Structured re-assessment system at 6 months after a disabling stroke: a randomised controlled trial with resource use...

Area of Science:

• Rehabilitation medicine
• Health services research
• Geriatric medicine

Background:

• National policy advocates for routine re-assessment of disabled stroke patients and their carers at 6 months post-stroke.
• The clinical effectiveness and resource implications of this policy require investigation.

Purpose of the Study:

• To evaluate the clinical and resource outcomes of a structured, systematic re-assessment policy for stroke patients and their carers at 6 months post-stroke.
• To determine if this policy improves patient independence and reduces carer stress.

Main Methods:

• A prospective, single-blind, randomized controlled trial was conducted in two centers.
• 265 patients with disabling stroke and their carers were recruited.
• The intervention involved a structured re-assessment system at 6 months post-stroke, compared to existing care.

Main Results:

• No significant difference in patient independence (Frenchay Activities Index) at 12 months post-stroke between groups (adjusted mean difference 0.64).
• No significant difference in carer emotional distress (General Health Questionnaire 28) at 12 months post-stroke between groups (mean difference 0.02).
• Secondary outcomes and total mean costs were similar; however, the intervention group used fewer hospital and care home bed days.

Conclusions:

• A structured, systematic re-assessment for stroke patients and carers at 6 months did not demonstrate clinically significant benefits at 12 months.
• Health and social care resource utilization and mean costs per patient were comparable between the intervention and control groups.