Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial

Objective To establish if a brief programme of domiciliary occupational therapy could improve the recovery of patients with stroke discharged from hospital. Design Single blind randomised controlled trial. Setting Two hospital sites within a UK teaching hospital. Subjects 138 patients with stroke with a definite plan for discharge home from hospital. Intervention Six week domiciliary occupational therapy or routine follow up. Main outcome measures Nottingham extended activities of daily living score and "global outcome" (deterioration according to the Barthel activities of daily living index, or death). Results By eight weeks the mean Nottingham extended activities of daily living score in the intervention group was 4.8 points (95% confidence interval -0.5 to 10.0, P = 0.08) greater than that of the control group. Overall, 16 (24%) intervention patients had a poor global outcome compared with 30 (42%) control patients (odds ratio 0.43, 0.21 to 0.89, P = 0.02). These patterns persisted at six months but were not statistically significant Patients in the intervention group were more likely to report satisfaction with a range of aspects of services. Conclusion The functional outcome and satisfaction of patients with stroke can be improved by a brief occupational therapy programme carried out in the patient's home immediately after discharge. Major benefits may not, however, be sustained.