And why would you expect extended rehab to be effective? If you want rehab to be more effective you are going to have to stop the 5 causes of the neuronal cascade of death in the first week. If my doctors had done that they would have saved me 5.4 billion neurons. Recovery would have been easy with only 171 million dead neurons. Or you get neuroplasticity and neurogenesis to be repeatable on demand. Not guidelines, PROTOCOLS.
Evaluation of an extended stroke rehabilitation service (EXTRAS): a multicentre randomized controlled trial
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This is the authors' accepted manuscript of a conference proceedings (inc. abstract) that has been published in its final definitive form by Sage Publications Ltd, 2019.For re-use rights please refer to the publisher's terms and conditions.
Abstract
Background:Stroke survivors frequently report unmet needs in the longer term but there is limited evidence to guide provision of ongoing rehabilitation.
Method:
This study was a randomized controlled trial involving 19 UK centres which provided early supported discharge (ESD). Adult stroke patients were individually randomized to receive extended stroke rehabilitation service (EXTRAS) or usual care (1:1). EXTRAS involved five rehabilitation reviews provided by an ESD team member between 1 and 18 months postESD. Reviews consisted of a semi-structured assessment of rehabilitation needs followed by goal-setting and action planning. The primary outcome was performance in extended activities of daily living (Nottingham Extended Activities of Daily Living (NEADL) scale) at 24months. Secondary outcomes included satisfaction with services, quality-adjusted life-year (QALYs) and costs. Analyses were ‘intention to treat’. Results/Findings:
A total of 573 participants were randomized (EXTRAS n=285, usual care n=288). Mean 24-month NEADL scores were EXTRAS 40.0 (SD 18.1) and usual care 37.2 (SD 18.5) giving an adjusted mean difference of 1.8 (95% confidence interval (CI) –0.7 to 4.2). At 24 months, patients in the intervention group were more satisfied with the services they received (97.7% vs. 87.5%, difference 10.2% (95% CI 5.3– 15.0)). EXTRAS provided more QALYs (0.07, 95% CI 0.01–0.12) and when combined with costs, there was a 90% chance of EXTRAS being costeffective at conventional thresholds of willingness to pay (£20,000 per QALY).
Conclusion:
EXTRAS did not improve stroke survivors’ performance in extended activities of daily living. However, due to the impact on costs and QALYs, EXTRAS has a high probability of being cost-effective at conventional thresholds of NHS willingness to pay.
Publication metadata
Author(s): Shaw L, Cant R, Drummond A, Ford GA, Forster A, Francis R, Hills K, Howel D, Laverty A, McKevitt C, McMeekin P, Price C, Stamp E, Stevens E, Vale L, Rodgers HPublication type: Conference Proceedings (inc. Abstract)
Publication status: Published
Conference Name: The Society for Research in Rehabilitation Winter 2019 Meeting
Year of Conference: 2019
Pages: 1540–1556
Print publication date: 01/09/2019
Online publication date: 27/08/2019
Acceptance date: 01/07/2019
Date deposited: 21/11/2019
Publisher: Sage Publications Ltd
URL: https://doi.org/10.1177/0269215519843983
DOI: 10.1177/0269215519843983
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