News Release

There’s no place like home for stroke rehabilitation

Peer-Reviewed Publication

American Heart Association

Stroke survivors who can leave the hospital early and rehab at home fare better than those who don't get that opportunity, researchers report in this month's Stroke: Journal of the American Heart Association.

"Going home to rehabilitate empowers the survivor and the family to take charge of the care," says the study's lead author Nancy E. Mayo, Ph.D., associate professor, school of physical and occupational therapy at McGill University in Montreal, Quebec, Canada. "Instead of being passive observers around the bedside of the patient, they were in charge, actively making decisions and taking action."

Mayo stresses that the study doesn't give license to send patients home early regardless of their condition.

"They all wanted to go home," says Mayo, referring say they to the patients studied. "It was very rare that we would find someone who wanted to spend another six weeks in the hospital. We weren't pushing people out. If we can provide rehabilitation to people at home, that adds alternatives aside from the hospital."

A scale to measure physical health -- called the Measuring Outcomes Study Short-Form-36 (SF-36) -- found that three months after hospital discharge, the average score in the home group survivors rated 5 points higher than the usual care group (who received rehabiliation either in the hospital or at an outpatient rehabilitation center), a clinically meaningful result according to Mayo. The home group also scored higher when measuring daily living activities and reintegration into the community.

There are more than 4 million stroke survivors in the United States, according to the American Heart Association. As new and better stroke treatments become available, the number of stroke survivors will likely increase, thereby increasing the importance of after-care and rehabilitation for stroke survivors.

Even if a person has what might be considered a "mild" stroke on a neurological scale, it may result in a "major" decline in quality of life. Mayo says this reinforces the need for improved stroke rehabilitation.

"In the past, there was the belief that if patients could walk and go to the bathroom by themselves, we had done a good job," says Mayo. "This is terrible. Our expectations for recovery need to be much higher. Rehabilitation should get people back to playing golf, back to work and driving the car. What we currently consider to be good enough simply isn't anymore."

The study compared 58 stroke survivors who received a 4-week, individualized home rehabilitation program and 56 survivors who received a typical post-stroke care regimen at the hospital or community health clinic.

The survivors who were promptly discharged from the hospital once it was determined the patient was medically stable to do so became the home care group. They received follow-up services at home from nurses, physical therapists, occupational therapists, speech therapists and dietitians. Those in the usual care group were eligible to receive a similar range of services as requested by the patient's care provider, but they received their rehab either in the hospital or at an outpatient clinic.

The home rehabilitation group may have fared better, according to Mayo, because the goals of their rehabilitation were more familiar to them.

"People want to be able to climb the stairs, walk out to their patio or go back to gardening," says Mayo. "It makes a difference when someone is trying to relearn one of those skills instead of seeing how long they can walk on a treadmill."

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Co-authors are Sharon Wood-Dauphinee, Ph.D.; Robert Cote, M.D.; David Gayton, M.D.; Joseph Carlton, M.D.; Joanne Buttery; and Robyn Tamblyn, Ph.D.

Media advisory: Dr. Mayo may be reached by phone at 514-842-1231, xt. 6922 or by email at mdnm@musica.mcgill.ca. (Please do not publish numbers.)

OTHER CONTACTS:
For journal copies only, please call: 214-706-1173
For other information, call: Brian Henry: 214-706-1135; Carole Bullock: 214-706-1279


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