Background and Purpose: This study sought to evaluate early supported discharge and continued rehabilitation at home after stroke, at a minimum of 6 months 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, dysphasia, activities of daily living, social activities, perceived dysfunction, and self-reported falls. Resource use over 12 months included inpatient hospital care, outpatient health care, use of health-related services, informal 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 days (control) (p = 0.002). Further significant differences were that the control group registered more outpatient visits to hospital occupational therapists (p = 0.02), private physical therapists (p = 0.03) and day-hospital attendance (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 rehabilitation at home proved no less beneficial as a rehabilitation service, and provided care and rehabilitation for 5 moderately disabled stroke patients over 12 months after stroke onset for the cost of 4 in routine rehabilitation.

Aboderin I, Venables G, for the Pan European consensus meeting on stroke management: Stroke management in Europe. J Internal Med 1996;240:173–180.
Stroke Unit Trialists’ Collaboration: Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 1997;314:1151–1159.
Langhorne P, Dennis M: Stroke Units: An Evidence Based Approach. London, BMJ Books, 1998.
Stegmayr B, Asplund K, Hulther-Åsberg K, Norrving B, Peltonen M, Terént A, Wester PO: Stroke units in their natural habitat. Can results of randomized trials be reproduced in routine clinical practice? Stroke 1999;30:709–714.
Rudd AG, Wolfe CDA, Tilling K, Beech R: Randomised controlled trial to evaluate early discharge scheme for patients with stroke. BMJ 1997;315:1039–1044.
Rodgers H, Soutter J, Kaiser W, Pearson P, Dobson R, Skilbeck C, Bond J: Early supported hospital discharge following acute stroke: Pilot study results. Clin Rehabil 1997;11:280–287.
McNamee P, Christensen J, Soutter J, Rodgers H, Craig N, Pearson P, Bond J: Cost analysis of early supported hospital discharge for stroke. Age Ageing 1998;27:345–351.
Beech R, Rudd AG, Tilling K, Wolfe CDA: Economic consequences of early inpatient discharge to community-based rehabilitation for stroke in an Inner-London teaching hospital. Stroke 1999;30:729–735.
Pound P, Tilling K, Rudd AG, Wolfe CDA: Does patient satisfaction reflect differences in care after stroke? Stroke 1999;30:49–55.
Widén Holmqvist L, von Koch L, Kostulas V, Holm M, Widsell G, Tegler H, Johansson K, Almazán J, de Pedro-Cuesta J: A randomized controlled trial of rehabilitation at home after stroke in Southwest Stockholm. Stroke 1998;29:591–597.
von Koch L, Widén Holmqvist L, Kostulas V, Almazán J, de Pedro-Cuesta J: A randomized controlled trial of rehabilitation at home after stroke in Southwest Stockholm: Outcome at six months. Scand J Rehabil Med 2000;32:80–86.
Widén Holmqvist L, von Koch L, de Pedro-Cuesta J: Use of health care, impact on family caregivers and patient satisfaction of rehabilitation at home after stroke in Southwest Stockholm. Scand J Rehabil Med 2000;32:164–170.
von Koch L, Widén Holmqvist L, Wohlin Wottrich A, Tham K, de Pedro-Cuesta J: Rehabilitation at home after stroke: A descriptive study of an individualized intervention. Clin Rehabil 2000;14:574–583.
WHO Task Force on Stroke and Other Cerebrovascular Disorders: Recommendations on stroke prevention, diagnosis, and therapy. Stroke 1989;20:1407–1431.
Widén Holmqvist L: Development and Evaluation of Rehabilitation at Home After Stroke in South-West Stockholm; thesis, Stockholm, 1997.
Lindmark B, Hamrin E: Evaluation of functional capacity after stroke as a basis for active intervention. Presentation of a modified chart of motor capacity assessment and its reliability. Scand J Rehabil Med 1988;20:103–109.
Reinvang I, Engvik H: Håndbok. Norsk Grunntest for Afasi. Oslo, Universitetsførlaget, 1980.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: The Index of ADL: A standardized measure of biological and psychosocial function. JAMA 1963;185:914–919.
Folstein MF, Folstein SE, McHugh PR: ‘Mini-Mental State’, a practical method for grading cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
Wade D, Wood V, Heller A, Maggs J, Langton Hewer R: Walking after stroke: Measurement and recovery over the first three months. Scand J Rehabil Med 1987;19:25–30.
Heller A, Wade DT, Wood VA, Sunderland A, Langton Hewer R, Ward E: Arm function after stroke: Measurement and recovery over the first three months. J Neurol Neurosurg Psychiatr 1987;50:714–719.
Mahoney FJ, Barthel DW: Functional evaluation: The Barthel index. Md State Med J 1965;14:61–65.
Hulter Åsberg K, Sonn U: The cumulative structure of personal and instrumental ADL. Scand J Rehabil Med 1989;21:171–177.
Wade DT, Legh-Smith J, Langton Hewer R: Social activities after stroke: Measurement and natural history using Frenchay Activities Index. Int Rehabil Med 1985;7:176–181.
Bergner M, Bobbitt RA, Carter WB, Gilson BS: The sicknes simpact profile: Development and final revision of a health status measure. Med Care 1981;19:787–805.
Sullivan M, Ahlmén M, Archenholtz B, Svensson G: Measuring health in rheumatic disorders by means of a Swedish version of Sickness Impact Profile. Results from a population study. Scand J Rheumatol 1986;15:193–200.
Antonovsky A: Unraveling the Mystery of Health. San Francisco, Jossey-Bass, 1987.
Langius A, Björvell H, Antonovsky A: The sense of coherence concept and its relation to personality traits in Swedish samples. Scand J Caring Sci 1992;6:165–171.
Languis A, Björvell H: Coping ability in functional status in a Swedish population sample. Scand J Caring Sci 1993;7:3–10.
Pedersen PM, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS: The impact of aphasia on ADL and social activities after stroke: The Copenhagen study. J Neuro Rehabil 1996;10:91–99.
Scandinavian Stroke Study Group: Multicenter trial of hemodilution in ischemic stroke. Background and study protocol. Stroke 1985;16:885–890.
Widén Holmqvist L, de Pedro Cuesta J, Möller G, Holm M, Sidén Å: A pilot study of rehabilitation at home after stroke: A health-economic appraisal. Scand J Rehabil Med 1996;28:9–18.
Riksförsäkringsverket [National (Swedish) Social Insurance board]. Statistisk rapport Is-R 1995:4. Privatläkarvård 1989–juni 1994.
Widén Holmqvist L, von Koch L, Kostulas V, Holm M, Widsell G, Tegler H, Johansson K, Almazán J, de Pedro-Cuesta J: Response to Letter to the Editor. Stroke 1998;29:1737–1739.
de Haan RJ, Limburg M, Van der Meulen JHP, Jacobs HM, Aaronson NK: Quality of life after stroke: Impact of stroke type and lesion location. Stroke 1995;26:402–408.
Sneeuw KCA, Aaronson NK, de Haan RJ, Limburg M: Assessing quality of life after stroke. The value and limitations of proxy ratings. Stroke 1997;28:1541–1549.
Nydevik I, Hulther Åsberg K: Sickness impact after stroke: A 3-year follow-up. Scand J Prim Health Care 1992;10:284–289.
Rønning OM, Guldvog B: Outcome of subacute stroke rehabilitation: A randomized controlled trial. Stroke 1998;29:779–784.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.