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Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial
L Gilbertson1, P Langhorne, A Walker
1Department of Occupational Therapy, Glasgow Royal Infirmary, Glasgow G4 0SF.
Objective:
To establish if a brief programme of domiciliary occupational therapy could improve the recovery of patients with stroke discharged from hospital.
Design:
Single blind randomised controlled trial.
Setting:
Two hospital sites within a UK teaching hospital.
Subjects:
138 patients with stroke with a definite plan for discharge home from hospital.
Intervention:
Six week domiciliary occupational therapy or routine follow up.
Main Outcome Measures:
Nottingham extended activities of daily living score and "global outcome" (deterioration according to the Barthel activities of daily living index, or death).
Results:
By eight weeks the mean Nottingham extended activities of daily living score in the intervention group was 4.8 points (95% confidence interval -0.5 to 10.0, P=0.08) greater than that of the control group. Overall, 16 (24%) intervention patients had a poor global outcome compared with 30 (42%) control patients (odds ratio 0.43, 0.21 to 0.89, P=0.02). These patterns persisted at six months but were not statistically significant. Patients in the intervention group were more likely to report satisfaction with a range of aspects of services.
Conclusion:
The functional outcome and satisfaction of patients with stroke can be improved by a brief occupational therapy programme carried out in the patient's home immediately after discharge. Major benefits may not, however, be sustained.