Sammendrag
Background and purpose: Several trials have shown that stroke unit care improves the 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, co-operation with the primary health care, and more emphasize on rehabilitation at home as essential elements. Patients and 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 being independent assessed by the modified Rankin Scale (RS)(RS95 = independent in ADL) after 26 weeks(w). Secondary outcomes were RS and BI after 6w, the proportion of patients at home, in institutions and deceased after 6 and 26 w and the length of stay in institutions. Results: After 26 w 65.0% in the ESUS versus 51.9% in the OSUS group showed a global independence (RS95) (P=0.056). The odds ratio(OR) for independence (ESUS versus OSUS) were for RS: 1.72 (95%CI:1.10-2.70), and for BI: 1.54 (95%CI:0.99-2.39). At 6 w 54.4% of the ESUS and 45.6% of the OSUS group were independent according to RS (P=0.118), and 56.3% versus 48.8% independent according to BI (P=0.179). The proportion of patients at home after 6w were 74.4%(ESUS) and 55.6%(OSUS) (P=0.0004), and in institutions 23.1% versus 40.0% (P=0.001). After 26 w 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 two groups did not differ. Average lengths of stay in institution was 18.6 days in the ESUS and 31.1 days in the OSUS group (P=0.0324). Conclusion: An extended stroke unit service with early supported discharge seems to improve functional outcome, and to reduce the length of stay in institutions compared to traditional stroke unit care.
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