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. 1992 Apr 25;304(6834):1085–1089. doi: 10.1136/bmj.304.6834.1085

The Bradford community stroke trial: results at six months.

J B Young 1, A Forster 1
PMCID: PMC1881935  PMID: 1586821

Abstract

OBJECTIVE--Comparison of day hospital attendance and home physiotherapy for stroke patients leaving hospital to determine which service produces greater functional and social improvement for the patient, reduces emotional stress for the care giver, and lessens the need for community support. DESIGN--Stratified, randomised trial of stroke patients attending day hospital two days a week or receiving home treatment from a community physiotherapist. The six month assessment results are reported in this paper. SUBJECTS--Patients over 60 years old resident within the Bradford metropolitan district discharged home after a new stroke with residual disability. SETTING--Four day hospitals in two health authorities and domiciliary work undertaken by experienced community physiotherapists. MAIN OUTCOME MEASURES--Barthel index, functional ambulatory categories, Motor Club assessment, Frenchay activities index, and Nottingham health profile were used. Carers' stress was indicated by the general health questionnaire. Treatment given and community care provided were recorded. RESULTS--Of 124 patients recruited, 108 were available for reassessment at six months. Both treatment groups had significantly improved in functional abilities between discharge and six months. The improvements were significantly greater for patients treated at home (Mann-Whitney test; Barthel index, median difference 2 (95% confidence interval 0 to 3) p = 0.01; Motor Club assessment, median difference 2 (1 to 5), p = 0.01). The home treated patients received less treatment (median difference 16 (11 to 21) treatments, p less than 0.001). More than a third of patients in both groups showed depressed mood, and a quarter of care givers were emotionally distressed. CONCLUSIONS--Home physiotherapy seems to be slightly more effective and more resource efficient than day hospital attendance and should be the preferred rehabilitation method for aftercare of stroke patients. New strategies are needed to address psychosocial function for both patients and care givers.

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Selected References

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  1. Ahlsiö B., Britton M., Murray V., Theorell T. Disablement and quality of life after stroke. Stroke. 1984 Sep-Oct;15(5):886–890. doi: 10.1161/01.str.15.5.886. [DOI] [PubMed] [Google Scholar]
  2. Ashburn A. A physical assessment for stroke patients. Physiotherapy. 1982 Apr;68(4):109–113. [PubMed] [Google Scholar]
  3. Brocklehurst J. C., Morris P., Andrews K., Richards B., Laycock P. Social effects of stroke. Soc Sci Med A. 1981 Jan;15(1):35–39. doi: 10.1016/0271-7123(81)90043-2. [DOI] [PubMed] [Google Scholar]
  4. Eagle D. J., Guyatt G. H., Patterson C., Turpie I., Sackett B., Singer J. Effectiveness of a geriatric day hospital. CMAJ. 1991 Mar 15;144(6):699–704. [PMC free article] [PubMed] [Google Scholar]
  5. Ebrahim S., Barer D., Nouri F. Use of the Nottingham Health Profile with patients after a stroke. J Epidemiol Community Health. 1986 Jun;40(2):166–169. doi: 10.1136/jech.40.2.166. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Forster A., Young J. Day hospital and stroke patients. Int Disabil Stud. 1989 Oct-Dec;11(4):181–183. doi: 10.3109/03790798909166675. [DOI] [PubMed] [Google Scholar]
  7. Garraway W. M., Akhtar A. J., Hockey L., Prescott R. J. Management of acute stroke in the elderly: follow-up of a controlled trial. Br Med J. 1980 Sep 27;281(6244):827–829. doi: 10.1136/bmj.281.6244.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Goldberg D. P., Hillier V. F. A scaled version of the General Health Questionnaire. Psychol Med. 1979 Feb;9(1):139–145. doi: 10.1017/s0033291700021644. [DOI] [PubMed] [Google Scholar]
  9. Hildick-Smith M. Geriatric rehabilitation in day hospitals. Int Rehabil Med. 1985;7(3):120–124. doi: 10.3109/03790798509166138. [DOI] [PubMed] [Google Scholar]
  10. Holbrook M. Stroke: social and emotional outcome. J R Coll Physicians Lond. 1982 Apr;16(2):100–104. [PMC free article] [PubMed] [Google Scholar]
  11. Schmidt S. M., Herman L. M., Koenig P., Leuze M., Monahan M. K., Stubbers R. W. Status of stroke patients: a community assessment. Arch Phys Med Rehabil. 1986 Feb;67(2):99–102. doi: 10.1016/0003-9993(86)90110-3. [DOI] [PubMed] [Google Scholar]
  12. Stokoe D., Zuccollo G. Travel sickness in patients attending a geriatric day hospital. Age Ageing. 1985 Sep;14(5):308–311. doi: 10.1093/ageing/14.5.308. [DOI] [PubMed] [Google Scholar]
  13. Tucker M. A., Davison J. G., Ogle S. J. Day hospital rehabilitation--effectiveness and cost in the elderly: a randomised controlled trial. Br Med J (Clin Res Ed) 1984 Nov 3;289(6453):1209–1212. doi: 10.1136/bmj.289.6453.1209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Wade D. T., Langton-Hewer R., Skilbeck C. E., Bainton D., Burns-Cox C. Controlled trial of a home-care service for acute stroke patients. Lancet. 1985 Feb 9;1(8424):323–326. doi: 10.1016/s0140-6736(85)91091-8. [DOI] [PubMed] [Google Scholar]
  15. Wade D. T., Legh-Smith J., Langton Hewer R. Social activities after stroke: measurement and natural history using the Frenchay Activities Index. Int Rehabil Med. 1985;7(4):176–181. doi: 10.3109/03790798509165991. [DOI] [PubMed] [Google Scholar]
  16. Wade D. T., Wood V. A., Heller A., Maggs J., Langton Hewer R. Walking after stroke. Measurement and recovery over the first 3 months. Scand J Rehabil Med. 1987;19(1):25–30. [PubMed] [Google Scholar]

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