Use of healthcare, impact on family caregivers and patient satisfaction ofrehabilitation at home after stroke in southwest Stockholm

We previously conducted a randomized controlled trial in which early suppor ted discharge from the Department of Neurology at Huddinge Hospital in sout hwest Stockholm with continuity of rehabilitation at home (n=41) was compar ed to routine rehabilitation services (n=40) for moderately disabled select ed stroke patients. No statistical significant differences were found in pa tient outcome at 3 or 6 months, but a moderately positive effect in the hom e rehabilitation group was suggested, In the present study we evaluated res ource utilization of health and social care, impact on family caregivers du ring 6 months after acute stroke and patient satisfaction. A 50% reduction in total hospitalization (initial and recurrent) was observed, from 30 days in the routine rehabilitation group to 15 days in the home rehabilitation group (p < 0.001), After discharge, the mean number of home visits in the h ome rehabilitation group was 12, In total, the routine rehabilitation group had a higher frequency of therapy contacts and daycare in outpatient care. Seventy-eight percent received help from a family caregiver in activities of daily living, yet only 15% had formal home help service. No major differ ences were found in use of home help service or impact on family caregivers in the form of time devoted to helping the patient or subjective well-bein g of spouses as per Sickness Impact Profile. Patient satisfaction was in fa vour of the home rehabilitation group, but a significant difference was onl y found in active participation in rehabilitation programme planning. In co nclusion, early supported discharge with continuity of rehabilitation at ho me, using goal-directed functional activities based on the patient's person al interests, should be the rehabilitation service of choice for moderately disabled stroke patients fulfilling certain criteria, provided that furthe r evaluation during the first year after stroke reveals no great changes in outcome or resource use, More research into the effectiveness and cost imp lications of early supported discharge with continuity of rehabilitation at home is needed in other parts of Sweden and in other countries before it c an be asserted that the conclusions drawn from this study are applicable el sewhere.