***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 Objectives : There is inconclusive evidence of the effectiveness of stroke rehabilitation by a community stroke team . The aim was to evaluate a specialist multiprofessional team in a community setting . Design : R and omized controlled trial . Setting : Community . Participants : Stroke patients and their informal carers who were referred to receive rehabilitation from a community stroke team . Outcome measures : Barthel Index , Extended Activities of Daily Living Scale ( EADL ) , General Health Question naire ( GHQ-12 ) by patient and carer , Carer Strain Index ( CSI ) , Euroquol , knowledge of stroke and satisfaction with services six months after recruitment . Results : There were no significant differences between patients who received rehabilitation from community stroke team ( n = 189 ) and those who received routine care ( n = 232 ) in their independence in activities of daily living , mood , quality of life or knowledge of stroke . The patients in the community stroke team group were significantly more satisfied with the emotional support they had received ( p < 0.01 ) . There were no significant differences between the groups in satisfaction with practical help or overall satisfaction . Carers of patients in the community stroke team were under significantly less strain than carers in the routine care group ( p < 0.04 ) . Carers of patients in the community stroke team group were significantly more satisfied with their knowledge of stroke ( p < 0.01 ) and were more satisfied overall ( p < 0.01 ) . Conclusions : The patients treated by the community stroke team were more satisfied with the emotional support they received and had equivalent outcomes in terms of independence in activities of daily living and mood . Their carers were under less strain and were more satisfied with their knowledge of stroke recovery , the emotional support they received and overall satisfaction with services . The results support the provision of rehabilitation by a community-based specialist multiprofessional team BACKGROUND AND PURPOSE Many stroke survivors have minimal to moderate neurological deficits but are physically deconditioned and have a high prevalence of cardiovascular problems ; all of these are potentially modifiable with exercise . The purpose s of this r and omized , controlled pilot study were ( 1 ) to develop a home-based balance , strength , and endurance program ; ( 2 ) to evaluate the ability to recruit and retain stroke subjects ; and ( 3 ) to assess the effects of the interventions used . METHODS Twenty minimally and moderately impaired stroke patients who had completed inpatient rehabilitation and who were 30 to 90 days after stroke onset were r and omized to a  control group or to an experimental group that received a therapist-supervised , 8-week , 3-times-per-week , home-based exercise program . The control group received usual care as prescribed by the patients ' physicians . Baseline and postintervention assessment s included the Fugl-Meyer Motor Assessment , the Barthel Index of Activities of Daily Living ( ADL ) , the Lawton Scale of Instrumental ADL , and the Medical Outcomes Study -36 Health Status Measurement . Functional assessment s of balance and gait included a 10-m walk , 6-Minute Walk , and the Berg Balance Scale . Upper extremity function was evaluated by the Jebsen Test of H and Function . RESULTS Of 22 patients who met study criteria , 20 completed the study and 2 refused to participate . The experimental group tended to improve more than the control group in motor function ( Fugl-Meyer Upper Extremity : mean change in score , 8 . 4 versus 2.2 ; Fugl-Meyer Lower Extremity : 4.7 versus -0.9 ; gait velocity : median change , 0.25 versus .09 m/s ; 6-Minute Walk : 195 versus 114 ft ; Berg Balance Score : 7.8 versus 5 ; and Medical Outcomes Study -36 Health Status Measurement of Physical Function : 15 . 5 versus 9 ) . There were no trends in differences in change scores by the Jebsen Test of H and Function , Barthel Index , and Lawton Instrumental ADL Scale . CONCLUSIONS This study demonstrated that a r and omized , controlled clinical trial of a poststroke exercise program is feasible . Measures of neurological impairments and lower extremity function showed the most benefit . Effects of the intervention on upper extremity dexterity and functional health status were equivocal . The lasting effects of the intervention were not assessed Abstract 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 r and omised 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 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 describe and compare six community services providing co-ordinated , multidisciplinary rehabilitation to people with stroke . Design : Prospect i ve , descriptive , quantitative study . Setting : Engl and and Northern Irel and . Subjects : Community rehabilitation teams and the patients treated by them . Main outcome measures : Annual numbers treated , Barthel Index , mortality , place of discharge , crude costs . Results : Between mid-1997 and mid-1999 , data were collected on 1076 patients who received community-based rehabilitation of whom 48.7 % were male . Mean age ( SD ) was 71 years ( 13.1 ) ; 115 ( 10.7 % ) were under 55 years of age and 278 ( 25.9 % ) under 65 years of age . Median time between stroke and intervention by the community service was six weeks ( 25th , 75th percentiles 2.6 , 14.4 weeks ) and 80.5 % had been admitted to hospital . The median Barthel score at the start of community rehabilitation was 15 ( 11.0 , 18.0 ) and at the end was 18.0 ( 14.0 , 20.0 ) . Median duration of intervention was 12 weeks ( 6.0 , 22.0 ) . At the end of community rehabilitation 912 patients ( 86.5 % ) were in the community , 52 ( 4.9 % ) had died , 10 ( 0.9 % ) were in hospital and 77 ( 7.3 % ) in long-term care . Comparative data given here are for one year , 1998 , when a total of 519 patients began community rehabilitation . Details of 1855 face-to-face interventions were also recorded from subsets of 10 consecutive patients . Conclusions : Community rehabilitation teams differed in their target population s , in the timing and duration of intervention . A taxonomy of four types of co-ordinated community-based rehabilitation for people with stroke is proposed : ( 1 ) Early-supported discharge rehabilitation aim ed to reduce length of hospital stay and offered an alternative to hospital rehabilitation . ( 2 ) Post-discharge rehabilitation provided additional rehabilitation and aim ed for a seamless transfer of patients from hospital to community . ( 3 ) General practitioner-oriented post-stroke rehabilitation provided an alternative to hospital admission and rehabilitation . ( 4 ) Late community rehabilitation provided patients with the opportunity of an autonomous service , unconnected with hospital or GP referral . Purchasers need to decide for what purpose a team is to be set up . Research ers need to be similarly aware of diversity in community rehabilitation before comparisons are made 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-eight patients ( median age 53 years ) consecutively discharged from inpatient rehabilitation with a first occurrence of stroke participated in training directly after discharge . Intervention : Rehabilitation was given for 9 hours/week 
    Output:
    
Individual studies reported cost benefits and increased carer satisfaction in favour of home-based rehabilitation .