Abstract
BackgroundAlmost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate ambulatory aftercare in the community. Therefore, we developed an integrated multidisciplinary rehabilitation programme that includes aftercare for older persons with stroke. We evaluated the effectiveness of this newly developed rehabilitation programme in comparison to usual care.MethodsA multicentre randomised controlled trial was conducted in eight geriatric rehabilitation stroke units and their collaborating partners in primary care. The study population involved stroke patients and their informal caregivers who were aged 65 or over, living in the community before admission to geriatric rehabilitation, and expected to be able to return home after discharge. The programme consisted of three modules: inpatient neurorehabilitation, home-based self-management training, and stroke education. For patients, daily activity (FAI) was assessed as primary outcome and functional dependence (Katz-15), perceived quality of life (SSQoL) and social participation (IPA) as secondary outcomes. Additionally, among informal caregivers perceived care burden (self-rated burden VAS), objective care burden (Erasmus iBMG), and quality of life (CarerQol), were assessed as secondary outcomes.ResultsIn total 190 patients and 172 informal caregivers were included. Mean age of the patients in the intervention group was 78.9 years (SD = 7.0) and in the usual care group 79.0 years (SD = 6.5). Significant favourable effects for the programme were observed for the subscale autonomy outdoors of the IPA (− 2.15, P = .047, and for the informal caregivers perceived care burden (1.23, P = .048. For the primary outcome daily activity and the other secondary outcomes, no significant effects were observed.ConclusionThe integrated multidisciplinary programme had no effect on daily activity of older stroke patients. However, patients participating in the programme had a higher level of perceived autonomy of outdoor activities and their informal caregivers perceived a lower care burden. The programme might be promising in providing adequate (after) care, although adaptation of the programme is recommended to increase its feasibility and improve its effects.Trial registrationCurrent Controlled Trials ISRCTN62286281. Registered 19-3-2010.
Highlights
Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge
The integrated multidisciplinary programme had no effect on daily activity of older stroke patients
Patients participating in the programme had a higher level of perceived autonomy of outdoor activities and their informal caregivers perceived a lower care burden
Summary
Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Besides a negative impact on patients, stroke and multimorbidity may increase the burden of care perceived by informal caregivers which may result in a decrease in their quality of life [7, 8]. Research assistants conducted the interviews in the geriatric rehabilitation unit and at the patient’s home and provided the self-administered questionnaires to caregivers at baseline, after 6 months and after 12 months. Analyses of the difference between primary and secondary outcomes for intervention group and usual care group were performed according to the intention-to-treat principle (with possible covariates taken into account in case of observed imbalance in baseline characteristics), including all valid data of all available participants, regardless of whether they received the (complete) programme. All statistical analyses were conducted using IBM SPSS software version 25 for Windows by a researcher who was blinded for treatment allocation
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