Effect of very early supported discharge versus usual care on activi­ties of daily living ability after mild stroke: a randomized controlled trial

Authors

  • Ann Björkdahl nstitute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ²Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden. https://orcid.org/0000-0002-2194-6773
  • Lena Rafsten Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden https://orcid.org/0000-0002-2226-6227
  • Cathrine Petersson Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Katharina S. Sunnerhagen Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden https://orcid.org/0000-0002-5940-4400
  • Anna Danielsson Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden. https://orcid.org/0000-0002-6496-4066

DOI:

https://doi.org/10.2340/jrm.v55.12363

Keywords:

activities of daily living, cerebrovascular disorders, hospital to home transition, rehabilitation

Abstract

Objective: To examine the ability to perform basic and instrumental activities of daily life after very early supported discharge vs usual discharge and referral routine during the first year after mild stroke.

Design: A secondary analysis of data from the Gothenburg Very Early Supported Discharge randomized controlled trial. 

Patients: A total of 104 patients (56% men; mean (standard deviation) age 75 (11) years) who had experienced a first stroke classified as mild.

Methods: The primary outcome was the Activities of Daily Living Taxonomy score. Stroke Impact Scale (activities of daily living, and mobility) scores was a secondary measure. Patients were randomized to either very early supported discharge with 4 weeks of home rehabilitation provided by a multidisciplinary stroke team, or a control group discharged according to usual routine (referral to primary care when needed). Assessments were performed at discharge, 4 weeks post-discharge, and 3 and 12 months post-stroke.

Results: Instrumental activities of the Activities of Daily Living Taxonomy scores (the lower the better) in the very early supported discharge and control groups were median 4 and 6 (p = 0.039) at 4 weeks post-discharge and 3 and 4.5 (p = 0.013 at 3 months post-stroke, respectively. Stroke Impact Scale (Mobility) median scores (the higher the better) in the very early supported discharge and control groups at 3 months were 97 and 86 (p = 0.040), respectively. There were no group differences in the 2 outcomes at 12 months post-stroke.

Conclusion: Compared with usual discharge routine, team-based rehabilitation during the first month at home is beneficial for instrumental activity in the subacute phase, in patients with mild stroke. One year post-stroke both groups show equal results.

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Author Biography

Anna Danielsson, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden.

Associate professor (Health and Rehabilitation/Unit of Physiotherapy)

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Published

2023-08-24

How to Cite

Björkdahl, A., Rafsten, L., Petersson, C., S. Sunnerhagen, K., & Danielsson, A. (2023). Effect of very early supported discharge versus usual care on activi­ties of daily living ability after mild stroke: a randomized controlled trial. Journal of Rehabilitation Medicine, 55, jrm12363. https://doi.org/10.2340/jrm.v55.12363

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Vol. 55 (2023)

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Original Report

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Copyright (c) 2023 Ann Björkdahl, Lena Rafsten, Cathrine Petersson, Katharina S. Sunnerhagen, Anna Danielsson

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