Services for reducing duration of hospital care for acute stroke patients

Fearon, P. and Langhorne, P. (2012) Services for reducing duration of hospital care for acute stroke patients. Cochrane Database of Systematic Reviews, 2012(9), pp. 1-97. (doi: 10.1002/14651858.CD000443.pub3)

Abstract

<p>Background: Stroke patients conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed which offer patients in hospital an early discharge with rehabilitation at home (early supported discharge (ESD)).</p> <p>Objectives: To establish the effects and costs of ESD services compared with conventional services.</p> <p>Search methods: We searched the trials registers of the Cochrane Stroke Group (January 2012) and the Cochrane Effective Practice and Organisation of Care (EPOC) Group, MEDLINE (2008 to 7 February 2012), EMBASE (2008 to 7 February 2012) and CINAHL (1982 to 7 February 2012). In an effort to identify further published, unpublished and ongoing trials we searched 17 trial registers (February 2012), performed citation tracking of included studies, checked reference lists of relevant articles and contacted trialists.</p> <p>Selection criteria: Randomised controlled trials recruiting stroke patients in hospital to receive either conventional care or any service intervention which has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care.</p> <p>Data collection and analysis: The primary patient outcome was the composite end-point of death or long-term dependency recorded at the end of scheduled follow up. Two review authors scrutinised trials and categorised them on their eligibility.We then sought standardised individual patient data from the primary trialists. We analysed the results for all trials and for subgroups of patients and services, in particular whether the intervention was provided by a co-ordinated multidisciplinary team (co-ordinated ESD team) or not.</p> <p>Main results: Outcome data are currently available for 14 trials (1957 patients). Patients tended to be a selected elderly group withmoderate disability. The ESD group showed significant reductions (P = 0.0001) in the length of hospital stay equivalent to approximately seven days. Overall, the odds ratios (OR) (95% confidence interval (CI)) for death, death or institutionalisation, death or dependency at the end of scheduled follow-up were OR 0.91 (95% CI 0.67 to 1.25, P = 0.58), OR 0.78 (95% CI 0.61 to 1.00, P = 0.05) and OR 0.80 (95% CI 0.67 to 0.97, P = 0.02) respectively. The greatest benefits were seen in the trials evaluating a co-ordinated ESD team and in stroke patients with mild to moderate disability. Improvements were also seen in patients’ extended activities of daily living scores (standardised mean difference 0.12, 95% CI 0.00 to 0.25, P = 0.05) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02) but no statistically significant differences were seen in carers’ subjective health status, mood or satisfaction with services. The apparent benefits were no longer statistically significant at five-year follow-up.</p> <p>Authors’ conclusions: Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as reducing the length of hospital stay. We observed no adverse impact on the mood or subjective health status of patients or carers.</p>

• Item Type: Articles
• Additional Information: This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2012, Issue 9. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review. This can be found at: Fearon P, Langhorne P, Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD000443. DOI: 10.1002/14651858.CD000443.pub3. Stable link: http://dx.doi.org/10.1002/14651858.CD000443.pub3. The original review can be found here: Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients. The Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: CD000443. DOI: 10.1002/14651858.CD000443. Stable link: http://dx.doi.org/10.1002/14651858.CD000443
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Langhorne, Professor Peter and Fearon, Dr Patricia
• Authors: Fearon, P., and Langhorne, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Cochrane Database of Systematic Reviews
• Publisher: John Wiley & Sons, Ltd
• ISSN (Online): 1469-493X
• Published Online: 12 September 2012
• Copyright Holders: Copyright © 2012 The Cochrane Collaboration
• First Published: First published in Cochrane Database of Systematic Reviews 9(1):1-97
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher