Individualized home-based rehabilitation after stroke in France: a pragmatic study of a community stroke rehabilitation team

Background: Community stroke rehabilitation teams (CSRT) provide an individualized home-based rehabilitation service to patients recovering from stroke. Objective: To examine whether there is an improvement in the social participation of patients who received a rehabilitation program provided by CSRT. The secondary objectives were to show if there is an improvement in the patients' quality of life and a reduction in the caregiver burden. Methods: Retrospective cohort study, pragmatic in real-care conditions. The rehabilitation program delivered by the CSRT was adapted to the needs of the patients and caregivers. The outcome questionnaires included: the Frenchay Activity Index (FAI), the Minizarit, the EuroQol EQ5D, and the Barthel Index. The primary outcome measure was the FAI. Results: We included 206 patients followed by the CSRT over the 2018-2020 study period, for whom the primary endpoint was present. The mean age was 66.3 +/- 12.7 years, the post-stroke delay was 16.4 +/- 32.7 months, and the Barthel index was 66.42 +/- 12.6. The duration of the rehabilitation program was on average 162 +/- 109 days. We observed a significant improvement in the FAI, from 12.9 +/- 10.4 to 17.85 +/- 12.4 (p < 0.00001); in the EuroQol, from 57.51 +/- 19.96 to 66.36 +/- 18.87 (p < 0.00001); in the mini-Zarit, from 2.49 +/- 1.75 to 2.06 +/- 1.67 (p = 0.0002); and in the Barthel index, from 66.42 +/- 12.67 to 84.81 +/- 23.70 (p < 0.001). Conclusion: Patients who received a rehabilitation program by the CSRT have an improvement in their social participation, and their informal caregivers have a reduction in their burden.