***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 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 PURPOSE Stroke rehabilitation has received increased attention in the past decade . Recent trials with new alternatives such as home-based rehabilitation services are being conducted . The purpose of the study was to explore differences between a therapy session with a stroke patient in two different context s , i.e. in the patient 's home and in the hospital . METHODS The research design was a qualitative case study . Three data collection methods were used ; participant observations of therapy sessions in two different context s , semi-structured interviews and documents . RESULTS The data were examined and coded for common categories . Analysis of the data looking for similarities and differences in behaviour of two therapists and their patients during therapy sessions in the hospital and in the home was performed . The observations revealed that there was clearly a difference in behaviour ; a different role-set used by the two therapists when working in the patient 's home versus in the hospital . The major difference in patient behaviour was that the patient , observed in his home , took the initiative and expressed his goals , which was not the case with the patients observed in the hospital . The findings were confirmed in the interviews and the documents . CONCLUSION It is suggested that the context is a key component to be considered in the rehabilitation process of stroke patients Background and Purpose — The optimal organization of rehabilitation services after discharge from a stroke unit has not been determined . This study sought to evaluate the effect of early supported discharge and continued rehabilitation at home ( ESD ) , in terms of patient outcome 5 years after stroke and changes in selected data over time . Methods — Eighty-three patients from Southwest Stockholm , mildly or moderately impaired 5 to 7 days after acute stroke , were enrolled in a r and omized controlled trial . The core components of the ESD service were initial treatment in a stroke unit and the involvement of an outreach team to deliver and coordinate home-based rehabilitation in partnership with the patient . At the 5-year follow-up , measures used to assess patient outcome included survival , motor capacity , dysphasia , activities of daily living ( ADL ) , social activities , subjective dysfunction , and self-reported falls . Results — Fifty-four patients ( 30 in the intervention group and 24 in the control group ) were evaluated 5 years after stroke , at which time a significantly larger proportion of patients in the intervention group were independent in extended ADL and active in household activities . Conclusions — This ESD service has a beneficial effect on extended ADL 5 years after stroke for mildly to moderately impaired patients Objective : To describe the content of a programme involving early hospital discharge and continued rehabilitation at home after stroke . Design : Quantitative and qualitative descriptive study of an intervention within the context of a r and omized controlled trial . Setting : Huddinge University Hospital , Stockholm , Sweden . Subjects : Forty-one patients , moderately impaired after stroke , rehabilitated by a team of six occupational , physical , and speech and language therapists . Results : The average duration of the programme was 14 weeks , the mean number of home visits 12 , and the median total time consumption 23 hours and 20 minutes , of which face-to-face contact with the patient constituted 54 % . The rehabilitation process was pursued by the patient and the therapist in partnership . Supported by the team the therapists incorporated a wider domain of activities than usual and left a considerable amount of the training to self-directed activities . The most common foci of the visits were speech and communication , ADL activities and ambulation . When planning the intervention the therapists paid attention to discrepancies between the desires and abilities of the patient on the one h and and environmental dem and s on the other – discrepancies detected through observation of the patient in the home environment . Conclusions : The home environment offers therapists working in a team opportunities to adopt a behaviour that enables patients with moderate neurological impairments after stroke to resume responsibility and influence over their rehabilitation process , result ing in an individualized rehabilitation programme that varies in duration , content and frequency of home visits Background and Purpose : This study sought to evaluate early supported discharge and continued rehabilitation at home after stroke , at a minimum of 6 months after the intervention , in terms of patient outcome , re source use and health care cost . Methods : Eighty-three patients , moderately impaired 5–7 days after acute stroke , were included in a r and omized controlled trial , 42 being allocated to the intervention and 41 to routine rehabilitation . One-year follow-up of patient outcome included mortality , motor capacity , dysphasia , activities of daily living , social activities , perceived dysfunction , and self-reported falls . Re source use over 12 months included inpatient hospital care , outpatient health care , use of health-related services , informal care , and cost of health care . Results : On univariate analysis there was no difference in patient outcome . Multivariate regression analysis showed that intervention had a significant effect on independence in activities of daily living . A significant difference in inpatient hospital care , initial and recurrent , was observed , with a mean of 18 ( intervention ) versus 33 days ( control ) ( p = 0.002 ) . Further significant differences were that the control group registered more outpatient visits to hospital occupational therapists ( p = 0.02 ) , private physical therapists ( p = 0.03 ) and day-hospital attendance ( p = < 0.001 ) , while the intervention group registered more visits to nurses in primary care ( p = 0.03 ) and home rehabilitation ( p = < 0.001 ) . Other differences in outcomes or re source utilization were nonsignificant . Conclusion : In Sweden , early supported discharge with continued rehabilitation at home proved no less beneficial as a rehabilitation service , and provided care and rehabilitation for 5 moderately disabled stroke patients over 12 months after stroke onset for the cost of 4 in routine rehabilitation BACKGROUND Early supported discharge ( ESD ) with continued rehabilitation at home has shown a beneficial effect on extended activities of daily living 5 years after stroke . The long-term effect of ESD on re source use has not been explored . METHODS At 5 years , 54 patients with mild to moderate disability , enrolled in a r and omized controlled trial of ESD  , were followed up . Data were collected from a county register and by interviewing the patient or the patient 's spouse . RESULTS There were differences in mean length of hospitalization , 51 versus 32 days ( P = .02 ) . There was no significant difference between the groups in regard to total outpatient rehabilitation , ESD visits included , but there was a difference in where the services were obtained . The ESD group had more  rehabilitation at home  ( ESD service ) and the control group had more  outpatient rehabilitation  ( P = .04 ) , including physiotherapy in primary care ( P = .05 ) . There were no other differences . CONCLUSION We conclude that , 5 years after stroke , our ESD service was favorable with regard to re source use Objective : To evaluate the effect of an extended stroke unit service ( extended service ) , with early supported discharge and co-ordination of further rehabilitation in co-operation with the primary health care system in three rural municipalities . Design : A r and omized controlled trial comparing extended service with ordinary stroke unit service ( ordinary service ) . Subjects : Sixty-two eligible patients with acute stroke living in the rural municipalities of Malvik , Melhus and Klñ bu . Main measures : The primary outcome was the proportion of patients who were independent according to Modified Rankin Scale ( mRS ) ( independence = mRS < 2 ) 52 weeks after onset of stroke . Secondary outcomes were mRS at 6 and 26 weeks and Barthel Index ( BI ) , Nottingham Health Profile ( NHP ) and Caregiver Strain Index ( CSI ) at 6 , 26 and 52 weeks . Mortality and length of stay were registered during the 52 weeks . Results : Twelve patients ( 39 % ) in the extended service group versus 16 patients ( 52 % ) in the ordinary service group were independent according to mRS at 52 weeks ( p= 0.444 ) . The odds ratio for independence ( extended service versus ordinary service ) was 0.33 ( 95 % confidence interval ( CI ) 0.088 –1.234 ) . According to outcome by secondary measures there were no significant differences except less social isolation on NHP in the extended service group at 26 weeks ( p= 0.046 ) . There were no significant differences in length of stay . Conclusion : An extended stroke unit service with early supported discharge seems to have no positive effect on functional outcome for patients living in rural communities , but might give a trend toward better quality of life . There were no significant differences in length of stay Background : Engagement in therapeutic activity among stroke in patients is advocated by many rehabilitation professionals . However , there is a lack of published evidence to indicate whether this is currently being achieved . Objective : To investigate the extent and types of ' rehabilitation ' activities on a new neurological rehabilitation ward , and examine change in patients ' behaviour related to the new environment and new initiatives . Design : Five one-week observation periods were conducted over two years , with a total of 67 patients being observed . A comparison was made with results of an earlier study of stroke patients ' activities conducted at the same hospital . Results : Patients spent an average 43 min per day with therapists  ( 9 % of the working day ) and this was only marginally supplemented by  self-exercise  ( 2 % of the working day - approximately 10 min ) . However , the provision of a new rehabilitation environment was associated with a marked decrease in the time patients spent at their bedsides , and a decrease in time spent passively gazing or watching others . Conclusions : Overall there was some positive change in patients ' behaviour . We suggest that structured guidance is required from the whole multidisciplinary team to stimulate more self-directed therapy practice and recreation BACKGROUND Organised specialist care for stroke improves outcome , but the merits of different methods of organisation are in doubt . This study compares the efficacy of stroke unit with stroke team or domiciliary care . METHODS A single-blind , r and omised , controlled trial was undertaken in 457 acute-stroke patients ( average age 76 years , 48 % women ) r and omly assigned to stroke unit , general wards with stroke team support , or domiciliary stroke care , within 72 h of stroke onset . Outcome was assessed at 3 , 6 , and 12 months . The primary outcome measure was death or institutionalisation at 12 months . Analyses were by intention to treat . FINDINGS 152 patients were allocated to the stroke unit , 152 to stroke team , and 153 to domiciliary stroke care . 51 ( 34 % ) patients in the domiciliary group were admitted to hospital after r and omisation . Mortality or institutionalisation at 1 year were lower in patients on a stroke unit than for those receiving care from a stroke team ( 21/152 [ 14 % ] vs 45/ 
    Output:
    
The greatest benefits were seen in the trials evaluating a co-ordinated multidisciplinary early supported discharge team and with patients with mild-moderate disability .
In conclusion , an illustrative case report is set out , indicating a typical patient pathway in an early supported discharge service