Stroke Early Supported Discharge Program: a multidisciplinary effort for enhancing early and safe discharge for home-based rehabilitation

Abstract Description

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Authors (including presenting author) :

Chao CYL(1), Poon MWM(1), Ng VTW(1), Yeung SCS(1), Fong MHK(1), Tam SHY(1), Yeung JSY(1), Liu BKP(1), Wong GHS(1), Wan SPC(1), Fong WC(2), Chan ACM(1)

Affiliation :

(1)Physiotherapy Department, Queen Elizabeth Hospital; (2)Department of Medicine, Queen Elizabeth Hospital

Introduction :

Home-based rehabilitation is a vital component for improving care and outcomes for stroke survivors. Recovery from stroke involves making changes in the physical, social and emotional aspects of life with multidisciplinary concerned effort. Stroke Early supported discharge (ESD) Program has been implemented in the Queen Elizabeth Hospital since December 2011, aiming at providing an early and safe discharge for selected stroke cases and supported with timely home-based rehabilitation followed by out-patient training. Patients can return to their own homes to maximize independence as quickly as possible. It also enhances the hospital service delivering efficiencies in acute bed usage.

Objectives :

To evaluate the rehabilitation outcomes of home-based physiotherapy rehabilitation program for patients with mild to moderate severity of stroke discharged early from acute hospital and the stress and strain of their caregivers.

Methodology :

Patients admitted to Acute Stroke Unit of Queen Elizabeth Hospital and direct discharged home early as agreed from the multidisciplinary discussion with doctors, nurses, other allied health professionals, patients and their caregivers for receiving the home-based rehabilitation program were analysed. The Physiotherapy Home Program included home safety screening, fall risk assessment, exercise programs and caregivers education. Each patient received 2 to 4 visits in the critical post-discharge support period, depending on their physical condition and individual needs. Selected cases continued receiving the subsequent out-patient training as indicated.

Result & Outcome :

From December 2011 to November 2018, 812 acute stroke patients received the Physiotherapy Home Program with a total of 1,782 home visits provided. The percentage of direct home discharge from acute stroke unit increased from 45.18% in 2011 to 54.76% in 2017. The averaged time interval between hospital discharge and the first Physiotherapy home visit was 4.6±3.0 days. On completion of the Physiotherapy Home Program, the averaged Modified Barthel Index (MBI) score improved from 80.9±16.4 to 92.8±16.4 (p< 0.001); Modified Rivermead Mobility Index (MRMI) score improved from 30.9±8.0 to 36.8±6.1 (p< 0.001); median of Modified Functional Ambulatory Categories (MFAC) improved from 5 to 7 (p< 0.001); and the mean Berg Balance Scale (BBS) Score improved from 43.5±13.3 to 49.6±12.2 (p< 0.001). Caregivers stress index was 3.9±5.53 upon discharge from the Home Program which indicated a low stress level. All stroke patients and their caregivers satisfied with the program. The Stroke Early Supported Discharge Program as supported by the timely home-based physiotherapy rehabilitation promotes the rehabilitation outcomes for mild to moderate severity of stroke patients in terms of functional independences, physical mobility level and ambulatory status. It also helped to relieve the stress and burden of the caregivers. The Program provides a cost-effective alternative to institution-based rehabilitation and facilitates an early community re-integration of both patients and their caregivers.