Early supported discharge services for people with acute stroke

Area of Science:

• Neurology and Rehabilitation
• Health Services Research

Background:

• Stroke rehabilitation traditionally occurs in hospitals.
• Early supported discharge (ESD) services facilitate early hospital discharge with home-based rehabilitation.

Purpose of the Study:

• To evaluate if ESD services improve upon conventional care for stroke patients.
• Key objectives include accelerating return home, enhancing patient/carer outcomes, ensuring patient satisfaction, and assessing resource implications.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted.
• Searches included major databases (Cochrane, MEDLINE, Embase, CINAHL, Web of Science) and trial registries up to January 2017.
• Data extraction and analysis focused on patient outcomes, service delivery models (co-ordinated vs. non-co-ordinated teams), and cost-effectiveness.

Main Results:

• Seventeen RCTs involving 2422 participants were included.
• ESD reduced hospital stay by approximately six days (moderate-grade evidence).
• ESD decreased the composite endpoint of death or dependency by 5 per 100 patients (OR 0.80, moderate-grade evidence) and reduced institutional care admissions (OR 0.75, moderate-grade evidence).

Conclusions:

• Well-resourced ESD services, particularly those with co-ordinated multidisciplinary teams, effectively reduce long-term dependency and hospital length of stay for selected stroke patients.
• No adverse impact on patient or carer mood or subjective health status was observed.
• Results for services lacking co-ordinated multidisciplinary input were inconclusive.