Home versus day rehabilitation: a randomised controlled trial

Objective: to assess the effect of home versus day rehabilitation on patient outcomes. Design: randomised controlled trial. Setting: post-hospital rehabilitation. Participants: two hundred and twenty-nine hospitalised patients referred for ambulatory rehabilitation. Interventions: hospital-based day rehabilitation programme versus home-based rehabilitation programme. Main Outcome Measures: at 3 months, information was collected on hospital readmission, transfer to residential care, functional level, quality of life, carer stress and carer quality of life. At 6 months, place of residence, hospital re-admissions and mortality status were collected. Results: there were significant improvements in the functional outcomes from baseline to 3 months for all participants. At discharge, carers of patients in day hospital reported higher Caregiver Strain Index (CSI) scores in comparison to home rehabilitation carers (4.95 versus 3.56, P = 0.047). Patients in day hospital had double the risk of readmission compared to those in home rehabilitation (RR = 2.1; 95% CI 1.2-3.9). This effect persisted at 6 months. Conclusions: day hospital patients are more likely to be readmitted to hospital possibly due to increased access to admitting medical staff. This small trial favours the home as a better site for post-hospital rehabilitation.