INTERVENTION DESIGN FOR REHABILITATION AT HOME AFTER STROKE - A PILOTFEASIBILITY STUDY

This study aimed at identifying the characteristics and feasibility of rehabilitation at home for acute stroke patients in south-west Stockh olm. A population-based systematic sample of 16 patients, fulfilling d efined criteria, was selected from approximately 1/3 of the stroke pat ients having been in hospital for one week or more at a neurology depa rtment, and offered early discharge in combination with home-based reh abilitation as an alternative to sustained rehabilitation in hospital. Fifteen patients, mean age 68.2 years, male/female ratio 9/6, indepen dent in feeding and continent one week after acute stroke, participate d in the study. The most important components of the home-based rehabi litation programme were that: 1) one therapist was selected as case-ma nager using the other therapists on a consultant basis; 2) the trainin g sessions consisted of different task-specific activities, based on t he patients' personal interest; 3) education and individual counsellin g were offered to all spouses; and 4) adherence to structured training between therapy sessions was promoted. The length of such programmes varied from 4 to 19 weeks after discharge and the mean number of home visits was 11. Reported time for training between therapy sessions for 14 patients was mean 1.2 hours per day. The patients' lifestyle activ ities, personal and instrumental ADL, and motor capacity at 3, 6 and 1 2 months after stroke, assessed by validated and reliable methods, fol lowed patterns similar to those reported for other stroke patients. Th e mean time in hospital for patients in the study was 14 days; for pat ients with similar ADL capacity but not included in the study it was 2 7 days. Rehabilitation at home, in some cases combined with early disc harge, may be suitable for a large proportion of incident acute stroke patients, as well as cost-effective.