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Early supported discharge after stroke.
Peter Langhorne1, Lotta Widén Holmqvist,
1Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK. p.langhorne@clinmed.gla.ac.uk
Journal of Rehabilitation Medicine
|March 14, 2007
Summary
Early supported discharge services for stroke patients reduce hospital stays and improve outcomes. This systematic review found fewer deaths or dependencies, demonstrating the effectiveness of home-based rehabilitation.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Health Services Research
Background:
- Stroke rehabilitation traditionally occurs in hospitals.
- Early supported discharge (ESD) services facilitate earlier hospital release with home-based rehabilitation.
- Evidence on the effectiveness of ESD services requires systematic evaluation.
Purpose of the Study:
- To systematically review randomized trials of early supported discharge services for stroke patients.
- To quantify the impact of ESD on patient outcomes, including mortality and dependency.
- To identify factors influencing the effectiveness of ESD services.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) involving ESD services.
- Included 12 trials with a total of 1659 patients.
- Analyzed data on death, dependency, and length of hospital stay.
Main Results:
- ESD services were associated with reduced odds of death or dependency (5 fewer adverse outcomes per 100 patients, p=0.04).
- Patients receiving ESD services experienced an average reduction of 8 days in hospital stay (p<0.0001).
- Greatest benefits observed with coordinated multidisciplinary ESD teams and patients with mild-moderate disability.
Conclusions:
- Early supported discharge services are effective in improving patient outcomes post-stroke.
- ESD services reduce hospital length of stay and adverse events like death or dependency.
- Coordinated multidisciplinary ESD teams and appropriate patient selection enhance benefits.
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