The effectiveness of an early supported discharge program (ESDP) in rehabilitation of patients after stroke

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The effectiveness of an early supported discharge program (ESDP) in rehabilitation of patients after stroke


Author: Cheung, Yim-yau
Title: The effectiveness of an early supported discharge program (ESDP) in rehabilitation of patients after stroke
Degree: M.Sc.
Year: 2002
Subject: Hong Kong Polytechnic University -- Dissertations
Cerebrovascular disease -- Patients -- Rehabilitation
Cerebrovascular disease -- Patients -- Home care
Hospitals -- After care
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: xi, 93 leaves ; 30 cm
Language: English
InnoPac Record:
Abstract: Objective: The objective of this randomized controlled study was to investigate if patients with stroke in the Early Supported Discharge Program (ESDP) with shorter length of stay in the hospital have similar rehabilitation outcomes as the patients with stroke receiving the hospital routine program. Methods: Twenty-five subjects with acute on set of stroke were randomized into the ESDP or the control group. Subjects in the ESDP group received a home-based rehabilitation program provided by physiotherapist and occupational therapist upon discharge. The total number of visits by both disciplines was less than six. In the program, education to the patients' caregivers was emphasized. Subjects in the control group received the conventional rehabilitation program as prescribed by the patient's medical officer. Baseline assessments included demographic data, Motor Assessment Scale (MAS) and Modified Barthel Index (BI100) were done on the first attendance to the subjects during hospitalization. The first assessment of the Chinese version of Caregiver Strain Index (CSI), the Chinese version of Community Integration Questionnaire (CIQ) and the Chinese version of Short-form 36 (HK SF36) was done one week after discharge from the hospital. Reassessment of all measurements was done at three months after stroke. Results: Twenty-five subjects who met the study criteria were recruited and completed the study. There were 14 subjects in the ESDP group and 11 in the control group. The baseline data of subjects in both groups was comparable and homogenous. The mean length of hospital stay of subjects in the ESDP group was significantly lower than those in the control group (6.4 days vs. 20.7 days, p=0.0l4). Subjects in the intervention group showed the same physical recovery from disability as those in the control group. However, subjects in the intervention group did not show any difference in most health outcomes when compared with subjects in the control group at three months after the onset of stroke, except that the CSI of the intervention group was significantly lower than that of the control group (1.9 versus 5.8, p=0.007). Discussion and Conclusion: This study demonstrated that patients with stroke in the intervention group could achieve similar improvement of physical and health outcomes as those in the control group but with shorter length of hospital stay. One distinct benefit of the program was that the caregivers in the intervention group had less stress than those in the control group. It was believed that the education to caregivers by visiting physiotherapist / occupational therapist had contributed to such improvement. There was no improvement in the perceived health and community reintegration. It was believed that other components of the program should be included to improve these aspects in the future study. It was also proposed that another assessment tools was required to measure the perceived health and community reintegration of the subjects with stoke as both the HK SF-36 and CIQ might not be sensitive enough to explore the change of the subjects in this early stage of stoke.

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