Bråndal Anna, Eriksson Marie, Glader Eva-Lotta, Wester Per
Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umeå, Sweden.
Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, S-901 87, Umeå, Sweden.
BMC Neurol. 2019 Mar 12;19(1):40. doi: 10.1186/s12883-019-1268-8.
The efficacy of early supported discharge (ESD) has not been tested in current stroke care setting, which provide relatively short hospital stays, access to hyper-acute therapies and early carotid stenosis interventions. This study aimed to compare patient-reported outcome measures (PROM) among patients with stroke that received modern stroke unit care with or without ESD.
Observational study of 30,232 patients with first-ever stroke registered in the Riksstroke registry in Sweden, between 1 January 2010 and 31 December 2013. Patient characteristics were collected from the Riksstroke and Statistics Sweden databases. The primary outcome was satisfaction with the rehabilitation at 3 months after discharge. Secondary outcome were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toileting and dressing) at 3 months after the stroke. We used separate multivariable logistic regression models for each PROM variable to analyze associations between PROMs and ESD/no ESD.
The ESD group comprised 1495 participants: the control group comprised 28,737 participants. Multivariable logistic regression models of PROMs showed that, compared to controls, the ESD group was more satisfied with rehabilitation after discharge (OR: 1.78, 95% CI: 1.17-2.49), experienced less dysthymia/depression (OR: 0.68, 95% 0.55-0.84) and showed more independence in mobility (OR: 1.50, 95% CI: 1.17-1.92), toileting (OR: 1.30, 95%CI: 1.05-1.61), and dressing (OR: 1.23, 95%CI: 1.02-1.48).
In the setting of modern stroke unit care, ESD appeared to have positive effects on stroke rehabilitation, in the subacute phase.
早期支持性出院（ESD）的疗效在当前的卒中护理环境中尚未得到验证，当前的卒中护理环境提供相对较短的住院时间、超急性治疗以及早期颈动脉狭窄干预措施。本研究旨在比较接受现代卒中单元护理且有或无早期支持性出院的卒中患者的患者报告结局指标（PROM）。
对2010年1月1日至2013年12月31日期间在瑞典Riksstroke登记处登记的30232例首次发生卒中的患者进行观察性研究。患者特征从Riksstroke和瑞典统计局数据库中收集。主要结局是出院后3个月时对康复的满意度。次要结局是卒中后3个月时提供的卒中信息、疲倦/疲劳、疼痛、心境恶劣/抑郁、总体健康状况以及日常生活活动（移动、如厕和穿衣）的依赖程度。我们针对每个PROM变量使用单独的多变量逻辑回归模型来分析PROM与早期支持性出院/无早期支持性出院之间的关联。
早期支持性出院组包括1495名参与者：对照组包括28737名参与者。PROM的多变量逻辑回归模型显示，与对照组相比，早期支持性出院组出院后对康复更满意（比值比：1.78，95%置信区间：1.17 - 2.49），经历的心境恶劣/抑郁更少（比值比：0.68，95%：0.55 - 0.84），并且在移动（比值比：1.50，95%置信区间：1.17 - 1.92）、如厕（比值比：1.30，95%置信区间：1.05 - 1.61）和穿衣（比值比：1.23，95%置信区间：1.02 - 1.48）方面表现出更大的独立性。
在现代卒中单元护理环境中，早期支持性出院在亚急性期似乎对卒中康复有积极影响。
