A randomized controlled trial to evaluate intensity of community-based rehabilitation provision following stroke or hip fracture in old age

Objective: To compare intensive with non-intensive home-based rehabilitation provision following stroke or hip fracture in old age (65 years+). Design: Parallel single-blind randomized control trial. Setting: Domiciliary provided multidisciplinary rehabilitation. Subjects: One hundred and sixty patients aged 65 or over recently discharged from hospital after suffering a stroke or hip fracture. Intervention: Patients assigned to receive six or more face-to-face contacts or three or less face-to-face contacts from members of a multidisciplinary rehabilitation team. Main measures: Patients assessed using the Barthel Index, Therapy Outcome Measure, Euroqol 5D (EQ-5D), Hospital Anxiety and Depression Scale (HADS) and Frenchay Activities Index (FAI) at three months. All follow-up assessments were conducted blind to allocation. Results: Subgroup analysis was conducted on the basis of incident condition (stroke or hip fracture). Significant differences were detected for the stroke subgroup at three months [Therapy Outcome Measure Handicap (median difference 0.5 (P < 0.05)) and EQ-5D (median difference 0.17 (P < 0.05))] and in change at three months [Therapy Outcome Measure (mean difference 0.52 (SD 0.85) 95% CI (0.16, 0.88)) and EQ-5D (mean difference 0.15 (SD 0.25) 95% CI (0.05, 0.26))]. No significant differences were detected between the two arms of the study for the hip fracture subgroup. Conclusion: Following stroke older people who receive a more intensive community-based multidisciplinary rehabilitation service may experience short-term benefit in relation to social participation and some aspects of health-related quality of life. A more intensive service after discharge from hospital following a hip fracture is unlikely to result in similar patient benefit.