Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke

Objective: To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke, supervised once a week by therapists. Design: A randomized controlled trial of 100 patients discharged from hospital after a stroke, requiring ongoing therapy. The control group received outpatient or day hospital therapy; the experimental group were visited once a week by an occupational and/or physiotherapist who prescribed a programme of exercises and activities for the following week. Subjects were studied for the first three months after discharge from hospital. Setting: A district general hospital, or the homes of subjects randomized to the experimental group, in New Zealand. Main outcome measures: (1) Characteristics of the groups, (2) gait speed, limb function, activities of daily living, (3) time with therapists, (4) mood of both subjects and caregivers, (5) anticipation of outcome at entry, compared with perceived outcome at exit. Results: No statistical differences between the control and experimental groups in characteristics, or in any outcomes measured, except that the contact time period, but not the number of visits, was longer in the experimental group (p =0.003). Conclusions: A supervised home-based programme is as effective as outpatient or day hospital therapy.