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Stroke rehabilitation after hospital discharge: a randomized trial comparing domiciliary and day-hospital care

Stroke rehabilitation after hospital discharge: a randomized trial comparing domiciliary and day-hospital care
Stroke rehabilitation after hospital discharge: a randomized trial comparing domiciliary and day-hospital care
Objectives: to compare the effectiveness and costs of a new domiciliary rehabilitation service for elderly stroke patients with geriatric day-hospital care.

Design: randomized controlled trial.

Participants: stroke patients aged 55+ who required further rehabilitation after hospital discharge or after referral to geriatricians from the community.

Setting: Poole area, East Dorset, a mixed urban/rural area on the south coast of England.

Main outcomes: primary—changes between hospital discharge and 6-month follow-up in physical function as measured by Barthel index. Secondary—changes over this period in Rivermead Mobility Index and mental state (Philadelphia Geriatric Centre Morale Scale) and differences in social activity (Frenchay Activities Index) and generic health status (SF-36). Health service and social service cost per patient were compared for the two groups.

Results: 180 patients were eligible and 140 (78%) were randomized. The groups were well balanced for age, sex, social class and initial Barthel index. We achieved follow-up in 88% of subjects who were alive at 6 months. We detected no significant differences in patient outcomes, although there was a non-significant improvement in measures of physical function and social activity in the domiciliary group. Domiciliary patients had more physiotherapy time per session and more district nurse time, and made greater use of social service day centres and home helps. Total cost per patient did not differ significantly between the two groups, with reduced health service costs in the domiciliary arm offset by higher social service costs.

Conclusion: no significant differences were detected in the effectiveness of the two services. Neither service influenced patients’ mental state, and their social activity remained low. Total costs were similar. A mixed model of day-hospital and domiciliary care may be most cost-effective for community stroke rehabilitation, but this requires further evaluation.
day hospital, domiciliary care, randomized trial, stroke rehabilitation, arm, sex, middle aged, research, health, cerebrovascular accident, aged, social class, statistics & numerical data, social work, design, male, day care, humans, health services for the aged, follow-up studies, health status, home care services, non-us government, clinical-trial, patients, rehabilitation, research support, female, 80 and over, activity, england, patient discharge, time, elderly, comparative study, stroke, treatment outcome
0002-0729
303-310
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Low, Joe
29b70d2a-b0c1-4a8b-9183-18e99b3ec743
Day, Richard
9a39b260-6e05-4938-9e23-2e3f2163e0ae
Peasgood, Tessa
eb4beabb-a466-47ec-9e43-2a2c565ddf8d
Mullee, Mark A.
fd3f91c3-5e95-4f56-8d73-260824eeb362
Turnbull, Joanne C.
a21f82e1-5cd3-4185-a5cf-a3fbd694369a
Villar, Tracey
a60bc25d-eb77-40fe-8712-88af50918430
Raftery, James
de9dd294-3a0e-4756-8427-a4f2382495db
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Low, Joe
29b70d2a-b0c1-4a8b-9183-18e99b3ec743
Day, Richard
9a39b260-6e05-4938-9e23-2e3f2163e0ae
Peasgood, Tessa
eb4beabb-a466-47ec-9e43-2a2c565ddf8d
Mullee, Mark A.
fd3f91c3-5e95-4f56-8d73-260824eeb362
Turnbull, Joanne C.
a21f82e1-5cd3-4185-a5cf-a3fbd694369a
Villar, Tracey
a60bc25d-eb77-40fe-8712-88af50918430
Raftery, James
de9dd294-3a0e-4756-8427-a4f2382495db

Roderick, Paul, Low, Joe, Day, Richard, Peasgood, Tessa, Mullee, Mark A., Turnbull, Joanne C., Villar, Tracey and Raftery, James (2001) Stroke rehabilitation after hospital discharge: a randomized trial comparing domiciliary and day-hospital care. Age and Ageing, 30 (4), 303-310. (doi:10.1093/ageing/30.4.303).

Record type: Article

Abstract

Objectives: to compare the effectiveness and costs of a new domiciliary rehabilitation service for elderly stroke patients with geriatric day-hospital care.

Design: randomized controlled trial.

Participants: stroke patients aged 55+ who required further rehabilitation after hospital discharge or after referral to geriatricians from the community.

Setting: Poole area, East Dorset, a mixed urban/rural area on the south coast of England.

Main outcomes: primary—changes between hospital discharge and 6-month follow-up in physical function as measured by Barthel index. Secondary—changes over this period in Rivermead Mobility Index and mental state (Philadelphia Geriatric Centre Morale Scale) and differences in social activity (Frenchay Activities Index) and generic health status (SF-36). Health service and social service cost per patient were compared for the two groups.

Results: 180 patients were eligible and 140 (78%) were randomized. The groups were well balanced for age, sex, social class and initial Barthel index. We achieved follow-up in 88% of subjects who were alive at 6 months. We detected no significant differences in patient outcomes, although there was a non-significant improvement in measures of physical function and social activity in the domiciliary group. Domiciliary patients had more physiotherapy time per session and more district nurse time, and made greater use of social service day centres and home helps. Total cost per patient did not differ significantly between the two groups, with reduced health service costs in the domiciliary arm offset by higher social service costs.

Conclusion: no significant differences were detected in the effectiveness of the two services. Neither service influenced patients’ mental state, and their social activity remained low. Total costs were similar. A mixed model of day-hospital and domiciliary care may be most cost-effective for community stroke rehabilitation, but this requires further evaluation.

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More information

Published date: 2001
Keywords: day hospital, domiciliary care, randomized trial, stroke rehabilitation, arm, sex, middle aged, research, health, cerebrovascular accident, aged, social class, statistics & numerical data, social work, design, male, day care, humans, health services for the aged, follow-up studies, health status, home care services, non-us government, clinical-trial, patients, rehabilitation, research support, female, 80 and over, activity, england, patient discharge, time, elderly, comparative study, stroke, treatment outcome

Identifiers

Local EPrints ID: 24484
URI: http://eprints.soton.ac.uk/id/eprint/24484
ISSN: 0002-0729
PURE UUID: 17d847cf-af40-4ce2-810b-cb2e353da06c
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 31 Mar 2006
Last modified: 09 Jan 2022 02:47

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Contributors

Author: Paul Roderick ORCID iD
Author: Joe Low
Author: Richard Day
Author: Tessa Peasgood
Author: Mark A. Mullee
Author: Joanne C. Turnbull
Author: Tracey Villar
Author: James Raftery

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