Randomized controlled trial of rehabilitation at home after stroke: One-year follow-up of patient outcome, resource use and cost

Background and Purpose: This study sought to evaluate early supported disch arge and continued rehabilitation at home after stroke, at a minimum of 6 m onths after the intervention, in terms of patient outcome, resource use and health care cost. Methods: Eighty-three patients, moderately impaired 5-7 days after acute stroke, were included in a randomized controlled trial, 42 being allocated to the intervention and 41 to routine rehabilitation. One- year follow-up of patient outcome included mortality, motor capacity, dysph asia, activities of daily living, social activities, perceived dysfunction, and self-reported falls. Resource use over 12 months included inpatient ho spital care, outpatient health care, use of health-related services, inform al care, and cost of health care. Results: On univariate analysis there was no difference in patient outcome. Multivariate regression analysis showed that intervention had a significant effect on independence in activities of daily living. A significant difference in inpatient hospital care, initial and recurrent, was observed, with a mean of 18 (intervention) versus 33 da ys (control) (p = 0.002). Further significant differences were that the con trol group registered more outpatient visits to hospital occupational thera pists (p = 0.02), private physical therapists (p = 0.03) and day-hospital a ttendance (p = <0.001), while the intervention group registered more visits to nurses in primary care (p = 0.03) and home rehabilitation (p = <0.001). Other differences in outcomes or resource utilization were nonsignificant. Conclusion: In Sweden, early supported discharge with continued rehabilita tion at home proved no less beneficial as a rehabilitation service, and pro vided care and rehabilitation for 5 moderately disabled stroke patients ove r 12 months after stroke onset for the cost of 4 in routine rehabilitation. Copyright (C) 2001 S. Karger AG, Basel.