Objectives: The aim of the present trial was to compare the effects of an extended stroke unit service (ESUS) with the effects of an ordinary stroke unit service (OSUS) on long-term quality of life (QoL).
Design: One year follow-up of a randomized controlled trial with 320 acute stroke patients allocated either to OSUS (160 patients) or ESUS (160 patients) with early supported discharge and follow-up by a mobile team. The intervention was a mobile team and close co-operation with the primary health care service. All assessments were blinded.
Main outcome measure: Primary outcome of QoL in this paper was measured by the Nottingham Health Profile (NHP) at 52 weeks. Secondary outcomes measured at 52 weeks were differences between the groups measured by the Frenchay Activity Index, Montgomery-A ° sberg Depression Scale, Mini-Mental State Score and the Caregivers Strain Index.
Results: The ESUS group had a significantly better QoL (mean score 78.9) assessed by global NHP after one year than the OSUS group (mean score 75.2) (p -0.048). There were no significant differences between the groups in the secondary outcomes, but a trend in favour of ESUS. Caregivers Strain Index showed a mean score of 23.3 in the ESUS group and 22.6 in the OSUS group (p -0.089).
Conclusion: It seems that stroke unit treatment combined with early supported discharge in addition to reducing the length of hospital stay can improve long-term QoL. However, similar trials are necessary to confirm the benefit of this type of service.
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References
1.
1 Stroke Unit Trialists' Collaboration. A collaborative systematic review of the randomized controlled trial of organized inpatient (stroke unit) care after stroke. BMJ1997; 314: 1151-1159.
2.
2 Indredavik B, Bakke F, Slørdahl SA, Rokseth R, Ha°heim LL. Stroke unit treatment: 10-year followup. Stroke1999; 30: 1524-1527.
3.
3 Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients (Cochrane review). The Cochrane Library, Issue 3. Oxford: Update Software2002.
4.
4 Mayo N, Wood-Dauphinee S, Cote R et al. There's no place like home. An evaluation of early supported discharge for stroke. Stroke2000; 31: 1016-1023.
5.
5 Bautz-Holter E, Sveen U, Rygh J, Rodgers H, Wyller TB. Early supported discharge of patients with acute stroke: Disabil Rehabil2002; 24: 348-355.
6.
6 Rodgers H, Soutter J, Kaiser W et al. Early supported hospital discharge following acute stroke: pilot study results. Clin Rehabil1997; 11: 280-287.
7.
7 Rudd AG, Wolfe CDA, Tilling K, Beech R. Randomized controlled trial to evaluate early discharge scheme for patients with stroke. BMJ1997; 315: 1039-1044.
8.
8 Widen Holmqvist L, Von Koch L, Kostulas V et al. A randomized controlled trial of rehabilitation at home after stroke in southwest Stockholm. Stroke1998; 29: 591-597.
9.
9 Anderson C, Rubenach S, Mhurchu CN, Clark M, Spencer C, Winsor A. Hospital or home for stroke rehabilitation? Results of a randomized controlled trial. I: Health outcomes at 6 months. Stroke2000; 31: 1024-1031.
10.
10 de Haan R, Aaronsen N, Limburg M Langton Hewer R, Van C. Measuring quality of life in stroke. Stroke1993; 24: 320-322.
11.
11 Aaronsen NK. Quality of life: What is it? How should it be measured?Oncology1988; 2: 69-74.
12.
12 Indredavik B, Fjartoft H, Ekeberg G, Løge A, Mørch B. Benefit of an extended stroke unit service with early supported discharge. A randomized, controlled trial. Stroke2000; 31: 2989-2989.
13.
13 Fjærtoft H, Indredavik B, Johnsen R, Lydersen S. Stroke unit care combined with early supported discharge. Long term follow-up of a randomized controlled trial. Stroke2003; 34: 2687-2692.
14.
14 Ebrahim S, Barer D, Nouri F. Use of Nottingham Health Profile with patients after stroke. J Epidemiol Community Health1986; 40: 166-169.
15.
15 Thurstone LL: The measurement of values. Chicago, IL: University Chicago Press, 1959.
16.
16 O'Brian BJ, Buxton MJ, Ferguson BA. Measuring the effective heart transplantation programmes: quality of life data and the relationship to survival analyses. J Chronic Dis1987; 40 (suppl 1): 137s-153s.
17.
17 Holbrook M, Skilbeck CE. An activities index for use with stroke patients. Age Ageing1983; 12: 166-170.
18.
18 A° sberg M, Mongomery SA. A new depression scale designed to be sensitive to change. Br J Psychiatry1979; 134: 382-389.
19.
19 Folstein MF, Folstein SE, McHugh PR. ‘Minimental state’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res1975; 12: 189-198.
21 Walker S, Rosser R. Quality of life assessment: key issues in the 1990s. Dordrecht: Kluwer Academic, 1993.
22.
22 Juby LC, Lincoln NB, Berman P. The effect of a stroke rehabilitation unit on functional and psychological outcome. A randomized controlled trial. Cerebrovasc Dis1996; 6: 106-110.
23.
23 Indredavik B, Bakke, F, Slørdahl, S, Rokseth R, Ha°heim L. Stroke unit treatment improves longterm quality of life. A randomized controlled trial. Stroke1998; 29: 895-899.
24.
24 Ronning OM, Guldvog B. Outcome of subacute stroke rehabilitation. A randomized controlled trial. Stroke1998; 29: 779-784.
25.
25 Suenkeler I, Nowak M, Misselwitz B. Timecourse of health-related quality of life as determined 3,6,12 months after stroke. J Neurol2002; 249: 1160-1167.
