People who are mildly to moderately impaired after a stroke do better when they are sent home early from the hospital, with support and continued rehabilitation at home.

This approach, compared with standard post-stroke treatment, has a beneficial effect on activities of daily living five years after the stroke, a study demonstrates.

Dr. Lena von Koch, of Karolinska University Hospital in Stockholm, and colleagues evaluated 83 patients who were mildly or moderately impaired 5-to-7 days after suffering a stroke.

The subjects were randomly assigned to early supported discharge or conventional rehabilitation.

The early-discharge group received home-based rehabilitation from a team of occupational therapists, physiotherapists, and a speech-and-language specialist.

Rehab lasted an average of 14 weeks, with a focus on speech and communication, activities of daily living, and ambulation. If necessary, the conventional treatment group received additional rehabilitation.

Thirty subjects in the early intervention group and 24 in the conventional care group were available for follow-up after five years.

A significantly higher percentage of intervention-group patients were independent in extended activities of daily living, scored better in movement ability, and were active in household activities.

For example, significantly more intervention patients were able to wash dishes, wash clothes and to read books. However, no significant difference in the number of falls was observed, the investigators report in the American Heart Association’s journal Stroke:

They conclude that these findings, despite uncertainties about why early supported discharge after stroke works so well, “will have implications for further research on allocation of health-care resources including provision of informal care.”

SOURCE: Stroke, February 2005.