Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T17:46:01.021Z Has data issue: false hasContentIssue false
  • English
  • Français

A review of early supported discharge after stroke

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  31 August 2010

Linda Brewer  and
David Williams
Linda Brewer*
Affiliation:
Department of Geriatric Medicine, Beaumont Hospital, Dublin 9, Ireland
David Williams
Affiliation:
Department of Geriatric Medicine, Beaumont Hospital, Dublin 9, Ireland Royal College of Surgeons in Ireland, Dublin 2, Ireland
*
Address for correspondence: lindabrewer@physicians.ie
Get access Rights & Permissions [Opens in a new window]

Summary

Stroke is a leading cause of disability worldwide and patients with stroke frequently require prolonged periods of in-patient rehabilitation prior to discharge. This poses a large economic strain on health services, and the cost-effectiveness of this system has been questioned. However, in implementing changes in the delivery of post-acute stroke care it is important that patient outcome is not compromised. Early supported discharge (ESD) was introduced approximately 15 years ago and allows suitable patients to be discharged home early with increased support from a well co-ordinated, multi-disciplinary rehabilitation team in the patient's own home. This paper focuses upon the evidence available from multiple international studies of ESD over the last decade, including both clinical benefit and cost-effectiveness. Findings from these trials are largely positive resulting from a reduction in bed days, therefore overall cost, and an improvement in function and independence reported in many studies. Suitable patient selection, careful discharge planning and continuity of care by the ESD linked to a stroke unit are essential components of the success of this service.

Keywords

strokerehabilitationearly supported discharge
Type
Intermediate care and rehabilitation
Information
Reviews in Clinical Gerontology , Volume 20 , Issue 4 , November 2010 , pp. 327 - 337
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

12005 Coronary Heart Disease Statistics. British Heart Foundation.Google Scholar
2Wade, DT. Stroke (acute cerebrovascular disease), ed Stevens, A, Rafferty, J et al. Health Care Needs Assessment, vol 1. Oxford: Radcliffe Medical Press, 1994: pp. 111–255.Google Scholar
3Reducing Brain Damage: Faster access to better stroke care. National Audit Office 2005.Google Scholar
4Dewey, HM, Thrift, AG, Mihalopoulos, C, Carter, R, Macdonell, RA, McNeil, JJ, Donnan, GA. Informal care for stroke survivors. Results from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2002; 33; 1028–33.CrossRefGoogle Scholar
5Stroke Unit Trialists' Collaboration. Organized Inpatient (Stroke Unit) Care After Stroke (Cochrane Review). The Cochrane Library, issue 1. Oxford: Update Software, 2000.Google Scholar
6Stroke Unit Trialists' Collaboration. How do stroke units improve patient outcomes? A collaborative review of the randomized trials. Stroke 1997; 28: 2139–44.CrossRefGoogle Scholar
7Langhorne, P. Developing comprehensive stroke services: an evidence-based approach. Postgrad Med J 1995; 71: 733–37.CrossRefGoogle ScholarPubMed
8Rudd, AG, Wolfe, CD, Tilling, K, Beech, R. Randomised controlled trial to evaluate early discharge scheme for patients with stroke. BMJ 1997; 315: 1039–44.CrossRefGoogle ScholarPubMed
9von Koch, L, Holmqvist, LW, Wottrich, AW, Tham, K, de Pedro-Cuesta, J. Rehabilitation at home after stroke: a descriptive study of an individualised intervention. Clin Rehabil 2000; 14: 574–83.CrossRefGoogle Scholar
10Widén Holmqvist, L, von Koch, L, Kostulas, V, Holm, M, Widsell, G, Tegler, H, Johansson, K, Almazán, J, de Pedro-Cuesta, J. A randomized controlled trial of rehabilitation at home after stroke in southwest Stockholm. Stroke 1998; 29: 591–97.CrossRefGoogle ScholarPubMed
11von Koch, L, Widén Holmqvist, L, Kostulas, V, Almazán, J, de Pedro-Cuesta, J. A randomised controlled trial of rehabilitation at home after stroke in Southwest Stockholm: outcome at six months. Scan J Rehabil Med 2000; 32: 80–86.Google ScholarPubMed
12Holmqvist, LW, von Koch, L, de Pedro-Cuesta, J. Use of healthcare, impact on family caregivers and patient satisfaction of rehabilitation at home after stroke in southwest Stockholm. Scand J Rehabil Med 2000; 32: 173–79.CrossRefGoogle ScholarPubMed
13Indredavik, B, Fjaertoft, H, Ekeberg, G, Løge, AD, Mørch, B. Benefit of an extended stroke unit service with early supported discharge. A randomised controlled trial. Stroke 2000; 31: 2989–94.CrossRefGoogle Scholar
14Fjaertoft, H, Indredavik, B, Lydersen, S. Stroke unit care combined with early supported discharge. Long-term follow-up of a randomised controlled trial. Stroke 2003; 34: 2687.CrossRefGoogle Scholar
15Fjaertoft, H, Indredavik, B, Johnsen, R, Lydersen, S. Acute stroke unit care combined with early supported discharge. Long-term effects of quality of life. A randomised controlled trial. Clin Rehabil 2004; 18: 580–86.CrossRefGoogle Scholar
16Bautz-Holtert, E, Sveen, U, Rygh, J, Rodgers, H, Wyller, TB. Early supported discharge of patients with acute stroke: a randomised controlled trial. Disabil Rehabil 2002; 24: 348–55.CrossRefGoogle Scholar
17Mayo, NE, Wood-Dauphinee, S, Côté, R, Gayton, D, Carlton, J, Buttery, J, Tamblyn, R. There's no place like home: an evaluation of early supported discharge for stroke. Stroke 2000; 31: 1016–23.CrossRefGoogle ScholarPubMed
18Suwanwela, NC, Eusattasak, N, Phanthumchinda, K, Piravej, K, Locharoenkul, C. Combination of acute stroke unit and short-term stroke ward with early supported discharge decreases mortality and complications after acute ischaemic stroke. J Med Assoc Thai 2007; 90: 1089–96.Google Scholar
19Thorsén, AM, Holmqvist, LW, de Pedro-Cuesta, J, von Koch, L. A Randomised controlled trial of early supported discharge and continued rehabilitation at home after stroke: five-year follow-up of patient outcome. Stroke 2005; 36: 297–303.CrossRefGoogle ScholarPubMed
20Langhorne, P, Taylor, G, Murray, G, Dennis, M, Anderson, C, Bautz-Holter, E, Dey, P, Indredavik, B, Mayo, N, Power, M, Rodgers, H, Ronning, OM, Rudd, A, Suwanwela, N, Widen-Holmqvist, L, Wolfe, C. Early supported discharge services for stroke patients: a meta-analysis of individual patients' data. Lancet 2005; 365: 501–6.CrossRefGoogle ScholarPubMed
21Langhorne, P, Widen-Holmqvist, L, for the Early Supported Discharge trialists. Early supported discharge after stroke. J Rehabil Med 2007; 39: 103–8.CrossRefGoogle ScholarPubMed
22Early Supported Discharge Trialists. Services for reducing the duration of hospital care for acute stroke patients (Cochrane Database of Systematic Reviews 2009). The Cochrane Library, issue 1. John Wiley and Sons Ltd.Google Scholar
23von Koch, L, de Pedro-Cuesta, J, Kostulas, V, Almazán, J, Widén Holmqvist, L. Randomised controlled trial of rehabilitation at home after stroke: one-year follow-up of patient outcome, resource use and cost. Cerebrovasc Dis 2001; 12: 131–38.CrossRefGoogle ScholarPubMed
24Thorsen, AM, Widen Holmqvist, L, von Koch, L. Early supported discharge and continued rehabilitation at home after stroke: 5-year follow-up of resource use. J Stroke Cerebrovasc Dis 2006; 15: 139–43.CrossRefGoogle ScholarPubMed
25Teng, J, Mayo, NE, Latimer, E, Hanley, J, Wood-Dauphinee, S, Côté, R, Scott, S. Costs and caregiver consequences of early supported discharge for stroke patients. Stroke 2003; 34: 528–36.CrossRefGoogle ScholarPubMed
26Anderson, C, Ni Mhurchu, C, Brown, PM, Carter, K. Stroke rehabilitation services to accelerate hospital discharge and provide home-based care: an overview and cost analysis. Pharmacoeconomics 2002; 20: 537–52.CrossRefGoogle ScholarPubMed
27McNamee, P, Christensen, J, Soutter, J et al. Cost analysis of early supported hospital discharge for stroke. Age Ageing 1998; 27: 345–51.CrossRefGoogle Scholar
28Fjaertoft, H, Indredavik, B, Magnussen, J, Johnsen, R. Early supported discharge for stroke patients improves clinical outcome. Does it also reduce use of health services and costs? One-year follow up of a randomised controlled trial. Cerebrovasc Dis 2005; 19: 376–83.CrossRefGoogle Scholar
29Anderson, C, Mhurchu, CN, Rubenach, S, Clark, M, Spencer, C, Winsor, A. Home or hospital for stroke rehabilitation? Results of a randomised controlled trial. II: cost minimisation analysis at 6 months. Stroke 2000; 31: 1032–37.CrossRefGoogle ScholarPubMed
30Beech, R, Rudd, AG, Tilling, K, Wolfe, CD. Economic consequences of early supported discharge to community-based rehabilitation for stroke in an inner-London teaching hospital. Stroke 1999; 30: 729–35.CrossRefGoogle Scholar
31Stroke Unit Trialists' Collaboration. Collaborative systematic review of the randomized trials of organised inpatient (stroke unit) care after stroke. BMJ 1997; 314: 2139–44.Google Scholar
32Jørgensen, HS, Kammersgaard, LP, Nakayama, H, Raaschou, HO, Larsen, K, Hübbe, P, Olsen, TS. Treatment and rehabilitation on a stroke unit improves 5-year survival: a community based study. Stroke 1999; 30: 930–33.CrossRefGoogle ScholarPubMed
33Launois, R, Giroud, M, Mégnigbêto, AC, Le Lay, K, Présenté, G, Mahagne, MH, Durand, I, Gaudin, AF. Estimating the cost-effectiveness of stroke units in France compared with conventional care. Stroke 2004; 35: 770–75.CrossRefGoogle ScholarPubMed
34Saka, O, Serra, V, Samyshkin, Y, McGuire, A, Wolfe, CC. Cost-effectiveness of stroke unit care followed by early supported discharge. Stroke 2009; 40: 24–29.CrossRefGoogle ScholarPubMed
35Askim, T, Rohweder, G, Lydersen, S, Indredavik, B. Evaluation of an extended stroke unit service with early supported discharge for patients living in a rural community. A randomised controlled trial. Clin Rehabil 2004; 18: 238.CrossRefGoogle Scholar
36Pessah-Rasmussen, H, Wendel, K. Early supported discharge after stroke and continued rehabilitation at home co-ordinated and delivered by a stroke unit in an urban area. J Rehabil Med 2009; 41: 482–88.CrossRefGoogle Scholar
37Donnelly, M, Power, M, Russell, M, Fullerton, K. Randomised controlled trial of an early discharge rehabilitation service: the Belfast community stroke trial. Stroke 2004; 35: 127–33.CrossRefGoogle ScholarPubMed