***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 We wished to examine the effectiveness of an early hospital discharge and home-based rehabilitation scheme for patients with acute stroke . METHODS This was a r and omized , controlled trial comparing early hospital discharge and home-based rehabilitation with usual inpatient rehabilitation and follow-up care . The trial was carried out in 2 affiliated teaching hospitals in Adelaide , South Australia . Participants were 86 patients with acute stroke ( mean age , 75 years ) who were admitted to hospital and required rehabilitation . Forty-two patients received early hospital discharge and home-based rehabilitation ( median duration , 5 weeks ) , and 44 patients continued with conventional rehabilitation care after r and omization . The primary end point was self-reported general health status ( SF-36 ) at 6 months after r and omization . A variety of secondary outcome measures were also assessed . RESULTS Overall , clinical outcomes for patients did not differ significantly between the groups at 6 months after r and omization , but the total duration of hospital stay in the experimental group was significantly reduced ( 15 versus 30 days ; P<0.001 ) . Caregivers among the home-based rehabilitation group had significantly lower mental health SF-36 scores ( mean difference , 7 points ) . CONCLUSIONS A policy of early hospital discharge and home-based rehabilitation for patients with stroke can reduce the use of hospital rehabilitation beds without compromising clinical patient outcomes . However , there is a potential risk of poorer mental health on the part of caregivers . The choice of this management strategy may therefore depend on convenience and costs but also on further evaluations of the impact of stroke on caregivers BACKGROUND AND PURPOSE This study describes the methodology , patient outcome , and use of hospital and rehabilitation services at 3 months of a population -based r and omized controlled trial . The purpose was to evaluate rehabilitation at home after early supported discharge from the Department of Neurology , Huddinge Hospital , for moderately disabled stroke patients in southwest Stockholm . METHODS The patients were eligible if they were continent , independent in feeding , had mental function within normal limits , and had impaired motor function and /or aphasia 1 week after stroke . Patients were r and omized either to early supported discharge with continuity of rehabilitation at home for 3 to 4 months or to routine rehabilitation service  in a hospital , day care , and /or outpatient care . The home rehabilitation team consisted of two physical therapists , two occupational therapists , and one speech therapist ; one of the therapists was assigned as case manager for the patient . The rehabilitation program at home emphasized a task- and context -oriented approach . The activities were chosen on the basis of the patient 's personal interests . Spouses were offered education and individual counseling . A total of 81 patients were followed up for a minimum of 3 months . Patient outcome was assessed by the Frenchay Social Activity Index , Extended Katz Index , Barthel Index , Lindmark Motor Capacity Assessment , Nine-Hole Peg Test , walking speed over 10 m , reported falls , and subjective dysfunction according to the Sickness Impact Profile . Patient use of hospital and home rehabilitation service and patient satisfaction with care were studied . RESULTS Overall there were no statistical significant differences in outcome . Multivariate logistic regression analysis suggested a systematic positive effect for the home rehabilitation group in social activity , activities of daily living , motor capacity , manual dexterity , and walking . A considerable difference in re source use during such a 3-month period was seen . A 52 % reduction in hospitalization was observed : from 29 days in the routine rehabilitation group to 14 days in the home rehabilitation group . Patient satisfaction was in favor of the latter group . CONCLUSIONS Early supported discharge with continuity of home rehabilitation services for the majority of moderately disabled stroke patients during the first 3-month period after acute stroke is not less beneficial than routine rehabilitation and can be a rehabilitation service of choice if follow-up at 6 and 12 months confirms the suggested effectiveness and considerable reduction in use of health care BACKGROUND AND PURPOSE Organized acute stroke treatment reduces mortality , functional deficits , and the need of institutionalization after stroke . It is largely unknown whether the effects of treatment are due to early or subacute efforts . The aim of this r and omized , controlled study was to test the hypothesis that rehabilitation of stroke patients in the subacute phase in a hospital rehabilitation unit is beneficial in reducing death and dependency and increasing health-related quality of life . METHODS 251 patients initially treated in the hospital were r and omized to subacute rehabilitation in a hospital rehabilitation unit ( n = 127 ) or to the health services in the municipality ( n = 124 ) and were followed up for 7 months . RESULTS The combined outcome of patients being dead or dependent ( Barthel Index score of < 75 ) was 23 % in the hospital group and 38 % in the municipality group ( P=.01 ) . Seven-month survival rates were 90.6 % and 83.9 % ( P=.11 ) , respectively . Dependency in activities of daily living was 12.6 % in the hospital group and 25.0 % in the municipality group ( P=.07 ) . Patients with a BI score of < 50 before rehabilitation had significantly better outcome in the hospital rehabilitation unit , with fewer patients becoming dependent ( P=.005 ) and patients having higher Sc and inavian Stroke Scale ( P=.026 ) and BI scores ( P=.005 ) . No significant differences in health-related quality of life were found . Many patients treated in the municipalities ( 30 % ) did not receive any organized rehabilitation in this study . CONCLUSIONS Subacute rehabilitation of stroke patients in a hospital-based rehabilitation unit improves outcome .  Patients with moderate or severe stroke appear to benefit most Background and Purpose Several trials have shown that stroke unit care improves outcome for stroke patients . The aim of the present trial was to evaluate the effects of an extended stroke unit service ( ESUS ) , with early supported discharge , cooperation with the primary healthcare system , and more emphasis on rehabilitation at home as essential elements . Methods In a r and omized , controlled trial , 160 patients with acute stroke were allocated to the ESUS and 160 to the ordinary stroke unit service ( OSUS ) .  The primary outcome was the proportion of patients who were independent as assessed by the modified Rankin Scale ( RS ) ( RS ≤2=global independence ) and independent in activities of daily living ( ADL ) as assessed by Barthel Index ( BI ) ( BI ≥95=independent in ADL ) after 26 weeks . Secondary outcomes were RS and BI scores after 6 weeks ; the proportion of patients at home , in institutions , and deceased after 6 and 26 weeks ; and the length of stay in institutions . Results After 26 weeks , 65.0 % in the ESUS versus 51.9 % in the OSUS group showed global independence ( RS ≤2 ) ( P= 0.017 ) , while 60.0 % in the ESUS versus 49.4 % in the OSUS group were independent in ADL ( BI ≥95 ) ( P = 0.056 ) . The odds ratios for independence ( ESUS versus OSUS ) were as follows : RS , 1.72 ( 95 % CI , 1.10 to 2.70 ) ; BI , 1.54 ( 95 % CI , 0.99 to 2.39 ) . At 6 weeks , 54.4 % of the ESUS group and 45.6 % of the OSUS group were independent according to RS ( P = 0.118 ) , and 56.3 % versus 48.8 % were independent according to BI ( P = 0.179 ) . The proportion of patients at home after 6 weeks was 74.4 % for ESUS and 55.6 % for OSUS ( P = 0.0004 ) , and the proportion in institutions was 23.1 % versus 40.0 % , respectively ( P = 0.001 ) . After 26 weeks , 78.8 % in the ESUS group versus 73.1 % in the OSUS were at home ( P = 0.239 ) , while 13.1 % versus 17.5 % were in institutions ( P = 0.277 ) . The mortality in the 2 groups did not differ . Average lengths of stay in an institution were 18.6 days in the ESUS and 31.1 days in the OSUS group ( P = 0.0324 ) . Conclusions An ESUS with early supported discharge seems to improve functional outcome and to reduce the length of stay in institutions compared with traditional stroke unit care Objective : To establish the feasibility and method of evaluation of an early supported hospital discharge policy for patients with acute stroke . Design : A r and omized controlled trial comparing an early supported discharge service to conventional care . Setting : Three acute hospitals in Newcastle upon Tyne . Subjects : Ninety-two eligible patients with acute stroke admitted between 1 February 1995 and 31 January 1996 . Main outcome measures : Placement , length of stay , readmission rates , mortality , functional ability ( Nottingham Extended Activities of Daily Living ( ADL ) Scale ) , h and icap ( Oxford H and icap Scale ) , global health status ( Dartmouth Coop Function Charts ) and carer stress ( General Health Question naire 30 item ) . Results : The median length of stay for patients r and omized to early supported discharge was 13 days compared to 22 days in the conventional care group ( p = 0.02 ) . The median Barthel ADL Index at seven days post stroke of patients r and omized to early supported discharge was 15 , and 13 for those r and omized to conventional care ( NS ) . At three months post stroke the median Nottingham EADL score of patients r and omized to early supported discharge was 10 compared to 7 for those who received conventional care ( NS ) . There were no statistically significant differences in the global health status of patients or carer stress . Conclusion : An early supported discharge service following acute stroke with individualized rehabilitation in the community is feasible and can be evaluated by a r and omized controlled trial but a larger multicentre trial is needed before such a service is widely adopted BACKGROUND AND PURPOSE Because stroke management is aim ed at facilitating community reintegration , it would be logical that the sooner the patient can be discharged home , the sooner reintegration can commence . The purpose of this study was to determine the effectiveness of prompt discharge combined with home rehabilitation on function , community reintegration , and health-related quality of life during the first 3 months after stroke . METHODS A r and omized trial was carried out involving patients who required rehabilitation services and who had a caregiver at home . When medically ready for discharge , persons with stroke were r and omized to either the  home intervention group ( n=58 ) or the usual care group ( n=56 ) . The home group received a 4-week , tailor-made home program of rehabilitation and nursing services ;  persons r and omized to the usual care group received services provided through a variety of mechanisms , depending on institutional , care provider , and personal preference . The main outcome measure was the Physical Health component of the Measuring Outcomes Study Short-Form-36 ( SF-36 ) . Associated outcomes measures included the Timed Up & Go ( TUG ) , Barthel Index ( BI ) , the Older Americans Re source Scale for instrumental activities of daily living ( OARS-IADL ) , Reintegration to Normal Living ( RNL ) , and the SF-36 Mental Health component . RESULTS The total length of stay for the home group was , on average , 10 days , 6 days shorter than that for the usual care group . There were no differences between the 2 groups on the BI or on the TUG at either 1 or 3 months after stroke ; however , there was a significantly beneficial impact of the home intervention on IADL and reintegration ( RNL ) . By 3 months after stroke , the home intervention group showed a significantly higher score on the SF-36 Physical Health component than the usual care group . The total number of services received by the home group was actually lower than that received by the usual care group . CONCLUSIONS Prompt discharge combined with home rehabilitation appeared to translate motor and functional gains that occur through natural recovery and rehabilitation into a greater degree of higher-level function and satisfaction with community reintegration , and these in turn were translated into a better physical health Abstract Objective : To assess the clinical effectiveness of an early discharge policy for patients with stroke by using a community based rehabilitation team . Design : R and omised controlled trial to compare conventional care with an early discharge policy . Setting : Two teaching hospitals in inner London . Subjects : 331 medically stable patients with stroke ( mean age 71 ) who lived alone and were able to transfer independently or who lived with a resident carer and were able to transfer with help . Interventions : 167 patients received specialist community rehabilitation for up to 3 months after r and omisation . 164 patients continued with conventional hospital and community care . Main outcome measures : Barthel score at 12 months . Secondary outcomes measured impairment with motoricity index , minimental state examination , and Frenchay aphasia screening test ; disability with the Rivermead activity of daily living scales , hospital anxiety and depression scale , and 5 m walk ; h and icap with the Nottingham health profile ; carer stress with caregiver strain index and patient and carer satisfaction . The main process measure was length of stay after r and omisation . Results : One year after r and omisation no significant differences in clinical outcomes were found apart from increased satisfaction with hospital care in the community therapy group . Length of stay after r and omisation in the community therapy group was significantly reduced ( 12 v 18 days ; P<0.0001 ) . Patients with impairments were more likely to receive treatment in the community therapy group . Conclusions : Early discharge with specialist community rehabilitation after stroke is feasible , as clinical ly effective as conventional care , and acceptable to patients . Considerable reductions in use of hospital beds are achievable . Key messages Early discharge from hospital after 
    Output:
    
Conclusions : A policy of early hospital discharge and home-based rehabilitation for patients with stroke may reduce the use of hospital beds without compromising clinical outcomes .
Our analysis shows this service to be a cost saving alternative to conventional in-hospital stroke rehabilitation for an important subgroup of patients with stroke-related disability