Therapy led Stroke Early Supported Discharge: outcomes in mild to moderate stroke survivors

Purpose

The Stroke Early Supported Discharge (ESD) service enables accelerated discharge to service users providing seven days a week specialist rehabilitation and social support in the community to mild and moderately impaired stroke survivors. Service provision is focused around time specific goals and will consider the needs and ability of their carers. The main focus is to save bed days and improve patient outcomes and goals in the community setting.

The main aims and objectives is to demonstrate the outcomes particularly in relation to physiotherapy with ESD input in patients who have had a mild to moderate stroke.

Approach

Patients with strokes were given up to six weeks of multidisciplinary team rehabilitation by the stroke ESD team in their own home. Outcome measures were recorded at the beginning and the end of ESD and discharge from ESD.

Of all the indices (Barthel, Rivermead, Berg and Stroke Self-efficacy (SSEQ) are based on discharges from the Stroke ESD service in 2017/18 where the indices were not 0 or NULL. The Barthel and RMI/s SSEQ are required outcomes and the Berg outcome was from a battery of physio outcomes to be chosen.

Outcomes

Modified Bartel Index

188 patients total.

92.6% Increase

3.3% No change

2.1% Reduction in score.

 

Rivermead Mobility Index

109 patients total.

96.3% Increase

3.7% No change

 

BERG

28 patients total.

82.1% Increase

17.9% No change

 

Stroke Self Efficacy Score

152 patients total.

82.2% Increase

4.6% No change

13.2% Decrease  

Implications

A high percentage of patients improved on all outcome measures over the course of ESD intervention.

Implications for managers - current service only offers up to 6 weeks of therapy, however if this were to be extended for a further 6 weeks and outcomes re-evaluated there may be an even greater improvement. Implications for education - a limited range of outcome measures are currently being used, with further training the team may be able to use other measures to ensure that improvements in other areas is also being recorded, eg upper limb function using ARAT. Rehabilitation assistants can also be trained to perform these outcome measures. Implications for practice - if further outcomes are recorded then this will measure the impact of targeted therapy interventions. . Using the evidence base regarding upper limb predictors following stroke in relation to recovery the team will be better able to target therapy at the individuals who will most benefit from it.

Fund acknowledgements

This work was not funded.

Additional notes

This work was presented at Physiotherapy 2018.