The effectiveness of community-based rehabilitation for stroke patients who remain at home: a pilot randomized trial

OBJECTIVE: To assess the effectiveness of community-based rehabilitation for stroke patients who were not admitted to hospital in South London. DESIGN: Randomized controlled trial. SETTING: Patients' homes in South London. SUBJECTS: Stroke patients not admitted to hospital after a stroke. INTERVENTION: Rehabilitation at home by rehabilitation team for up to three months or usual care. MAIN OUTCOME MEASURES: The primary outcome measure was the Barthel score. Secondary measures included the Motricity Index, Rivermead ADL, Hospital Anxiety and Depression score and Nottingham Health Profile. RESULTS: Forty-three patients who remained at home were randomized to rehabilitation team (23) or 'usual' care (20). The mean number of physiotherapy sessions was three (range 1-14) for the rehabilitation team group and two for the usual care group. Patients (with a deficit) in the rehabilitation arm of the trial were more likely to receive occupational, physical and speech therapy than those in the control arm (p = 0.03, 0.01 and 0.008, respectively). For those patients actually receiving therapy, there was no evidence that the amount received differed between the groups. However, the number of patients in each of these comparisons was very small. The outcome for patients in the rehabilitation team arm of the trial was nonsignificantly higher (0.05 < p < 0.2) than for those in the control arm for the areas of Nottingham Health Profile, anxiety, depression, caregiver strain and the proportion of patients living at home. Based on the data observed here, a trial with approximately 150 patients in each arm would be needed to have adequate power to detect a 33% difference between intervention and control groups in these outcomes. CONCLUSION: Community therapy support for patients not admitted to hospital is feasible but to determine whether it is cost- or clinically effective would require trials of adequate size.