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Objective: To evaluate whether follow-up services for stroke survivors could improve functional outcome and reduce readmission rate. In this paper results of functional outcome are reported., Design: Randomized controlled trial allocating patients to one of three different types of aftercare: (1) follow-up home visits by a physician, (2) physiotherapist instruction in the patient's home, or (3) standard aftercare., Subjects: Stroke patients with persisting impairment and disability who, after completing inpatient rehabilitation, were discharged to their homes., Outcome Measures: Six months after discharge, functional outcome was assessed with Functional Quality of Movement, Barthel Index, Frenchay Activity Index and Index of Extended Activites of Daily Living., Results: One-hundred and fifty-five stroke patients were included in the study. Fifty-four received follow-up home visits by a physician, 53 were given instructions by a physiotherapist in their home and 48 received standard aftercare only. No statistically significant differences in functional outcome six months after discharge were demonstrated between the three groups. However, all measurements showed a tendency towards higher scores indicating better function in both interventions groups compared with the control group., Conclusion: Follow-up services after stroke may be a way of improving functional outcome. The results of the present study should be evaluated in future trials. More research in this field is needed, especially studies of how to support stroke survivors to resume social and leisure activities.

Introduction: The aim of this study was to evaluate two models of an organised postdischarge follow-up service for stroke survivors in comparison with standard aftercare., Methods: One hundred and fifty-five stroke patients discharged to their homes with lasting impairment were randomised as follows: 54 to follow-up home visits by a physician (INT1-HVP), 53 to instruction by a physiotherapist in their home (INT2-PI), and 48 to standard aftercare (control). Six months after discharge, data on readmission were collected., Results: The readmission rate over the six-month period was 26% in the INT1-HVP group, 34% in the INT2-PI group, and 44% for the controls (p = 0.028). Multivariate analysis of the readmission risk showed a significant, favourable effect of intervention in interaction with the length of hospital stay (p = 0.0332), which indicates that the effect of intervention was strongest for patients with a long inpatient rehabilitation., Discussion: Follow-up intervention after discharge seems to be a way of preventing readmission, especially for patients with a long inpatient rehabilitation.

Stroke is among the leading causes of disability in Denmark. Rehabilitation services are in the process of being reorganised into dedicated stroke units. There is a general tendency toward reduction of length of in-patient treatment. The literature on outpatient rehabilitation services following primary rehabilitation on an inpatient basis was reviewed. The results of 16 randomised studies indicate that: 1) Continued rehabilitation after discharge can improve functional capacity of disabled stroke survivors; 2) Home-based rehabilitation is as effective as hospital-based outpatient rehabilitation; 3) Early supported discharge (ESD) services can reduce length of hospital stay but the relative advantages and drawbacks remain unclear. Ongoing rehabilitation by teams specialised in stroke rehabilitation seems to be crucial. More research, including evaluation of home-based rehabilitation services, is called for and existing outpatient rehabilitation services should be evaluated scientifically.

Psychosocial support has been suggested as a way of easing stroke survivors' and their carers' adjustment to a life with disability. The literature on psychosocial support services following primary rehabilitation in hospital was reviewed. Eleven controlled studies evaluating the effect of psychosocial support interventions after discharge from hospital were identified. The studies differed widely with respect to design, intervention and evaluation methods. The results suggest that psychosocial support after discharge can improve psychological well being and quality of life for stroke survivors and their families and improve the social activity of patients. The effect was achieved by using different types of intervention such as providing information, counselling and support from stroke clubs. Psychosocial support for carers was effective as well. Future research should elucidate this area, including evaluation of psychosocial support as a tertiary prevention strategy.

Background and Purpose: About 50% of stroke survivors are discharged to their homes with lasting disability. Knowledge, however, of the importance of follow-up services that targets these patients is sparse. The purpose of the present study was to evaluate 2 models of follow-up intervention after discharge. The study hypothesis was that intervention could reduce readmission rates and institutionalization and prevent functional decline. We report the results regarding readmission., Methods: This randomized study included 155 stroke patients with persistent impairment and disability who, after the completion of inpatient rehabilitation, were discharged to their homes. The patients were randomized to 1 of 2 follow-up interventions provided in addition to standard care or to standard aftercare. Fifty-four received follow-up home visits by a physician (INT1-HVP), 53 were provided instructions by a physiotherapist in their home (INT2-PI), and 48 received standard aftercare only (controls). Baseline characteristics for the 3 groups were comparable. Six months after discharge, data were obtained on readmission and institutionalization., Results: The readmission rates within 6 months after discharge were significantly lower in the intervention groups than in the control group (INT1-HVP 26%, INT2-PI 34%, controls 44%; P=0.028). Multivariate analysis of readmission risk showed a significant favorable effect of intervention (INT1-HVP or INT2-PI) in interaction with length of hospital stay (P=0.0332), indicating that the effect of intervention was strongest for patients with a prolonged inpatient rehabilitation., Conclusions: Readmission is common among disabled stroke survivors. Follow-up intervention after discharge seems to be a way of preventing readmission, especially for patients with long inpatient rehabilitation.