A randomised controlled trial of home based occupational therapy for stroke patients

[摘要] Discharge home would appear to be a critical stage in stroke rehabilitation with patients experiencing poor co-ordination of discharge planning, psychosocial problems and reduced quality of life. This study used a randomised controlled trial to evaluate the effectiveness of a short post-discharge home-based occupational therapy service on the recovery of stroke patients discharged home from hospital. The home based intervention programme was designed using focus group discussions to determine the views of patients and local therapists. One hundred and thirty eight patients were randomly allocated to either a conventional outpatient follow-up or conventional services plus six weeks of home based occupational therapy intervention. All patients were assessed before discharge, at seven weeks and six months to measure functional ability, quality of life, and perception of outcome and experience of discharge. Information was also obtained on readmission rates, strain on carers and resources used to operate the home based service. At seven weeks the intervention group showed significant (p<0.05) benefits in terms of improvement in self-care, extended activities of daily living, and satisfaction with their performance. The intervention group also reported improved subjective health experience on the emotion score of the COOP charts and in work/leisure on the London Handicap Scale. Patients receiving home-based occupational therapy were significantly less likely to deteriorate (death or increased disability) and were significantly more likely to continue therapy at home and to have received additional aids/equipment. No significant differences were observed in carer outcome between the two groups. By six months the treatment group were still reporting significant improvements in self-care and a trend towards treatment patients achieving higher functional scores was apparent but not statistically significant. No differences were observed in subjective health experience. However intervention patients were more satisfied with the preparations made for them to return home, with the stroke information they received and who to contact for further advise. The study concluded that a brief occupational therapy service carried out in the patient's home immediately after discharge can provide a continuity of care between hospital and the community and improve the functional outcome and satisfaction of stroke patients. The effects of the intervention were diluted over time and did not appear to influence the subjective health experience of patients or carers.

[发布机构] University:University of Glasgow

[关键词] Occupational therapy, Physical therapy