+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Early supported discharge services for stroke patients: a meta-analysis of individual patients' data

Early supported discharge services for stroke patients: a meta-analysis of individual patients' data

Lancet 365(9458): 501-506

Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (p<0.0001). There were also significant improvements in scores on the extended activities of daily living scale and in the odds of living at home and reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patients with mild to moderate disability. 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 shortening hospital stays.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 011985864

Download citation: RISBibTeXText

PMID: 15705460

DOI: 10.1016/s0140-6736(05)17868-4

Related references

Gothenburg very early supported discharge study (GOTVED) NCT01622205: a block randomized trial with superiority design of very early supported discharge for patients with stroke. Bmc Neurology 13: 66, 2013

A qualitative study exploring patients' and carers' experiences of Early Supported Discharge services after stroke. Clinical Rehabilitation 27(8): 750-757, 2013

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 randomized controlled trial. Cerebrovascular Diseases 19(6): 376-383, 2005

Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis. Cochrane Database of Systematic Reviews 2010(5): Cd005066, 2010

Early supported discharge after stroke in Bergen (ESD Stroke Bergen): three and six months results of a randomised controlled trial comparing two early supported discharge schemes with treatment as usual. Bmc Neurology 14: 239, 2014

An individual patient data meta-analysis of long supported adjuvant chemotherapy with oral carmofur in patients with curatively resected colorectal cancer. Oncology Reports 8(3): 697-703, 2001

Early supported discharge: a valuable alternative for some stroke patients. Lancet 365(9458): 455-456, 2005

Costs and caregiver consequences of early supported discharge for stroke patients. Stroke 34(2): 528-536, 2003

Individual patient data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients. Stroke 35(9): 2226-2232, 2004

Early supported discharge of patients with acute stroke: a randomized controlled trial. Disability and Rehabilitation 24(7): 348-355, 2002

Early home-supported discharge of stroke patients: a health technology assessment. International Journal of Technology Assessment in Health Care 22(3): 313-320, 2006

Anticoagulant vs. antiplatelet therapy in patients with cryptogenic stroke and patent foramen ovale: an individual participant data meta-analysis. European Heart Journal 36(35): 2381-2389, 2015

Early home-supported discharge for patients with stroke in Portugal: a randomised controlled trial. Clinical Rehabilitation 31(2): 197-206, 2017

A critical review of Early Supported Discharge for stroke patients: from evidence to implementation into practice. International Journal of Stroke 10(1): 7, 2015

Early mobilization after stroke: an example of an individual patient data meta-analysis of a complex intervention. Stroke 41(11): 2632-2636, 2010