Trial

Allocation concealment

Major diagnostic category

Day Hospital Treatment

Comparison Treatment

Numbers at recruitment &No’s followed up DH V Alternative

Follow up

Woodford-Williams Sunderland (1962)

n=331

Uncertain "reference to random number tables"

Contactable patients from a consecutive series of 500 former inpatients discharged to live alone. Patients >60 years.

Not psychiatric

Attendance x 1 a week up to one year

Eligible, but not referred to usual services.

168 V 163

168 V 163

12 months

Weissert USA (1980)

n=644

Not reported

Referrals from many sources.

Eligible for Medicare.

Need rehabilitation

70% moderately or severely disabled.

41% of pts. with circulatory disorders

New service.

Average of 70 days attendance over one year.

Eligible, but not referred to usual services.

322 V 322

Death and poor outcome:

V 239

(n=384)

Institutionalisation

194 V 190

ADL (survivors): 169 V 151

12 months

Some outcome data available only for a subgroup of 384 patients

Tucker Auckland (1984)

n=120

Uncertain "reference to random number tables"

Referrals from hospital & GP’s

>55 years

Patients need assessment & rehabilitation.

Excluded:Dementia, needing social care.

54% of pts. with stroke

Baseline Northwick Park ADL score mean (range)

17.6 (12-31) and 16.3 (12-25)

New service.

Attendance 2/3 days week for 6-8 weeks.

Comprehensive elderly care (Inpatient, outpatient

follow-up with or without outpatient physiotherapy, domiciliary services,GP, day centre).

62 V 58

Death:

62 V 57

Institutionalisation

59 V 50

5 months

Cummings New York (1985)

n=96

Not reported

Patients referred for inpatient rehabilitation:

>15 years

Disabled (not Spinal injuries or head injury).

Living with someone, fit to travel, telephone, suitable residence, Medicare eligible 57% of pts. with stroke

Baseline Kenny ADL index

21.8 and 22.1

New service

Attendance 5 days a week

Mean attendance

69 days.

Continuing rehabilitation in hospital.

48 V 48

Death:

48 V 48

Poor outcome:

42 V 45

3 months after discharge from treatment

Vetter Cardiff (1989)

n=59

Concealed allocation

Consecutive patients attending two day hospitals eligible if:

Need rehabilitation

Not attended day hospital in previous year.

Did not require medical investigations.

Not confused.

Randomised after first assessment visit to day hospital.

22% of pts with stroke

Baseline Barthel

Index @ 13 (median)

Attendance for eight weeks

New service

Home rehabilitation by therapy team. Attempt to equalise amount of treatment given.

29 V 30

Death & institutionalisation

29 V 30

ADL:

27 V 30

8 weeks

Pitkala Helsinki, (1991)

n=174

Not concealed randomised by date of birth

Patients receiving home-care in a rural community in Finland.

30% pts. With arthritis

19% pts. with moderate/severe dementia

New service.

Attendance over two months for a total of 20 visits.

Usual elderly care: home support + hospital care if necessary.

88 V 86

Death & institutionalisation

88 V 86

ADL: 75 V 74

12 months

Eagle Ontario, (1991)

n=113

Not reported

Hospital and community referrals

>65 years

Rehabilitation potential. 28% of pts with depression

Baseline Geriatric Qualtiy of Life Questionnaire (ADL) mean 4.49 and 4.46

Attendance 2 days a week.

Usual elderly care; (inpatient, or outpatient clinic or community follow up). Same staff treated both groups.

55 V 58

55 V 58

12 months

Young Bradford, (1992)

n=124

Concealed allocation

Patients discharged home from hospital after new stroke event. Fit to travel.

>60 years, Barthel Index <20

Excluded: Patients discharged to residential/nursing home. Patients who needed to attend day hospital for respite (n=9)

Baseline Barthel Index median(range)

15 (4-19) and 16 (1-19)

Attendance 2 days a week for at least 8 weeks.

Home physiotherapy to a maximum of 20 hours over the first 8 weeks.

61 V 63

Death & institutionalisation

61 V 63

ADL:

52 V 56

6 months

Hedrick USA, (1993)

n=826

Concealed allocation.

Eligible for Veterans Service & one of the following:

1 Living in a nursing home

2 Needed help for ADL activities.

3 Bowel incontinence

4 Significant cognitive impairment

5 Acceptable to day care staff

21% with diseases of the nervous system

Baseline Sickness Impact Profile (Physical) mean (SD)

31.7 (18.8) and 33.8 (18.4)

Attendance 2/3 times a week. Average of 45 visits in 12 months.

‘Customary care’ (nursing home, inpatient care, clinic visits, home care etc.)

411 V 415

Death & institutionalisation

395 V 390

12 months

Gladman Nottingham, (1993)

n=155

(Health Care of the Elderly stratum only)

Concealed allocation

Patients discharged home from hospital after new stroke event.

Excluded:

Discharged to residential/nursing home.

Requiring respite or terminal care.

Receiving outpatient rehabilitation prior to the stroke.

No significant disability

In hospital <7 days

Baseline Barthel Index median (IQR)

17 (14-17) and 16 (13-17)

Routine hospital based services if considered appropriate, outpatient physiotherapy, OT, day hospital attendance etc.

37% (n=28) attended day hospital.

New service

Domiciliary rehabilitation team

2 half-time physiotherapists

1 OT.

75% allocated patients received treatment.

76 V 79

Death & institutionalisation

76 V 79

ADL:

73 V 67

12 months

(hospital bed use & disability reported at 6 months)

Hui

Hong Kong (1995)

n=120

Concealed allocation

Patients admitted to a rehabilitation ward one week after acute stroke.

Excluded: <65 years, previous stroke, dementia, Barthel Index =20

Baseline Barthel Index mean (SD)

9.9 (4.9) and 10.4 (5.3)

Care under geriatrician led team with day hospital follow up after discharge.

Same ward but care led by neurology team with medical outpatient follow up.

59 V 61

Death & institutionalisation

49 V 50

ADL: 43 V 44

6 months

Borland Huntingdon (1997)

n=105

Concealed allocation

Patients referred to day hospital

Excluded:

Patients with dysphasia

If the multidisciplinary team recommended that the patients required nursing, Occupational Therapy >2 x week

22% of pts with stroke

Baseline Barthel Index median (IQR)

15 (12-17) and 15 (11-17)

Multidisciplinary rehabilitation Median of 16 attendance’s

Rehabilitation at a day centre provided by a physiotherapist and two support workers, available two days a week. Median of 10 attendance’s.

50 V 55

Death and institutionalisation

50 V 55

ADL: 19 V 25

12 months