Early supported discharge of patients with acute stroke: a randomized controlled trial

Purpose: To evaluate the feasibility and effectiveness of early supported discharge (ESD) following acute stroke. Method: An ESD scheme was compared to conventional rehabilitation in a randomized controlled trial. All patients admitted with acute stroke were considered for inclusion. Eighty-eight (20.2%) were found to be eligible and 82 were randomized either to early supported discharge (n=42) or conventional rehabilitation (n=40). The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale. The General Health Questionnaire, the Montgomery Aasberg Depression Rating Scale, mortality, placement and patient and carer satisfaction served as secondary outcome measures. Results: Median length of stay was reduced from 31 days in the conventional hospital rehabilitation group to 22 days in the early supported discharge group (p=0.09). No differences were found regarding primary outcome. The General Health Questionnaire score showed a significant difference in favour of the early supported discharge group at three months (19.5/24, p=0.02), but not at six. At six months, the proportion of patients being dead or in institution showed a trend of being higher in the conventional rehabilitation group (OR 3.8, 95% CI 0.8-23). Conclusions: Early supported discharge after stroke is feasible and it is possible that it has benefits compared with conventional rehabilitation.