SPECIALIST NURSE SUPPORT FOR PATIENTS WITH STROKE IN THE COMMUNITY - A RANDOMIZED CONTROLLED TRIAL

Objective-To evaluate whether specialist nurse visits enhance the soci al integration and perceived health of patients with stroke or allevia te stress in carers in longer term stroke care, Design-Stratified rand omised controlled trial; both groups assessed at time of recruitment a nd at 3, 6, and 12 months. Setting-Patients with disability related to new stroke who lived in their own homes in the Bradford Metropolitan District. Subjects-240 patients aged 60 years or over, randomly alloca ted to control group (n = 120) or intervention group (n = 120). Interv ention-Visits by specialist outreach nurses over 12 months to provide information, advice, and support; minimum of six visits during the fir st six months. The control group received no visits. Main outcome meas ures-The Barthel index (functional ability), the Frenchay activities i ndex (social activity), the Nottingham health profile (perceived healt h status). Stress among carers was indicated by the general health que stionnaire-28 (28 items). The nurses recorded their interventions in t rial diaries. Results-There were no significant differences in perceiv ed health, social activities, or stress among carers between the treat ment and control groups at any of the assessments points. A subgroup o f mildly disabled patients with stroke (Barthel index 15-19) had an im proved social outcome at six months (Frenchay activities index, median difference 3 (95% confidence interval 0 to 6; P = 0.03)) and for the full 12 months of follow up (analysis of covariance P = 0.01) compared with the control group. Conclusions-The specialist nurse intervention resulted in a small improvement in social activities only for the mil dly disabled patients. No proved strategy yet exists that can be recom mended to address the psychosocial difficulties of patients with strok e and their families.