Benefit of an Extended Stroke Unit Service With Early Supported Discharge

Abstract

Background and Purpose —Several trials have shown that stroke unit care improves outcome for stroke patients. The aim of the present trial was to evaluate the effects of an extended stroke unit service (ESUS), with early supported discharge, cooperation with the primary healthcare system, and more emphasis on rehabilitation at home as essential elements. Methods —In a randomized, controlled trial, 160 patients with acute stroke were allocated to the ESUS and 160 to the ordinary stroke unit service (OSUS). The primary outcome was the proportion of patients who were independent as assessed by the modified Rankin Scale (RS) (RS ≤2=global independence) and independent in activities of daily living (ADL) as assessed by Barthel Index (BI) (BI ≥95=independent in ADL) after 26 weeks. Secondary outcomes were RS and BI scores after 6 weeks; the proportion of patients at home, in institutions, and deceased after 6 and 26 weeks; and the length of stay in institutions. Results —After 26 weeks, 65.0% in the ESUS versus 51.9% in the OSUS group showed global independence (RS ≤2) ( P= 0.017) , while 60.0% in the ESUS versus 49.4% in the OSUS group were independent in ADL (BI ≥95) ( P =0.056). The odds ratios for independence (ESUS versus OSUS) were as follows: RS, 1.72 (95% CI, 1.10 to 2.70); BI, 1.54 (95% CI, 0.99 to 2.39). At 6 weeks, 54.4% of the ESUS group and 45.6% of the OSUS group were independent according to RS ( P =0.118), and 56.3% versus 48.8% were independent according to BI ( P =0.179). The proportion of patients at home after 6 weeks was 74.4% for ESUS and 55.6% for OSUS ( P =0.0004), and the proportion in institutions was 23.1% versus 40.0%, respectively ( P =0.001). After 26 weeks, 78.8% in the ESUS group versus 73.1% in the OSUS were at home ( P =0.239), while 13.1% versus 17.5% were in institutions ( P =0.277). The mortality in the 2 groups did not differ. Average lengths of stay in an institution were 18.6 days in the ESUS and 31.1 days in the OSUS group ( P =0.0324). Conclusions —An ESUS with early supported discharge seems to improve functional outcome and to reduce the length of stay in institutions compared with traditional stroke unit care.