Home-Based Therapy Beneficial for Stroke Patients

A systematic review of published studies investigating the provision of therapy-based services targeted towards people living at home who have had strokes highlights the benefits of these services-the main finding shows that the rate of deterioration in the ability to carry out daily living tasks could be reduced by up to 30% for patients who receive therapy in the home environment.

Stroke is one of the most frequent causes of disability in developed countries and accounts for considerable costs for health and social services. Organised inpatient care in multidisciplinary stroke units can reduce adverse health outcomes compared with less organised inpatient care; however, there is no widespread agreement concerning the effects of rehabilitation services for stroke patients once they have left hospital.

Lynn Legg from the University of Glasgow, UK, and colleagues did a systematic review of randomised trials of outpatient services, including physiotherapy, occupational therapy, and multidisciplinary teams. 14 trials involving over 1600 stroke patients were included for analysis. All patients were living at home within one year of stroke onset or discharge from hospital. Therapy-based rehabilitation services for stroke patients living at home reduced the odds of deteriorating in personal activities of daily living (eg. walking, dressing) by 28% and increased the ability of patients to undertake activities of daily living by 14%

Ms Legg comments: "Our results suggest that a therapy-based rehabilitation service could be beneficial. Although the health gain we recorded is fairly modest, we know of no other intervention at present that can provide this increase at this stage of recovery. The exact nature and content of therapy-based rehabilitation services is not answered by our review; neither is the most effective way to structure provision of these services, nor their economic benefits. What does seem clear is that the debate should move from whether such services are effective to how to make the most of their benefits."

Contact: Ms Lynn Legg, Geriatric Medicine, University of Glasgow Royal Infirmary, Glasgow, SCOTLAND lynn@legg80.freeserve.co.uk or Professor Peter Langhorne p.Langhorne@clinmed.gla.ac.uk

Lancet 2004; 363: 356-56