between countries and regions; therefore, the involved parties in the baseline services may vary considerably. This needs to be considered when planning early home-supported discharge services. Patient selection criteria cannot be precise; however, patients who can benefit most are likely to have moderate stroke severity and may be able to cooperate with rehabilitation in the home setting. Staffing requirements will vary according to several factors. These will include (a) the severity and complexity of stroke impairments, (b) the current level of community support, (c) the duration of rehabilitation input, and (d) the rehabilitation targets planned.