Early home-supported discharge for patients with stroke in Portugal: a randomised controlled trial.
Silvina Santana, José Rente, Conceição Neves and 5 others
PMID 26837431WHAT IT FOUND
Early home-supported discharge did not improve functional independence scores compared to usual care.
However, fewer patients in the home-supported group had severe disability (FIM < 60) at six months, suggesting a potential benefit for the most impaired patients that requires further study.
Key findings
01The primary outcome, functional independence (FIM) at six months, showed no significant difference between the early home-supported discharge group and the usual care group.
02At six months, fewer patients in the home-supported group had low functional independence scores (FIM ≤ 60) compared to the usual care group, though this was an exploratory analysis.
03There were no significant differences in activity levels (Frenchay Activity Index) between the two groups at six months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The analysis of patients with low FIM scores was exploratory and the threshold (≤ 60) was not defined a priori. There was a notable loss to follow-up (34 patients, 18%), which reduced power and may have influenced the results, particularly in the subgroup analysis. Data on ambulatory rehabilitation sessions was incomplete and of poor quality, making it difficult to compare the intensity of rehabilitation received by the two groups. The study was conducted in Portugal, and the healthcare system structure (fragmented post-discharge care) may limit generalisability to other countries.
Declared interests
The study was funded by the European Commission (FP7-Homecare 222954). The authors declared no potential conflicts of interest.
The easy way to misread this
Do not interpret the reduction in patients with severe disability (FIM ≤ 60) in the EHSD group as definitive proof of efficacy. This was an exploratory analysis with a threshold not set before the study began, and the primary outcome for the whole group was null.