Peter Langhorne and colleagues (Glasgow Royal Infirmary, Scotland) combined data from 11 trials, involving 1597 patients altogether that recruited stroke patients to receive conventional care or early supported discharge (ESD). Trials were selected if ESD provided rehabilitation and support in a community setting with the aim of shortening hospital care. ESD services were mostly provided by a specialist multi-disciplinary team (comprising physiotherapy, occupational therapy, and speech and language therapy, staff with medical, nursing, and social work support) to a selected group (41%) of stroke patients admitted to hospital.

Patients in the analysis had similar characteristics. The investigators found that those who received the ESD service had statistically fewer deaths and reduced dependency. The reduction equates to an extra six patients regaining independence for every 100 patients receiving ESD services. The hospital stays were 8 days shorter for patients assigned to ESD services than those assigned to conventional services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary team and stroke patients with mild to moderate disability. Five of the 11 trials reported an economic analysis. All concluded that savings from fewer hospital-bed days were greater than the cost of the ESD service.

Professor Langhorne concludes: "An appropriately resourced and coordinated ESD team can offer a further effective service option for a selected group of stroke patients and should be considered, in addition to organised inpatient (stroke unit) care, as part of a comprehensive stroke service."

In an accompanying commentary Ronald Meijer and Jacques van Limbeek (Rehabilitation Centre Groot Klim
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
3-Feb-2005