Stroke: home physiotherapy improved recovery.

Clinical bottom line (level 1b)

  1. Patients who had a stroke and were given home physiotherapy, were more likely to have independence of functional movement, than those attending day hospitals. (NNT = 4 at 6 months) .
  2. Patients who were given home physiotherapy were more likely to have independence of functional ambulation, than those attending day hospital (NNT = 5 at 6 months) .
  3. Patients given home physiotherapy were less likely to still be receiving treatment at six months (NNT = 3 at 6 months) .
  4. There was no clear difference in independence in performing daily activities, little social activity, considerable stress and stress of carers between the two groups.
Young and Forster: British Medical Journal 1992; 304: 1085-1089
Expires November 2002

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: four day hospitals in two health authorities and community, UK

124 patients (aged range 60 to 89 years; mean 71, 56% male) about to be discharged home after a new stroke episode that had caused persisting disability

Excluded if
  • = 60 years old


    • Note:
  • Patients were stratified before randomisation according to severity of disability, using the Barthel index score.


    • Control Group: (n = 61, 52 analysed): attended one of four geriatric day hospitals twice a week
    Experimental Group: (n = 63, 56 analysed): treated at home by one of five experienced community physiotherapists

    87% followed for 6 months
    Outcome notes:
    • independence in performance of activities of daily living : a score of 20 on the Barthel index
    • independence in functional movement : score of 41 to 45 on the Motor Club assessment
    • little social activity : score of 0 to 10 on the Frenchay activities index
    • independence in functional ambulation : score of 5 in the Functional ambulation category
    • considerable distress : score of 30 to 100 on the Nottingham health profile (measuring health status)
    • stressed carers : score of 5 to 28 on the General health questionnaire
    • still receiving treatment :

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    independence in performance of activities of daily living 6 months 4
    (7.69%)    		 11
    (19.6%)    		 13%
    (-1% to 25%)    		 11.95%
    (-.73% to 24.63%)    		 8
    (NNT = 4 to infinity;
    NNH = 137 to infinity)
    independence in functional movement 6 months 16
    (30.77%)    		 32
    (57.1%)    		 38%
    (12% to 56%)    		 26.37%
    (8.34% to 44.41%)    		 4
    (2 to 12)
    little social activity 6 months 39
    (75.0%)    		 34
    (60.7%)    		 19.0%
    (-5.00% to 38.0%)    		 14.29%
    (-3.10% to 31.7%)    		 7
    (NNT = 3 to infinity;
    NNH = 32 to infinity)
    independence in functional ambulation 6 months 12
    (23.1%)    		 25
    (44.6%)    		 28%
    (5% to 46%)    		 21.57%
    (4.32% to 38.91%)    		 5
    (3 to 24)
    considerable distress 6 months 19
    (36.5%)    		 20
    (35.7%)    		 2.00%
    (-61.0% to 41.0%)    		 0.82%
    (-17.3% to 19.0%)    		 121
    (NNT = 5 to infinity;
    NNH = 6 to infinity)
    stressed carers 6 months 14
    (26.9%)    		 8
    (14.3%)    		 47.0%
    (-16.0% to 76.0%)    		 12.64%
    (-2.51% to 27.8%)    		 8
    (NNT = 4 to infinity;
    NNH = 40 to infinity)
    still receiving treatment 6 months 27
    (51.9%)    		 12
    (21.4%)    		 59.0%
    (27.0% to 77.0%)    		 30.5%
    (13.2% to 47.8%)    		 3
    (2 to 8)

    Citation

    1. Young JB, and Forster A: The Bradford community stroke trial: results at six months. British Medical Journal 1992; 304: 1085-1089
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer: Rowan Harwood

    Clinical Question.
    Patient stroke
    Intervention or Exposure home physiotherapy
    Comparison day hospital attendance
    Outcome functional and social improvement