Establishing an effective and efficient Early Supported Discharge (ESD) rehabilitation program for Stroke clients in Perth WA

Providing an early home visit for mild-moderate severity strokes and facilitated discharge with the South Metro Area Health Service (SMAHS) Rehabilitation in the Home (RITH) therapists reduces length of stay for stroke unit patients in Perth WA: a randomised control trial.

Status

Recruiting

Phases

Unknown

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12611001243909

Enrollment

180

Registered

2011-12-06

Start date

2011-11-20

Completion date

Unknown

Last updated

2020-01-13

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

Early Supported Discharge (ESD) rehabilitation is considered internationally as best practice in rehabilitation of mild and moderate strokes when transferring from hospital to home. At RPH there are approximately 500 admissions for stroke. This research study will undertake a randomised controlled trial comparing an early discharge strategy to that of normal care in 90 individuals with mild and moderate stroke admitted to Royal Perth Hospital. This research study is designed to optimise the rehabilitation processes and pathway of people who have recently had a stroke. This study is a cost utility analysis of processes associated with the pathway of individuals admitted to RPH with mild or moderate stroke. The proposed change in model of care (ESD process) may have an impact on acute LOS and we would like to test the hypothesis that if there is a change that it will not detract from the long term functional outcomes nor satisfaction of the clients Hypothesis: H1: That the ESD strategy decreases LOS when compared to a matched cohort with no difference in functional outcomes at 6 and 12 months.

Interventions

identification of stroke severity - individual assessment of stroke patients using the NIHSS on acute stroke unit admission. duration approximately 20-30 mins to complete early home visit - joint home visit with ward and RITH therapists with the patient to assess home environment and patient requirements for safe discharge. duration 2-4 hours depending on home location and travel time facilitated goal setting and discharge planning - after the early home visit the ward and RITH teharpist will jointly establish goals for early discharge with the patient and family and document this in the patients medical record. RITH ESD team interface with ward based therapists - RITH therapist to visit the Stroke unit on a daily basis.

Study design

Allocation

Randomised controlled trial

Intervention model

Parallel

Primary purpose

Treatment

Masking

Blinded (masking used)

Eligibility

Sex/Gender

All

Age

16 Years to 100 Years

Healthy volunteers

Inclusion criteria

- Resident in SMAHS catchment area (postcode) - admitted to RPH Stroke unit - mild/mod stroke as assessed on the NIHSS - eligible for RITH program as per RITH criteria (including exclusion criteria for safe home visiting).

Exclusion criteria

- Known discharge destination not in the SMAHS RITH catchment area, i.e. rural patients - Medically unstable for discharge to a home based service - safety concerns for home visiting as per RITH SMAHS safe home visiting policy

Outcome results