***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND AND PURPOSE The goal of the present study was to examine the re source and economic implication s of an early hospital discharge and home-based rehabilitation scheme for patients with acute stroke . METHODS A cost minimization analysis in conjunction with a r and omized controlled trial was carried out at 2 affiliated teaching hospitals in the southern metropolitan region of Adelaide , South Australia , between 1997 and 1998 . Eighty-six hospitalized patients with acute stroke who required rehabilitation were r and omized to  receive both early hospital discharge and home-based rehabilitation , or conventional in-hospital rehabilitation and community care .  Direct and indirect costs related to stroke rehabilitation were calculated , including hospital bed days , home-based intervention program , community services , and personal expenses during the 6 months after r and omization . RESULTS The mean cost per patient was lower for patients r and omized to the early hospital discharge and home-based rehabilitation ( $ 8040 ) compared with those who received conventional care ( $ 10 054 ) . This cost saving was not statistically significant ( P=0.14 ) . However , sensitivity analyses indicated that the cost of home-based rehabilitation  was consistently lower than that of conventional care except when hospital costs were assumed to be 50 % less than those used in the main analysis . Multiple regression analysis demonstrated that the cost of the home-based program was significantly related to a patient 's level of disability after adjustment for age , comorbidity , and the presence or absence of a caregiver . CONCLUSIONS The early hospital discharge and home-based rehabilitation scheme was less costly than  conventional hospital care for patients with stroke . Limitation of the provision of such services to patients with mild disability is likely to be most cost effective Abstract Objectives : To examine the cost of providing hospital at home in place of some forms of inpatient hospital care . Design : Cost minimisation study within a r and omised controlled trial . Setting : District general hospital and catchment area of neighbouring community trust . Subjects : Patients recovering from hip replacement ( n=86 ) , knee replacement ( n=86 ) , and hysterectomy ( n=238 ) ; elderly medical patients ( n=96 ) ; and patients with chronic obstructive airways disease ( n=32 ) . Interventions : Hospital at home or inpatient hospital care . Main outcome measures : Cost of  hospital at home scheme to health service , to general practitioners , and to patients and their families compared with hospital care . Results : No difference was detected in total healthcare costs between hospital at home and hospital care for patients recovering from a hip or knee replacement , or elderly medical patients .  Hospital at home significantly increased healthcare costs for patients recovering from a hysterectomy ( ratio of geometrical means 1.15 , 95 % confidence interval 1.04 to 1.29 , P=0.009 ) and for those with chronic obstructive airways disease ( Mann-Whitney U test , P=0.01 ) . Hospital at home significantly increased general practitioners ' costs for elderly medical patients ( Mann-Whitney U test , P<0.01 ) and for those with chronic obstructive airways disease ( P=0.02 ) . Patient and carer expenditure made up a small proportion of total costs . Conclusion : Hospital at home care did not reduce total healthcare costs for the conditions studied in this trial , and costs were significantly increased for patients recovering from a hysterectomy and those with chronic obstructive airways disease . There was some evidence that costs were shifted to primary care for elderly medical patients and those with chronic obstructive airways disease . Key messages Hospital at home schemes are a popular alternative to st and ard hospital care , but there is uncertainty about their cost effectiveness In our r and omised controlled trial we compared the cost of hospital at home care with that of inpatient hospital care for patients recovering from hip replacement , knee replacement , and hysterectomy ; elderly medical patients ; and those with chronic obstructive airways disease There were no major differences in health service costs between the two arms of the trial for patients recovering from hip or knee replacement and elderly medical patients Hospital at home care increased healthcare costs for patients recovering from hysterectomy and for those with chronic obstructive airways disease Hospital at home care result ed in some costs shifting to general practitioners for elderly medical patients and those with chronic obstructive airways Background and Purpose — Early supported discharge ( ESD ) for stroke has been shown to yield outcomes similar to or better than those of conventional care , but there is less information on the impact on costs and on the caregiver . The purpose of this study is to estimate the costs associated with an ESD program compared with those of usual care . Methods — We conducted a r and omized controlled trial of stroke patients who required rehabilitation services and who had a caregiver at home . Results — Acute-care costs incurred before r and omization when patients were medically ready for discharge averaged $ 3251 per person . The costs for the balance of the acute-care stay , from r and omization to discharge , were $ 1383 for the home group and $ 2220 for the usual care group . The average cost of providing the 4-week home intervention service was $ 943 per person . The total cost generated by persons assigned to the home group averaged $ 7784 per person , significantly lower than the $ 11 065 per person for those assigned to usual care . A large proportion of the cost differential between the 2 groups arose from readmissions , for which the usual care group generated costs more than quadruple those of the home intervention group . Conclusions — Providing care at home was no more ( or less ) expensive for those with greater functional limitation than for those with less . Caregivers in the ESD group scored consistently lower on the Burden Index than caregivers with usual care , even caregivers of persons with major functional limitations . For persons recovering from stroke and their families , ESD provides a cost-effective alternative to usual care Background and Purpose — This proof-of-concept trial investigated the effects of an 8-week program of  caregiver-mediated exercises commenced in hospital combined with tele-rehabilitation services on patient self-reported mobility and caregiver burden . Methods — Sixty-three hospitalized stroke patients ( mean age 68.7 , 64 % female ) were r and omly allocated to an 8-week caregiver-mediated exercises program with e-health support or usual care . Primary outcome was the Stroke Impact Scale mobility domain . Secondary outcomes included length of stay , other Stroke Impact Scale domains , readmissions , motor impairment , strength , walking ability , balance , mobility , ( extended ) activities of daily living , psychosocial functioning , self-efficacy , quality of life , and fatigue . Additionally , caregiver ’s self-reported fatigue , symptoms of anxiety , self-efficacy , and strain were assessed . Assessment s were completed at baseline and at 8 and 12 weeks . Results — Intention-to-treat analysis showed no between-group difference in Stroke Impact Scale mobility ( P=0.6 ) ; however , carers reported less fatigue ( 4.6 , confidence interval [ CI ] 95 % 0.3–8.8 ; P=0.04 ) and higher self-efficacy ( −3.3 , CI 95 % −5.7 to −0.9 ; P=0.01 ) at week 12 . Per- protocol analysis , examining those who were discharged home with tele-rehabilitation demonstrated a trend toward improved mobility ( −9.8 , CI 95 % −20.1 to 0.4 ; P=0.06 ) , significantly improved extended activities of daily living scores at week 8 ( −3.6 , CI 95 % −6.3 to −0.8 ; P=0.01 ) and week 12 ( 3.0 , CI 95 % −5.8 to −0.3 ; P=0.03 ) , a 9-day shorter length of stay ( P=0.046 ) , and fewer readmissions over 12 months ( P<0.05 ) . Conclusions — Caregiver-mediated exercises supported by tele-rehabilitation show promise to augment intensity of practice , result ing in improved patient-extended activities of daily living , reduced length of stay with fewer readmissions post stroke , and reduced levels of caregiver fatigue with increased feelings of self-efficacy . The current findings justify a larger definite phase III r and omized controlled trial . Clinical Trial Registration — URL : http://www.anzctr.org.au . Unique identifier : ACTRN12613000779774 Background Development of longer term stroke rehabilitation services is limited by lack of evidence of effectiveness for specific interventions and service models . We describe the protocol for a multicentre r and omised controlled trial which is evaluating an extended stroke rehabilitation service . The extended service commences when routine ‘ organised stroke care ’ ( stroke unit and early supported discharge ( ESD ) ) ends . Methods / design This study is a multicentre r and omised controlled trial with health economic and process evaluations . It is set within NHS stroke services which provide ESD . Participants are adults who have experienced a new stroke ( and carer if appropriate ) , discharged from hospital under the care of an ESD team . The intervention group receives an extended stroke rehabilitation service provided for 18 months following completion of ESD . The extended rehabilitation service involves regular contact with a senior ESD team member who leads and coordinates further rehabilitation . Contact is usually by telephone . The control group receives usual stroke care post-ESD . Usual care may involve referral of patients to a range of rehabilitation services upon completion of ESD in accordance with local clinical practice . R and omisation is via a central independent web-based service . The primary outcome is extended activities of daily living ( Nottingham Extended Activities of Daily Living Scale ) at 24 months post-r and omisation . Secondary outcomes ( at 12 and 24 months post-r and omisation ) are health status , quality of life , mood and experience of services for patients , and quality of life , experience of services and carer stress for carers . Re source use and adverse events are also collected . Outcomes are undertaken by a blinded assessor . Implementation and delivery of the extended stroke rehabilitation service will also be described . Semi-structured interviews will be conducted with a sub sample of participants and staff to gain insight into perceptions and experiences of rehabilitation services delivered or received . Allowing for 25 % attrition , 510 participants are needed to provide 90 % power to detect a difference in mean Nottingham Extended Activities of Daily Living Scale score of 6 with a 5 % significance level . Discussion The provision of longer term support for stroke survivors is currently limited . The results from this trial will inform future stroke service planning and configuration . Trial registration This trial was registered with IS RCT N ( identifier : IS RCT N45203373 ) on 9 August 2012 Background and Purpose — Early supported discharge from a stroke unit reduces the length of hospital stay . Evidence of a benefit for the patients is still unknown . The aim of this trial was to evaluate the long-term effects of an extended stroke unit service ( ESUS ) , characterized by early supported discharge . The short-term effects were published previously . Methods — We performed a r and omized controlled trial in which 320 acute stroke patients were allocated to either ordinary stroke unit service ( OSUS ) ( 160 patients ) or stroke unit care with early supported discharge ( 160 patients ) . The ESUS consists of a mobile team that coordinates early supported discharge and further rehabilitation . Primary outcome was the proportion of patients who were independent as assessed by modified Rankin Scale ( RS ) ( RS ≤2=global independence ) . Secondary outcomes measured at 52 weeks were performance on the Barthel Index ( BI ) ( BI ≥95=independent in activities of daily living ) , differences in final residence , and analyses to identify patients who benefited most from an early supported discharge service . All assessment s were blinded . Results — We found that 56.3 % of the patients in the ESUS versus 45.0 % in the OSUS were independent ( RS ≤2 ) ( P = 0.045 ) . The number needed to treat to achieve 1 independent patient in ESUS versus OSUS was 9 . The odds ratio for independence was 1.56 ( 95 % CI , 1.01 to 2.44 ) . There were no significant differences in BI score and final residence . Patients with moderate to severe stroke benefited most from the ESUS . Conclusions — Stroke service based on treatment in a stroke unit combined with early supported discharge appears to improve the long-term clinical outcome compared with ordinary stroke unit care . Patients with moderate to severe stroke benefit most Background and Purpose — Early supported discharge ( ESD ) seems to be a promising alternative to conventional follow-up care after acute stroke . We have previously shown that stroke unit care combined with ESD has beneficial effects on functional outcome and the use of re sources for up to 1 year . The aim of this trial was to evaluate outcome after 5 years . Methods — We performed a r and omized controlled trial with 320 acute stroke patients allocated to ordinary stroke unit care ( 160 patients ) or stroke unit care with ESD ( 160 patients ) . The ESD service consisted of a mobile team that co-coordinated hospital discharge and further rehabilitation during 1 month of follow-up in cooperation with the primary health care . Mortality , residence , and functional outcome including modified Rankin scale were registered after 5 years . All assessment s were blinded . Results — There was no difference between the groups with modified Rankin scale score ⩽2 ( P=0.213 ) , but there was a trend toward greater improvement in modified Rankin scale score in the ESD group from onset of stroke ( 38 % versus 30 % ; P=0.106 ) . More patients were dead or institutionalized in the ordinary stroke unit care group ( P=0.032 ) ; 158 patients were alive , 84 were in ESD , and 74 were in ordinary stroke unit care . Of the 158 patients alive , a greater proportion were living at home  in ESD ( 86%/70 % ; P=0.019 ) . Conclusions — Stroke unit care combined with ESD seems to reduce death and institutional care and to improve patients ' chances of living at home 5 years after stroke compared to traditional stroke care 
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Participants tended to be a selected elderly group of stroke survivors with moderate disability .
We saw no clear differences in participants ' activities of daily living scores , patients subjective health status or mood , or the subjective health status , mood or satisfaction with services of carers .
Appropriately re source d ESD services with co-ordinated multidisciplinary team input 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 .
Results are inconclusive for services without co-ordinated multidisciplinary team input .
We observed no adverse impact on the mood or subjective health status of patients or carers , nor on readmission to hospital