Rasmussen Rune Skovgaard, Østergaard Ann, Kjær Pia, Skerris Anja, Skou Christina, Christoffersen Jane, Seest Line Skou, Poulsen Mai Bang, Rønholt Finn, Overgaard Karsten
Department of Neurology N108, Copenhagen University Hospital Herlev, Herlev, Denmark
Medical Department C, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Clin Rehabil. 2016 Mar;30(3):225-36. doi: 10.1177/0269215515575165. Epub 2015 Mar 10.
To evaluate if home-based rehabilitation of inpatients improved outcome compared to standard care.
Interventional, randomised, safety/efficacy open-label trial.
University hospital stroke unit in collaboration with three municipalities.
Seventy-one eligible stroke patients (41 women) with focal neurological deficits hospitalised in a stroke unit for more than three days and in need of rehabilitation.
Thirty-eight patients were randomised to home-based rehabilitation during hospitalization and for up to four weeks after discharge to replace part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients.
Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome measures were the modified Barthel-100 Index, Motor Assessment Scale, CT-50 Cognitive Test, EuroQol-5D, Body Mass Index and treatment-associated economy.
Thirty-one intervention and 30 control patients completed the study. Patients in the intervention group achieved better modified Rankin Scale score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2-4; P=0.04). EuroQol-5D quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66-0.79; Control median = 0.66, IQR = 0.56 - 0.72; P=0.03). The total amount of home-based training in minutes highly correlated with mRS, Barthel, Motor Assessment Scale and EuroQol-5D™ scores (P-values ranging from P<0.00001 to P=0.01). Economical estimations of intervention costs were lower than total costs of standard treatment.
Early home-based rehabilitation reduced disability and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective.
评估与标准护理相比，住院患者的居家康复是否能改善预后。
干预性、随机、安全性/有效性开放标签试验。
与三个市政当局合作的大学医院卒中单元。
71例符合条件的卒中患者（41名女性），有局灶性神经功能缺损，在卒中单元住院超过三天且需要康复治疗。
38例患者被随机分配至住院期间及出院后长达四周进行居家康复，以替代部分常规治疗和康复服务。33例对照患者按照卒中患者常规治疗指南接受治疗和康复。
卒中后90天改良Rankin量表评分是主要终点。其他结局指标包括改良Barthel-100指数、运动评估量表、CT-50认知测试、欧洲五维度健康量表、体重指数以及治疗相关经济情况。
31例干预组患者和30例对照组患者完成了研究。干预组患者的改良Rankin量表评分更好（干预组中位数 = 2，四分位间距 = 2 - 3；对照组中位数 = 3，四分位间距 = 2 - 4；P = 0.04）。干预组患者的欧洲五维度健康量表生活质量中位数评分有所改善（干预组中位数 = 0.77，四分位间距 = 0.66 - 0.79；对照组中位数 = 0.66，四分位间距 = 0.56 - 0.72；P = 0.03）。以分钟计的居家训练总量与改良Rankin量表、Barthel指数、运动评估量表及欧洲五维度健康量表评分高度相关（P值范围从P < 0.00001至P = 0.01）。干预成本的经济估算低于标准治疗的总成本。
早期居家康复可减少残疾并提高生活质量。与标准护理相比，居家卒中康复更具成本效益。
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