cqvip:Background: Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients ea rly discharge from hospital with rehabilitation at home (early supported discharge [ESD]). W e have assessed the effects and costs of such services. Methods: We did a meta- analysis of data from individual patients who took part in randomised trials tha t recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a c ommunity setting with the aim of shortening the duration of hospital care. The p rimary outcome was death or dependency at the end of scheduled follow-up. Findi ngs:Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (medi an 41%) of stroke patients admitted to hospital. There was a reduced risk of de ath or dependency equivalent to six (95%CI one to ten) fewer adverse outcomes f or every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned convent ional care (p < 0.0001). There were also significant improvements in scores on t he extended activities of daily living scale and in the odds of living at home a nd reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patient s with mild to moderate disability.Interpretation: Appropriately resourced ESD s ervices provided for a selected group of stroke patients can reduce long-term d ependency and admission to institutional care as well as shortening hospital sta ys.
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