Jj Baskett

Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke

Objective: To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke, supervised once a week by therapists. Design: A randomized controlled trial of 100 patients discharged from hospital after a stroke, requiring ongoing therapy. The control group received outpatient or day hospital therapy; the experimental group were visited once a week by an occupational and/or physiotherapist who prescribed a programme of exercises and activities for the following week. Subjects were studied for the first three months after discharge from hospital. Setting: A district general hospital, or the homes of subjects randomized to the experimental group, in New Zealand. Main outcome measures: (1) Characteristics of the groups, (2) gait speed, limb function, activities of daily living, (3) time with therapists, (4) mood of both subjects and caregivers, (5) anticipation of outcome at entry, compared with perceived outcome at exit. Results: No statistical differences between the control and experimental groups in characteristics, or in any outcomes measured, except that the contact time period, but not the number of visits, was longer in the experimental group (p = 0.003). Conclusions: A supervised home-based programme is as effective as outpatient or day hospital therapy.

Sensitivity of Shah, Vanclay and Cooper's modified Barthel Index

Objective: To investigate whether Shah, Vanclay and Coopers modification of the Barthel Index improved its sensitivity to change. Design: Correlational study. Setting: School of Occupational Therapy at Auckland Institute of Technology, Auckland, New Zealand. Subjects: One hundred subjects requiring rehabilitation following a stroke. Main outcome measures: Change in function which was measured using Shah, Vanclay and Coopers (1989) modified Barthel Index and walking speed over 10 metres. Results: Five statistical analyses were undertaken, none of which demonstrated clear superiority of one measure over the other. Conclusions: The study did not indicate the modified Barthel Index to be more sensitive to change than the 20-point Barthel Index for this population. The statistical analysis strategies utilized are recommended for similar studies.