A randomized controlled trial of day hospital and day centre therapy

Objective: To compare the outcome of day hospital to day centre rehabilitat ion. Design: Single blind randomized controlled trial with home assessments at b aseline (twice), six weeks and three months. Setting: Mainly rural health district. Day hospital and social services day centres in market towns. Subjects: One hundred and five physically disabled older patients living at home referred for day hospital rehabilitation or maintenance before discha rge from hospital (66) or referred as outpatients (39). Interventions: Day hospital treatment or day centre rehabilitation by a phy siotherapist and two health support workers. Main outcome measures: Barthel Index, Philadelphia Geriatric Morale Scale a nd Caregiver Strain Index. Results: More day centre (23/55) than day hospital patients (6/50) (p <0.00 1) withdrew from allocated treatment by choice or because of operational di fficulties. Both groups improved significantly in functional ability and re duction of care-giver strain by three months but there was no significant d ifference between groups. The mean improvement in Barthel Index (standard e rror) for day hospital = +1.5 (0.41) (n = 34) and day centres = +1.5 (0.48) (n = 38). The mean difference (95% confidence interval) between day hospit al and day centre was 0 (-1.28, +1.28). Likewise the mean Philadelphia Geri atric Morale Scale improvement for day hospital +1.8 (0.66) (n = 35) and da y centres was +0.9 (0.63) (n = 38). The mean difference was -0.88 (-2.7, +0 .95). The mean reduction in Caregiver Strain for day hospital was -1.45 (0. 5) (n = 23) and day centre was -1.59 (0.47) (n = 27). The difference was -0 .14 (1.52,+1.24). (These analyses are all on an intention-to-treat basis.) Conclusion: Whilst the improvement in functional ability and care-giver str ain was similar in both groups, day centre rehabilitation was less popular and had practical difficulties. If these difficulties can be overcome the m odel should be tested elsewhere.