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Early home-supported discharge for patients with stroke in Portugal: a randomised controlled trial [with consumer summary] |
Santana S, Rente J, Neves C, Redondo P, Szczygiel N, Larsen T, Jepsen B, Langhorne P |
Clinical Rehabilitation 2017 Feb;31(2):197-206 |
clinical trial |
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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 to 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 versus 26/95) and lower at follow-up (2/74 versus 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.
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