Early Supported Discharge

One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Anderson et al., 2000) investigated the effects of early supported discharge on activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. among carers of patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. There was a significant between-group difference in carers’ activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. (Adelaide Activity Profile – household maintenance activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
only) at 6 months post-stroke, in favour of conventional care compared to early supported discharge.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that early supported discharge is not more effective than conventional care for improving carers’ activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations.. In fact, early supported discharge was less effective than conventional care for improving carers’ participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in household maintenance activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
.

Four high quality RCTs (Widén Holmqvist et al., 1998, – von Koch et al., 2000 6-month follow-up study, von Koch et al., 2001 12-month follow-up study, Thorsén et al., 2005 5-year follow-up study – ; Anderson et al., 2000; Indredavik et al., 2000 – Fjærtoft et al, 2004 1-year follow-up study; Fjærtoft et al, 2011 5-year follow-up study –; and Mayo et al., 2000) investigated the effects of early supported discharge on activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. among patients with stroke.

The first high quality RCT (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. There was no significant between-group difference in patients’ activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. (Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index) at 3 months post-stroke.

A 6-month follow-up to the study by Widén Holmqvist et al. (1998) (von Koch et al., 2000) revealed a significant between-group difference in only one activity (Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index washing subscore), in favour of early supported discharge compared to conventional rehabilitation.

A 12-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2001) found no significant between-group differences in patients’ activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. (Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index) at 12 months post-stroke.

A 5-year follow-up to the study by Widén Holmqvist et al., (1998) (Thorsén et al., 2005) found significant between-group differences in patients’ activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. (Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index washing dishes, washing clothes and reading books subscores) at 5 years post-stroke, favoring early supported discharge compared to conventional care.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. There were no significant between-group differences in patients’ activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. (Adelaide Activity Profile) at 6 months post-stroke.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Indredavik et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received multidisciplinary home services that included a home assessment, discharge form the stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.), follow up rehabilitation program, out-patient clinic 4 weeks after discharge, and information meeting 3 months after discharge. Patients’ activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. was reported in a one-year follow-up study (Fjæroft et al, 2004). There were no significant between-group differences in activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. (Frenchay Activity Index) at 1 year post-stroke.

A five-year follow-up to the study by Indredavik et al. (2000) (Fjærtoft et al, 2011) also revealed no significant between-group difference in patients’ activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. (Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index) at 5 years post-stroke.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mayo et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive prompt discharge and home rehabilitation or usual care. The intervention group received home-based rehabilitation and nursing services for 4 weeks. There was a significant between-group difference in patients’ social participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. (Reintegration to Normal Living Index) in favour of prompt discharge compared to usual care at post-treatment (4 weeks), but differences did not remain significant at follow-up (3 months).

Conclusion: There is strong evidence (level 1a) from three high quality RCTs that early supported discharge is not more effective than conventional care for improving patient’s activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations..

Note: A fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported a significant difference in social participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in favour of prompt discharge and home rehabilitation compared to usual care, although results did not remain significant long-term. This study used a measure of social participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. (Reintegration to Normal Living Index) different to the measures of activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. used in other studies (Adelaide ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Profile and Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index), which may account for this discrepancy in results among studies.

One high quality RCT (Anderson et al., 2000) investigated the effects of early supported discharge on process measures (adverse events) following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCT randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. Process measures included length of stay/total bed days, use of health services, institutionalization, frequency of readmissions and incidence of adverse events (death or falls). This study only reported results at 6-month follow-up. Significant between-group differences were found in length of stay/total bed days only, favoring early supported discharge compared to conventional care. There were no other significant between-group differences in patient outcomes at 6 months.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that there is no significant difference in incidence of adverse events between early supported discharge and conventional care.

One high quality RCT (Widén Holmqvist et al., 1998 and von Koch et al., 2000, von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) investigated the effect of early supported discharge on aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. There was no significant between-group difference in patients’ aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quotient) at 3 months post-stroke.

A 6-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2000) revealed a significant between-group difference in aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (Reinvang AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Test literal paraphrasia subscore only), favoring conventional therapy compared to early supported discharge.

A 12-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2001) found no significant between-group differences in aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (Reinvang AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Test) at 12 months post-stroke.

A 5-year follow-up to the study by Widén Holmqvist et al., (1998) (Thorsén et al., 2005) found no significant between-group differences in aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (Reinvang AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Test ) at 5 years post-stroke.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. There were no significant between-group differences in aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) (Frenchay AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) ScreeningTesting for disease in people without symptoms.
Test) at 12 months post-stroke.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fairquality RCTthat early supported discharge is not more effective than conventional care for improving patients’ aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada). In fact, one study noted significantly better literal paraphrasia following conventional care compared to early supported discharge at 6 months post-stroke.

Two high quality RCTs (Widén Holmqvist et al., 1998 and von Koch et al., 2000, von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies; Askim et al., 2006) investigated the effect of early supported discharge on balance in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. There was no significant between-group difference in patients’ self-reported incidence of falls at 3 months post-stroke.

A 6-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2000) revealed no significant between-group difference in patients’ self-reported incidence of falls at 6 months post-stroke.

A 12-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2001) found no significant between-group differences in patients’ self-reported incidence of falls at 12 months post-stroke.

A 5-year follow-up to the study by Widén Holmqvist et al., (1998) (Thorsén et al., 2005) found no significant between-group differences in patients’ self-reported incidence of falls at 5 years post-stroke.

The second high quality RCT (Askim et al., 2006) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received early supported discharge and home-based rehabilitation for 4 weeks post-discharge whereas the OSUS group received regular inpatient rehabilitation. There were no significant between-group differences in balance (Berg Balance Scale) at 6, 26, or 52 weeks post-stroke.

Conclusion: There is strong evidence (level 1 a) from two high quality RCTs that early supported discharge is not more effective than conventional care for improving balance following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Two high quality RCTs (Anderson et al., 2000; Indredavik et al., 2000 and Fjærtoft et al, 2004 and Fjærtoft et al, 2011 follow-up studies) and one fair quality RCT(Rudd et al., 1997) investigated the effect of early supported discharge on cognition following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. There were no significant between-group differences in patients’ cognitive function (Mini Mental State Examination) at 6 months post-stroke.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Indredavik et al., 2000) randomized patients with acute stroke to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received multidisciplinary home services that included a home assessment, discharge form the stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.), follow up rehabilitation program, out-patient clinic 4 weeks after discharge, and information meeting 3 months after discharge. Patients’ cognition was reported in a one-year follow-up study (Fjærtoft et al, 2004). There were no significant between-group differences in cognition (Mini Mental State Examination) at 1 year post-stroke.

A five-year follow-up to the study by Indredavik et al. (2000) (Fjærtoft et al, 2011) also revealed no significant between-group difference in cognition (Mini Mental State Examination ) at 5 years post-stroke.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. There were no significant between-group differences in patients’ cognition (Mini-Mental State Examination) at 12 months post-stroke.

Conclusion: There is moderate evidence (level 1a) from two high quality RCTs and one fairquality RCTthat early supported discharge is not more effective than conventional care for improving cognition following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Two high qualities RCTs (Ronning & Guldvog, 1998; Widén Holmqvist et al., 1998 and von Koch et al., 2000, von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies) and one fair quality RCT(Suwanwela et al., 2002 investigated the effects of early supported discharge on process measures (dependency) following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Two high qualities RCTs (Ronning & Guldvog, 1998; Widén Holmqvist et al., 1998 and von Koch et al., 2000, von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies) and one fair quality RCT (Suwanwela et al., 2002 investigated the effects of early supported discharge on process measures (dependency) following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Ronning & Guldvog, 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive municipality rehabilitation or hospital rehabilitation. Municipality rehabilitation comprised nursing home rehabilitation on inpatient or day-patient basis, and further ambulatory rehabilitation by a visiting physical therapistIn charge of the “assessment and treatment of motor functioning, including motor control, strength and physical conditioning; balance, gait and mobility retraining; home and community visits; patient and family education regarding mobility and safety issues.” (Suggested by Philips et al, 2002)
, speech therapist and/or nurse. Hospital rehabilitation was provided in a generalized hospital rehabilitation unit that provided coordinated multidisciplinary rehabilitation consisting of nursing care, physical, occupational and speech therapy, social work and neurologistThis team member is responsible for “the diagnostic evaluation, medical treatment, prevention of stroke recurrence, patient and family education, staff and trainee education, research, program evaluation.”(Suggested by Philips et al, 2002)
services. Process measures included mortality, institutionalization and dependency (Barthel Index score of <75). While no significant between-group differences in individual process measures were found, there was a significant between-group difference in combined death/dependency rates, in favour of hospital rehabilitation compared to municipality rehabilitation. Further, there were significant between-group differences in dependency and death/dependency rates among patients with moderate to severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., in favour of hospital rehabilitation vs. municipality rehabilitation. Among patients with mild strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (BI score ≥50) there was a significant between-group difference in need of long-term care (p=0.02), in favour of municipality rehabilitation compared to hospital rehabilitation.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge with home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. Process measures taken at 3 months post-stroke included length of stay, mortality, service use and dependency. Significant between-group differences in length of stay only were found, favoring early supported discharge and home rehabilitation compared to conventional rehabilitation.

A 6-month follow-up to the Widén Holmqvist et al., (1998) study (von Koch et al., 2000) found no significant between-group differences in process measures (length of stay, mortality, service use) at 6 months post-stroke.

A 12-month follow-up to the Widén Holmqvist et al., (1998) study (von Koch et al., 2001) found significant between-group differences in use of primary care and home rehabilitation services, whereby patients in the conventional rehabilitation received more outpatient occupational therapy, private physiotherapy and day-hospital services, whereas patients in the early supported discharge and home rehabilitation group received more nursing and home rehabilitation services. There were no significant between-group differences in other process measures (mortality, dependency, cost of health care).

A 5-year follow up to the Widén Holmqvist et al. (1998) study (Thorsén et al., 2005) found no significant between-group differences in process measures (mortality, dependency) at 5 years post-stroke.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Suwanwela et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early discharge and home rehabilitation or conventional rehabilitation. The home rehabilitation intervention consisted of 3 days hospitalization followed by home interventions for 10 consecutive days and follow-up by visits in the 2nd week, at 1, 3, and 6 months. Process measures included mortality and dependency. There were no significant between-group differences in process measures.

Conclusion: There is strong evidence (level 1a) from two high quality RCTand one fairquality RCTthat there is no significant difference in dependency rates between early supported discharge and conventional care.

Five high quality RCTs (Anderson et al., 2000; Bautz-Holter et al., 2002; Donnelly et al., 2004; Rodgers et al., 1997; Indredavik et al., 2000 and Fjærtoft et al., 2004 follow-up study), one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) investigated the effects of early supported discharge on mood and emotional wellbeing of carers of patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. There were no significant between-group differences in carers’ emotional wellbeing (General Health Questionnaire-28, Caregiver Strain Index) at 6 months post-stroke.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bautz-Holter et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional hospital rehabilitation. Patients in the early supported discharge group received multidisciplinary home rehabilitation, followed by outpatient clinic services. There were no significant between-group differences in carers’ emotional wellbeing (General Health Questionnaire-20) at 3 or 6 months post-stroke.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Donnelly et al., 2004) randomly assigned patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or usual hospital rehabilitation. The early discharge group received multidisciplinary home services for 3 months (average of 2.5 visits a week/45 minutes per session). There were no significant between-group differences in carers’ emotional wellbeing (Caregiver Strain Index) at 12 months post-stroke.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rodgers et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early supported discharge group received home rehabilitation services from a community-based multidisciplinary strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. discharge team 5 days/week for a median of 9 weeks (range 1-44 weeks). There were no significant between-group differences in carers’ emotional wellbeing (General Health Questionnaire-30) at 7-10 days post discharge or at 3 months post-stroke.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Indredavik et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received multidisciplinary home services that included a home assessment, discharge form the stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.), follow up rehabilitation program, out-patient clinic 4 weeks after discharge, and information meeting 3 months after discharge. Carers’ emotional wellbeing was reported in a 1-year follow-up fair quality RCT (Fjærtoft et al., 2004). There were no significant between-group differences in carers’ emotional wellbeing (Caregiver Strain Index) at 1 year post-stroke.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to specialist community rehabilitation or conventional hospital care. The specialist community rehabilitation group received an individualised multidisciplinary daily care plan for up to 3 months. There were no significant between-group differences in carers’ emotional wellbeing (Caregiver Strain Index) at 12 months post-stroke.

The quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 20055) allocated patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to an intervention group that received intensified transition consisting of education and support for patients and carers prior to and following discharge (ST+IT), or a control group that received standard transition (ST). There were no significant between-group differences in carers’ emotional wellbeing (Zerssen DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale and the Burden Scale for Family Caregivers) at 4 weeks or 6 months post-discharge.

Conclusion: There is strong evidence (level 1a) from five high quality RCTs, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
that early supported discharge is not more effective than conventional care for improving carers’ emotional wellbeing.

Five high quality RCTs (Rodgers et al., 1997; Anderson et al., 2000; Indredavik et al., 2000 and Fjærtoft et al., 2004 follow-up study; Bautz-Holter et al., 2002; Widén Holmqvist et al., 1998 and von Koch et al., 2000 and von Koch et al., 2001 follow-up studies) and two fair quality RCTs (Hui et al., 1995; Rudd et al., 1997) investigated the effects of early supported discharge on mood and emotional wellbeing of patients following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rodgers et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early supported discharge group received home rehabilitation services from a multidisciplinary community-based strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. discharge team for 5 days/week for a median of 9 weeks (range 1-44 weeks). There were no significant between-group differences in patients’ mood (Wakefield DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale) at 7-10 days post discharge or at 3 months post-stroke.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. There were no significant between-group differences in patients’ emotional wellbeing (General Health Questionnaire – 28) at 6 months post-stroke.

The third high quality RCT (Indredavik et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received multidisciplinary home services that included a home assessment, discharge form the stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.), follow up rehabilitation program, out-patient clinic 4 weeks after discharge, and information meeting 3 months after discharge. Patients’ mood was reported in a 1-year follow-up study (Fjærtoft et al., 2004). There were no significant between-group differences in patients’ mood (Montgomery Asberg DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale) at 1 year post-stroke.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bautz-Holter et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional hospital rehabilitation. Patients in the early supported discharge group received multidisciplinary home rehabilitation, followed by outpatient clinic services. There was a significant between-group difference in patients’ emotional wellbeing (General Health Questionnaire-20) in favour of early supported discharge compared to conventional hospital rehabilitation at 3 months post-stroke, but this did not remain significant at 6 months post-stroke. There were no significant differences in other measures of mood (Montgomery Asberg DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Rating Scale) at 3 or 6 months post-stroke.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. Patient’s emotional wellbeing was reported in a 6-month follow-up study (von Koch et al., 2000). There were no significant between-group differences in patients’ emotional wellbeing (Sense of Coherence Test) at 6 months post-stroke.

A 12-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2001) also found no significant between-group differences in patients’ emotional wellbeing (Sense of Coherence Test) at 12 months post-stroke.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hui et al., 1995) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early supported discharge (ESD) geriatrician team or a conventional medical care team. Patients in the ESD team were discharged home with day hospital rehabilitation and management by a geriatrician. There were no significant between-group differences in patients’ mood (Geriatric DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale) at 3 or 6 months post-stroke.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. There were no significant between-group differences in patients’ emotional wellbeing (Hospital Anxiety and DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale) at 12 months post-stroke.

Conclusion: There is strong evidence (level 1a) from five high quality RCTs and two fairquality RCTs that early supported discharge is not more effective than conventional care for improving patients’ mood and emotional wellbeing.
Note: A high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. did report significant between-group differences in emotional wellbeing at 3 months post-stroke in favour of early supported discharge, but results were not maintained at 6 months post-stroke. This study measured patients’ emotional wellbeing using the GHQ-20, whereas other studies used the GHQ-28 or other measures of mood and emotional wellbeing.

One high quality RCT (Anderson et al., 2000) investigated the effects of early supported discharge on carers’ perception of family dynamics following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. There were no significant between-group differences in family dynamics (McMaster Family Assessment Device – general functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
) reported by carers at 6 months post-stroke.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that early supported discharge is not more effective than conventional care for improving carers’ perception of family dynamics following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Anderson et al., 2000) investigated the effects of early supported discharge on patients’ perception of family dynamics following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. There were no significant between-group differences in family dynamics (McMaster Family Assessment Device – general functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
) reported by patients at 6 months post-stroke.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that early supported discharge is not more effective than conventional care for improving patients’ perception of family dynamics following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Eight high quality RCTs (Rodgers et al., 1997; Ronning & Guldvog, 1998; Widén Holmqvist et al., 1998 –von Koch et al., 2000, von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies –; Anderson et al., 2000; Indredavik et al., 2000 – Fjærtoft et al., 2011 follow-up study–; Mayo et al., 2000; Bautz-Holter et al., 2002; Donnelly et al., 2004), three fair quality RCTs (Hui et al., 1995; Rudd et al., 1997; Suwanwela et al., 2002), one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Shyu et al., 2010) and two quasi-experimental studies (Gräsel et al., 2005; Pessah-Rasmussen & Wendel, 2009) investigated the effect of early supported discharge on patients’ functional independence following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rodgers et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early supported discharge group received home rehabilitation services from a multidisciplinary community-based stroke discharge team for 5 days/week for a median of 9 weeks (range 1-44 weeks). There were no significant between-group differences in patients’ functional ability (Nottingham Extended ADL Scale, Oxford Handicap Scale) at 7-10 days post-discharge or at 3 months post-stroke.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Ronning & Guldvog, 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive municipality rehabilitation or standard hospital rehabilitation. Municipality rehabilitation comprised nursing home rehabilitation on inpatient or day-patient basis, and further ambulatory rehabilitation by a visiting physical therapistIn charge of the “assessment and treatment of motor functioning, including motor control, strength and physical conditioning; balance, gait and mobility retraining; home and community visits; patient and family education regarding mobility and safety issues.” (Suggested by Philips et al, 2002)
, speech therapist and/or nurseIn charge of, but not limited to, the “assessment and provision of care needs; support and education for patients and families; discharge planning.”(Suggested by Philips et al, 2002)
. There were no significant between-group differences in patients’ functional independence (Barthel Index) at 7 months post-stroke.

Note: Subgroup analysis showed a significant between-group difference among patients with moderate to severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (BI score <50) in functional independence (Barthel Index) at 7 months, in favour of hospital rehabilitation compared to municipality rehabilitation. There were no significant between-group differences in the subgroup of patients with mild strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (BI score ≥50).

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. There were no significant between-group differences in patients’ functional independence (Barthel ADL Index, Katz ADL Index, Extended Katz ADL Index) at 3 months post-stroke.

A 6-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2000) found no significant between-group differences in functional independence (Barthel Index, Katz ADL Index, Extended Katz ADL Index) at 6 months post-stroke.

Note: there was a significant between-group difference in functional mobility (Barthel ADL Index mobility subscore), in favour of early supported discharge compared to conventional rehabilitation.

A 12-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2001) found no significant between-group differences in patients’ functional independence (Barthel ADL Index, Katz ADL Index, Extended Katz ADL index) at 12 months post-stroke.

A 5-year follow-up to the study by Widén Holmqvist et al., (1998) (Thorsén et al., 2005) found no significant between-group differences in patients’ functional independence (Barthel ADL Index, Katz ADL index) at 5 years post-stroke. However, there was a significant between-group difference in extended ADLs (Extended Katz ADL Index), in favour of early supported discharge compared to conventional care.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. There were no significant between-group differences in patients’ functional independence (modified Barthel Index) at 6 months post-stroke.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Indredavik et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received multidisciplinary home services that included a home assessment, discharge form the stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.), follow up rehabilitation program, out-patient clinic 4 weeks after discharge, and information meeting 3 months after discharge. There were no significant between-group differences in patients’ functional independence (Barthel Index, Modified Rankin Scale) at 6 weeks post-stroke. There was a significant between-group difference in Modified Rankin Scale scores at 26 weeks post-stroke, favoring the ESUS compared to the OSUS. There were no significant differences in Barthel Index scores at 26 weeks post-stroke.

Note: subgroup analysis at 26 weeks post-stroke revealed significant between-group differences in patients’ functional ability (Barthel Index and Modified Rankin Scale) among patients with moderate to severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., in favour of the ESUS compared to the OSUS.

A five-year follow-up to the study by Indredavik et al. (2000) (Fjærtoft et al., 2011) found no significant between-group difference in patients’ functional independence (Barthel Index and Modified Rankin Scale) at 5 years post-stroke.

The sixth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mayo et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive prompt discharge and home rehabilitation or usual care. The intervention group received home-based rehabilitation and nursing services for 4 weeks. There were no significant between-group differences in patients’ functional independence (Barthel Index, Older American Resource Scale for Instrumental ADLs) at post-treatment (4 weeks). There was a significant between-group difference in instrumental activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living (Older American Resource Scale for Instrumental ADLs) at follow-up (3 months post-stroke), in favour of prompt discharge compared to usual care.

The seventh high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bautz-Holter et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional hospital rehabilitation. The early supported discharge group received multidisciplinary rehabilitation at home for as long as considered necessary followed by outpatient clinic intervention. There were no significant between-group differences in patients’ functional independence (Nottingham Extended ADL) at 3 or 6 months post-stroke.

The eighth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Donnelly et al., 2004) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early hospital discharge or usual hospital rehabilitation. The early discharge group received multidisciplinary home services for 3 months (average of 2.5 visits a week, 45 minutes per session). There were no significant between-group differences in patients’ functional independence (Barthel Index, Nottingham ADL scale) at 12 months post-stroke.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hui et al., 1995) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early supported discharge (ESD) geriatrician team or a conventional medical team. Patients in the ESD group were discharged home with day hospital rehabilitation and management by a geriatrician. There was no significant between-group difference in functional independence (Barthel Index) at 3 or 6 months post-stroke.

Note: There was a significant between-group difference in BI change scores from baseline to 3 months post-stroke in a subgroup of patients with BI scores ≤15, in favour of ESD compared to conventional medical care.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. There were no significant between-group differences in patients’ functional independence (Barthel Index, Rivermead Activity of Daily Living Scale) at 12 months post-stroke.

The third fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Suwanwela et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early discharge and home rehabilitation or conventional rehabilitation. Home rehabilitation intervention consisted of 3 days hospitalization followed by home interventions for 10 consecutive days and follow-up by visits. There were no significant between-group differences in patients’ functional independence (Barthel Index) at 6 months post-stroke.

The poor quality study (Shyu et al., 2009) randomised patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to receive a caregiver-oriented discharge preparation programme that comprised health education, referrals and problem-solving“Goal-directed cognitive activity that arises in situations for which no response is immediately apparent or available” (Luria, 1966; as cited in (Rath et al., 2004))
support, or routine discharge services. There were no significant between-group differences in patients’ functional independence (Chinese Barthel Index) at 1, 3, 6 or 12 months post-discharge.

The first quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) allocated patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to an intervention group that received intensified transition consisting of education and support for patients and carers prior to and following discharge (ST+IT), or a control group that received standard transition (ST). There were no significant between-group differences in patients’ functional independence (Barthel Index, Functional Independence Measure) at 4 weeks or 6 months post-discharge.

The second quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Pessah-Rasmussen & Wendel, 2009) assigned patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge (ESD) that consisted of a pre-discharge home visit, coordinated planned discharge from the hospital and post-discharge multidisciplinary care. Patients demonstrated a significant improvement in functional independence (Katz ADL Index) at post-treatment (feeding, transfers, toileting, dressing, bathing grooming and communication) and at 6 months post-stroke (transfers, dressing), but no significant improvements were seen at 12 months post-stroke.

Conclusion: There is strong evidence (level 1a) from eight high quality RCTs, three fairquality RCTs, one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
that early supported discharge is not more effective than conventional care for improving patients’ functional independence following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Note: However, 1 RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported better instrumental ADLs at 3 months, 1 RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported better functional independence at 6 month, and 1 RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported better functional mobility at 6 months and better extended ADLs at 5 years post-stroke, all in favour of early supported discharge compared to usual care. Furthermore, a second quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
found a significant improvement in the short term for certain aspects of functional independence in patients who received early supported discharge.

Note: There is conflicting evidence regarding the effectiveness of early supported discharge for patients with moderate to severe impairment. One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that patients with moderate to severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. demonstrated better functional independence following hospital rehabilitation compared to early supported discharge with municipality rehabilitation; another high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and a fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported better functional independence or better gains in functional independence among patients with moderate to severe impairment who receive early supported discharge compared to those who received conventional care.

Two high quality RTCs (Widén Holmqvist et al., 1998; Anderson et al., 2000) and one poor quality RCT (Shyu et al., 2009) investigated the effects of early supported discharge on health-related quality of life of carers following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. There were no significant between-group differences in carers’ quality of life (measured according to time spent helping the patient with instrumental and self-care ADLs) at 3 months post-stroke.

The second high quality RCT (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early supported discharge group received multidisciplinary rehabilitation at home for 5 weeks. There was a significant between-group difference in carers’ health related quality of life (Medical Outcomes Study Short Form – 36 mental health score only) at 6 months post-stroke, in favour of conventional care compared to early supported discharge.

The poor quality study (Shyu et al., 2009) randomised patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to receive a caregiver-oriented discharge preparation programme that comprised health education, referrals and problem-solving“Goal-directed cognitive activity that arises in situations for which no response is immediately apparent or available” (Luria, 1966; as cited in (Rath et al., 2004))
support, or routine discharge services. Carers’ quality of life was measured by the Medical Outcomes Study Short Form (SF-36) at 1, 3, 6 and 12 months post-discharge. At 3 months carers in the intervention group scored significantly worse on the SF-36 social functioning subtest than carers in the control group. No other between-group differences were seen at any time point.

Conclusion: There is strong evidence (level 1a) from two high quality RCTs and one poorquality RCTthat early supported discharge is not more effective than conventional care in improving carers’ health-related quality of life in the acute care period. In fact, one highquality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported significantly better mental health and one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported significant better social functioning among carers following conventional care compared to early supported discharge.

Note: The authors of the poor quality study commented that the discharge preparation programme is likely to have increased carers’ awareness of the demands of caregiving, thus contributing to a consequent reduction in social activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
. The study also found lower rates of institutionalization at 6 to 12 months post-discharge in the intervention group than the control group, which may have increased burden among carers in the intervention group and contributed to poorer social functioning.

Four high qualities RTCs (Ronning & Guldvog, 1998; Anderson et al., 2000; Mayo et al., 2000; Donnelly et al., 2004), one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Shyu et al., 2009) and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) investigated the effects of early supported discharge on patients’ health-related quality of life following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Ronning & Guldvog, 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive municipality rehabilitation or hospital rehabilitation. Municipality rehabilitation comprised nursing home rehabilitation on inpatient or day-patient basis, and further ambulatory rehabilitation by a visiting physical therapistIn charge of the “assessment and treatment of motor functioning, including motor control, strength and physical conditioning; balance, gait and mobility retraining; home and community visits; patient and family education regarding mobility and safety issues.” (Suggested by Philips et al, 2002)
, speech therapist and/or nurse. Hospital rehabilitation was provided in a generalized hospital rehabilitation unit that provided coordinated multidisciplinary rehabilitation consisting of nursing care, physical, occupational and speech therapy, social work and neurologistThis team member is responsible for “the diagnostic evaluation, medical treatment, prevention of stroke recurrence, patient and family education, staff and trainee education, research, program evaluation.”(Suggested by Philips et al, 2002)
services. There were no significant between-group differences in patients’ health-related quality of life (Medical Outcomes Study Short Form – SF 36) at 7 months post-stroke.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early supported discharge group received multidisciplinary rehabilitation at home for 5 weeks. There were no significant between-group differences in patients’ health related quality of life (SF-36) at 6 months post-stroke.

The third high quality RCT (Mayo et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive prompt discharge and home rehabilitation or usual care. The intervention group received a home rehabilitation program for 4 weeks consisting of tailor-made rehabilitation and nursing services. There were no significant between-group differences in patients’ health related quality of life (SF-36) at post-treatment (4 weeks). There was a significant between-group difference in quality of life related to physical health (SF-36 Physical Health and Physical Role subscales) at follow-up (3 months post-stroke), favoring prompt discharge and home rehabilitation compared to usual care.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Donnelly et al., 2004) randomly assigned patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early discharge rehabilitation service or usual hospital rehabilitation. The early discharge group received multidisciplinary home services for 3 months (average of 2.5 visits a week, 45 minutes per session). There was no significant between-group difference in patients’ health related quality of life (SF-36, EuroQoL, non-standardized quality of life questionnaire) at 12 months post-stroke.

The poor quality study (Shyu et al., 2009) randomised patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to receive a caregiver-oriented discharge preparation programme that comprised health education, referrals and problem-solving“Goal-directed cognitive activity that arises in situations for which no response is immediately apparent or available” (Luria, 1966; as cited in (Rath et al., 2004))
support, or routine discharge services. There were no significant between-group differences in patients’ health related quality of life (SF-36) at 1, 3, 6 and 12 months post-discharge.

The quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) allocated patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to an intervention group that received intensified transition consisting of education and support for patients and carers prior to and following discharge (ST+IT), or a control group that received standard transition (ST). There were no significant between-group differences in patients’ health-related quality of life (SF-36) at 4 weeks or 6 months post-discharge.

Conclusion: There is strong evidence (level 1a) from four high quality RCTs, one poorquality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
that early supported discharge is not more effective than conventional care for improving health-related quality of life among patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Note: One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found a significant between-group difference in quality of life related to physical health at follow-up (3 months post-stroke), favoring prompt discharge and home rehabilitation compared to usual care.

One high quality RCT (Widén Holmqvist et al., 1998 and von Koch et al., 2001 follow-up study) and one quasi-experimental study(Gräsel et al., 2005) investigated the effects of early supported discharge on health status of carers of patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomised patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional rehabilitation. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months after discharge. Carers’ health status was reported in a 12-month follow-up study (von Koch et al., 2001). There were no significant between-group differences in carers’ health status (Sickness Impact Profile) at 12 months post-stroke.

The quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) allocated patients with stroke and their carers to an intervention group that received intensified transition consisting of education and support for patients and carers prior to and following discharge (ST+IT), or a control group that received standard transition (ST). There were no significant between-group differences in carers’ health status (Giessen Symptom List) at 4 weeks or 6 months post-discharge.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one quasi-experimental studythat early supported discharge is not more effective than conventional care for improving carers’ health status.

Four high qualities RCTs (Rodgers et al., 1997; Widén Holmqvist et al., 1998 and von Koch et al., 2000, von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies; Anderson et al., 2000; Indredavik et al., 2000 and Fjærtoft et al., 2004 follow-up study) and two fair qualities RCTs (Hui et al., 1995; Rudd et al., 1997) investigated the effects of early supported discharge on patients’ health status following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Rodgers et al., 1997) randomized patients with acute stroke to receive early supported discharge or conventional care. The early supported discharge group received home rehabilitation services from a community-based multidisciplinary strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. discharge team 5 days/week for a median of 9 weeks (range 1-44 weeks). There were no significant between-group differences in patients’ health status (Dartmouth Coop Function Charts) at 7-10 days post discharge or at 3 months post-stroke.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute stroke to receive early supported discharge and home rehabilitation or conventional care. Early supported discharge and home rehabilitation comprised multidisciplinary home rehabilitation for 3-4 months. Significant between group differences in health status (Sickness Impact Profile – SIP, Psychological dimension, and emotional behavioural and communication subtests) were found at 3 months post-stroke, favoring conventional rehabilitation compared to early supported discharge.

A 6-month follow-up to the Widén Holmqvist et al. (1998) study (von Koch et al., 2000), found significant between-group differences in patients’ health status (SIP Communication subtest only) at 6 months post-stroke, this time favoring early supported discharge and home rehabilitation compared to conventional rehabilitation.

A 12-month follow-up to the Widén Holmqvist et al., (1998) study (von Koch et al., 2001) found no significant between-group differences in patients’ health status (Sickness Impact Profile) at 12 months post-stroke.

A 5-year follow-up to the Widén Holmqvist et al., (1998) study (Thorsén et al., 2005) found no significant between-group differences in patients’ health status (Sickness Impact Profile) at 5 years post-stroke.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early supported discharge group received multidisciplinary rehabilitation at home for 5 weeks. There were no significant between-group differences in patients’ health status (Nottingham Health Profile) at 6 months post-stroke.

The forth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Indredavik et al., 2000) randomized patients with acute stroke to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received multidisciplinary home services that included a home assessment, discharge form the stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.), follow up rehabilitation program, out-patient clinic 4 weeks after discharge, and information meeting 3 months after discharge. Patients’ health status was reported in a 1-year follow-up study (Fjærtoft et al., 2004). There were significant between-group differences in patients’ health status (Nottingham Health Profile) at 1 year post-stroke, favoring the ESUS group compared to the OSUS group.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hui et al., 1995) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early supported discharge (ESD) geriatrician team or a conventional medical team. Patients in the ESD group were discharged home with day hospital rehabilitation and management by a geriatrician. Patients’ health status was measured using non standardized general wellbeing and sleep quality scale. There were no significant between-group differences in patients’ health status (measured using non-standardized general wellbeing and sleep quality scales) at 3 or 6 months post-stroke.

The second fair quality RCT (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. There were no significant between-group differences in patients’ health status (Nottingham Health Profile) at 12 months post-stroke.

Conclusion: There is strong evidence (level 1a) from three high quality RCTs and two fairquality RCTs that early supported discharge is not more effective than conventional care for patients’ health status.

Note: While a high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found significant differences in health status (SIP psychological dimension, emotional behaviours and communication subtests) in favour of conventional rehabilitation at 3 months post-stroke, the study subsequently found significant differences in SIP communication scores in favour of early supported discharge at 6 months post-stroke. A second study found significant differences in health status in favour of early supported discharge compared to conventional care at 12 months post-stroke.

Five high qualities RCTs (Rodgers et al., 1997; Ronning & Guldvog, 1998; Anderson et al., 2000; Indredavik et al., 2000 and Fjærtoft et al., 2011 follow up study; Bautz-Holter et al., 2002;), one fair quality RCT (Rudd et al., 1997), one poor quality RCT (Shyu et al., 2009) and two quasi-experimental studies (Gräsel et al., 2005 and Gräsel et al., 2006 follow-up study; Pessah-Rasmussen & Wendel, 2009) investigated the effects of early supported discharge on process measures (institutionalisation) following stroke.

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rodgers et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early supported discharge group received multidisciplinary rehabilitation home services 5 days per week. Process measures included length of stay, readmission rates, institutionalization and mortality. Significant between-group differences were found in length of stay only, favoring early supported discharge compared to conventional care.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Ronning & Guldvog, 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive municipality rehabilitation or hospital rehabilitation. Municipality rehabilitation comprised nursing home rehabilitation on inpatient or day-patient basis, and further ambulatory rehabilitation by a visiting physical therapistIn charge of the “assessment and treatment of motor functioning, including motor control, strength and physical conditioning; balance, gait and mobility retraining; home and community visits; patient and family education regarding mobility and safety issues.” (Suggested by Philips et al, 2002)
, speech therapist and/or nurseIn charge of, but not limited to, the “assessment and provision of care needs; support and education for patients and families; discharge planning.”(Suggested by Philips et al, 2002)
. Hospital rehabilitation was provided in a generalized hospital rehabilitation unit that provided coordinated multidisciplinary rehabilitation consisting of nursing care, physical, occupational and speech therapy, social work and neurologistThis team member is responsible for “the diagnostic evaluation, medical treatment, prevention of stroke recurrence, patient and family education, staff and trainee education, research, program evaluation.”(Suggested by Philips et al, 2002)
services. Process measures included mortality, institutionalization and dependency (Barthel Index score of <75). While no significant between-group differences in individual process measures were found, there was a significant between-group difference in combined death/dependency rates, in favour of hospital rehabilitation compared to municipality rehabilitation. Further, there were significant between-group differences in dependency and death/dependency rates among patients with moderate to severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., in favour of hospital rehabilitation vs. municipality rehabilitation. Among patients with mild strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (BI score ≥50) there was a significant between-group difference in need of long-term care (p=0.02), in favour of municipality rehabilitation compared to hospital rehabilitation.

The third high quality RCT (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. Process measures included length of stay/total bed days, use of health services, institutionalization, frequency of readmissions and incidence of adverse events (death or falls). Significant between-group differences were found in length of stay/total bed days only, favoring early supported discharge compared to conventional care.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Indredavik et al., 2000) randomized patients with acute stroke to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received multidisciplinary home services that included a home assessment, discharge form the stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.), follow up rehabilitation program, out-patient clinic 4 weeks after discharge, and information meeting 3 months after discharge. Process measures included mortality, institutionalization and length of stay. Significant between-group differences were found in average length of stay in hospital (stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) and rehabilitation clinic) recorded at discharge, and number of patients discharged home vs. institutions recorded at discharge and 6 weeks post-stroke, favoring the ESUS compared to the OSUS. Differences in residential status were no longer significant at long-term follow-up (26 weeks post-stroke). There were no significant between-group differences in mortality rates.

A 5-year follow-up to the Indredavik et al., (2000) study (Fjærtoft et al., 2011) found significant between-group differences in mortality and institutionalization rates at 5 years post-stroke, favoring the ESUS compared to the OSUS.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bautz-Holter et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional hospital rehabilitation. The early supported discharge group received multidisciplinary rehabilitation at home for as long as considered necessary followed by outpatient clinic intervention. Process measures included use of health services, mortality and institutionalization. No significant between-group differences were found.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital and community care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. Process measures included length of stay, readmission rates, institutionalization, mortality and health service use. Significant between-group differences were found in length of stay only, favoring specialist community rehabilitation compared to conventional hospital and community care.

The poor quality study (Shyu et al., 2009) randomised patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to receive a caregiver-oriented discharge preparation programme that comprised health education, referrals and problem-solving“Goal-directed cognitive activity that arises in situations for which no response is immediately apparent or available” (Luria, 1966; as cited in (Rath et al., 2004))
support, or routine discharge services. Patient service use was measured at 1, 3, 6 and 12 months post-discharge according to length of hospital stay, hospital readmissions and institutionalisations. Patients in the intervention group demonstrated significantly less institutionalisation than patients in the control group 6 to 12 months post-discharge. There were no significant between-group differences in length of hospital stay or hospital readmissions at any time point.

The first quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) allocated patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to receive intensified transition consisting of education and support for patients and carers prior to and following discharge (ST+IT), or a control group that received standard transition (ST). Number of physician visits and newly appearing illnesses were measured at 4 weeks and 6 months post-discharge. Patients in the control group showed significantly more new illnesses than those in the intervention group at 4 weeks post-discharge, but this difference did not remain significant at 6 months. There was a significant between-group difference in the number of physician visits in favour of the intervention group compared to the control group at 6 months post-discharge (these differences were not present at four weeks post-discharge).

In a follow-up study (Gräsel et al., 2006), patients were contacted by telephone on average 31 months after discharge from hospital to determine whether the patient was (a) alive; and (b) living at home or in a nursing home. There was a significant difference between groups in the number of patients who were alive and living at home, in favour of the intervention group compared to the control group.

The second quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Pessah-Rasmussen & Wendel, 2009) assigned patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge (ESD) and compared results with a control strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. population. Early supported discharge services consisted of a pre-discharge home visit, coordinated planned discharge from the hospital and post-discharge multidisciplinary care. Process measures included length of stay and institutionalization. A significant between-group difference was found in number of patients living alone, favoring ESD compared to the control cohort.

Conclusion: There is strong evidence (level 1a) from five high quality RCTs, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and two quasi-experimental studies that there is no significant difference in institutionalisation rates between early supported discharge and conventional care.

Six high qualities RCTs (Rodgers et al., 1997; Widén Holmqvist et al., 1998 and von Koch et al., 2000, follow-up study; Anderson et al., 2000; Indredavik et al., 2000; Mayo et al., 2000; Donnelly et al., 2004), two fair qualities RCTs (Hui et al., 1995;Rudd et al., 1997), one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Shyu et al., 2009) and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Pessah-Rasmussen & Wendel, 2009) investigated the effects of early supported discharge on process measures (length of stay) following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rodgers et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early supported discharge group received multidisciplinary rehabilitation home services 5 days per week. Process measures included length of stay, readmission rates, institutionalization and mortality. Significant between-group differences were found in length of stay only, favoring early supported discharge compared to conventional care.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge with home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. Process measures taken at 3 months post-stroke included length of stay, mortality, service use and dependency. Significant between-group differences in length of stay only were found, favoring early supported discharge and home rehabilitation compared to conventional rehabilitation.

A 6-month follow-up to the Widén Holmqvist et al., (1998) study (von Koch et al., 2000) found no significant between-group differences in process measures (length of stay, mortality, service use) at 6 months post-stroke.

The third high quality RCT (Anderson et al., 2000) randomized patients with acute stroke to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. Process measures included length of stay/total bed days, use of health services, institutionalization, frequency of readmissions and incidence of adverse events (death or falls). Significant between-group differences were found in length of stay/total bed days only, favoring early supported discharge compared to conventional care.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Indredavik et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received multidisciplinary home services that included a home assessment, discharge form thestroke unit, follow up rehabilitation program, out-patient clinic 4 weeks after discharge, and information meeting 3 months after discharge. Process measures included mortality, institutionalization and length of stay. Significant between-group differences were found in average length of stay in hospital (stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) and rehabilitation clinic) recorded at discharge, and number of patients discharged home vs. institutions recorded at discharge and 6 weeks post-stroke, favoring the ESUS compared to the OSUS. Differences in residential status were no longer significant at long-term follow-up (26 weeks post-stroke). There were no significant between-group differences in mortality rates.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mayo et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive prompt discharge and home rehabilitation or usual care. The intervention group received a home rehabilitation program for 4 weeks consisting of tailor-made rehabilitation and nursing services. Process measures included length of stay and health services use. Significant between-group differences were found in length of stay, favoring the intervention group.

The sixth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Donnelly et al., 2004) randomly assigned patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to early hospital discharge or usual hospital rehabilitation. The early discharge group received multidisciplinary home services for 3 months (average of 2.5 visits a week, 45 minutes per session). Process measures included length of stay, service use and cost. Significant between-group differences were found in use of occupational therapy, social work and rehabilitation assistant services (but not physiotherapy or Meals on Wheels services), favoring early discharge rehabilitation compared to conventional rehabilitation. There were no significant between-group differences in length of stay or cost.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hui et al., 1995) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early supported discharge (ESD) team managed by a geriatrician or a conventional medical team managed by a neurologistThis team member is responsible for “the diagnostic evaluation, medical treatment, prevention of stroke recurrence, patient and family education, staff and trainee education, research, program evaluation.”(Suggested by Philips et al, 2002)
. Patients in the ESD team were managed by a geriatrician and received rehabilitation at a day hospital. Process measures included length of stay, mortality, health service use (readmissions, outpatient services and community services) and cost. Significant between-group differences were found in number of outpatient visits only, favoring ESD compared to conventional care.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital and community care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. Process measures included length of stay, readmission rates, institutionalization, mortality and health service use. Significant between-group differences were found in length of stay only, favoring specialist community rehabilitation compared to conventional hospital and community care.

The poor quality study (Shyu et al., 2009) randomised patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to receive a caregiver-oriented discharge preparation programme that comprised health education, referrals and problem-solving“Goal-directed cognitive activity that arises in situations for which no response is immediately apparent or available” (Luria, 1966; as cited in (Rath et al., 2004))
support, or routine discharge services. Patient service use was measured at 1, 3, 6 and 12 months post-discharge according to length of hospital stay, hospital readmissions and institutionalisations. Patients in the intervention group demonstrated significantly less institutionalisation than patients in the control group 6 to 12 months post-discharge. There were no significant between-group differences in length of hospital stay or hospital readmissions at any time point.

The quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Pessah-Rasmussen & Wendel, 2009) assigned patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge (ESD) and compared results with a control strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. population. Early supported discharge services consisted of a pre-discharge home visit, coordinated planned discharge from the hospital and post-discharge multidisciplinary care. Process measures included length of stay and institutionalization. A significant between-group difference was found in number of patients living alone, favoring ESD compared to the control cohort.

Conclusion: There is strong evidence (level 1a) from five high quality RCTs and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that there is a significant difference in length of stay following early supported discharge compared to usual care.

Note: However, one high quality RCT, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one quasi experimental study found no significant between-group differences following early supported discharge.

Four high quality RCTs (Widén Holmqvist et al., 1998 and von Koch et al., 2000 and von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies; Mayo et al., 2000; Donnelly et al., 2004; Askim et al., 2006), one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) investigated the effect of early supported discharge on patients’ mobility following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. There was no significant between-group difference in mobility (10m walking test) at 3 months post-stroke.

A 6-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2000) revealed no significant between-group difference in mobility (10m walking test) at 6 months post-stroke.

A 12-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2001) found no significant between-group differences in mobility (10m walking test) at 12 months post-stroke.

A 5-year follow-up to the study by Widén Holmqvist et al., (1998) (Thorsén et al., 2005) found no significant between-group differences in mobility (10m walking test) at 5 years post-stroke.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mayo et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive prompt discharge and home rehabilitation or usual care. The intervention group received home-based rehabilitation and nursing services for 4 weeks. There were no significant between-group differences in patients’ movement and mobility (StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Rehabilitation Assessment of Movement, Timed Up and Go Test) at post-treatment (4 weeks) or follow-up (3 months post-stroke).

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Donnelly et al., 2004) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early hospital discharge or usual hospital rehabilitation. The early discharge group received multidisciplinary home services for 3 months (average of 2.5 visits a week, 45 minutes per session). There were no significant between-group differences in patients’ mobility (10 meter timed walk test) at 12 months post-stroke.

The fourth high quality RCT (Askim et al., 2006) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received early supported discharge and home-based rehabilitation for 4 weeks post-discharge whereas the OSUS group received regular inpatient rehabilitation. There were no significant between-group differences in walking speed (5 Meter Walking Test) at 6, 26, or 52 weeks post-stroke.
Note: There was a significant between-group difference in walking speed at 1 week post-stroke (while both groups were receiving the same treatment), in favour of the OSUS group compared to the ESUS group.

The fair quality RCT (Rudd et al., 1997) randomized patients with acute stroke to receive specialist community rehabilitation or conventional hospital care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. There were no significant between-group differences in mobility (5 Meter Walking Test) at 12 months post-stroke.

The quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) allocated patients with acute stroke and their carers to an intervention group that received intensified transition consisting of education and support for patients and carers prior to and following discharge (ST+IT), or a control group that received standard transition (ST). There were no significant between-group differences in mobility (Timed Up and Go Test) at 4 weeks or 6 months post-discharge.

Conclusion: There is strong evidence (level 1a) from four high quality RCTs, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
that early supported discharge is not more effective than conventional care in improving patients’ mobility following stroke.

Five high qualities RCTs (Rodgers et al., 1997; Ronning & Guldvog, 1998; Widén Holmqvist et al., 1998 and von Koch et al., 2000, von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies; Indredavik et al., 2000 and Fjærtoft et al., 2011 follow up study; Bautz-Holter et al., 2002) and three fair qualities RCTs (Hui et al., 1995;Rudd et al., 1997; Suwanwela et al., 2002) investigated the effects of early supported discharge on process measures (mortality) following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rodgers et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early supported discharge group received multidisciplinary rehabilitation home services 5 days per week. Process measures included length of stay, readmission rates, institutionalization and mortality. Significant between-group differences were found in length of stay only, favoring early supported discharge compared to conventional care.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Ronning & Guldvog, 1998) randomized patients with acute stroke to receive municipality rehabilitation or hospital rehabilitation. Municipality rehabilitation comprised nursing home rehabilitation on inpatient or day-patient basis, and further ambulatory rehabilitation by a visiting physical therapistIn charge of the “assessment and treatment of motor functioning, including motor control, strength and physical conditioning; balance, gait and mobility retraining; home and community visits; patient and family education regarding mobility and safety issues.” (Suggested by Philips et al, 2002)
, speech therapist and/or nurseIn charge of, but not limited to, the “assessment and provision of care needs; support and education for patients and families; discharge planning.”(Suggested by Philips et al, 2002)
. Hospital rehabilitation was provided in a generalized hospital rehabilitation unit that provided coordinated multidisciplinary rehabilitation consisting of nursing care, physical, occupational and speech therapy, social work and neurologistThis team member is responsible for “the diagnostic evaluation, medical treatment, prevention of stroke recurrence, patient and family education, staff and trainee education, research, program evaluation.”(Suggested by Philips et al, 2002)
services. Process measures included mortality, institutionalization and dependency (Barthel Index score of <75). While no significant between-group differences in individual process measures were found, there was a significant between-group difference in combined death/dependency rates, in favour of hospital rehabilitation compared to municipality rehabilitation. Further, there were significant between-group differences in dependency and death/dependency rates among patients with moderate to severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., in favour of hospital rehabilitation vs. municipality rehabilitation. Among patients with mild strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (BI score ≥50) there was a significant between-group difference in need of long-term care (p=0.02), in favour of municipality rehabilitation compared to hospital rehabilitation.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge with home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. Process measures taken at 3 months post-stroke included length of stay, mortality, service use and dependency. Significant between-group differences in length of stay only were found, favoring early supported discharge and home rehabilitation compared to conventional rehabilitation.

A 6-month follow-up to the Widén Holmqvist et al., (1998) study (von Koch et al., 2000) found no significant between-group differences in process measures (length of stay, mortality, service use) at 6 months post-stroke.

A 12-month follow-up to the Widén Holmqvist et al., (1998) study (von Koch et al., 2001) found significant between-group differences in use of primary care and home rehabilitation services, whereby patients in the conventional rehabilitation received more outpatient occupational therapy, private physiotherapy and day-hospital services, whereas patients in the early supported discharge and home rehabilitation group received more nursing and home rehabilitation services. There were no significant between-group differences in other process measures (mortality, dependency, cost of health care).

A 5-year follow up to the Widén Holmqvist et al. (1998) study (Thorsén et al., 2005) found no significant between-group differences in process measures (mortality, dependency) at 5 years post-stroke.

The fourh high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Indredavik et al., 2000) randomized patients with acute stroke to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received multidisciplinary home services that included a home assessment, discharge form thestroke unit, follow up rehabilitation program, out-patient clinic 4 weeks after discharge, and information meeting 3 months after discharge. Process measures included mortality, institutionalization and length of stay. Significant between-group differences were found in average length of stay in hospital (stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) and rehabilitation clinic) recorded at discharge, and number of patients discharged home vs. institutions recorded at discharge and 6 weeks post-stroke, favoring the ESUS compared to the OSUS. Differences in residential status were no longer significant at long-term follow-up (26 weeks post-stroke). There were no significant between-group differences in mortality rates.

A 5-year follow-up to the Indredavik et al., (2000) study (Fjæroft et al., 2011) found significant between-group differences in mortality and institutionalization rates at 5 years post-stroke, favoring the ESUS compared to the OSUS.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bautz-Holter et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional hospital rehabilitation. The early supported discharge group received multidisciplinary rehabilitation at home for as long as considered necessary followed by outpatient clinic intervention. Process measures included use of health services, mortality and institutionalization. No significant between-group differences were found.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hui et al., 1995) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early supported discharge (ESD) team managed by a geriatrician or a conventional medical team managed by a neurologistThis team member is responsible for “the diagnostic evaluation, medical treatment, prevention of stroke recurrence, patient and family education, staff and trainee education, research, program evaluation.”(Suggested by Philips et al, 2002)
. Patients in the ESD team were managed by a geriatrician and received rehabilitation at a day hospital. Process measures included length of stay, mortality, health service use (readmissions, outpatient services and community services) and cost. Significant between-group differences were found in number of outpatient visits only, favoring ESD compared to conventional care.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital and community care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. Process measures included length of stay, readmission rates, institutionalization, mortality and health service use. Significant between-group differences were found in length of stay only, favoring specialist community rehabilitation compared to conventional hospital and community care.

The third fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Suwanwela et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early discharge and home rehabilitation or conventional rehabilitation. The home rehabilitation intervention consisted of 3 days hospitalization followed by home interventions for 10 consecutive days and follow-up by visits in the 2nd week, at 1, 3, and 6 months. Process measures included mortality and dependency. There were no significant between-group differences in process measures.

Conclusion: There is strong evidence (level 1a) from five high quality RCTs and three fairquality RCTs that there is no significant difference in mortality rates following early supported discharge compared to conventional care.

One high quality RCT (Widén Holmqvist et al., 1998 and von Koch et al., 2000 and von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) investigated the effect of early supported discharge on patients’ motor skills following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. At 3 months post-stroke, there was a significant between-group difference in motor capacity (Lindmark Motor Capacity Assessment coordination subtest), favoring early supported discharge compared to conventional rehabilitation.

A 6-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2000) also revealed significant between-group differences in motor capacity (Lindmark Motor Capacity Assessment total maximal motor score) at 6 months post-stroke, in favour of early supported discharge compared to conventional rehabilitation.

A 12-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2001) found no significant between-group differences in patients’ motor capacity (Lindmark Motor Capacity Assessment) at 12 months post-stroke.

A 5-year follow-up to the study by Widén Holmqvist et al., (1998) (Thorsén et al., 2005) found no significant between-group differences in patients’ motor capacity (Lindmark Motor Capacity Assessment) at 5 years post-stroke.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. There were no significant between-group differences in patients’ motor abilities (Motricity Index) at 12 months post-stroke.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that early supported discharge is more effective than conventional care for improving patients’ motor capacity following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Note: Significant between-group differences were not maintained long term. A fair quality RCT found no significant between-group differences in patients’ motor abilities.

One poor quality RCT (Shyu et al., 2009) investigated the effects of early supported discharge on quality of care provided by carers of patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This poor quality study randomised patients with acute stroke and their carers to receive a caregiver-oriented discharge preparation programme that comprised health education, referrals and problem-solving“Goal-directed cognitive activity that arises in situations for which no response is immediately apparent or available” (Luria, 1966; as cited in (Rath et al., 2004))
support, or routine discharge services. There was a significant between-group difference in quality of care (Family Caregiving Consequence Inventory – frail elder outcome subscale) at 6 months, in favour of the intervention group compared to the control group, and caregivers in the intervention group provided significantly better overall quality of care in the first 12 months than those in the control group.

Conclusion: There is limited evidence (level 2b) from one poor quality RCT that early supported discharge is more effective than conventional care for improving carers’ quality of care.

Two high qualities RCTs (Rodgers et al., 1997; Anderson et al., 2000), two fair qualities RCTs (Hui et al., 1995; Rudd et al., 1997) and one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Shyu et al., 2009) investigated the effects of early supported discharge on process measures (readmission rates) following stroke.

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rodgers et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early supported discharge group received multidisciplinary rehabilitation home services 5 days per week. Process measures included length of stay, readmission rates, institutionalization and mortality. Significant between-group differences were found in length of stay only, favoring early supported discharge compared to conventional care.

The second high quality RCT (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. Process measures included length of stay/total bed days, use of health services, institutionalization, frequency of readmissions and incidence of adverse events (death or falls). Significant between-group differences were found in length of stay/total bed days only, favoring early supported discharge compared to conventional care.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hui et al., 1995) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early supported discharge (ESD) team managed by a geriatrician or a conventional medical team managed by a neurologistThis team member is responsible for “the diagnostic evaluation, medical treatment, prevention of stroke recurrence, patient and family education, staff and trainee education, research, program evaluation.”(Suggested by Philips et al, 2002)
. Patients in the ESD team were managed by a geriatrician and received rehabilitation at a day hospital. Process measures included length of stay, mortality, health service use (readmissions, outpatient services and community services) and cost. Significant between-group differences were found in number of outpatient visits only, favoring ESD compared to conventional care.

The second fair quality RCT (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital and community care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. Process measures included length of stay, readmission rates, institutionalization, mortality and health service use. Significant between-group differences were found in length of stay only, favoring specialist community rehabilitation compared to conventional hospital and community care.

The poor quality study (Shyu et al., 2009) randomised patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to receive a caregiver-oriented discharge preparation programme that comprised health education, referrals and problem-solving“Goal-directed cognitive activity that arises in situations for which no response is immediately apparent or available” (Luria, 1966; as cited in (Rath et al., 2004))
support, or routine discharge services. Patient service use was measured at 1, 3, 6 and 12 months post-discharge according to length of hospital stay, hospital readmissions and institutionalisations. Patients in the intervention group demonstrated significantly less institutionalisation than patients in the control group 6 to 12 months post-discharge. There were no significant between-group differences in length of hospital stay or hospital readmissions at any time point.

Conclusion: There is strong evidence (level 1a) from two high quality RCTs and two fair quality RCTs and one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that there is no significant difference in rate of readmission following early supported discharge compared to conventional care.

Four high quality RTCs (Widén Holmqvist et al., 1998 and von Koch et al., 2000, von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies; Anderson et al., 2000; Bautz-Holter et al., 2002; Donnelly et al., 2004) and two fair quality RCTs (Hui et al., 1995; Rudd et al, 1997) investigated the effects of early supported discharge on satisfaction among carers’ of patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Widén Holmqvist et al., 1998) randomized patients with acute stroke to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. No significant between-group differences in carers’ satisfaction (measured by non-standardized questionnaire) were found at 3 months post-stroke.

A 6-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2000) also found no significant between-group differences in carers’ satisfaction (measured by non-standardized questionnaire) at 6 months post-stroke.

A 12-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2001) also found no significant between-group differences in carers’ satisfaction (measured by non-standardized questionnaire) at 12 months post-stroke.

A 5-year follow-up to the study by Widén Holmqvist et al., (1998) (Thorsén et al., 2005) found no significant between-group differences in carers’ satisfaction (measured by non-standardized questionnaire) at 5 years post-stroke.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to the early supported discharge or the conventional care group. In the early discharge group, patients received multidisciplinary rehabilitation at home for 5 weeks. No significant between-group differences in carers’ satisfaction (measured by a non-standardized questionnaire) were found at 6 months post-stroke.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bautz-Holter et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional hospital rehabilitation. The early supported discharge group received multidisciplinary rehabilitation at home for as long as considered necessary followed by outpatient clinic intervention. No significant between-group differences in carers’ satisfaction (measured by a 5-point Likert scaleLikert scaling is one type of response to items in a questionnaire or tool. For example, Likert scaling would have you rate an item such as “I am satisfied with the care I received” on a scale using a 1-to-5 response scale where:
• 1 = strongly disagree
• 2 = disagree
• 3 = undecided
• 4 = agree
• 5 = strongly agree
You will find various options and scaling methods for the number of response choices (1-to-7, 1-to-9, 0-to-4). Odd-numbered scales usually have a middle value that is labelled Neutral or Undecided. Some tools used forced-choice Likert scaling with an even number of responses and no middle neutral or undecided choice.) were found at 3 or 6 months post-stroke.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Donnelly et al., 2004) randomly assigned patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early hospital discharge service or usual hospital rehabilitation. The early discharge group received multidisciplinary home services for 3 months (average of 2.5 visits a week, 45 minutes per session). No significant between-group difference in carers’ satisfaction (measured by non-standardized questionnaire) were found 12 months post-stroke.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hui et al., 1995) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early supported discharge (ESD) geriatrician team or a conventional medical team. Patients in the ESD group were discharged home with day hospital rehabilitation and management by a geriatrician. No significant between-group differences were found for carers’ satisfaction (measured by non-standardized questionnaire) at 3 or 6 months post-stroke.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al, 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to the specialist community rehabilitation or the conventional hospital care group. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. No significant between group difference in carers’ satisfaction with hospital care, therapy provision, community support and general satisfaction (measured with stroke-specific questionnaires) were found at 12 months post-stroke.

Conclusion: There is strong evidence (level 1a) from four high quality RCTs and two fairquality RCTs that early supported discharge is not more effective than conventional care for improving satisfaction among carers of patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Four high qualities RTCs (Widén Holmqvist et al., 1998 and von Koch et al., 2000, von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies; Anderson et al., 2000; Bautz-Holter et al., 2002; Donnelly et al., 2004), and three fair quality RCTs (Hui et al., 1995; Rudd et al,, 1997; Suwanwela et al., 2002) investigated the effects of early supported discharge on satisfaction among patients with stroke.

The first high quality RCT (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. No significant between-group differences in patients’ satisfaction (measured by non-standardized questionnaire) were found at 3 months post-stroke.

A 6-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2000) also found no significant between-group differences in patients’ satisfaction (measured by non-standardized questionnaire) at 6 months post-stroke.

A 12-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2001) also found no significant between-group differences in patients’ satisfaction (measured by non-standardized questionnaire) at 12 months post-stroke.

A 5-year follow-up to the study by Widén Holmqvist et al., (1998) (Thorsén et al., 2005) found no significant between-group differences in patients’ satisfaction (measured by non-standardized questionnaire) at 5 years post-stroke.

The second high quality RCT (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to the early supported discharge or the conventional care group. In the early discharge group, patients received multidisciplinary rehabilitation at home for 5 weeks. No significant between-group differences in patients’ satisfaction with medical care, rehabiliation or recovery (measured by non-standardized questionnaire) were found at 6 months post-stroke.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bautz-Holter et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional hospital rehabilitation. The early supported discharge group received multidisciplinary rehabilitation at home for as long as considered necessary followed by outpatient clinic intervention. No significant between-group differences in patients’ satisfaction (measured by a 5-point Likert scaleLikert scaling is one type of response to items in a questionnaire or tool. For example, Likert scaling would have you rate an item such as “I am satisfied with the care I received” on a scale using a 1-to-5 response scale where:
• 1 = strongly disagree
• 2 = disagree
• 3 = undecided
• 4 = agree
• 5 = strongly agree
You will find various options and scaling methods for the number of response choices (1-to-7, 1-to-9, 0-to-4). Odd-numbered scales usually have a middle value that is labelled Neutral or Undecided. Some tools used forced-choice Likert scaling with an even number of responses and no middle neutral or undecided choice.) were found at 3 or 6 months post-stroke.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Donnelly et al., 2004) randomly assigned patients with acute stroke to the earlier hospital discharge or the usual hospital rehabilitation group. The earlier discharge group received multidisciplinary home services for 3 months (average of 2.5 visits a week, 45 minutes per session). A significant between-group difference in patient satisfaction (measured using a non-standardized questionnaire) was found at 12 months post-stroke, favoring early discharge compared to usual hospital rehabilitation.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hui et al., 1995) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early supported discharge (ESD) geriatrician team or a conventional medical team. Patients in the ESD group were discharged home with day hospital rehabilitation and management by a geriatrician. Patients’ satisfaction was measured using a questionnaire developed at the day hospital. No significant between-group differences in patients’ satisfaction (measured using a non-standardized questionnaire) were found at 3 or 6 months post-stroke.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al,, 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to the specialist community rehabilitation or the conventional hospital care group. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. Significant between-group differences were found in patient’s satisfaction with hospital care (measured by questionnaire), favoring specialist community rehabilitation compared to conventional care. There were no significant between-group differences in patients’ satisfaction with therapy provision, community support or general satisfaction (measured by stroke-specific questionnaires) at 12 months post-stroke.

The third fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Suwanwela et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early discharge and home rehabilitation or conventional rehabilitation. The home rehabilitation intervention consisted of 3 days hospitalization followed by home interventions for 10 consecutive days and follow-up by visits in the 2nd week, at 1, 3, and 6 months. No significant between-group differences in patients’ satisfaction (measured by non-standardized questionnaire) were found at 6 months post-stroke.

Conclusion: There is strong evidence (level 1a) from three high quality RCTs and three fairquality RCTs that early supported discharge is not more effective than conventional care for improving satisfaction among patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Note: However, 1 high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported higher satisfaction among patients following early supported discharge compared to conventional rehabilitation, and 1 fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found a significant between-group difference in patients’ satisfaction with hospital care in favour of early supported discharge compared to conventional rehabilitation.

One quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) investigated the effect of early supported discharge on spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
allocated patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to an intervention group that received intensified transition consisting of education and support for patients and carers prior to and following discharge (ST+IT), or a control group that received standard transition (ST). There were no significant between-group differences in patients’ spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
(Ashworth SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
Scale) at 4 weeks or 6 months post-discharge.

Conclusion: There is limited evidence (level 2b) from one quasi-experimental studythat early supported discharge is not more effective than conventional care in improving patients’ spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
.

Four high quality RCTs (Ronning & Guldvog, 1998; Indredavik et al., 2000 – Fjærtoft et al., 2011 follow-up study–; Mayo et al., 2000; Askim et al., 2006) and one fair quality RCT (Suwanwela et al., 2002) investigated the effect of early supported discharge on stroke severity.

The first high quality RCT (Ronning & Guldvog, 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive municipality rehabilitation or standard hospital rehabilitation. Municipality rehabilitation comprised nursing home rehabilitation on inpatient or day-patient basis, and further ambulatory rehabilitation by a visiting physical therapistIn charge of the “assessment and treatment of motor functioning, including motor control, strength and physical conditioning; balance, gait and mobility retraining; home and community visits; patient and family education regarding mobility and safety issues.” (Suggested by Philips et al, 2002)
, speech therapist and/or nurseIn charge of, but not limited to, the “assessment and provision of care needs; support and education for patients and families; discharge planning.”(Suggested by Philips et al, 2002)
. There were no significant between-group differences in patients’ stroke severity (Scandinavian StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Scale – SSS) at 7 months post-stroke.
Note: Subgroup analysis showed a significant between-group difference in strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity (SSS) among patients with moderate to severe stroke (Barthel Index score <50), in favour of hospital rehabilitation compared to municipality rehabilitation. There were no significant between-group differences in the subgroup of patients with mild strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The second high quality RCT (Indredavik et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received multidisciplinary home services that included a home assessment, discharge form thestroke unit, follow up rehabilitation program, out-patient clinic 4 weeks after discharge, and information meeting 3 months after discharge. StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity was reported in a five-year follow-up study (Fjæroft et al, 2011). There was no significant between-group difference in stroke severity (Scandinavian StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Scale) at 5 years post-stroke.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mayo et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive prompt discharge and home rehabilitation or usual care. The intervention group received home-based rehabilitation and nursing services for 4 weeks. There were no significant between-group differences in strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity (Canadian Neurological Scale) at post-treatment (4 weeks) or follow-up (3 months post-stroke).

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Askim et al., 2006) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an extended stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (ESUS) or an ordinary stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) service (OSUS). The ESUS group received early supported discharge and home-based rehabilitation for 4 weeks post-discharge whereas the OSUS group received regular inpatient rehabilitation. There were no significant between-group differences in strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity (Scandinavian Stroke Scale) at 6, 26, or 52 weeks post-stroke.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Suwanwela et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early discharge and home rehabilitation or conventional rehabilitation. Home rehabilitation intervention consisted of 3 days hospitalization followed by home interventions for 10 consecutive days and follow-up by visits. There were no significant between-group differences in stroke severity (National Institute of Health StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Scale) at 6 months post-stroke.

Conclusion: There is strong evidence (level 1a) from four high quality RCTs and one fairquality RCTthat early supported discharge is not more effective than conventional care for improving severity of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Note: A high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported a significant between-group difference in strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity among patients with moderate to severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., in favour of conventional care compared to early supported discharge.

One high quality RCT (Widén Holmqvist et al., 1998 and von Koch et al., 2000 and von Koch et al., 2001 and Thorsén et al., 2005 follow-up studies) and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) investigated the effect of early supported discharge on upper extremity function and dexterity following stroke.

The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge and home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. There were no significant between-group differences in dexterity (Nine Hole Peg Test) at 3 months follow-up.

A 6-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2000) revealed no significant between-group difference in patients’ dexterity (Nine Hole Peg Test) at 6 months post-stroke.

A 12-month follow-up to the study by Widén Holmqvist et al., (1998) (von Koch et al., 2001) found no significant between-group differences in patients’ dexterity (Nine Hole Peg Test) at 12 months post-stroke.

A 5-year follow-up to the study by Widén Holmqvist et al., (1998) (Thorsén et al., 2005) found no significant between-group differences in patients’ dexterity (Nine Hole Peg Test) at 5 years post-stroke.

The quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) allocated patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to an intervention group that received intensified transition consisting of education and support for patients and carers prior to and following discharge (ST+IT), or a control group that received standard transition (ST). There were no significant between-group differences in upper extremity function (Frenchay Arm Test) at 4 weeks or 6 months post-discharge.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
that early supported discharge is not more effective than conventional care for improving upper extremity function and dexterity following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Five high qualities RCTs (Widén Holmqvist et al., 1998 and von Koch et al., 2000 follow-up study; Anderson et al., 2000; Mayo et al., 2000; Bautz-Holter et al., 2002; Donnelly et al., 2004), two fair qualities RCTs (Hui et al., 1995; Rudd et al., 1997), and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005 and Gräsel et al., 2006 follow-up study) investigated the effects of early supported discharge on process measures (use of health services) following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Widén Holmqvist et al., 1998) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge with home rehabilitation or conventional care. The home rehabilitation group received multidisciplinary home rehabilitation for 3-4 months. Process measures taken at 3 months post-stroke included length of stay, mortality, service use and dependency. Significant between-group differences in length of stay only were found, favoring early supported discharge and home rehabilitation compared to conventional rehabilitation.

A 6-month follow-up to the Widén Holmqvist et al., (1998) study (von Koch et al., 2000) found no significant between-group differences in process measures (length of stay, mortality, service use) at 6 months post-stroke.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Anderson et al., 2000) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional care. The early discharge group received multidisciplinary rehabilitation at home for 5 weeks. Process measures included length of stay/total bed days, use of health services, institutionalization, frequency of readmissions and incidence of adverse events (death or falls). Significant between-group differences were found in length of stay/total bed days only, favoring early supported discharge compared to conventional care.

The third high quality RCT (Mayo et al., 2000) randomized patients with acute stroke to receive prompt discharge and home rehabilitation or usual care. The intervention group received a home rehabilitation program for 4 weeks consisting of tailor-made rehabilitation and nursing services. Process measures included length of stay and health services use. Significant between-group differences were found in length of stay, favoring the intervention group.

The fourth high quality RCT (Bautz-Holter et al., 2002) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive early supported discharge or conventional hospital rehabilitation. The early supported discharge group received multidisciplinary rehabilitation at home for as long as considered necessary followed by outpatient clinic intervention. Process measures included use of health services, mortality and institutionalization. No significant between-group differences were found.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Donnelly et al., 2004) randomly assigned patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to early hospital discharge or usual hospital rehabilitation. The early discharge group received multidisciplinary home services for 3 months (average of 2.5 visits a week, 45 minutes per session). Process measures included length of stay, service use and cost. Significant between-group differences were found in use of occupational therapy, social work and rehabilitation assistant services (but not physiotherapy or Meals on Wheels services), favoring early discharge rehabilitation compared to conventional rehabilitation. There were no significant between-group differences in length of stay or cost.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hui et al., 1995) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an early supported discharge (ESD) team managed by a geriatrician or a conventional medical team managed by a neurologistThis team member is responsible for “the diagnostic evaluation, medical treatment, prevention of stroke recurrence, patient and family education, staff and trainee education, research, program evaluation.”(Suggested by Philips et al, 2002)
. Patients in the ESD team were managed by a geriatrician and received rehabilitation at a day hospital. Process measures included length of stay, mortality, health service use (readmissions, outpatient services and community services) and cost. Significant between-group differences were found in number of outpatient visits only, favoring ESD compared to conventional care.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rudd et al., 1997) randomized patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive specialist community rehabilitation or conventional hospital and community care. The specialist community rehabilitation group received an individual multidisciplinary daily care plan for 3 months. Process measures included length of stay, readmission rates, institutionalization, mortality and health service use. Significant between-group differences were found in length of stay only, favoring specialist community rehabilitation compared to conventional hospital and community care.

The quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
(Gräsel et al., 2005) allocated patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their carers to receive intensified transition consisting of education and support for patients and carers prior to and following discharge (ST+IT), or a control group that received standard transition (ST). Number of physician visits and newly appearing illnesses were measured at 4 weeks and 6 months post-discharge. Patients in the control group showed significantly more new illnesses than those in the intervention group at 4 weeks post-discharge, but this difference did not remain significant at 6 months. There was a significant between-group difference in the number of physician visits in favour of the intervention group compared to the control group at 6 months post-discharge (these differences were not present at four weeks post-discharge).

In a follow-up study (Gräsel et al., 2006), patients were contacted by telephone on average 31 months after discharge from hospital to determine whether the patient was (a) alive; and (b) living at home or in a nursing home. There was a significant difference between groups in the number of patients who were alive and living at home, in favour of the intervention group compared to the control group.

Conclusion: There is strong evidence (level 1a) from four high quality RCTs and two fair quality RCTs that there is no significant difference in use of health services between early supported discharge and conventional care.

Note: However, a fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found a significant between-group differences in use of occupational therapy, social work and rehabilitation assistant services, favoring early discharge rehabilitation compared to conventional rehabilitation. Furthermore, one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints.
found a significant between-group difference in the number of physician visits in favour of the intervention group of intensified transition compared to the control group, at 6 months post-discharge.