Effect of very early supported discharge versus usual care on activi-ties of daily living ability after mild stroke: a randomized controlled trial.
Ann Björkdahl, Lena Rafsten, Cathrine Petersson and 2 others
PMID 37615492WHAT IT FOUND
Very early supported discharge sped up recovery of complex daily tasks like shopping and transport.
By three months, home-based teams helped patients with mild stroke do these tasks better than usual care, but the groups were equal by one year.
Key findings
01At three months post-stroke, the home-based supported discharge group had significantly better function in instrumental activities of daily living (I-ADL) than the usual care group.
02Self-reported mobility and daily living abilities also favored the supported discharge group at three months, with differences disappearing by twelve months.
03The supported discharge intervention consisted of 2–4 home visits per week for 4 weeks by a team including an OT, PT, and nurse, focused on individual goals.
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
This is a secondary analysis of a trial originally powered for anxiety outcomes, not ADL ability. The intensity and content of 'usual care' in the control group were not well documented, making it difficult to compare the specific effect of the VESD intervention versus just receiving more therapy. The study excluded patients who could not speak Swedish. A small number of patients were excluded from change-score analyses due to new strokes or medical issues. The primary outcome measure (ADL Taxonomy) and secondary measure (SIS) rely partly on patient self-report, which may be affected by cognitive deficits present in some participants.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the lack of difference at 12 months as evidence that the intervention is ineffective. The study shows that supported discharge significantly speeds up recovery of complex daily tasks in the first three months, even if the gap closes by one year.