Home or hospital for stroke rehabilitation? Results of a randomized controlled trial - I: Health outcomes at 6 months

Background and Purpose-We wished to examine the effectiveness of an early h ospital discharge and home-based rehabilitation scheme for patients with ac ute stroke. Methods-This was a randomized, controlled trial comparing early hospital di scharge and home-based rehabilitation with usual inpatient rehabilitation a nd follow-up care. The trial was carried out in 2 affiliated teaching hospi tals in Adelaide, South Australia. Participants were 86 patients with acute stroke (mean age, 75 years) who were admitted to hospital and required reh abilitation. Forty-two patients received early hospital discharge and home- based rehabilitation (median duration, 5 weeks), and 44 patients continued with conventional rehabilitation care after randomization. The primary end point was self-reported general health status (SF-36) at 6 months after ran domization. A variety of secondary outcome measures were also assessed. Results-Overall. clinical outcomes for patients did nor differ significantl y between the groups at 6 months after randomization, but the total duratio n of hospital stay in the experimental group was significantly reduced (15 versus 30 days; P<0.001). Caregivers among the home-based rehabilitation gr oup had significantly lower mental health SF-36 scores (mean difference, 7 points). Conclusions-A policy of early hospital discharge and home-based rehabilitat ion for patients with stroke can reduce the use of hospital rehabilitation beds without compromising clinical patient outcomes. However, there is a po tential risk of poorer mental health on the part of caregivers. The choice of this management strategy may therefore depend on convenience and costs b ut also on further evaluations of the impact of stroke on caregivers.