Resource use of healthcare services 1 year after stroke : a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention

Objective: The objective of the study was to compare the total use of healthcare services in the course of the first year after a stroke between participants who, after the acute care, had received occupational therapy as a client-centred activities of daily living (ADL) intervention (CADL) and participants who had received usual ADL intervention (UADL). Design: A secondary analysis of a multicentre cluster-randomised controlled trial (RCT). Setting: Primary and secondary care in Sweden. Participants: Participants were included if they: (1) had received CADL or UADL in the RCT, either as inpatients in geriatric rehabilitation units or in their own homes, and (2) data could be retrieved about their use of healthcare services provided by the county council from computerised registers. Interventions: CADL or UADL. Outcome measures: Inpatient and outpatient healthcare in the course of the first year after stroke. Results: Participants from 7 of the 16 units included in the RCT met the criteria. Participants in the CADL group (n=26) who received geriatric inpatient rehabilitation had a shorter length of hospital stay (p=0.03) than participants in the UADL group (n=46), and the CADL group with home rehabilitation (n=13) had fewer outpatient contacts (p=0.01) compared with the UADL group (n=25). Multiple regression analyses showed that in four of the models, a higher age was associated with a lower use of healthcare services. The use of healthcare services was also associated (some of the models) with dependence in ADL, stroke severity and type of rehabilitation received, CADL or UADL. Conclusions: The provision of client-centred occupational therapy after stroke did not appear to increase the use of healthcare services during the first year after stroke. Trial registration number NCT01417585.