The effectiveness of rehabilitation after stroke remains largely unproven. Attempts have been made to evalute domiciliary therapy,1 community stroke teams2 and the intensity of therapy,3 but much of the evidence is inconclusive. We have been engaged in a randomized comparison trial of day hospital and home physiotherapy for elderly stroke patients discharged from hospital. This paper describes the background to the study and the pilot work from which the methodology was determined.
Get full access to this article
View all access options for this article.
References
1.
Bryant NH, Candland L., Loewenstein R.Comparison of care and cost outcomes for stroke patients with and without home care. Stroke1974; 5: 54-59.
2.
Wade DT, Langton Hewer R, Skilbeck C., Bainton D., Burns-Cox C.Controlled trial of a home-care service for acute stroke patients. Lancet1985; i: 323-26.
3.
Smith DS, Goldenberg E., Ashburn A. et al. Remedial therapy after stroke: a randomised controlled trial . Br Med J1981; 282: 517-20.
4.
Stroke. London: Office of Health Economics, 1988: 10.
5.
Rose RCClinical neuroepidemiology. Tunbridge Wells: Pitman Medical, 1980.
6.
Lind K.A synthesis of studies on stroke rehabilitation. J Chronic Dis1982; 35: 133-49.
7.
Consensus Statement .Treatment of Stroke. Br Med J1988; 297: 126-28.
Mulley G., Arie T.Treating stroke: home or hospital?Br Med J1978; ii: 1321-22.
10.
Brocklehurst JC, Andrews K., Morris P., Richards BR, Laycock PLWhy admit stroke patients to hospital?Age Ageing1978; 7: 100-108.
11.
Bamford J., Sandercock P., Warlow C., Gray M.Why are patients with acute stroke admitted to hospital?Br Med J1986; 292: 1369-72.
12.
Cochrane A.The burden of cerebrovascular disease. Br Med J1970; ii: 165.
13.
TheOxfordshire Community Stroke Project. Incidence of stroke in Oxfordshire: first year's experience of a community stroke registrar. Br Med J1983; 287: 713-17.
Kettle M., Chamberlain MAThe stroke patient in an urban environment. Clinical Rehabilitation1989; 3: 131-38.
16.
Andrews K., Stewart J.Stroke recovery: he can but does he? Rheumatology and Rehabilitation1979; 18: 43-48.
17.
Carnwath Tcm , Johnson Daw.Psychiatric morbidity among spouses of patients with stroke. Br Med J1987; 294: 409-11.
18.
Brocklehurst JC, Tucker JSProgress in geriatric day care. London: King Edwards Hospital Fund1980.
19.
Forster A., Young J.Day hospital and stroke patients. Int Disabil Stud1989; 11: 181-83.
20.
Tucker MA, Davison JG, Ogle SJDay hospital rehabilitation - effectiveness and cost in the elderly: a randomised controlled trial. Br Med J1984; 289: 1209-12.
21.
Hildick-Smith M.Geriatric day hospitals - changing emphasis in costs. Age Ageing1984; 13: 95-100.
22.
Brocklehurst JC, Morris P., Andrews K., Richards B., Laycock P.Social effects of stroke. Soc Sci Med1981; 15A: 35-39.
23.
Forster A., Young J.The role of community physiotherapy for stroke patients. Physiotherapy1990; 76: 495-97.
Aho K., Harmsen P., Hatano S., Marquardsen J., Smirnov VE, Strasser T.Cerebrovascular disease in the community: results of a World Health Organisation collaborative study. Bull WHO1980; 58: 113-30.
26.
Allen Cmc.Predicting recovery after acute stroke. Br J Hosp Med1984; 31: 428-34.
27.
Wade DT, Skilbeck CE, Langton Hewer R.Predicting Barthel ADL score at 6 months after an acute stroke. Arch Phys Med Rehabil1983; 64: 24-28.
28.
Partridge CJ , Johnston M., Edwards S.Recovery from physical disability after stroke: normal patterns as a basis for evaluation. Lancet1987; i: 373-75.
29.
Wade DT, Langton Hewer R.Functional abilities after stroke: measurement, natural history and prognosis . J Neurol Neurosurg Psychiatry1987; 50: 177-82.
30.
Wade DT, Langton Hewer R.Stroke: associations with age, sex, and side of weakness. Arch Phys Med Rehabil1986; 67: 540-45.
31.
Wade DT, Langton Hewer R, Wood VAStroke: the influence of age upon outcome. Age Ageing1984; 13: 357-62.
32.
Gore SMAssessing clinical trials - restricted randomisation. In: Gore SM, Altman DG eds, Statistics in practice. London: British Medical Association, 1982: 44-47.
33.
Nichols Pjr.Outcome measures in rehabilitation. Rheumatology and Rehabilitation1976; 15: 170-73.
34.
Ashburn A.A physical assessment for stroke patients. Physiotherapy1982; 68: 109-13.
35.
Wade DT, Wood VA, Heller A., Maggs J., Langton Hewer R.Walking after stroke. Scand J Rehabil Med1987; 19: 25-30.
36.
Wade DT, Legh-Smith J., Langton Hewer R.Social activities after stroke: measurement and natural history using the Frenchay Activities Index. Int Rehabil Med1985; 7: 176-81.
Ebrahim S., Barer D., Nouri F.Use of the Nottingham Health Profile with patients after a stroke. J Epidemiol Community Health1986; 40: 166-69.
39.
Goldberg D. , Hillier VFA scaled version of the General Health Questionnaire . Psychol Med1979; 9: 139-45.
40.
Enderby PM, Wood VA, Wade DT, Langton Hewer R.The Frenchay Aphasia Screening Test: a short, simple test for aphasia appropriate for non-specialists. Int Rehabil Med1987; 8: 166-70.
41.
Altman DGHow large a sample? In: Gore SM, Altman DG eds, Statistics in practice. London: British Medical Association, 1982: 6-8.
42.
Sheikh K., Smith DS, Meade TW, Brennan PJMethods and problems of a stroke rehabilitation trial. Occupational Therapy1978; 262-65.
43.
Meade TWProblems for the research worker in rehabilitation studies. Rheumatology and Rehabilitation1977; 16: 254-56.
44.
Donaldson C. , Wright K., Maynard A.Determining value for money in day hospital care for the elderly. Age Ageing1986; 15: 1-7.
