EFFECT OF VERY EARLY SUPPORTED DISCHARGE VERSUS USUAL CARE ON ACTIVITIES OF DAILY LIVING ABILITY AFTER MILD STROKE: A RANDOMIZED CONTROLLED TRIAL

OBJECTIVE: To examine the ability to perform basic and instrumental activities of daily life after very early supported discharge vs usual discharge and referral routine during the first year after mild stroke. DESIGN: A secondary analysis of data from the Gothenburg Very Early Supported Discharge randomized controlled trial. PATIENTS: A total of 104 patients (56% men; mean (standard deviation) age 75 (11) years) who had experienced a first stroke classified as mild. METHODS: The primary outcome was the Activities of Daily Living Taxonomy score. Stroke Impact Scale (activities of daily living, and mobility) scores was a secondary measure. Patients were randomized to either very early supported discharge with 4 weeks of home rehabilitation provided by a multidisciplinary stroke team, or a control group discharged according to usual routine (referral to primary care when needed). Assessments were performed at discharge, 4 weeks post-discharge, and 3 and 12 months post-stroke. RESULTS: Instrumental activities of the Activities of Daily Living Taxonomy scores (the lower the better) in the very early supported discharge and control groups were median 4 and 6 (p = 0.039) at 4 weeks post-discharge and 3 and 4.5 (p = 0.013 at 3 months post-stroke, respectively. Stroke Impact Scale (Mobility) median scores (the higher the better) in the very early supported discharge and control groups at 3 months were 97 and 86 (p = 0.040), respectively. There were no group differences in the 2 outcomes at 12 months post-stroke. CONCLUSION: Compared with usual discharge routine, team-based rehabilitation during the first month at home is beneficial for instrumental activity in the subacute phase, in patients with mild stroke. One year post-stroke both groups show equal results. LAY ABSTRACT After stroke, even mild symptoms may impact ability to perform activities of daily living, such as household chores, outdoor walking and transport. It is necessary to understand more about the effects of different rehabilitation methods after mild stroke. The aim of this study was to investigate whether home-based rehabilitation provided by a stroke team during the first 4 weeks post-discharge after mild stroke is comparable to usual discharge routine implicating referral to primary care when needed, with respect to facilitating simple and complex everyday activities. The home-based rehabilitation programme was tailored to the patients’ own goals and problems. The group receiving supported training at home recovered faster, and was more able than controls to manage activities indoors and outdoors, at both 4 weeks post-discharge and at 3 months post-stroke. Twelve months post-stroke, the group that received usual care had also improved, so there was no longer a difference between the outcomes of the two approaches.