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.