Increased independence post ischemic stroke : home vs facility rehabilitation

Abstract

Overview of the topic: Ischemic stroke is one of the leading causes of severe long term disability since it decreases mobility in more than half of stroke survivors at the age of sixty-five or older (Stroke Foundation, 2021). Stroke rehabilitation in a facility involves a multidisciplinary team care with a focus to enhance mobility. Alternatively, Home based care rehabilitation programme offers the patient better quality of life (O’Reilly, 2021). Research Question and PICO Elements: ‘Does rehabilitation at home for a patient who sustained ischemic stroke lead to increased level of independence when compared to a rehabilitation facility?’ The population under study included adult patients who sustained an ischemic stroke. The intervention under review included stroke rehabilitation at home. The comparison was stroke rehabilitation facility. The expected outcome was improved level of independence. Methods: A systematic search for literature was carried out through HyDi, PubMed, EBSCO host, and Google Scholar with elicited keywords and synonyms. The PRISMA checklist was used as a framework to screen articles. Systematic reviews (SRs), randomised controlled trials (RCTs), or case-control studies (CCS) were eligible for inclusion. Studies had to be peer reviewed and written in English Language. The outcome of the search consisted of one systematic review, three randomised controlled trials and one case study. Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the studies. Results: The studies selected provided inconsistent results, as a result of several factors. The Systematic review only presented statistical significance that home based rehabilitation is superior to facility rehabilitation, whilst the other four studies showed no statistical significance. Conclusion: A clear conclusion about the relationship between home-based rehabilitation and facility rehabilitation on the level of independence in patients who sustained ischemic stroke cannot be inferred since the results of the chosen studies are not consistent. Implications and recommendations: Stronger evidence is required to better understand the relationship of home-based rehabilitation on the level of independence. Until stronger evidence emerges, it is ideal that healthcare professionals involved in stroke rehabilitation are provided with comprehensive knowledge and training on how to better facilitate stroke rehabilitation for patients.