Background and Purpose
Early supported discharge (ESD) post stroke has been demonstrated as a cost-effective strategy for provision of rehabilitation to eligible patients. However, consensus on which patients are best-suited for ESD has yet to be established. This systematic review was designed to retrieve information on patients included in all published, peer-reviewed literature pertaining to ESD for post-stroke rehabilitation with the goal of identifying common criteria used to infer candidacy for ESD.
Methods
A systematic review of the literature was performed in three electronic databases (Medline, Embase, CINAHL) for peer-reviewed journal articles evaluating ESD for post-stroke rehabilitation published between January 1980 and September 2010. Research studies were considered if 1) they only included patients with primary diagnosis of stroke 2) the intervention under study was outpatient or community-based rehabilitation (ESD) as an alternative to in-hospital rehabilitation and 3) inclusion/ exclusion criteria and/or patient data at time of discharge to the community were reported. Information about study design, inclusion/exclusion criteria, discharge patient data and study results were collected.
Results
In total, 612 journal articles were screened and 20 were included for further assessment. No consensus on ESD suitability could be derived from the identified studies. Interventions under study ranged from organized in-home rehabilitation to “hospital at home” where therapy was provided by family members. On average, 34.7% (13%-70%) of patients screened for ESD candidacy were identified as suitable, but little consistency in screening procedures or criteria were noted. Recruitment generally took place within the first week post stroke but extended to as many as 4 weeks post stroke, while the average day of discharge into an ESD program ranged from 1 to as many as 42 days post stroke. Nine articles reported information about patient’s functional level within 48 hours of discharge to ESD, however, 27 different measures of patient function were reported.
Conclusions
Most research to date suggests that ESD is an effective strategy for providing rehabilitation to patients post-stroke. However, based on current research it is not possible to derive definitive criteria by which candidates for ESD can be identified. Future research is warranted.
Wearable sensors and machine learning in post-stroke rehabilitation assessment: A systematic review
