Abstract
A previous randomized controlled comparison of hospital-based and domiciliary rehabilitation for stroke patients discharged from hospital (the DOMINO study) found home therapy to be beneficial in a subgroup who had been in hospital on a stroke unit before entering the trial, whereas no benefit was seen in patients who had been on ordinary geriatric or general medical wards. In this study, to explain the findings of the DOMINO study further, the therapy records kept during the DOMINO study of the amount and type of rehabilitation provided by the domiciliary rehabilitation team were examined.
More patients who had been on the stroke unit before entering the trial received therapy and they received more and longer visits than those who had been on geriatric or medical wards. The group from the stroke unit were more likely to receive practice in activities of daily living (ADL), assessment for and instruction in the use of aids and appliances, gait re-education, mobility practice and facilitation of normal muscle tone.
One possible deduction is that home rehabilitation services should aim to deliver an average of 15-20 visits in six months, since only this amount of therapy was associated with a measurable benefit. The active components of home therapy may be ADL practice, assessment for and instruction in the use of aids and appliances, gait re-education, mobility, mobility practice and facilitation of normal muscle tone.
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