RESEARCH REPORT PLATFORM PRESENTATION

DOES AN EXTENDED STROKE UNIT SERVICE WITH EARLY SUPPORTED DISCHARGE HAVE ANY EFFECT ON BALANCE OR WALKING SPEED? Askim T^1,2, Mørkved S^2,1, Indredavik B^3,4; ¹Department of Community Medicine and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. ²Clinical Services, University Hospital of Trondheim, Norway. ³Stroke Unit, University Hospital of Trondheim, Norway. ⁴Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

PURPOSE: Effective stroke unit care with early mobilisation improves functional outcome after stroke, however increased risk of falling is a major problem among persons with stroke and impaired balance is one of the main reasons for falling. A new kind of service has been developed during the last decade that offers Early Supported Discharge (ESD). In the present study the aims were to evaluate the effect of an extended stroke unit service with ESD on balance and walking speed, and to explore the association between initial leg paresis, initial movement ability and balance one year after a stroke. RELEVANCE: Functional disability after stroke is costly to the health care system. This study seeks more knowledge about improvement of function after stroke. PARTICIPANTS: Sixty-two patients admitted to the Stroke Unit at Trondheim University Hospital, fulfilling the inclusion criteria, were included in the trial. METHODS: A randomized controlled design was used, comparing the ESD with ordinary stroke unit service. The outcome measures were Berg Balance Scale (BBS) and walking speed at one, six, twenty-six and fifty-two weeks after the stroke. On the multiple regression analysis BBS was dichotomised into good balance (BBS ≥ 45) versus poor balance (BBS < 45). The ESD service consisted of stroke unit treatment combined with a home-based program including follow up care co-ordinated by a mobile stroke team that offers early supported discharge and works in close co-operation with the primary health care system during the first four weeks after discharge. The intervention placed emphasize on task spesific exercise therapy in the patients’ home. ANALYSIS: In all analysis between groups Mann–Whitney U-test was used for ordinal data, t-test for ratio data, and χ² tests for nominal data. Multiple logistic regression was used to analyse the association between initial leg paresis, initial movement ability and balance fifty-two weeks after stroke allowing adjustments for potential confounders as age, sex, treatment group and number of days from onset of symptoms to hospital admission. RESULTS: 23 patients in each group completed all assessments on BBS. The differences in change between the two groups showed a trend toward greater improvement in the ESD group compared to the ordinary service group from one week follow up to six weeks follow up (p = 0.065) and from one week follow up to twenty-six weeks follow up (p = 0.142) on the BBS, but no differences in change between the two groups on fast walking speed. All patients with initial severe leg paresis suffered from poor balance one year after the stroke. The odds ratio for poor balance was 42.1 (95% confidence interval; 3.5–513.9) among patients with no initial walking ability. CONCLUSIONS: Our results do not conclusively indicate that ESD has an effect on balance. We found a strong association between initial severe leg paresis, initial inability to walk and poor balance after one year. IMPLICATIONS: Further research should emphasize task specific exercise therapy with a higher intensity in addition to ESD to enhance further improvement on balance and walking speed in order to facilitate an active life for persons with stroke. KEYWORDS: stroke, balance, rehabilitation. FUNDING ACKNOWLEDGEMENTS: This study has received financial support from The Norwegian Fund for Post-graduate Training in Physiotherapy and from Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Norway. CONTACT: torunn.askim@ntnu.no

ETHICS COMMITTEE: Regional Committee for Medical Research Ethics in Norway, REK