Scolaris Content Display Scolaris Content Display

Flow diagram illustrating the results of the updated searches
Figures and Tables -
Figure 1

Flow diagram illustrating the results of the updated searches

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 1 Death.
Figures and Tables -
Analysis 1.1

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 1 Death.

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 2 Death or requiring institutional care.
Figures and Tables -
Analysis 1.2

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 2 Death or requiring institutional care.

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 3 Death or dependency.
Figures and Tables -
Analysis 1.3

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 3 Death or dependency.

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 4 Activities of daily living (Barthel ADL) score.
Figures and Tables -
Analysis 1.4

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 4 Activities of daily living (Barthel ADL) score.

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 5 Extended activities of daily living (EADL) score.
Figures and Tables -
Analysis 1.5

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 5 Extended activities of daily living (EADL) score.

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 6 Subjective health status.
Figures and Tables -
Analysis 1.6

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 6 Subjective health status.

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 7 Mood status.
Figures and Tables -
Analysis 1.7

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 7 Mood status.

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 8 Satisfaction with services.
Figures and Tables -
Analysis 1.8

Comparison 1 Early supported discharge service versus conventional care: patient outcomes, Outcome 8 Satisfaction with services.

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 1 Death: within 6 months.
Figures and Tables -
Analysis 2.1

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 1 Death: within 6 months.

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 2 Death or dependency: within 6 months.
Figures and Tables -
Analysis 2.2

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 2 Death or dependency: within 6 months.

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 3 Death: within 1 year.
Figures and Tables -
Analysis 2.3

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 3 Death: within 1 year.

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 4 Death or dependency: within 1 year.
Figures and Tables -
Analysis 2.4

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 4 Death or dependency: within 1 year.

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 5 Death: within 5 years.
Figures and Tables -
Analysis 2.5

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 5 Death: within 5 years.

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 6 Death or dependency: within 5 years.
Figures and Tables -
Analysis 2.6

Comparison 2 Early supported discharge service versus conventional care: duration of follow‐up, Outcome 6 Death or dependency: within 5 years.

Comparison 3 Early supported discharge service versus conventional care: carer outcomes, Outcome 1 Subjective health status.
Figures and Tables -
Analysis 3.1

Comparison 3 Early supported discharge service versus conventional care: carer outcomes, Outcome 1 Subjective health status.

Comparison 3 Early supported discharge service versus conventional care: carer outcomes, Outcome 2 Mood status.
Figures and Tables -
Analysis 3.2

Comparison 3 Early supported discharge service versus conventional care: carer outcomes, Outcome 2 Mood status.

Comparison 3 Early supported discharge service versus conventional care: carer outcomes, Outcome 3 Satisfaction with services.
Figures and Tables -
Analysis 3.3

Comparison 3 Early supported discharge service versus conventional care: carer outcomes, Outcome 3 Satisfaction with services.

Comparison 4 Early supported discharge service versus conventional care: resource use, Outcome 1 Length of initial hospital stay (days).
Figures and Tables -
Analysis 4.1

Comparison 4 Early supported discharge service versus conventional care: resource use, Outcome 1 Length of initial hospital stay (days).

Comparison 4 Early supported discharge service versus conventional care: resource use, Outcome 2 Readmission to hospital.
Figures and Tables -
Analysis 4.2

Comparison 4 Early supported discharge service versus conventional care: resource use, Outcome 2 Readmission to hospital.

Comparison 5 Early supported discharge service versus conventional care: age subgroups, Outcome 1 Death or dependency.
Figures and Tables -
Analysis 5.1

Comparison 5 Early supported discharge service versus conventional care: age subgroups, Outcome 1 Death or dependency.

Comparison 5 Early supported discharge service versus conventional care: age subgroups, Outcome 2 Length of stay (days).
Figures and Tables -
Analysis 5.2

Comparison 5 Early supported discharge service versus conventional care: age subgroups, Outcome 2 Length of stay (days).

Comparison 6 Early supported discharge service versus conventional care: gender subgroups, Outcome 1 Death or dependency.
Figures and Tables -
Analysis 6.1

Comparison 6 Early supported discharge service versus conventional care: gender subgroups, Outcome 1 Death or dependency.

Comparison 6 Early supported discharge service versus conventional care: gender subgroups, Outcome 2 Length of stay (days).
Figures and Tables -
Analysis 6.2

Comparison 6 Early supported discharge service versus conventional care: gender subgroups, Outcome 2 Length of stay (days).

Comparison 7 Early supported discharge service versus conventional care: stroke severity subgroups, Outcome 1 Death or dependency.
Figures and Tables -
Analysis 7.1

Comparison 7 Early supported discharge service versus conventional care: stroke severity subgroups, Outcome 1 Death or dependency.

Comparison 7 Early supported discharge service versus conventional care: stroke severity subgroups, Outcome 2 Length of stay (days).
Figures and Tables -
Analysis 7.2

Comparison 7 Early supported discharge service versus conventional care: stroke severity subgroups, Outcome 2 Length of stay (days).

Comparison 8 Early supported discharge service versus conventional care: carer subgroups, Outcome 1 Death or dependency.
Figures and Tables -
Analysis 8.1

Comparison 8 Early supported discharge service versus conventional care: carer subgroups, Outcome 1 Death or dependency.

Comparison 8 Early supported discharge service versus conventional care: carer subgroups, Outcome 2 Length of stay (days).
Figures and Tables -
Analysis 8.2

Comparison 8 Early supported discharge service versus conventional care: carer subgroups, Outcome 2 Length of stay (days).

Comparison 9 Early supported discharge service versus conventional care: ESD service subgroups: service base, Outcome 1 Death or dependency.
Figures and Tables -
Analysis 9.1

Comparison 9 Early supported discharge service versus conventional care: ESD service subgroups: service base, Outcome 1 Death or dependency.

Comparison 9 Early supported discharge service versus conventional care: ESD service subgroups: service base, Outcome 2 Length of stay (days).
Figures and Tables -
Analysis 9.2

Comparison 9 Early supported discharge service versus conventional care: ESD service subgroups: service base, Outcome 2 Length of stay (days).

Comparison 10 Early supported discharge service versus conventional care: ESD service subgroups: MDT co‐ordination, Outcome 1 Death.
Figures and Tables -
Analysis 10.1

Comparison 10 Early supported discharge service versus conventional care: ESD service subgroups: MDT co‐ordination, Outcome 1 Death.

Comparison 10 Early supported discharge service versus conventional care: ESD service subgroups: MDT co‐ordination, Outcome 2 Death or requiring institutional care.
Figures and Tables -
Analysis 10.2

Comparison 10 Early supported discharge service versus conventional care: ESD service subgroups: MDT co‐ordination, Outcome 2 Death or requiring institutional care.

Comparison 10 Early supported discharge service versus conventional care: ESD service subgroups: MDT co‐ordination, Outcome 3 Death or dependency.
Figures and Tables -
Analysis 10.3

Comparison 10 Early supported discharge service versus conventional care: ESD service subgroups: MDT co‐ordination, Outcome 3 Death or dependency.

Comparison 10 Early supported discharge service versus conventional care: ESD service subgroups: MDT co‐ordination, Outcome 4 Length of stay (days).
Figures and Tables -
Analysis 10.4

Comparison 10 Early supported discharge service versus conventional care: ESD service subgroups: MDT co‐ordination, Outcome 4 Length of stay (days).

Comparison 11 Early supported discharge service versus conventional care: conventional service subgroups, Outcome 1 Death or dependency.
Figures and Tables -
Analysis 11.1

Comparison 11 Early supported discharge service versus conventional care: conventional service subgroups, Outcome 1 Death or dependency.

Comparison 11 Early supported discharge service versus conventional care: conventional service subgroups, Outcome 2 Length of stay (days).
Figures and Tables -
Analysis 11.2

Comparison 11 Early supported discharge service versus conventional care: conventional service subgroups, Outcome 2 Length of stay (days).

Table 1. Characteristics and staffing of ESD trials

Trial

Setting

 Key features

Control  service base

ESD staffing (whole time equivalents for caseload of 100 patients/year; median and range)

Medical

Nursing

Physio

OT

SALT

Assistant

Other

Total

Adelaide 2000

Urban

PHMR

Goals documented

Rehabilitation unit (stroke and neurological)

0.06

0.06

0.7

1.6

0.25

 

0.4

 

Social work

2.6

Aveiro

Mixed

Tailored

Mixture (stroke unit, case managers in community‐based team)

0.8

0

1.0

1.5

0

0

Psychology

3.2

Belfast 2004

Mixed

PHMR

Mixture (medical, geriatric, stroke unit)

0.1

0

1.5

 

1.0

 

0.5

 

1.5

Secretary

Social work

4.6

Copenhagen 2009

Urban

Tailored

Stroke unit

 

 

 

 

 

 

 

 

Glostrup 2006

Mixed

Tailored

Neurology, geriatrics

0

0

2.0

2.0

0

0

0

4.0

London 1999

Urban

Equipment store

Mixture (medical, stroke unit)

0.1 

0

0.5 

0.5

3.1

Manchester 2001

Urban

 

Mixture (medical, stroke team or unit)

nd

nd

nd

nd

nd

nd

nd

Montreal 2000

Urban

 

Mixture (medical neurology)

0

0.4 

1.0 

0.7 

0.4

Dietitian

2.7

Newcastle 1997

Urban

Envt visit

Key worker

7‐day input

PHMR

Mixture

(medical, geriatric)

0

 

0

0.8

1.0

0.3

0.2

 

Secretary

Social work

Carers

2.8

Stockholm 1998

Urban

Case manager

Patient diary

Stroke unit

0.03

0

1.0

1.0

0.5

2.6

Oslo 2000

Urban

Key worker

Community services

Stroke unit

nd

nd

nd

nd

nd

nd

nd

Trondheim 2000

Urban

Key worker

Team Community services

Stroke unit

0.12

1.2

1.2

1.2

0

3.7

Trondheim 2004

Rural

 

Stroke unit

0.12

1.2

1.2

1.2

0

3.7

West Denmark

Mixed

Tailored

Neurorehabilitation centres (3)

?

0

?

?

0

0

0

?

 

9 urban

4 mixed

1 rural

 

6 stroke unit

6 mixed service

2 neurorehabilitation unit

0.08

(0 to 0.12)

0

(0 to 1.2)

1.1

(0.7 to 2)

1.0

(0.7 to 2)

0.1 (0 to 0.5)

0.2

(0 to 1.5)

3.0

(2.6 to 4.6)

MDT mtg: multidisciplinary team meeting
N: number of participants
nd: no comparable data
OT: occupational therapy
PDHV: pre‐discharge home visit
PHMR: patient held medical record
physio: physiotherapy
PNH: private nursing home
SALT: speech and language therapy

Figures and Tables -
Table 1. Characteristics and staffing of ESD trials
Table 2. Plan and timing of primary analyses

Trial

Death

Institutional care

Dependency

Defined dependent

Length of stay

Adelaide 2000

6 months

6 months

6 months

Barthel index < 95/100

Initial hospital discharge

Akershus 1998

7 months

7 months

7 months

Barthel index < 95/100

Not used ‐ only available for acute hospital

Bangkok 2002

6 months

6 months

6 months

Barthel index < 95/100

Initial hospital discharge

Belfast 2004

12 months

12 months

12 months

Barthel index < 19/20

Initial hospital discharge

Copenhagen 2009

5 months

5 months

3 months

Rankin score 3 to 5

Initial hospital stay

Glostrup 2006

12 months

12 months

6 months

Barthel index ‐ significant reduction

Initial hospital discharge

London 1999

12 months

12 months

12 months

Barthel index < 19/20

Initial hospital discharge

Manchester 2001

12 months

12 months

12 months

Barthel index < 19/20

Initial hospital stay (acute and rehabilitation wards)

Montreal 2000

3 months

3 months

3 months

Barthel index < 95/100

Initial hospital stay

Newcastle 1997

3 month

3 month

3 month

Rankin score 3 to 5

Initial hospital stay

Oslo 2000

6 month

6 month

6 month

Rankin score 3 to 5

Initial hospital stay

Stockholm 1998

6 month

6 month

6 month

Barthel index 95/100

Initial hospital stay

Trondheim 2000

6 months

6 months

6 months

Barthel index 95/100

Initial hospital stay

Trondheim 2004

12 months

12 months

12 months

Rankin score 3 to 5

Initial hospital stay (acute and rehabilitation wards)

Figures and Tables -
Table 2. Plan and timing of primary analyses
Table 3. Plan of secondary analyses: patient outcomes

Trial

Timing of outcome

ADL score

Extended ADL score

Subjective health

Mood

Service satisfaction

Hospital readmission

Adelaide 2000

6 months

Barthel index (median, IQR)

Adelaide Activities Profile

SF‐36 (General health perceptions)

SF‐36 (mental health)

Satisfied with rehabilitation programme

6 months

Akershus 1998

7 month

Barthel index (median, imputed SD)

SF‐36 (general health perceptions)

SF‐36 (mental health)

Bangkok 2002

Belfast 2004

12 months

Barthel index

Nottingham extended ADL

SF‐36 (general health perceptions)

SF‐36 (mental health)

Satisfied with outpatient rehabilitation

6 month

Copenhagen 2009

3 months

Barthel Index (median, imputed SD)

EQ‐5D

5 months

Glostrup 2006

6 months

Barthel index

Frenchay activities index

SF‐36

GDS

12 month

London 1999

12 months

Barthel index

Rivermead ADL score

Nottingham health profile (score reversed)

Number abnormal on hospital anxiety and depression scale

Satisfied with care in general

12 month

Manchester 2001

12 months

Barthel index

Nottingham extended ADL score

Euroquol scale (0 to 100)

Hospital anxiety and depression scale (depression subscore, score reversed)

Montreal 2000

3 month

Barthel index

Instrumental ADL (OARS) scale

SF‐36 (general health perceptions)

SF‐36 (mental health)

Newcastle 1997

3 month

Nottingham extended ADL score (median, IQR)

Dartmouth COOP chart overall health section (median, IQR; scale reversed)

Dartmouth COOP chart feelings section (median, IQR; scale reversed)

3 month

Oslo 2000

6 month

Nottingham extended ADL score (median, IQR)

General Health Questionnaire (reversed score)

MADRS score

Satisfied with care in general

Stockholm 1998

8 months

Frenchay Activities index (median, IQR)

Sickness impact profile score (median, IQR)

Satisfied with care received

6 months

Trondheim 2000

12 months

Frenchay social activity index

Nottingham Health Profile (average of sum 1 and 2)

MADRS

Trondheim 2004

12 months

Barthel Index

Nottingham health profile

ADL: activities of daily living
COOP: Care Cooperative Information Project
GDS: Geriatric Depression Scale
IQR: interquartile range
MADRS: Montgomery‐Åsberg Depression Rating Scale
OARS: Older Americans Resources and Services scale
SD: standard deviation
SF: short form

Figures and Tables -
Table 3. Plan of secondary analyses: patient outcomes
Table 4. Plan of secondary analyses: carer outcomes

Trial

Timing of outcome

Subjective health

Mood

Service satisfaction

Adelaide 2000

6 months

SF‐36 general health perceptions

SF‐36 mental health

Satisfied with rehabilitation programme

Akershus 1998

Bangkok 2002

Belfast 2004

6 months

Caregiver strain index (score reversed)

Satisfied with outpatient services

Copenhagen 2009

3 months

Satisfied with rehabilitation programme

Glostrup 2006

London 1999

12 months

Caregiver strain index (score reversed)

Satisfied with care in general

Manchester 2001

12 month

Hospital anxiety and depression scale (depression subscore, score reversed)

Montreal 2000

3 months

Caregiver Burden Index

Newcastle 1997

3 months

General health questionnaire (median, range; score reversed)

Oslo 2000

6 months

General health questionnaire (score reversed)

Satisfied with care in general

Stockholm 1998

Trondheim 2000

12 months

Caregiver Burden score

Trondheim 2004

12 months

Caregiver strain index (score reversed)

Figures and Tables -
Table 4. Plan of secondary analyses: carer outcomes
Table 5. Patterns of discharge from hospital in ESD and control groups

Time from randomisation

Number (%) discharged

Risk difference (95% CI)

Significance

ESD service

(364 patients)

Control

(354 patients)

2 weeks

116 (32%)

77 (22%)

11 (‐3, 24)

0.13

4 weeks

236 (65%)

179 (50%)

19 (4, 35)

0.01

6 weeks

277 (76%)

249 (70 %)

8 (1, 15)

0.02

8 weeks

303 (83%)

275 (78%)

8 (3, 13)

0.003

3 months

345 (95%)

324 (92%)

2 (‐1, 6)

0.21

6 months

363 (100%)

353 (100%)

0 (‐2, 1)

0.71

Data are presented from six trials (Adelaide 2000, Belfast 2004, London 1999, Manchester 2001, Oslo 2000, Stockholm 1998) that could provide relevant data on 718 participants. Discharges include deaths and do not include readmissions. The risk difference (95% confidence interval) is calculated taking into account variation between trials

Figures and Tables -
Table 5. Patterns of discharge from hospital in ESD and control groups
Table 6. Service costs of individual trials

Trial

Items costed

ESD cost / patient

Control cost / pt

Percent difference

Adelaide 2000

Cost minimisation. Direct and indirect

$8040 Aus

$10054 Aus

‐ 20%

Glostrup 2006

Direct costs

€7674

€6660

+15%

London 1999

Direct and indirect to 12 months

£6800

£7432

‐ 9%

Montreal 2000

Direct and indirect to 3 months

$7784 Canadian

$11,065 Canadian

‐30%

Newcastle 1997

Direct and indirect

£7155

£7480

‐ 4%

Stockholm 1998

Hospital, community, private costs

2806 SEK

3475 SEK

‐ 19%

Trondheim 2000

Direct costs to 12 months

€5,113

€6,665

‐ 23%

Figures and Tables -
Table 6. Service costs of individual trials
Comparison 1. Early supported discharge service versus conventional care: patient outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death Show forest plot

14

1957

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.67, 1.25]

1.1 ESD team co‐ordination and delivery

9

1140

Odds Ratio (M‐H, Fixed, 95% CI)

0.69 [0.44, 1.07]

1.2 ESD team co‐ordination

3

464

Odds Ratio (M‐H, Fixed, 95% CI)

0.95 [0.52, 1.74]

1.3 No ESD team

2

353

Odds Ratio (M‐H, Fixed, 95% CI)

1.90 [0.90, 3.98]

2 Death or requiring institutional care Show forest plot

12

1758

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.61, 1.00]

2.1 ESD team co‐ordination and delivery

7

941

Odds Ratio (M‐H, Fixed, 95% CI)

0.65 [0.45, 0.93]

2.2 ESD team co‐ordination

3

464

Odds Ratio (M‐H, Fixed, 95% CI)

0.75 [0.50, 1.14]

2.3 No ESD team

2

353

Odds Ratio (M‐H, Fixed, 95% CI)

1.32 [0.75, 2.33]

3 Death or dependency Show forest plot

14

1957

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.67, 0.97]

3.1 ESD team co‐ordination and delivery

9

1140

Odds Ratio (M‐H, Fixed, 95% CI)

0.71 [0.55, 0.91]

3.2 ESD team co‐ordination

3

464

Odds Ratio (M‐H, Fixed, 95% CI)

0.77 [0.54, 1.11]

3.3 No ESD team

2

353

Odds Ratio (M‐H, Fixed, 95% CI)

1.23 [0.79, 1.91]

4 Activities of daily living (Barthel ADL) score Show forest plot

9

1124

Std. Mean Difference (IV, Fixed, 95% CI)

0.03 [‐0.08, 0.15]

4.1 ESD team co‐ordination and delivery

7

825

Std. Mean Difference (IV, Fixed, 95% CI)

0.06 [‐0.08, 0.20]

4.2 ESD team co‐ordination

1

48

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.23 [‐0.79, 0.34]

4.3 No ESD team

1

251

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.25, 0.25]

5 Extended activities of daily living (EADL) score Show forest plot

9

1051

Std. Mean Difference (IV, Fixed, 95% CI)

0.14 [0.02, 0.26]

5.1 ESD team co‐ordination and delivery

7

729

Std. Mean Difference (IV, Fixed, 95% CI)

0.17 [0.02, 0.32]

5.2 ESD team co‐ordination

2

322

Std. Mean Difference (IV, Fixed, 95% CI)

0.07 [‐0.15, 0.29]

5.3 No ESD team

0

0

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Subjective health status Show forest plot

12

1377

Std. Mean Difference (IV, Fixed, 95% CI)

0.00 [‐0.10, 0.11]

6.1 ESD team co‐ordination and delivery

8

860

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.07 [‐0.21, 0.06]

6.2 ESD team co‐ordination

3

370

Std. Mean Difference (IV, Fixed, 95% CI)

0.14 [‐0.07, 0.34]

6.3 No ESD team

1

147

Std. Mean Difference (IV, Fixed, 95% CI)

0.14 [‐0.19, 0.47]

7 Mood status Show forest plot

8

851

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.06 [‐0.19, 0.07]

7.1 ESD team co‐ordination and delivery

5

383

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐0.22, 0.18]

7.2 ESD team co‐ordination

2

321

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.08 [‐0.30, 0.14]

7.3 No ESD team

1

147

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.12 [‐0.45, 0.20]

8 Satisfaction with services Show forest plot

5

513

Odds Ratio (M‐H, Fixed, 95% CI)

1.60 [1.08, 2.38]

8.1 ESD team co‐ordination and delivery

4

450

Odds Ratio (M‐H, Fixed, 95% CI)

1.74 [1.13, 2.67]

8.2 ESD team co‐ordination

1

63

Odds Ratio (M‐H, Fixed, 95% CI)

1.01 [0.36, 2.83]

8.3 No ESD team

0

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Early supported discharge service versus conventional care: patient outcomes
Comparison 2. Early supported discharge service versus conventional care: duration of follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death: within 6 months Show forest plot

9

1177

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.48, 1.34]

2 Death or dependency: within 6 months Show forest plot

9

1177

Odds Ratio (M‐H, Fixed, 95% CI)

0.68 [0.53, 0.87]

3 Death: within 1 year Show forest plot

8

1381

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.66, 1.26]

4 Death or dependency: within 1 year Show forest plot

7

1183

Odds Ratio (M‐H, Fixed, 95% CI)

0.84 [0.66, 1.05]

5 Death: within 5 years Show forest plot

2

403

Odds Ratio (M‐H, Fixed, 95% CI)

0.81 [0.54, 1.21]

6 Death or dependency: within 5 years Show forest plot

2

403

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.52, 1.17]

Figures and Tables -
Comparison 2. Early supported discharge service versus conventional care: duration of follow‐up
Comparison 3. Early supported discharge service versus conventional care: carer outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Subjective health status Show forest plot

8

749

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.03 [‐0.17, 0.12]

1.1 ESD team co‐ordination and delivery

5

373

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐0.35, 0.06]

1.2 ESD team co‐ordination

3

376

Std. Mean Difference (IV, Fixed, 95% CI)

0.09 [‐0.12, 0.29]

1.3 No ESD team

0

0

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Mood status Show forest plot

2

58

Std. Mean Difference (IV, Random, 95% CI)

‐0.19 [‐1.60, 1.22]

2.1 ESD team co‐ordination and delivery

2

58

Std. Mean Difference (IV, Random, 95% CI)

‐0.19 [‐1.60, 1.22]

2.2 ESD team co‐ordination

0

0

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 No ESD team

0

0

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 Satisfaction with services Show forest plot

4

279

Odds Ratio (M‐H, Fixed, 95% CI)

1.56 [0.87, 2.81]

3.1 ESD team co‐ordination and delivery

3

246

Odds Ratio (M‐H, Fixed, 95% CI)

1.60 [0.85, 3.01]

3.2 ESD team co‐ordination

1

33

Odds Ratio (M‐H, Fixed, 95% CI)

1.28 [0.24, 6.70]

3.3 No ESD team

0

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 3. Early supported discharge service versus conventional care: carer outcomes
Comparison 4. Early supported discharge service versus conventional care: resource use

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Length of initial hospital stay (days) Show forest plot

13

1695

Mean Difference (IV, Random, 95% CI)

‐7.10 [‐10.03, ‐4.17]

1.1 ESD team co‐ordination and delivery

9

1129

Mean Difference (IV, Random, 95% CI)

‐6.84 [‐11.20, ‐2.49]

1.2 ESD team co‐ordination

3

464

Mean Difference (IV, Random, 95% CI)

‐10.36 [‐15.39, ‐5.33]

1.3 No ESD team

1

102

Mean Difference (IV, Random, 95% CI)

‐7.0 [‐8.61, ‐5.39]

2 Readmission to hospital Show forest plot

7

918

Odds Ratio (M‐H, Fixed, 95% CI)

1.26 [0.94, 1.67]

2.1 ESD team co‐ordination and delivery

7

918

Odds Ratio (M‐H, Fixed, 95% CI)

1.26 [0.94, 1.67]

2.2 ESD team co‐ordination

0

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 No ESD team

0

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 4. Early supported discharge service versus conventional care: resource use
Comparison 5. Early supported discharge service versus conventional care: age subgroups

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependency Show forest plot

9

1175

Odds Ratio (M‐H, Fixed, 95% CI)

0.85 [0.67, 1.08]

1.1 Age < 75 years

9

695

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.60, 1.12]

1.2 Age > 75 years

9

480

Odds Ratio (M‐H, Fixed, 95% CI)

0.90 [0.61, 1.31]

2 Length of stay (days) Show forest plot

8

911

Mean Difference (IV, Random, 95% CI)

‐9.69 [‐13.56, ‐5.82]

2.1 Age < 75 years

8

566

Mean Difference (IV, Random, 95% CI)

‐11.68 [‐18.00, ‐5.36]

2.2 Age > 75 years

7

345

Mean Difference (IV, Random, 95% CI)

‐6.26 [‐10.51, ‐2.01]

Figures and Tables -
Comparison 5. Early supported discharge service versus conventional care: age subgroups
Comparison 6. Early supported discharge service versus conventional care: gender subgroups

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependency Show forest plot

9

1175

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.65, 1.05]

1.1 Male

9

654

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.54, 1.01]

1.2 Female

9

521

Odds Ratio (M‐H, Fixed, 95% CI)

0.98 [0.68, 1.40]

2 Length of stay (days) Show forest plot

8

909

Mean Difference (IV, Fixed, 95% CI)

‐4.54 [‐6.48, ‐2.60]

2.1 Male

8

518

Mean Difference (IV, Fixed, 95% CI)

‐4.32 [‐6.65, ‐1.98]

2.2 Female

7

391

Mean Difference (IV, Fixed, 95% CI)

‐5.05 [‐8.55, ‐1.55]

Figures and Tables -
Comparison 6. Early supported discharge service versus conventional care: gender subgroups
Comparison 7. Early supported discharge service versus conventional care: stroke severity subgroups

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependency Show forest plot

11

1545

Odds Ratio (M‐H, Fixed, 95% CI)

0.86 [0.69, 1.07]

1.1 Initial Barthel 10 to 20

11

1164

Odds Ratio (M‐H, Fixed, 95% CI)

0.77 [0.61, 0.98]

1.2 Initial Barthel < 10

10

381

Odds Ratio (M‐H, Fixed, 95% CI)

1.40 [0.83, 2.36]

2 Length of stay (days) Show forest plot

9

960

Mean Difference (IV, Random, 95% CI)

‐7.33 [‐12.15, ‐2.50]

2.1 Initial Barthel 10 to 20

9

788

Mean Difference (IV, Random, 95% CI)

‐3.11 [‐7.13, 0.92]

2.2 Initial Barthel < 10

7

172

Mean Difference (IV, Random, 95% CI)

‐28.32 [‐39.93, ‐16.71]

Figures and Tables -
Comparison 7. Early supported discharge service versus conventional care: stroke severity subgroups
Comparison 8. Early supported discharge service versus conventional care: carer subgroups

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependency Show forest plot

10

1237

Odds Ratio (M‐H, Fixed, 95% CI)

0.87 [0.69, 1.10]

1.1 Carer present

10

799

Odds Ratio (M‐H, Fixed, 95% CI)

0.86 [0.64, 1.14]

1.2 No carer

9

438

Odds Ratio (M‐H, Fixed, 95% CI)

0.90 [0.61, 1.32]

2 Length of stay (days) Show forest plot

9

970

Mean Difference (IV, Random, 95% CI)

‐7.96 [‐12.01, ‐3.92]

2.1 Carer present

9

636

Mean Difference (IV, Random, 95% CI)

‐9.70 [‐16.06, ‐3.33]

2.2 No carer

8

334

Mean Difference (IV, Random, 95% CI)

‐6.17 [‐9.00, ‐1.34]

Figures and Tables -
Comparison 8. Early supported discharge service versus conventional care: carer subgroups
Comparison 9. Early supported discharge service versus conventional care: ESD service subgroups: service base

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependency Show forest plot

12

1604

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.59, 0.90]

1.1 Community in‐reach

6

755

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.53, 0.96]

1.2 Hospital out‐reach

6

849

Odds Ratio (M‐H, Fixed, 95% CI)

0.74 [0.56, 1.00]

2 Length of stay (days) Show forest plot

11

1395

Mean Difference (IV, Random, 95% CI)

‐7.86 [‐11.99, ‐3.73]

2.1 Community in‐reach

6

744

Mean Difference (IV, Random, 95% CI)

‐4.34 [‐7.34, ‐1.34]

2.2 Hospital out‐reach

5

651

Mean Difference (IV, Random, 95% CI)

‐9.62 [‐17.88, ‐1.36]

Figures and Tables -
Comparison 9. Early supported discharge service versus conventional care: ESD service subgroups: service base
Comparison 10. Early supported discharge service versus conventional care: ESD service subgroups: MDT co‐ordination

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death Show forest plot

14

1957

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.67, 1.25]

1.1 MDT co‐ordination

12

1604

Odds Ratio (M‐H, Fixed, 95% CI)

0.77 [0.54, 1.09]

1.2 No MDT

2

353

Odds Ratio (M‐H, Fixed, 95% CI)

1.90 [0.90, 3.98]

2 Death or requiring institutional care Show forest plot

12

1758

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.61, 1.00]

2.1 MDT co‐ordination

10

1405

Odds Ratio (M‐H, Fixed, 95% CI)

0.69 [0.53, 0.91]

2.2 No MDT

2

353

Odds Ratio (M‐H, Fixed, 95% CI)

1.32 [0.75, 2.33]

3 Death or dependency Show forest plot

14

1957

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.67, 0.97]

3.1 MDT co‐ordination

12

1604

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.59, 0.90]

3.2 No MDT

2

353

Odds Ratio (M‐H, Fixed, 95% CI)

1.23 [0.79, 1.91]

4 Length of stay (days) Show forest plot

13

1695

Mean Difference (IV, Random, 95% CI)

‐7.21 [‐10.12, ‐4.30]

4.1 MDT co‐ordination

12

1593

Mean Difference (IV, Random, 95% CI)

‐7.62 [‐11.39, ‐3.86]

4.2 No MDT

1

102

Mean Difference (IV, Random, 95% CI)

‐7.0 [‐8.61, ‐5.39]

Figures and Tables -
Comparison 10. Early supported discharge service versus conventional care: ESD service subgroups: MDT co‐ordination
Comparison 11. Early supported discharge service versus conventional care: conventional service subgroups

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependency Show forest plot

14

1957

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.67, 0.97]

1.1 Stroke unit

9

1115

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.66, 1.06]

1.2 Other wards

7

842

Odds Ratio (M‐H, Fixed, 95% CI)

0.76 [0.56, 1.02]

2 Length of stay (days) Show forest plot

12

1517

Mean Difference (IV, Random, 95% CI)

‐7.28 [‐10.64, ‐3.93]

2.1 Stroke unit

9

882

Mean Difference (IV, Random, 95% CI)

‐6.37 [‐12.76, 0.02]

2.2 Other wards

6

635

Mean Difference (IV, Random, 95% CI)

‐7.25 [‐11.47, ‐3.03]

Figures and Tables -
Comparison 11. Early supported discharge service versus conventional care: conventional service subgroups