A randomized controlled trial of enhanced Social Service occupational therapy for stroke patients

Objective: To determine whether stroke patients referred to the Social Service occupational therapy service would benefit from an enhanced service compared to the usual service. Design: Randomized controlled study allocating patients to the enhanced service or the usual service. Subjects: Stroke patients discharged home from hospital and referred to Social Service occupational therapy department. Outcome measures: The sections and total score from the Nottingham Extended Activities of Daily living Scale (EADL), the Barthel Index, the General Health Questionnaire (GHQ) and the number of pieces of equipment provided were analysed. Results: One hundred and eleven stroke patients were recruited to this study. Fifty-three were randomly allocated to the enhanced service and 58 to the usual service. Patients receiving the enhanced service were seen more quickly after referral, for longer, and received significantly more visits (p<0.01) than those receiving the usual service. Three months after entry to the study the enhanced service group had better EADL (p<0.01) than the usual service group. This benefit remained significant in only the mobility section of the EADL at six months. Carers of the stroke patients in the enhanced group had lower GHQ scores (p<0.05) than those in the usual group at six months. Conclusions: This trial supports the use of domiciliary occupational therapy for stroke patients after discharge from hospital in terms of improvements in functional outcomes in the short term, but the long-term benefits remain unclear.