***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: In our experience , stroke patients discharged straight to their homes sometimes showed marked deterioration . We investigated whether this negative course of events could be prevented by means of follow-up visits entailing extensive testing and result ant measures one month after discharge . The patients in our study included a selection of mild cases with a short length of hospital stay . Forty-six patients returned to the stroke unit on a follow-up visit , and 49 patients made up the control group .  The groups were compared after 3 months , by means of question naires . The results did not show any definite difference between the groups . However , after 3 months we detected depressions in 13 patients in the study group and in 11 patients in the control group , most of them untreated . The study points to a need for follow-up aim ed specifically at detecting depression Background and Purpose — Functioning and disability after ischemic stroke are clinical ly meaningful and of major relevance to patients . Despite many instruments available to assess these outcomes , little is known about their interrelation and predictive factors . Methods — We prospect ively identified 4264 patients with acute ischemic stroke from 30 hospitals in Germany during a 1-year period between 1998 and 1999 and registered them in a common data bank . The patients were central ly followed up via telephone interview after 100 days and 1 year to assess various scales such as the Barthel Index ( BI ) , modified Rankin Scale ( MRS ) , extended Barthel Index ( EBI ) , Short Form-36 Physical Functioning ( SF-36 PF ) , and Center for Epidemiologic Studies –Depression short form ( CES-D ) . Results — Outcome status could be assessed in 67.2 % of patients 100 days after hospital admission . Of these , 13.9 % had died , 53.7 % had regained functional independence ( BI < 95 ) , 46.3 % had no or mild residual symptoms ( MRS ≤1 ) , and 44.6 % had no higher cognitive deficits on the EBI . Of the patients who personally answered the follow-up questions , 67 % had no major physical disability ( SF-36 PF < 60 ) , and 32.9 % reported symptoms classified as depression ( CES-D ≥10 ) . The high percentage of patients reaching the maximum score ( ceiling effect ) in the BI was less pronounced in the MRS and SF-36 PF . The predictive factors for dichotomized outcomes on each scale were similar for adverse functioning and disability but varied considerably for depression . Conclusions — To avoid ceiling effects in outcome distribution of patients treated in specialized stroke centers , the MRS and SF-36 PF instruments are preferable to the BI . Parametric use of the SF-36 PF could further improve outcome measurement by considering individual treatment effects BACKGROUND national policy recommends routine re- assessment of disabled patients and their carers at 6 months after stroke onset . The clinical and re source outcomes of this policy were investigated . DESIGN prospect i ve , single-blind , r and omised controlled trial in two centres . PARTICIPANTS a total of 265 patients with a disabling stroke and their carers . INTERVENTIONS a structured re- assessment system for patients and their carers at 6 months post-stroke or existing care . OUTCOME MEASURES primary : patient independence ( Frenchay activities index ) and carer stress ( general health question naire 28 ) . Secondary : activities of daily living , mood state , satisfaction with services , carer strain index , health and social service re source use and costs . RESULTS independence at 12 months post-stroke was similar in both groups ( Frenchay activities index , adjusted mean difference 0.64 ; 95 % confidence interval -0.74 - 2.02 ) . Emotional distress in carers was similar in both groups ( general health question naire 28 , mean difference 0.02 ; 95 % confidence interval -0.95 - 1.00 ) . Results for the secondary outcome measures and total mean costs were similar for both groups . The intervention group patients used 301 fewer hospital bed days and 1,631 fewer care home bed days . CONCLUSIONS the structured , systematic re- assessment for patients and their carers was not associated with any clinical ly significant evidence of benefit at 12 months . Health and social care re source use and mean cost per patient were broadly similar in both groups . TRIAL REGISTRATION International St and ard R and omised Controlled Trial Register ; number : IS RCT N55412871 Objective : To compare intensive with non-intensive home-based rehabilitation provision following stroke or hip fracture in old age ( 65 years ) . Design : Parallel single-blind r and omized control trial . Setting : Domiciliary provided multidisciplinary rehabilitation . Subjects : One hundred and sixty patients aged 65 or over recently discharged from hospital after suffering a stroke or hip fracture . Intervention : Patients assigned to receive six or more face-to-face contacts or three or less face-to-face contacts from members of a multidisciplinary rehabilitation team . Main measures : Patients assessed using the Barthel Index , Therapy Outcome Measure , Euroqol 5D ( EQ-5D ) , Hospital Anxiety and Depression Scale ( HADS ) and Frenchay Activities Index ( FAI ) at three months . All follow-up assessment s were conducted blind to allocation . Results : Subgroup analysis was conducted on the basis of incident condition ( stroke or hip fracture ) . Significant differences were detected for the stroke subgroup at three months [ Therapy Outcome Measure H and icap ( median difference 0.5 ( P < 0.05 ) ) and EQ-5D ( median difference 0.17 ( P < 0.05 ) ) ] and in change at three months [ Therapy Outcome Measure ( mean difference 0.52 ( SD 0.85 ) 95 % CI ( 0.16 , 0.88 ) ) and EQ-5D ( mean difference 0.15 ( SD 0.25 ) 95 % CI ( 0.05 , 0.26 ) ) ] . No significant differences were detected between the two arms of the study for the hip fracture subgroup . Conclusion : Following stroke older people who receive a more intensive communitybased multidisciplinary rehabilitation service may experience short-term benefit in relation to social participation and some aspects of health-related quality of life . A more intensive service after discharge from hospital following a hip fracture is unlikely to result in similar patient benefit OBJECTIVES To compare the effectiveness and costs of a new domiciliary rehabilitation service for elderly stroke patients with geriatric day-hospital care . DESIGN R and omized controlled trial . PARTICIPANTS Stroke patients aged 55 + who required further rehabilitation after hospital discharge or after referral to geriatricians from the community .  SETTING Poole area , East Dorset , a mixed urban/rural area on the south coast of Engl and . MAIN OUTCOMES Primary -changes between hospital discharge and 6-month follow-up in physical function as measured by Barthel index . Secondary -changes over this period in Rivermead Mobility Index and mental state ( Philadelphia Geriatric Centre Morale Scale ) and differences in social activity ( Frenchay Activities Index ) and generic health status ( SF-36 ) . Health service and social service cost per patient were compared for the two groups . RESULTS 180 patients were eligible and 140 ( 78 % ) were r and omized . The groups were well balanced for age , sex , social class and initial Barthel index . We achieved follow-up in 88 % of subjects who were alive at 6 months . We detected no significant differences in patient outcomes , although there was a non-significant improvement in measures of physical function and social activity in the domiciliary group . Domiciliary patients had more physiotherapy time per session and more district nurse time , and made greater use of social service day centres and home helps . Total cost per patient did not differ significantly between the two groups , with reduced health service costs in the domiciliary arm offset by higher social service costs . CONCLUSION No significant differences were detected in the effectiveness of the two services . Neither service influenced patients ' mental state , and their social activity remained low . Total costs were similar . A mixed model of day-hospital and domiciliary care may be most cost-effective for community stroke rehabilitation , but this requires further evaluation This study compared the functional ability and perceived health status of stroke patients treated by a domiciliary rehabilitation team or by routine hospital-based services after discharge from hospital . Patients discharged from two acute and three rehabilitation hospitals in Nottingham were r and omly allocated in three strata ( Health Care of the Elderly , General Medical and Stroke Unit ) to receive domiciliary or hospital-based care after discharge . Functional recovery was assessed by the Extended Activities of Daily Living ( ADL ) scale three and six months after discharge and perceived health at six months was measured by the Nottingham Health Profile .  A total of 327 eligible patients of 1119 on a register of acute stroke admissions were recruited over 16 months . Overall there were no differences between the groups in their Extended ADL scores at three or six months , or their Nottingham Health Profile scores at six months . In the Stroke Unit stratum , patients treated by the domiciliary team had higher household ( p = 0.02 ) and leisure activity ( p = 0.04 ) scores at six months than those receiving routine care . In the Health Care of the Elderly stratum , death or a move into long-term institutional care at six months occurred less frequently in patients allocated to the routine service , about half of whom attended a geriatric day hospital . Overall there was no difference in the effectiveness of the domiciliary and hospital-based services , although younger stroke unit patients appeared to do better with home therapy while some frail elderly patients might have benefited from day hospital attendance OBJECTIVE To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services . METHODS R and omized controlled trial of 101 community-living stroke survivors ( < 18 months post-stroke ) using home care services . Subjects were r and omized to intervention ( n=52 ) or control ( n=49 ) groups . The intervention was a 12-month specialized , evidence -based rehabilitation strategy involving an interprofessional team . The primary outcome was change in health-related quality of life and functioning ( SF-36 ) from baseline to 12 months . Secondary outcomes were number of strokes during the 12-month follow-up , and changes in community reintegration ( RNLI ) , perceived social support ( PRQ85-Part 2 ) , anxiety and depressive symptoms ( Kessler-10 ) , cognitive function ( SPMSQ ) , and costs of use of health services from baseline to 12 months . RESULTS A total of 82 subjects completed the 12-month follow-up . Compared with the usual care group , stroke survivors in the intervention group showed clinical ly important ( although not statistically significant ) greater improvements from baseline in mean SF-36 physical functioning score ( 5.87 , 95 % CI -3.98 to 15.7 ; p=0.24 ) and social functioning score ( 9.03 , CI-7.50 to 25.6 ; p=0.28 ) . The groups did not differ for any of the secondary effectiveness outcomes . There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant ( p=0.76 ) . CONCLUSIONS A 12-month specialized , interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care . Clinical trials.gov identifier : NCT00463229 BACKGROUND This r and omized controlled trial tested the effectiveness of comprehensive , interdisciplinary postdischarge care management in improving a profile of indicators of health recovery and secondary prevention ( profile of health and prevention ) in stroke and transient ischemic attack ( TIA ) patients . METHODS Ninety-six stroke/TIA patients were r and omized to usual care or intervention at discharge from our acute stroke unit . The intervention group received an in-home biopsychosocial assessment by an advanced practice nurse at 1 month . A care plan was developed by an interdisciplinary team and implemented in collaboration with the patient 's primary care physician . The profile of health and prevention , measured at 3 months , was comprised of 5 domains : ( 1 ) Neuromotor Function , ( 2 ) Severe Complications , ( 3 ) Quality of Life , ( 4 ) Management of Risk for common poststroke complications and recurrent stroke , and ( 5 ) Stroke Knowledge . A single global hypothesis test across multiple end points was used to compare the 2 groups . RESULTS The intervention significantly improved the profile of health and prevention ( P < .0001 ) . In addition , each domain showed a positive effect of the intervention . Effect sizes ( in st and ard deviation units ) of the intervention on domains were .1 for Neuromotor Function ( 90 % confidence interval [ CI ] = -.3 to .5 ) ; .4 for Severe Complications ( 90 % CI = .1 to .8 ) ; .5 for Quality of Life ( 90 % CI = .1 to .9 ) ; .6 for Management of Risk for common poststroke complications and recurrent stroke ( 90 % CI = .3 to 1 . ) ; and 1.0 for Stroke Knowledge ( 90 % CI = .6 to 1.4 ) . CONCLUSIONS This model of care management result ed in a significantly better profile of health and prevention for stroke/TIA patients 3 months postdischarge Objective : To assess the effect of three weeks of rehabilitation in the home setting for younger patients with stroke with the aim of improving activity level . Design : A r and omized controlled study with blinded evaluations at discharge , three weeks , three months and one year after discharge . Setting : Home of the patient or the ordinary day rehabilitation clinic at the university hospital . Subjects : Fifty- 
    Output:
    
DATA SYNTHESIS None of the studies showed favourable effects of the intervention on activities of daily living and none assessed social participation .
CONCLUSION There is little evidence for the effectiveness of multidisciplinary care for stroke patients being discharged home .