Abstract
Background
Stroke Unit care is now accepted as an effective service model for hospital care, but the effectiveness of outpatient care is less certain. This review focuses on therapy-based rehabilitation services targeted at stroke patients living at home.
Objectives
To assess the effects of therapy-based rehabilitation services targeted towards stroke patients resident in the community within one year of stroke onset/discharge from hospital following stroke.
Search methods
We searched the Cochrane Stroke Group Trials Register (last searched May 2001), the Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 2001), MEDLINE (1996 to November 2001), EMBASE (1980 to November 2001), CINAHL (1983 to November 2001), PsycINFO (1967 to November 2001), AMED (1985 to November 2001), Wilson Social Sciences Abstracts (1984 to November 2001), Science Citation Index and Social Sciences Citation Index (1981 to November 2001). Other strategies to ensure identification of all potentially relevant trials included scanning reference lists of relevant articles and original papers, personal communication and hand searching journals.
Selection criteria
All unconfounded, truly randomised controlled trials of stroke patients resident in the community receiving a therapy service intervention compared with conventional or no care. Therapy services were those provided by physiotherapy, occupational therapy, or multidisciplinary staff working with patients primarily to improve task-orientated behaviour and hence increase activity and participation.
Data collection and analysis
Two review authors independently selected trials and extracted data on a number of prespecified outcomes. The primary outcomes were the proportion of patients who had deteriorated or were dependent in personal activities of daily living and performance in personal activities of daily living at the end of follow up.
Main results
We identified 14 trials including 1617 patients. Therapy-based rehabilitation services reduced the odds of a poor outcome (Peto odds ratio 0.72, 95% confidence interval (CI) 0.57 to 0.92; P = 0.009) and increased personal activity of daily living scores (standardised mean difference 0.14, 95% CI 0.02 to 0.25; P = 0.02). For every 100 stroke patients resident in the community receiving therapy-based rehabilitation services, 7 (95% CI 2 to 11) patients would be spared a poor outcome, assuming 37.5% would have had a poor outcome with no treatment.
Authors’ conclusions
Therapy-based rehabilitation services targeted towards stroke patients living at home appear to improve independence in personal activities of daily living. However, the evidence is derived from a review of heterogeneous interventions and therefore further exploration of the interventions is justifiable.
Plain language summary
Therapy-based rehabilitation services for stroke patients at home
People who have had a recent stroke are more likely to maintain their ability to carry out daily activities if they receive therapy services at home. Therapy-based rehabilitation services for stroke survivors can include input from physiotherapists, occupational therapists or multidisciplinary teams. This review of 14 studies, involving 1617 participants, found that people who had a recent stroke were more independent in personal activities of daily living and more likely to maintain these abilities if they received therapy services at home. The amount of benefit that can be achieved is uncertain.
