Combined clinical and home rehabiliation for stroke patients: a pilotstudy into the implementation of a new treatment protocol.

Stroke patients often experience difficulties in transferring skills acquired
in the clinical setting to their home-setting. Therefore context-specific and
task-specific training is very important.
Simulation of the home-setting in the rehabiliation centre appears to be
difficult. Research has demonstrated that compared with conventional care,
early supported discharge services are associated to be effective to
independency concerning ADL and mobility.
For some patients early supported discharge is not possible because of the
amount of care and therapy that is needed. These patients are considered for
clinical rehabilitation in the CvR UMCG location Beatrixoord. To be sure that
these patients will be able to profit by the benefits of home rehabilitation,
we will execute a pilotstudy which consists of a combination of clinical and
home rehabilitation for stroke patients.
It might be possible that a combination of clinical and home rehabilitation
will provide earlier indepence concerning ADL and mobility as compared with
clinical rehabilitation. A consequence could be a reduction in length of stay
in the rehabilitation centre and lower costs.

The objective of the pilotstudy is to develop and evaluate a new combined
clinical and home rehabiliation research protocol for stroke patients. This
pilotstudy will focus on the (re)learning of ADL and mobility skills.

Important questions are:
-Is it possible to optimize the contents of the combined clinical and
home-based rehabilitation program?
-Which are the similarities and differences between the contents and the
theoretical starting points of the new combined rehabilitation program and the
care-as-usual?
-Is it possible to sharpen the the selection criteria?
-Which instruments can be used to objectivate the intended change and possible
secondary effects?

If the treatment protocol is useful this pilotstudy will be continued in an
RCT.

A single subject design is used.

The intervention consists of a combined clinical and home rehabilitation
program for stroke patients. Besides the rehabiliation that is given in the
rehabilitation centre, patients will travel two times a week (two times three
hours) to their homes for rehabilitation at home. This pilotstudy will focus on
the (re)learning of ADL and mobility skills.

Compared with the care-as-usual, patients that will participate in the
pilotstudy will receive rehabilitation at home for two days a week. This could
be a burden for the patient but the benefit is that context-specific training
is possible this way. To take notice of the fatigue which will arise from
travelling by car. patients have to live in a range of twenty kilometres from
the CvR UMCG location Beatrixoord.
Only patients that are physically, mentally as well as emotionally capable of
being treated at home will be able to participate.
If the patient isn't capable of being treated at home as a result of phycial,
emotional or mental problems, participation in the pilotstudy will be ended.
As a result of the combined rehabilitation program the partner/ caregiver will
be relieved by the stay in the rehabilitation centre because stroke patients
often have serious motor and/or cognitive impairments.
Because a part of the rehabilitation takes place in the home setting, the
partner can intensively participate during rehabilitation.
Home rehabiliation can give a quicker and better insight in de possibilities
and limitations of a life with a partner suffering from stroke.
For the patient and his/her partner, the change from staying in the
rehabilitation centre to discharge at home will be easier.
The moments when the patient will be tested and also the number of instruments
that are used in the pilotstudy hardly differ from the care-as-usual.