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A randomized controlled trial of day hospital and day centre therapy

Jenny Longbottom

Maggie McKay

Colin Borland Hinchingbrooke Hospital, Huntingdon, University of Cambridge, UK

Toby Prevost

Centre for Applied Medical Statistics, Institute of Public Health, University of Cambridge, UK

Objective: To compare the outcome of day hospital to day centre rehabilitation.

Design: Single blind randomized controlled trial with home assessments at baseline (twice), six weeks and three months.

Setting: Mainly rural health district. Day hospital and social services day centres in market towns.

Subjects: One hundred and five physically disabled older patients living at home referred for day hospital rehabilitation or maintenance before discharge from hospital (66) or referred as outpatients (39).

Interventions: Day hospital treatment or day centre rehabilitation by a physiotherapist and two health support workers.

Main outcome measures: Barthel Index, Philadelphia Geriatric Morale Scale and Caregiver Strain Index.

Results: More day centre (23/55) than day hospital patients (6/50) (p <0.001) withdrew from allocated treatment by choice or because of operational difficulties. Both groups improved significantly in functional ability and reduction of care-giver strain by three months but there was no significant difference between groups. The mean improvement in Barthel Index (standard error) for day hospital = +1.5 (0.41) (n = 34) and day centres = +1.5 (0.48) (n = 38). The mean difference (95% confidence interval) between day hospital and day centre was 0 (–1.28, +1.28). Likewise the mean Philadelphia Geriatric Morale Scale improvement for day hospital +1.8 (0.66) (n = 35) and day centres was +0.9 (0.63) (n = 38). The mean difference was –0.88 (–2.7, +0.95). The mean reduction in Caregiver Strain for day hospital was –1.45 (0.5) (n = 23) and day centre was –1.59 (0.47) (n = 27). The difference was –0.14 (1.52,+1.24). (These analyses are all on an intention-to-treat basis.)

Conclusion: Whilst the improvement in functional ability and care-giver strain was similar in both groups, day centre rehabilitation was less popular and had practical difficulties. If these difficulties can be overcome the model should be tested elsewhere.

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