Jee, Sungju; Jeong, Minah; Paik, Nam-Jong; Kim, Won-Seok; Shin, Yong-Il; Ko, Sung-Hwa; Kwon, In Sun; Choi, Bo Mi; Jung, Yunsun; Chang, Wonkee; Sohn, Min Kyun
Frontiers in neurology
2022NA ; 13 ( 5 ) :755316.
PMID : 35370909
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Jee, Sungju - Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea.
Jeong, Minah - Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea.
Paik, Nam-Jong - Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Kim, Won-Seok - Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Shin, Yong-Il - Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea.
Ko, Sung-Hwa - Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea.
Kwon, In Sun - Clinical Trials Center, Chungnam National University Hospital, Daejeon, South Korea.
Choi, Bo Mi - Department of Public Health and Medical Services, Chungnam National University Hospital, Daejeon, South Korea.
Jung, Yunsun - Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Chang, Wonkee - Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Sohn, Min Kyun - Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea.
ABSTRACT
OBJECTIVE: To investigate the available evidence on early supported discharge (ESD) and transitional care (TC) delivery service in patients with cerebrovascular disease.
METHODS: A systematic literature search was conducted to collect all available evidence on the use of ESD and TC services. We included cluster-randomized pragmatic trials or randomized controlled trials (RCTs) that recruited patients with stroke or transient ischemic attack to receive either conventional care or any care service intervention that included rehabilitation or support provided by professional medical personnel with the aim of accelerating and supporting home discharge. Relevant data were electronically searched through international databases (Cochrane Library, EMBASE, and PubMed) and incorporated into a summary grid to investigate research outcomes and provide a narrative synthesis. Furthermore, we compared the outcomes in terms of length of hospital stay, patient and caregiver outcomes, and mortality through meta-analysis.
RESULTS: We identified and included a total of 20 publications of various original randomized studies. There were 18 studies conducted in western countries and 2 in eastern countries. The meta-analysis revealed a tendency that ESD or TC could decrease the length of hospital stay more than the usual care [standardized mean difference (SMD) -0.13; 95% confidence interval (CI) -0.31 to 0.04 days; P = 0.14]. Moreover, there was a tendency that ESD resulted in better activities of daily living (ADL) than usual care (SMD 0.29; 95% CI -0.04 to 0.61; P = 0.08). Patient outcome based on modified Rankin scale (mRS) score (SMD -0.11; 95% CI -0.38 to 0.17; P = 0.45] and mortality (odds ratio 0.80; 95% CI 0.56-1.17; P = 0.25) did not reveal any significant difference. The Caregiver Strain Index revealed no difference. CONCLUSION: We did not find a large effect size for the use of TC and ESD. When implementing the TC and ESD model from western to Asian countries, services should be prepared and implemented in accordance with national medical rehabilitation pathways for cerebrovascular disease. CI - Copyright ??2022 Jee, Jeong, Paik, Kim, Shin, Ko, Kwon, Choi, Jung, Chang and Sohn.
keyword
cerebrovascular disease; continuity of patient care; early supported discharge (ESD); rehabilitation; transitional care
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