***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 — 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 Self-efficacy reflects an individual 's perceptions or beliefs about how capable he or she is of performing a specific activity or task and measures self-confidence to perform that specific activity or task . This study investigated the effect of  in-patient cardiac rehabilitation  on self-efficacy scores for 3 categories of activities : routine physical activities , daily living tasks and levels of concentration and ability to cope . On discharge from the intensive or coronary care unit , patients without contraindications to early ambulation were r and omized to either a  ward ambulation program ( n = 26 ) or a dedicated exercise center program ( n = 25 ) with all patients receiving the same st and ardized education/counseling . There were no differences between the groups in self-efficacy at baseline , at hospital discharge or 7 days later . Significant improvements in self-efficacy scores were observed by day 28 in both groups for routine physical activities and daily living tasks with no change in self-efficacy scores for concentration or ability to cope . At that time the exercise center patients had higher self-efficacy scores for walking time ( p = 0.041 ) and overall exertion ( p = 0.024 ) than the ward ambulation patients . For the majority of the self-efficacy variables considered , both in-patient exercise rehabilitation programs were equally effective in improving self-efficacy scores for physical activities and daily living tasks over the first 28 days after return to home . The lower cost associated with ward ambulation programs suggests that they are more cost-effective than developing a program in a dedicated in-patient exercise center OBJECTIVE To estimate the cost-utility and cost-effectiveness of a 3-week intensive exercise training ( IET ) program directly following hospital discharge in patients with rheumatic diseases . METHODS Patients with arthritis who were admitted to the hospital because of a disease activity flare or for elective hip or knee arthroplasty were r and omly assigned to either the  IET group or usual care ( UC ) group . Followup lasted 1 year . Quality -adjusted life years ( QALYs ) were derived from Short Form 6D scores and a visual analog scale ( VAS ) rating personal health . Function-related outcome was measured using the Health Assessment Question naire , the McMaster Toronto Arthritis ( MACTAR ) Patient Preference Disability Question naire , and the Escola Paulista de Medicina Range of Motion scale ( EPMROM ) . Costs were reported from a societal perspective . Differences in costs and incremental cost-effectiveness ratios ( ICERs ) were estimated . RESULTS Data from 85 patients ( 50 IET and 35 UC ) could be used for health-economic analysis . VAS personal health-based QALYs were in favor of IET . Function-related outcome showed statistically significant improvements in favor of IET over the first 6 months , according to the MACTAR ( P < 0.05 ) and the EPMROM ( P < 0.01 ) . At 1-year followup , IET was euro718 less per patient . The ICER showed a reduction in mean total costs per QALY . In 70 % of cases the intervention was cost-saving . CONCLUSION IET results in better quality of life at lower costs after 1 year . Thus , IET is the dominant strategy compared with UC . This highlights the need for implementation of IET after hospital discharge in patients with arthritis Objective : To assess the relative cost effectiveness of clinical nurse specialist care , inpatient team care , and day patient team care . Methods : Incremental cost effectiveness analysis and cost utility analysis , alongside a prospect i ve r and omised controlled trial with two year follow up . Included were patients with rheumatoid arthritis ( RA ) with increasing difficulty in performing activities of daily living over the previous six weeks .  Quality of life and utility were assessed by the Rheumatoid Arthritis Quality of Life question naire , the Short Form-6D , a transformed rating scale , and the time tradeoff . A cost-price analysis was conducted to estimate the costs of inpatient and day patient hospitalisations . Other healthcare and non-healthcare costs were estimated from cost question naires . Results : 210 patients with RA ( 75 % female , median age 59 years ) were included . Aggregated over the two year follow up period , no significant differences were found on the quality of life and utility instruments . The costs of the initial treatment were estimated at € 200 for clinical nurse specialist care , € 5000 for inpatient team care , and € 4100 for day patient team care . Other healthcare costs and non-healthcare costs were not significantly different . The total societal costs did not differ significantly between in patients and day patients , but were significantly lower for the clinical nurse specialist patients by at least € 5400 . Conclusions : Compared with inpatient and day patient team care , clinical nurse specialist care was shown to provide equivalent quality of life and utility , at lower costs . Therefore , for patients with health conditions that allow for any of the three types of care , the preferred treatment from a health-economic perspective is the care provided by the clinical nurse specialist Objective : To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome . Design : A r and omized controlled trial . Setting : A stroke unit which provides acute care and rehabilitation for all stroke admissions . Subjects : One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days . Intervention : The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist , commencing within 10 days of stroke , and available up to 30 minutes/day , five days/week for six weeks . The control group received stroke unit care . Main outcome measures : The primary outcome measure was the Action Research Arm Test ( ARAT ) three months after stroke . Secondary outcome measures : Motricity Index ; Frenchay Arm Test ; upper limb pain ; Barthel ADL Index ; Nottingham E-ADL Scale ; and costs to health and social services at three and six months after stroke . Results : There were no differences in outcomes between the intervention and control groups three and six months after stroke . During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as in patients . The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group ( p = 0.001 ) . There were no differences in service costs . Conclusions : An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke . The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias BACKGROUND AND PURPOSE In an inner-London teaching hospital , a r and omized trial of " conventional " care versus early discharge to community-based therapy found no significant differences in clinical outcomes between patient groups . This report examines the economic consequences of the alternative strategies . METHODS One hundred sixty-seven patients received the early discharge package , and 164 received conventional care .  Patient utilization of health and social services was recorded over a 12-month period , and cost was determined using data from provider departments and other published sources . RESULTS Inpatient stay after r and omization was 12 days ( intervention group ) versus 18 days ( controls ) ( P=0.0001 ) . Average units of therapy per patient were as follows : physiotherapy , 22.4 ( early discharge ) versus 15.0 ( conventional ) ( P=0.0006 ) ; occupational therapy , 29.0 versus 23.8 ( P=0.002 ) ; speech therapy , 13 . 7 versus 5.8 ( P=0.0001 ) . The early discharge group had more annual hospital physician contacts ( P=0.015 ) and general practitioner clinic visits ( P=0.019 ) but fewer incidences of day hospital attendance ( P=0.04 ) . Other differences in utilization were nonsignificant . Average annual costs per patient were pound sterling 6800 ( early discharge ) and pound sterling 7432 ( conventional ) . The early discharge group had lower inpatient costs per patient ( pound sterling 4862 [ 71 % of total cost ] versus pound sterling 6343 [ 85 % ] for controls ) but higher non-inpatient costs ( pound sterling 1938 [ 29 % ] versus pound sterling 1089 [ 15 % ] ) . Further analysis demonstrated that early discharge is unlikely to lead to financial savings ; its main benefit is to release capacity for an expansion in stroke caseload . CONCLUSIONS Overall results of this trial indicate that early discharge to community rehabilitation for stroke is cost-effective . It may provide a means of addressing the predicted increase in need for stroke care within existing hospital capacity & NA ; This study reports a 9–18 month follow‐up of a r and omised controlled trial of pain management programmes for chronic , non‐malignant pain . Twenty‐two in patients , 18 out patients and 12 control subjects completed the follow‐up assessment s. Significant treatment effects were demonstrated by the inpatient group on pain ratings , the Pain Behaviour Checklist , and General Health Question naire , with similar effects demonstrated by the outpatient group on the former 2 measures . The findings were confounded by higher inpatient scores at pretreatment , in comparison with the 2 other conditions . There was a high drop‐out rate of subjects , particularly from the control condition which illustrates the limitations of controlled group design s in this area . Analgesic use , activity levels and pain ratings were also evaluated using the criteria for ‘ success ’ described by Malec et al. ( 1981 ) . Results indicated that 68 % of in patients , 61 % of out patients and 21 % of control subjects met all 3 criteria . Both treatment programmes were effective in returning patients to paid employment , whilst 3 control group patients gave up work . The cost‐benefit implication s of these changes are discussed . We conclude that pain management programmes contribute substantially to the rehabilitation of chronic pain sufferers Background and Purpose The aim of the present study was to examine re source utilization during a 12-month period after acute stroke in elderly patients r and omized to care in an acute stroke unit integrated with a care continuum compared with conventional care in general medical wards . A secondary aim was to describe costs related to the severity of stroke . Methods Two hundred forty-nine consecutive patients aged ≥70 years with acute stroke within 7 days before admission , living in their own homes in Göteborg , Sweden , without recognized need of care were r and omized to 2 groups : 166 patients were assigned to nonintensive stroke unit care with a care continuum , and 83 patients were assigned to conventional care . There was no difference in mortality or the proportion of patients living at home after 1 year . Main outcomes were costs from inpatient care , outpatient care , and informal care . Results Mean annual cost per patient was 170 000 Swedish crowns ( SEK ) ( equivalent to $ 25 373 ) and 191 000 SEK ( $ 28 507 ) in the stroke unit and the general medical ward groups , respectively ( P = NS ) . Seventy percent of the total cost was for inpatient care , and 30 % was for outpatient and informal care . For patients with mild , moderate , and severe stroke , the mean annual costs per patient were 107 000 SEK ( $ 15 970 ) , 263 000 SEK ( $ 39 254 ) , and 220 000 SEK ( $ 32 836 ) , respectively ( P < 0.001 ) . There was no statistical difference in age or nonstroke diagnosis . Conclusions The total costs the first year did not differ significantly between the treatment groups in this prospect i ve study . The total annual cost per patient showed a very large variation , which was related to stroke severity at onset and not to age or nonstroke diagnoses . Costs other than those for hospital care constituted a substantial fraction of total costs and must be taken into account when organizing the management of stroke patients . The high variability in costs necessitates a larger study to assess long-term cost effectiveness STUDY OBJECTIVE We report on the incremental costs associated with improvements in health-related quality of life ( HRQL ) following 6 months of respiratory rehabilitation compared with conventional community care . DESIGN Prospect i ve r and omized controlled trial of rehabilitation . SET 
    Output:
    
Based on this systematic review and meta-analyses , a single rehabilitation service may not provide health economic benefits for all patient groups and situations .
For some patients , inpatient rehabilitation may be the most cost-effective method of providing rehabilitation ; yet , for other patients , rehabilitation in the home or community may be the most cost-effective model of care .