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Age and Ageing Advance Access originally published online on June 22, 2009
Age and Ageing 2009 38(5):576-583; doi:10.1093/ageing/afp095
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© The Author 2009. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Structured re-assessment system at 6 months after a disabling stroke: a randomised controlled trial with resource use and cost study

Anne Forster1, John Young1,2, John Green1, Chris Patterson2, Peter Wanklyn3, Jane Smith1, Jenni Murray4, Heather Wild3, Susan Bogle5 and Karin Lowson6

1 Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford, West Yorkshire, UK
2 Department of Health Care of the Elderly, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK
3 Department of Medicine for the Elderly, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
4 School of Healthcare, University of Leeds, Leeds, West Yorkshire, UK
5 Aysgarth Statistics, Beaconsfield, Buckinghamshire, UK
6 York Health Economics Consortium, University of York, York, UK

Address correspondence to: A. Forster: Tel: (+44) 1274 383406; Fax: (+44) 1274 382766; Email: a.forster{at}leeds.ac.uk

Background: national policy recommends routine re-assessment of disabled patients and their carers at 6 months after stroke onset. The clinical and resource outcomes of this policy were investigated.

Design: prospective, single-blind, randomised controlled trial in two centres.

Participants: a total of 265 patients with a disabling stroke and their carers.

Interventions: a structured re-assessment system for patients and their carers at 6 months post-stroke or existing care.

Outcome measures: primary: patient independence (Frenchay activities index) and carer stress (general health questionnaire 28). Secondary: activities of daily living, mood state, satisfaction with services, carer strain index, health and social service resource use and costs.

Results: independence at 12 months post-stroke was similar in both groups (Frenchay activities index, adjusted mean difference 0.64; 95% confidence interval –0.74–2.02). Emotional distress in carers was similar in both groups (general health questionnaire 28, mean difference 0.02; 95% confidence interval –0.95–1.00). Results for the secondary outcome measures and total mean costs were similar for both groups. The intervention group patients used 301 fewer hospital bed days and 1,631 fewer care home bed days.

Conclusions: the structured, systematic re-assessment for patients and their carers was not associated with any clinically significant evidence of benefit at 12 months. Health and social care resource use and mean cost per patient were broadly similar in both groups.

Trial registration: International Standard Randomised Controlled Trial Register; number: ISRCTN55412871 [controlled-trials.com] .

Keywords: stroke, randomised controlled trial, rehabilitation, patient outcome assessment, chronic disease, elderly

Received 15 December 2008; accepted in revised form 29 April 2009.


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