Stroke: community rehabilitation was not clearly different to conventional rehabilitation.

Clinical bottom line (level 1b-)

  1. Patients with stroke who were given specialist community rehabilitation had no clear difference in clinical outcomes, than those given conventional rehabilitation.
  2. Patients who were given community rehabilitation had no clear difference in patient or caregiver satisfaction, than those given conventional rehabilitation.
Rudd et al: British Medical Journal 1997; 315: 1039-1044
Expires November 2002

The study

Unblinded concealed randomised trial with intention-to-treat
Setting: two teaching hospitals, UK

331 patients (aged range 27 to 103 years; mean 71, 56% male) medically stable with stroke

Excluded if
  • were unable to transfer independently


    • Control Group: (n = 164, 126 analysed): conventional care- treatment, discharge planning and outpatient care
    Experimental Group: (n = 167, 136 analysed): community therapy- remained in hospital until the required package of social services care could be organised and any home adaptations undertaken. After discharge, patients were given a planned course of domiciliary physiotherapy, occupational therapy and speech therapy, with visits as frequently as considered appropriate (maximum one daily visit from each therapist). Each patient had an individual care plan which was reviewed weekly.
    The community therapy team comprised of a senior physiotherapist, a senior occupational therapist, a half time speech and language therapist and a full time therapy aide.
    97% followed for 12 months

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    general satisfaction of patients 1 years 43
    (34.1%)    		 58
    (42.7%)    		 -25.0%
    (-71.0% to 8.00%)    		 -8.52%
    (-20.3% to 3.21%)    		 12
    (NNT = 5 to infinity;
    NNH = 31 to infinity)
    general satisfaction of caregivers 1 years 52
    (41.3%)    		 68
    (50.0%)    		 -21.0%
    (-58.0% to 7.00%)    		 -8.73%
    (-20.8% to 3.29%)    		 11
    (NNT = 5 to infinity;
    NNH = 30 to infinity)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    mean Barthel activities of daily living score 16.0
    (4.00)     		16.0
    (4.00)     		0.00
    (-0.97 to 0.97)
    Frenchay aphasia score 23.0
    (7.00)     		22.0
    (8.00)     		1.00
    (-0.84 to 2.84)
    Mini mental state examination 25.0
    (6.00)     		25.0
    (6.00)     		0.00
    (-1.46 to 1.46)
    motoricity 87.0
    (14.0)     		88.0
    (13.0)     		-1.00
    (-4.29 to 2.29)
    five metre timed walk 12.0
    (8.00)     		12.0
    (6.00)     		0.00
    (-1.71 to 1.71)
    total Nottingham health profile 12.0
    (8.00)     		14.0
    (9.00)     		-2.00
    (-4.08 to 0.08)
    Rivermead activities of daily living scale 27.0
    (11.0)     		27.0
    (12.0)     		0.00
    (-2.81 to 2.81)

  • 26 patients in the community therapy group had died by one year and 34 in the conventional group.
  • There was no clear difference in the number of patients who were normal on the hospital anxiety and depression score between the two treatments.

    • Comments

    1. The trial was too small to show any clear difference in outcomes between the two groups, on indeed to confirm their equivalence.

    Citation

    1. Rudd AG, Wolfe CDA, Tilling K, et al: Randomised controlled trial to evaluate early discharge scheme for patients with stroke. British Medical Journal 1997; 315: 1039-1044
    Contributor: Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient stroke
    Intervention or Exposure community rehabilitation
    Comparison conventional hospital and community care
    Outcome severity of disability