Abstract TP52: Post-acute Transition Of Care In Stroke Patients: A Systematic Review

Abstract

Background: Post-acute transition of care (TOC) in stroke patients is a multifactorial process. Different TOC interventions have been tested, with inconsistent benefits. Objective: Our aim is to evaluate the effect of post-acute TOC interventions on various stroke patients’ outcomes. Methods: All published interventional studies evaluating the impacts of TOC models for stroke survivors, during their post-acute care disposition, were included. We excluded studies tackling only patients with intracerebral hemorrhage (ICH) or transient ischemic attacks, those with purely rehabilitative interventions, case reports and case studies, as well as systematic reviews and meta-analyses. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) through July 2022. Results: We included 38 studies involving 82,416 patients. TOC services were heterogeneous, commonly including scheduled home visits, telephone calls and office visits, in the setting of a multidisciplinary approach. Outcome measurement time varied between 1 month and 5 years. Activities of daily living (ADLs)-related outcomes, functionality, quality of life (QOL)-related outcomes, readmission rates, mental health-related outcomes, and mortality were reported in 20, 11, 10, 10, 7, and 6 studies, respectively. Only 4 studies looked at rates of medication adherence and 2 studies at control of vascular risk factors. In 6 out of 10 studies, improvements in QOL measurements and patient-reported health surveys were reported, whereas no study reported improvement in mortality rates. Three studies showed improvement for each of the following outcomes: ADLs, functionality, and readmission rates. Only 2 studies noted decrease in mental health problems with the intervention, and 2 noted better control of vascular risk factors. Both studies with medication adherence outcomes showed that the intervention increases rates of compliance to prescribed drugs. Conclusion: Post-acute TOC interventions seem to have a positive effect on stroke survivors’ quality of life and self-perceived health, as well as on rates of medication adherence, but bear no effect on mortality.