BMJ 2000;320:603-606 ( 4 March )

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Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial

Louise Gilbertson, research occupational therapist, ^a Peter Langhorne, senior lecturer, ^b Andrew Walker, health economist, ^c Ann Allen, helper, ^a Gordon D Murray, professor of medical statistics. ^d

^a Department of Occupational Therapy, Glasgow Royal Infirmary, Glasgow G4 0SF, ^b Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, ^c Greater Glasgow Health Board, Dalian House, Glasgow G3 8YU, ^d Department of Community Health Sciences, Medical Statistics Unit, University of Edinburgh Medical School, Edinburgh EH8 9AG

Correspondence to: P Langhorne P.Langhorne{at}clinmed.gla.ac.uk

Objective: To establish if a brief programme of domiciliary occupational therapy could improve the recovery of patients with stroke discharged from hospital.
Design: Single blind randomised controlled trial.
Setting: Two hospital sites within a UK teaching hospital.
Subjects: 138 patients with stroke with a definite plan for discharge home from hospital.
Intervention: Six week domiciliary occupational therapy or routine follow up.
Main outcome measures: Nottingham extended activities of daily living score and "global outcome" (deterioration according to the Barthel activities of daily living index, or death).
Results: By eight weeks the mean Nottingham extended activities of daily living score in the intervention group was 4.8 points (95% confidence interval 0.5 to 10.0, P=0.08) greater than that of the control group. Overall, 16 (24%) intervention patients had a poor global outcome compared with 30 (42%) control patients (odds ratio 0.43, 0.21 to 0.89, P=0.02). These patterns persisted at six months but were not statistically significant. Patients in the intervention group were more likely to report satisfaction with a range of aspects of services.
Conclusion: The functional outcome and satisfaction of patients with stroke can be improved by a brief occupational therapy programme carried out in the patient's home immediately after discharge. Major benefits may not, however, be sustained.

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