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A randomized controlled trial to evaluate intensity of community-based rehabilitation provision following stroke or hip fracture in old age

Department of Community, Ageing and Rehabilitation, School of Nursing and Midwifery, University of Sheffield, UK

Pam Enderby

Institute of General Practice and Primary Care, School of Health and Related Research, University of Sheffield, UK

Alan S Rigby

Department of Academic Cardiology, University of Hull, UK

Objective: To compare intensive with non-intensive home-based rehabilitation provision following stroke or hip fracture in old age (65 years).

Design: Parallel single-blind randomized control trial.

Setting: Domiciliary provided multidisciplinary rehabilitation.

Subjects: One hundred and sixty patients aged 65 or over recently discharged from hospital after suffering a stroke or hip fracture.

Intervention: Patients assigned to receive six or more face-to-face contacts or three or less face-to-face contacts from members of a multidisciplinary rehabilitation team.

Main measures: Patients assessed using the Barthel Index, Therapy Outcome Measure, Euroqol 5D (EQ-5D), Hospital Anxiety and Depression Scale (HADS) and Frenchay Activities Index (FAI) at three months. All follow-up assessments were conducted blind to allocation.

Results: Subgroup analysis was conducted on the basis of incident condition (stroke or hip fracture). Significant differences were detected for the stroke subgroup at three months [Therapy Outcome Measure Handicap (median difference 0.5 (P < 0.05)) and EQ-5D (median difference 0.17 (P < 0.05))] and in change at three months [Therapy Outcome Measure (mean difference 0.52 (SD 0.85) 95% CI (0.16, 0.88)) and EQ-5D (mean difference 0.15 (SD 0.25) 95% CI (0.05, 0.26))]. No significant differences were detected between the two arms of the study for the hip fracture subgroup.

Conclusion: Following stroke older people who receive a more intensive communitybased multidisciplinary rehabilitation service may experience short-term benefit in relation to social participation and some aspects of health-related quality of life. A more intensive service after discharge from hospital following a hip fracture is unlikely to result in similar patient benefit.

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