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Early supported hospital discharge following acute stroke: pilot study results

Objective: To establish the feasibility and method of evaluation of an early supported hospital discharge policy for patients with acute stroke. Design: A randomized controlled trial comparing an early supported discharge service to conventional care. Setting: Three acute hospitals in Newcastle upon Tyne. Subjects: Ninety-two eligible patients with acute stroke admitted between 1 February 1995 and 31 January 1996. Main outcome measures: Placement, length of stay, readmission rates, mortality, functional ability (Nottingham Extended Activities of Daily Living (ADL) Scale), handicap (Oxford Handicap Scale), global health status (Dartmouth Coop Function Charts) and carer stress (General Health Questionnaire 30 item). Results: The median length of stay for patients randomized to early supported discharge was 13 days compared to 22 days in the conventional care group (p = 0.02). The median Barthel ADL Index at seven days post stroke of patients randomized to early supported discharge was 15, and 13 for those randomized to conventional care (NS). At three months post stroke the median Nottingham EADL score of patients randomized to early supported discharge was 10 compared to 7 for those who received conventional care (NS). There were no statistically significant differences in the global health status of patients or carer stress. Conclusion: An early supported discharge service following acute stroke with individualized rehabilitation in the community is feasible and can be evaluated by a randomized controlled trial but a larger multicentre trial is needed before such a service is widely adopted.