Randomized controlled trial of home rehabilitation for patients with ischemic stroke: impact upon disability and elderly depression

Abstract

Abstract Background: Patients with major stroke are often left with disability and may have depression and dementia during the recovery phase. Rehabilitation programmes have been shown to improve short-term physical outcome, but their long-term effectiveness and impact on dementia and depression are uncertain. Methods: We performed a 6-month randomized controlled trial of a home rehabilitation programme and compared it with the standard care patients with recent ischemic stroke receive. The intervention group received home-based physical therapy once a month for 6 months, along with educational support, counselling and audiovisual materials. The control group received rehabilitation as prescribed by a physician and educational materials upon discharge from hospital. The primary measurement was a change in Barthel Index. Secondary measurements were the Hospital Anxiety and Depression Scale (HADS) and Thai Mini-Mental State Examination. Results: Of the 68 screened patients, 60 patients were enrolled. At baseline, there was no significant difference in patient characteristics between the two groups. Over 2 years, the mean Barthel Index and Hospital Anxiety and Depression Scale were significantly improved in the intervention group compared to the control group (Barthel Index mean: from 31.7 ± 5.9 to 97.2 ± 2.8 vs from 33.2 ± 4.8 to 76.4 ± 9.4, P < 0.001; Hospital Anxiety and Depression Scale mean: from 16.1 ± 7.6 to 9.1 ± 0.3 vs 16.4 ± 4.9 to 9.1 ± 0.3, P= 0.003). Depression was strongly associated with being dependent on others. However, the Thai Mini-Mental State Examination in both groups did not significantly differ (Thai Mini-Mental State Examination mean: from 24.4 ± 2.0 to 24.6 vs 23.8 ± 1.9 to 24.1 ± 0.3, P= 0.068). There was no significant interaction between baseline characteristics and treatment outcome. Conclusions: At 2 years follow-up, it was evident that a 6-month home rehabilitation programme after ischemic stroke improved functional outcome and reduced incidence of depression, but not dementia.