Accompagnement précoce de la sortie (Early Supported Discharge) et réadaptation ==> Stratégie intégrée de l'AVC

Schéma 1 ; Schéma 2; Schéma 3; Schéma 4; Schéma 5 (modèle 1: équipe sanitaire, ex.: HAD); schéma 6 (modèle 2: partenariats avec le secteur médico-social)

ESD : Editorial Comment--Early Supported Discharge: An Idea Whose Time Has Come
Peter Langhorne

http://stroke.ahajournals.org/cgi/content/full/34/11/2691

Lancet: Cliquer ici ; abstract

Schémas explicatifs de Langhorne: cliquer ici Diapos langhorne +++
http://www.medicaljournals.se/jrm/strokerehab/pdf/langhorne.pdf
http://asr.regione.emilia-romagna.it/wcm/asr/eventi/20050307_ws3_prier/link_rel/langhorne_diapo/langhorne_diapo.pdf

Rehabilitation at Home After Stroke: Five-Year Follow-Up of Patient Outcome
Stroke 2005;36;297-303; originally published online Dec 23, 2004;
Koch Ann-Mari Thorsén, Lotta Widés Holmqvist, Jesús de Pedro-Cuesta and Lena von
http://stroke.ahajournals.org/cgi/reprint/36/2/297.pdf


A Randomized Controlled Trial of Early Supported Discharge and Continued Rehabilitation at Home After Stroke: Five-Year Follow-Up of Patient Outcome
Ann-Mari Thorsén, Lotta Widés Holmqvist, Jesús de Pedro-Cuesta and Lena von Koch. Stroke 2005;36;297-303;
http://stroke.ahajournals.org/cgi/content/full/36/2/297

Stroke Unit Care Combined With Early Supported Discharge
http://stroke.ahajournals.org/cgi/content/abstract/34/11/2687

et
Neuroréhabilitation après un accident vasculaire cérébral
http://www.medicalforum.ch/pdf/pdf_f/2007/2007-12/2007-12-189.PDF

Does the Organization of Postacute Stroke Care Really Matter? Peter Langhorne and Pamela Duncan Stroke 2001;32;268-274
http://stroke.ahajournals.org/cgi/reprint/32/1/268.pdf

What are the components of effective stroke unit care?
http://ageing.oxfordjournals.org/cgi/content/abstract/31/5/365

Services for reducing duration of hospital care for acute stroke patients +++ Early Supported Discharge Trialists

Main results: Outcome data are currently available for 11 trials (1597 patients). Patients tended to be a selected elderly group with moderate disability. The ESD group showed significant reductions (P < 0.0001) in the length of hospital stay equivalent to approximately 8 days. Overall, the odds ratios (OR) (95% confidence interval (CI)) for death, death or institutionalisation, death or dependency at the end of scheduled follow up were OR 0.90, 95% CI 0.64 to 1.27, P = 0.56, OR 0.74, 95% CI 0.56 to 0.96, P = 0.02 and OR 0.79, 95% CI 0.64 to 0.97, P = 0.02, respectively. The greatest benefits were seen in the trials evaluating a co-ordinated ESD team and in stroke patients with mild-moderate disability. Improvements were also seen in patients' extended activities of daily living scores (standardised mean difference 0.12, 95% CI 0.00 to 0.25, P = 0.05) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02) but no statistically significant differences were seen in carers' subjective health status, mood or satisfaction with services.

Authors' conclusions: Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long term dependency and admission to institutional care as well as reducing the length of hospital stay. No adverse impact was observed on the mood or subjective health status of patients or carers.

Cliquer ici




Lancet. 2005 Feb 5-11;365(9458):501-6

Langhorne P, Taylor G, Murray G, Dennis M, Anderson C, Bautz-Holter E, Dey P, Indredavik B, Mayo N, Power M, Rodgers H, Ronning OM, Rudd A, Suwanwela N, Widen-Holmqvist L, Wolfe C.
Academic Section of Geriatric Medicine, Level 3, Centre Block, Royal Infirmary, Glasgow G4 OSF, UK. P.Langhorne@clinmed.gla.ac.uk

BACKGROUND: Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. METHODS: We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. FINDINGS: Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (p<0.0001). There were also significant improvements in scores on the extended activities of daily living scale and in the odds of living at home and reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patients with mild to moderate disability. INTERPRETATION: Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as shortening hospital stays.

PMID: 15705460 [PubMed - indexed for MEDLINE]


Related Articles
ReviewServices for reducing duration of hospital care for acute stroke patients. [Cochrane Database Syst Rev. 2005]
ReviewServices for reducing duration of hospital care for acute stroke patients. Early Supported Discharge Trialists. [Cochrane Database Syst Rev. 2000]
ReviewServices for reducing duration of hospital care for acute stroke patients. [Cochrane Database Syst Rev. 2002]
ReviewEarly supported discharge after stroke. [J Rehabil Med. 2007]
A randomised controlled comparison of alternative strategies in stroke care. [Health Technol Assess. 2005]
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Early supported discharge: a valuable alternative for some stroke patients
The Lancet, Volume 365, Issue 9458, Pages 455-456
R.Meijer, J.van Limbeek