Mortality at 12 months

T: 8/31 (25.8%); C: 5/31 (16.1%)

Difference 9.7%, 95% CI ‐10.8 to 29.3

12 months follow‐up

T: 6/43 (13.9%); C: 1/44 (2.3%)

Difference 11.7%, 95% CI ‐0.4 to 25.1

12 months follow‐up

T: 2/59 (3.4%); C: 3/54 (5.6%)

Difference ‐2.2%, 95% CI ‐12.0 to 6.8

12 months follow‐up

T: 26/167 (15.6%); C: 34/164 (20.7%)

Difference ‐5.1%, 95% CI ‐13.5 to 3.2

12 months follow‐up

Hospital readmission at 12 months follow‐up

12 months
T: 6/59 (10.2%); C: 7/54 (13%), P = 0.64

12 months
T: 44/167 (26.4%); C: 42/164 (25.6%), P = 0.89

Functional status

Barthel Index

6 months ‐ Median (IQR)
T: 96.0 (88.3 to 100); C: 98.0 (85.5 to 100); P = 0.99
Median difference ‐2.0, 95% CI ‐2.0 to 2.0

Modified Barthel Index

10 items covering activities of daily living (e.g. feeding, toilet use)

Scores 5 to 50 (higher scores: more independent)

Modified Rankin Scale *

At 6 weeks
T: 16/31 (52%); C: 16/31 (52%); P = 1.0, 95% CI ‐0.26 to 0.26
At 26 weeks
T: 13/31 (42%); C: 16/31 (52%); P = 0.62, 95% CI ‐0.35 to 0.16
At 52 weeks
T: 12/31 (39%); C: 16/31 (52%); P = 0.44, 95% CI ‐0.37 to 0.13

Barthel Index **
At 6 weeks
T: 13/31 (42%); C: 14/31 (45.2%); P = 1.0, 95% CI ‐0.28 to 0.22
Mean (SD)
T: 75 (30.6); C: 74 (31.2); P = 0.77 95% CI ‐15.1 to 17.5
At 26 weeks
T: 11/31 (35.5%); C: 14/31 (45.2%); P = 0.6, 95% CI ‐0.34 to 0.15
Mean (SD)
T: 75 (33); C: 77 (27.6); P = 0.9, 95% CI ‐20 to 14.7
At 52 weeks
T: 11/31 (35.5%); C: 15/31 (48%); P = 0.44, 95% CI ‐0.37 to 0.12
Mean (SD)
T: 71.7 (34.7); C: 79 (28.7); P = 0.45 95% CI ‐25.9 to 11.4

* Modified Rankin Scale

7 items covering stroke‐related disability

Scores 0 to 6 (higher scores = more disability)

Score of < 2 classified as independent

** Barthel Index

Max score 100; Independent > 95

Nottingham extended ADL
Mobility ‐ Median (IQR)
3 months
T: 10.5 (4 to 14); C: 8 (3 to 15)
Difference 95% CI ‐2 to 4, P = 0.41
At 6 months
T: 11 (6 to 14); C: 10 (4 to 15)
Difference 95% CI ‐2 to 4, P = 0.55

Kitchen ‐ Median (IQR)
3 months
T: 12 (8 to14); C: 12 (6 to 15)
Difference 95% ‐2 to 1, P = 0.87

6 months ‐ Median (IQR)
T: 12 (8 to 15); C: 13 (10 to 15)
Difference 95% CI ‐2 to 1, P = 0.52

Domestic ‐ Median (IQR)
3 months
T: 6 (3 to 8); C: 5 (3 to 10)
Difference 95% CI ‐3 to 1, P = 0.58
6 months
T: 5.5 (4 to 8); C: 6 (3 to 11)
Difference 95% ‐3 to 1, P = 0.47

Leisure ‐ Median (IQR)
3 months
T: 8 (6 to 9); C: 6 (5 to 9)
Difference 95% CI ‐1 to 2, P = 0.38
6 months
T: 7.5 (6 to 10); C: 7 (6 to 9)
Difference 95% CI ‐1 to 2, P = 0.55

Total ‐ Median (IQR)
3 months
T: 34.5 (28 to 44); C: 30 (14 to 46)
Difference 95% CI ‐8 to 7, P = 0.78
6 months
T: 24 (16 to27); C: 22 (17 to 26)
Difference 95% CI ‐4 to 4, P = 0.74

Nottingham extended ADL

22 items covering stroke‐related ADLs (four domains plus total score)

Higher scores: more independence

Barthel ADL
12 months ‐ Mean (SD)
T: 17.98 (3.1); C: 17.15 (3.8)
95% CI ‐2.24 to 0.58, P = 0.18

Nottingham ADL
12 months ‐ Mean (SD)
T: 12 (6.34); C: 10.43 (5.9)
95% CI ‐4.04 to 0.91, P = 0.24

10‐minute timed walk

12 months ‐ Mean (SD)
T: 28.13 (21.5); C: 28.9 (28.8)
95% CI ‐16.5 to 18.14, P = 0.34

12‐month follow‐up

Barthel Index (independent) *
26 weeks
T: 96/100 (60%); C: 79/160 (49.4%)
Difference 11.6%, P = 0.06

Odds ratio for independence
1.54 (95% CI 0.99 to 2.39)

Rankin Scale (independent) **
26 weeks
T: 104/160 (65%); C: 83/160 (51.9%)
Difference 13.1%, 95% CI 2.4% to 23.8%, P = 0.02

Odds ratio for independence
1.72 (95% CI 1.10 to 2.7)

Barthel Index > 95 ^
6 weeks
T: 56/121 (46.3%); C: 42/122 (34.4%)
Difference 11.9% 95% CI ‐0.4% to 24.1% P = 0.06

26 weeks
T: 63/121 (52.1%); C: 47/122 (38.5%)
Difference 13.6% (95% CI ‐1.1% to 25.9%), P = 0.03

Rankin Score < 2 ^^
6 weeks
T: 52/121 (43%); C: 38/122 (31.2%)
Difference 11.8% (95% CI ‐0.2% to 23.9%), P = 0.06

26 weeks
T: 70/121 (58%); C: 49/122 (40.2%)
Difference 17.8% (95% CI 5.3% to 30.1%), P = 0.01

* Barthel Index
Independent in activities of daily living

Authors reported %, numbers derived from percentages
Odds ratio for independence ‐
Barthel Index > 95 vs death or Barthel <95

** Rankin Scale, odds ratio for independence:

Rankin scale < 2 vs Rankin scale 3 to 6

^ Excluding those with a very mild stroke

Barthel Index > 95

^^ Excluding those with a mild stroke

Rankin score < 2

Barthel Index *

1 month ‐ Mean (SD)

T: 94.3 (10.6); C: 93.3 (10.1)

Difference 1 (95% CI ‐3.13 to 5.13)

3 month ‐ Mean (SD)

T: 97. (6.9), C: 95.1 (10.6)

Difference 2 (95% CI ‐1.69 to 5.69)

OARS‐IADL **

1 month ‐ Mean (SD)

T: 10.1 (3.5); C: 8.6 (3.5)

Difference 1.5 (95% CI 0.13 to 2.87)

3 month ‐ Mean (SD)

T: 11.0 (3.5); C: 9.5 (3.9)

Difference 1.5 (95% CI ‐0.01 to 3.01)

STREAM ^

1 month ‐ Mean (SD)

T: 90.3 (12.4); C: 91.7 (10.1)

Difference ‐1.4 (95% CI ‐5.89 to 3.09)

3 month ‐ Mean (SD)

T: 93.3 (11.7); C: 92.9 (10.0)

Difference 0.4 (95% CI ‐4.11 to 4.91)

* Barthel Index

** Older Americans Resource Scale for Instrumental ADL

7‐item scale ranging 0 to 14

(higher score: greater impairment)

^ Stroke Rehabilitation Assessment of Movement

30‐item scale ranging 0 to 100

(higher score: more voluntary movement)

Oxford Handicap Scale *

Categories 0 ‐ 2

T: 28/45 (62%); C 22/42 (52%)

Difference 9.8% (95% CI ‐10.9% to 30.5%)
Category 3

T: 8/45 (18%); C 10/42 (24%)

Difference 6% (95% CI ‐23% to 11%)

Categories 4‐5

T: 9/45 (20%); C: 10 /42 (24%)

Difference 4% (95% CI ‐21% to 14%)

Nottingham Extended ADL **

Median (range)
Mobility

T: 3 (0 ‐ 6); C: 1 (0 ‐ 6)
Kitchen

T: 4 (0 ‐ 5); C: 3 (0 ‐ 5)
Domestic

T:1 (0 ‐ 4); C: 0 (0 ‐ 5)
Leisure

T: 2 (0 ‐ 4); C: 2 (0 ‐ 6)
Total

T: 10 (0 ‐ 18); C: 7 (0 ‐ 21)

* Oxford Handicap Scale (Categories 0 ‐ 5)

No symptoms, minor symptoms, minor handicap,

moderate handicap, moderately severe handicap, and severe handicap

** Nottingham Extended ADL

Scores at 3 month follow‐up

Barthel Index *
12 month ‐ Mean (SD)
T: 16 (4); C: 16 (4), P = 0.3

Aphasia **

12 month ‐ Mean (SD)
T: 22 (8); C: 23 (7), P = 0.99

Rivermead ADL ^

12 month ‐ Mean (SD)
T: 22 (8); C: 23 (7), P = 0.93

5 metre timed walk ^^

12 month ‐ Mean (SD in seconds)
T: 12 (6); C: 12 (8), P = 0.34

* Barthel Index (0 ‐ 20)

** Frenchay Aphasia Screening Test

Scores < 13 indicates aphasia

^ Rivermead activities of daily living scale

Scores range 15 ‐ 45

(lower scores: higher dependence)

^^ 5‐metre timed walk

NIH stroke scale *
T: 40/52 (77%); C: 36/50 (73%)
RR 0.89 (95% CI 0.44 to 1.75), P = 0.73

Barthel Index **
T: 47/52 (77%); C: 43/50 (88%)
RR 0.69 (95% CI 0.23 to 2.02), P = 0.49

* NIH Stroke Scale

11‐item scale for stroke‐related symptoms (0 ‐ 42)

Higher scores: more symptoms

Proportion of patients who scored 0 ‐ 2 at 6‐month follow‐up

Proportion of patients who scored 75 ‐ 100 at 6‐month follow‐up

Functional status 1 *
T: 36/41; C: 32/40; P = 0.51

Functional status 2 **
T: 16/41(39%); C: 12/40 (30%)

Difference 9% (95% CI ‐12% to 30%), P = 0.53

Functional status 3 ^
T: 28/41 (68.3%); C: 25/40 (62.5%)

Difference 5.8% (95% CI ‐15% to 26%), P = 0.75

Functional status 4 ^^
T: 12 (8 ‐ 15); C: 12 (10 ‐ 16); P = 0.43

Motor capacity º
T: 146 (141 ‐ 150); C: 145 (134 ‐ 148); P = 0.18

* Functional status 1: independent in personal ADL

** Functional status 2: independent in instrumental ADL

^ Functional status 3: independent in Barthel

^^ Functional status 4: Median time (IQR) taken to walk 10 metres
º Motor capacity: Lindmark Motor Capacity Scale (0 ‐ 153)

Median score and (IQR)

All results for 3‐month follow‐up

At baseline T had 10% lower coping capacity,

increased frequency of disease (TIA and diabetes),

increased frequency of abnormal CT scans on admission

and left hemisphere lesions.

Patient outcomes

Quality of life/self‐reported health status

SF‐36 *

6 months ‐ Mean (SD)

Physical functioning
T: 41.3 (29.1); C: 42.5 (28.1), P = 0.86
Mean difference ‐1.2 (95% CI ‐13.8 to 11.5)

Physical role limitation
T: 70.7 (38.7); C: 76.9 (31.2), P = 0.43
Mean difference ‐6.1 (95% CI ‐21.7 to 9.4)

Bodily pain
T: 61.2 (33.1); C: 70.1 (34), P = 0.24
Mean difference ‐8.8 (95% CI ‐23.7 to 6.0)

General health perceptions
T: 61.8 (26.5); C: 67.3 (21.9), P = 0.31
Mean difference ‐5.5 (95% CI ‐16.3 to 5.2)

Vitality
T: 53.8 (26.2); C: 55.5 (22.2), P = 0.75
Mean difference ‐1.7 (95% CI ‐12.5 to 9.0)

Social functioning
T: 74.7 (31.3); C=82.8 (23.8), P = 0.19
Mean difference ‐8.1 (95% CI ‐20.4 to 4.2)

Emotional role limitation
T: 92.7 (21.7); C: 93.3 (24.1), P = 0.90
Mean difference ‐0.7 (95% CI ‐10.8 to 9.5)

Mental health
T: 80.5 (17.3); C: 82.6 (13.6), P = 0.54
Mean difference ‐2.1 (95% CI ‐9.0 to 4.8)

Physical component score
T: 37.4 (10.3); C: 39.6 (9.0), P = 0.47
Mean difference ‐2.2 (95% CI ‐6.5 to 2.1)

Mental component score
T: 4.4 (9.2); C: 55.7 (8.4), P = 0.58
Mean difference ‐1.3 (95% CI ‐5.2 to 2.6)

NHP **

6 months ‐ Median (IQR)

Energy
T: 24.0 (0 to 62.6); C: 24.0 (0 to 50.0), P = 0.6
Difference 0 (95% CI 0 to 21.6)

Pain
T: 0 (0 to 12.9); C: 0 (0 to 17.1), P = 0.87
Difference 0 (95% CI 0 to 0)

Emotion
T: 3.5 (0 to 10.5); C: 0 (0‐11.2), P = 0.77
Difference 0, 95% CI 0 to 0

Sleep
T: 12.6 (0 to 33.4); C: 0 (0‐22.4), P = 0.18
Difference 0, 95% CI 0 to 12.6

Social
T: 0 (0 to 22.4); C: 0 (0 to 22), P = 0.41
Difference 0 (95% CI 0 to 0)

Physical
T: 23.9 (10.9 to 46.1); C: 21.1.0 (2.6 to 44.9), P = 0.52
Difference 0.5 (95% CI ‐9.3 to 11.8)

* Short form survey of self‐reported health status

36 items, higher scores indicate better self‐perceived health status

** Nottingham Health Profile

Part 1 has 38 items focusing on 6 health domains

Higher scores: lower self‐perceived health

NHP *

6 weeks ‐ Median (IQR)
Energy
T: 24 (0.0 to 60.8); C: 24 (0.0 to 63.2); P = 0.64
Pain
T: 0.0 (0.0 to 9.0); C = 0.0 (0.0 to 12.9); P = 0.44
Emotion
T: 7.0 (0.0 to 17.6); C: 7.1 (0.0 to 19.3); P = 0.58
Sleep
T: 0.0 (0.0 to 35.9); C: 12.6 (0.0 to 35.9); P = 0.69
Social
T: 0.0 (0.0 to 22.0); C: 0.0 (0.0 to 22.5); P = 0.14
Physical
T: 34.7 (10.6 to 57.8); C: 47.1 (0.0 to 78.7); P = 0.67

Global score
6 weeks ‐ Median (IQR)
T: 81.6 (71.1 to 92.1); C: 76.3 (59.2 to 92.1); P = 0.44

Mean (SD)
T: 80 (15.3); C: 75.9 (18.3)

26 weeks ‐ Median (IQR)
Energy
T: 24 (0.0 to 24); C: 24 (0.0 to 63.2); P = 0.40
Pain
T: 0.0 (0.0 to 6.6); C: 0.0 (0.0 to 9.73); P = 0.49
Emotion
T: 0.0 (0.0 to 9.3); C: 7.2 (0.0 to 22.7); P = 0.13
Sleep
T: 0.0 (0.0 to 23.4); C: 4.3 (0.0 to 23.4); P = 0.64
Social
T: 0.0 (0.0 to 19.4); C: 11.0 (0.0 to 41.4); P = 0.05
Physical
T: 39.2 (0.0 to 70.8); C: 26.5 (0.0 to 76.0); P = 0.78

Global score
Median (IQR)
T: 81.6 (67.8 to 95.4); C: 76.3 (55.9 to 96.7); P = 0.21
Mean (SD)
T: 82.5 (13.7); C: 75.8 (19.5)

52 weeks ‐ Median (IQR)
T: N = 23; C: N = 25
Energy
T: 24 (0.0 to 60.8); C: 24 (12.0 to 62.0); P = 0.23
Pain
T: 0.0 (0.0 to 10.0); C: 0.0 (0.0 to 2.9); P = 0.70
Emotion
T: 0.0 (0.0 to 10.5); C: 0.0 (0.0 to 15.3); P = 0.90
Sleep
T: 0.0 (0.0 to 16.1); C: 0.0 (0.0 to 23.4); P = 0.95
Social
T: 0.0 (0.0 to 20.1); C: 11.0 (0.0 to 22.0); P = 0.97
Physical
T: 43.4 (0.0 to 100.0); C: 54.6 (0.0 to 83.0); P = 0.42
Global score

Median (IQR)
T: 79 (68.4 to 97.4); C: 81.6 (68.4 to 96.1); P = 0.92
Mean (SD)
T: 79.8 (16.8); C: 79.8 (17.7)

* Nottingham Health Profile

Part 1 has 38 items focusing on 6 health domains

Maximum score 100 within each domain

Higher scores: lower self‐perceived health

EuroQol *
12 months ‐ Mean (SD)
T: 66.36 (18.45); C: 68.21 (20.31), P = 0.6
95% CI ‐6.2 to 9.9


SF 36 **

12 months ‐ Mean (SD)

Physical functioning
T: 35.6 (31.32); C: 34.7 (32.01), P = 0.8
95% CI ‐13.7 to 11.88

Mental health
T: 69.49 (18.3); C: 67.3 (20.07), P = 0.68
95% CI ‐9.95 to 5.58

Quality of life
T: 18.57 (4.3); C: 18.92 (4.74), P = 0.58
95% CI ‐1.5 to 2.2

* EQ‐5D

Self‐reported health status

5 levels (1: no problems; 5: extreme problems)

** Short form survey of self‐reported health status

36 items, higher scores indicate better self‐perceived health status

SF 36

Physical function
1 month ‐ Mean (SD)
T: 54.3 (26.7); C: 53.4 (26.8), P = 0.87
3 months ‐ Mean (SD)
T: 60.5 (29.5); C: 49.2 (31.5), P = 0.08

Role: physical
1 month ‐ Mean (SD)
T: 23.7 (35.1); C: 10.6 (21.3), P = 0.02
3 months ‐ Mean (SD)
T: 46.6 (40.9); C: 31.2 (34.6), P = 0.12

Emotional
1 month ‐ Mean (SD)
T: 53.6 (45.7); C: 53.2 (46.4), P = 0.97
3 months ‐ Mean (SD)
T: 66 (41.9); C: 61.4 (40.6), P = 0.60

Pain index
1 month ‐ Mean (SD)
T: 73.5 (30.7); C: 75.1 (26.2) , P = 0.78
3 months ‐ Mean (SD)
T: 75.5 (26.7); C: 72.1 (27.4), P = 0.55

General health perceptions
1 month ‐ Mean (SD)
T: 62.6 (22.9); C: 55.1 (24.2), P = 0.11
3 months ‐ Mean (SD)
T: 63.5 (20.8); C: 56.7 (25.0), P = 0.16

Vitality
1 month ‐ Mean (SD)
T: 53.1 (20.8); C: 48.7 (25.0), P = 0.34
3 months ‐ Mean (SD)
T: 50.7 (23.9); C: 46.4 (22.9)

Social function
1 month ‐ Mean (SD)
T: 59.6 (33.2); C: 57.2 (35.0), P = 0.72
3 months ‐ Mean (SD)
T: 71.3 (28.5); C: 64.2 (28.7), P = 0.38

Mental health
1 month ‐ Mean (SD)
T: 67.1 (21.9); C: 67.7 (22.3), P = 0.89
3 months ‐ Mean (SD)
T: 65.2 (20.8); C: 66.4 (19.2), P = 0.78

SF 36 scored out of 100

1 month follow‐up

T: N = 56; C: N = 47

3‐month follow‐up

T: N = 47; C: N = 44

Dartmouth COOP charts

3 month ‐ Median (range)

Physical fitness
T: 5 (1 ‐ 5); C: 5 (3 ‐ 5)

Feelings
T: 2 (1 ‐ 5); C: 2 (1 ‐ 5)

Daily activities
T: 3 (1 ‐ 5); C: 3 (1 ‐ 5)

Social activities
T: 3 (1 ‐ 5); C: 4 (1 ‐ 5)

Pain:
T: 3 (1 ‐ 5); C: 3 (1 ‐ 5)

Social support
T: 1 (1 ‐ 4); C: 1 (1 ‐ 5)

Quality of life

T: 2 (1 ‐ 5); C: 3 (1 ‐ 5)

Change in health
T: 2 (1 ‐ 5); C: 2 (1 ‐ 5)

Overall health
T: 3 (1 ‐ 5); C: 3 (2 ‐ 5)

Dartmouth COOP charts

7 items covering different domains of health status

Each domain scored 1 ‐ 5

(low score: better quality of life)

Mean change at 3 months from baseline

T: N = 45; C: N = 42

No differences between groups (as reported by the authors)

NHP

12 month ‐ Mean (SD)
T: 14 (9); C: 12 (8), P = 0.11

Nottingham Health Profile

SIP ‐ Median (IQR)

Overall
T: 16.6 (11.1 to 25.3); C: 14.6 (19.3 to 19.6) P = 0.3

Physical dimension
T: 14.9 (5.5 to 25.1); C: 15.6 (9.5 to 21.4) P = 0.6

Ambulation:
T: 25.1 (10.6 to 37.4); C: 24.2 (12.3 to 34.2) P = 0.8

Mobility
T: 22.4 (0.0 to 39.1); C: 16.3 (3.8 to 33.1) P = 0.84

Body care and movement
T: 9.6 (2.1 to 16.9); C: 10.3 (4.9 to 21.6) P = 0.52

Psychosocial dimension
T: 16.6 (8.7 to 29.1); C: 10.0 (6.1 to 15.6) P = 0.02

Social interaction
T: 15 (8.4 to 26.1); C: 10.7 (3.6 to 18.8) P = 0.06

Alertness behaviour
T: 9.7 (0.0 to 35.5); C: 8.8 (0.0 to 19.8) P = 0.4

Emotional behaviour

T: 17.6 (0.0 to 31.3); C: 0.0 (0.0 to 19.7) P = 0.02

Communication
T: 18 (9.2 to 30.3); C: 9.7 (0.0 to 21.5) P = 0.01

Sleep and rest
T: 22 (11.6 to 33.7); C: 11.7 (0.0 to 26.1) P = 0.12

Eating
T: 5.2 (0.0 to 11.3); C: 5.2 (0.0 to 11.3) P = 0.52

Work
T: 0.0 (0.0 to 0.0); C: 0.0 (0.0 to 0.0) P = 1

Home management
T: 28.4 (9.3 to 53.7); C: 32.8 (14.7 to 46.6) P = 0.68

Recreation and pastime
T: 28.4 (10.2 to 40); C: 30 (10.2 to 43.7) P = 0.47

Overall SIP ‐ Sickness Impact Profile
Scale 0 to 100
Median and (IQR)
Higher score: increased dysfunction

Psychological well‐being

MADRS *
3 months ‐ Median (IQR)
T: 1.5 (0 to 4); C: 2.5 (0 to 6), P = 0.10
95% CI of the difference ‐2 to 0

6 months ‐ Median (IQR)
T: 2 (0 to 6); C: 2 (1 to 5), P = 0.30
95% CI of the difference ‐2 to 1

GHQ **
3 months ‐ Median (IQR)
T: 19.5 (14 to 26); C: 26 (19 to 31), P = 0.02
95% CI of the difference ‐9 to ‐1

* Montgomery Asberg Depression Rating Scale

10‐item, score 0 ‐ 60

Higher scores: more depressive symptoms

** General Health Questionnaire

Higher scores = worse mental health

HADS
At discharge from hospital, N (%) with anxiety
Normal
T: 89/167 (70%); C: 106/164 (82%), P = 0.02
95% CI ‐22% to ‐0.81%

Borderline
T: 18/167 (14%); C: 14/164 (11%)

95% CI ‐4.3% to 8.8%

Abnormal
T: 20/167 (16%); C: 10/164 (8%)

95% CI ‐0.4% to 12.3%
Aggregate data for borderline and abnormal groups (assessed only)
T: 38/126 (30.2%); Cl: 24/130 (18.5%)
Difference 11.7% (95% CI 1.3% to 22%)

Aggregated data for borderline and abnormal (assessed and not assessed)
T: 38/167 (23%); C: 24/164 (14.6%)
Difference 8% (95% CI ‐0.23% to 1)

Hospital Anxiety Depression Scale

14‐item scale, ranging from 0 ‐ 23

(for each subscale of anxiety and depression)

Higher scores: worse mental health

Patient satisfaction and preference for place of care

Satisfied with recovery
T: 33/42 (81%); C: 29/44 (73%)
Difference 95% CI ‐10.4 to 26.4, P = 0.56

Satisfied with rehabilitation programme
T: 37/42 (90%); C: 32/44 (80%)
Difference 95% CI ‐5.1 to 25.6, P = 0.33

Satisfied with return home
T: 36/42 (95%); C: 36/44 (90%)
Difference 95% CI ‐7.0 to 16.4, P = 0.68

Satisfied with information at time of illness
T: 26/42 (63%); C: 21/44 (53%)
Difference 95% CI ‐10.5 to 32.3, P = 0.44

Satisfied with communication with team
T: 33/42 (81%); C: 27/44 (68%)
Difference 95% CI ‐5.9 to 31.9, P = 0.28

Satisfied with understanding of why stroke occurred
T: 16/42 (39%); C: 22/44 (55%)
Difference 95% CI ‐37.4 to 5.5, P = 0.22

Satisfied with current support
T: 39/42 (95%); C: 36/44 (90%)
Difference 95% CI ‐6.3, 16.5 to P = 0.43

Questionnaire developed for the study

(not described)

Results at 6‐month follow‐up

Patient satisfaction

T: 18/24, C: 10/21, P = 0.06

4‐point Likert scale of agreement with satisfaction with rehabilitation

Patient satisfaction
12 months ‐ Mean (SD)
T: 10.72 (1.44); C: 9.7 (2.1),
Difference 95% CI ‐1.7 to ‐0.24, P = 0.02

Overall satisfaction

12 months ‐ Mean (SD)
T: 50 (9.7); C: 42.6 (11.2)
Difference 95% CI ‐11.7 to ‐3.1, P = 0.001

Patient satisfaction questionnaire developed by Pound 1994

12 items, higher scores: more satisfaction

Results at 12‐month follow‐up

Satisfaction with hospital care
T: 78/136 (79%); C: 59/126 (65%)
Difference 14%, 95% CI 1% to 27%

Satisfaction with therapy
T: 56/136 (58%); C: 46/126 (51%)
Difference 7% (95% ‐6% to 22%)

Satisfaction with community care
T: 28/136 (42%); C: 29/126 (51%)
Difference 11% (95% ‐26% to 9%)

Stroke‐specific questionnaire

(not described)

Satisfaction with treatment
10 day ‐ number wanting to be treated at home
T: 41/52 (79%); C: 15/50 (30%)

Difference 49% (95% CI 30% to 63%)

Questionnaire not described

Patient satisfaction with active participation in treatment:
P = 0.02 (favouring T)
General patient satisfaction
T: 68/136 (83%); C: 52/126 (83%)
Difference 95% CI ‐12% to 13%

No other data reported.

Results on other dimensions of patient satisfaction not reported

Questionnaire not described

Caregiver outcomes

Caregiver strain

6 weeks ‐ Mean (SD)
T: 24.5 (2.3); C: 23.5 (2.4)

Difference 1.0 (95% CI ‐0.2 to 2.2)
26 weeks ‐ Mean (SD)
T: 24.2 (2.5); C: 25.0 (1.6)

Difference 0.8 (95% CI ‐2.0 to 0.4)

52 weeks ‐ Mean (SD)
T: 24.3 (2.7); C: 24.8 (1.9)

Difference ‐0.5 (95% CI ‐1.9 to 0.9)

Carer Strain Index

13‐item scale, range 0 ‐ 13

Higher score: more strain

N at 6 weeks: T: 29; C: 29

N at 26 weeks: T: 22; C: 23

N at 52 weeks: T: 23; C: 22

Caregiver satisfaction

T: 12/19; C: 3/10, P = 0.09

4‐point Likert scale of agreement with satisfaction with rehabilitation

Caregiver strain
12 months ‐ Mean (SD)
T: 5.9 (2.9); C: 6.0 (4.2), P = 0.93
Difference 95% CI ‐2.14 to 2.3

Carer Strain Index

N: T: 27; C: 25

GHQ
Median (range)
T: 5 (0 ‐ 21); C: 5 (1 ‐ 27)

N: T: 22; C: 19

No differences between groups (as reported by authors)

Caregiver Strain *

Mean (SD)
T: 5 (4); C: 4 (3)

Median (range)
T: 5 (0 ‐ 12); C: 3 (0 ‐ 12), P = 0.14

Carer satisfaction with hospital care **
T: 60 (74%); C: 41 (67%)
Difference 7% (95% CI ‐8% to 22%)

Carer satisfaction with therapy
T: 40 (53%); C: 28 (46%)
Difference 7% (95% CI ‐9% to 24%)

Carer satisfaction with community support
T: 28 (42%); C: 29 (51%)
Difference 9% (95% CI ‐26% to 9%)

Carer satisfaction in general
T: 68 (83%); C:52 (83%)
Difference 0% (95% CI ‐12% to 13%)

* Carer Strain Index

13‐item scale, range 0 ‐ 13

Higher score: more strain

** Carer satisfaction with hospital care ‐ denominator is not clear

Length of stay: inpatient days (including readmission days) and home‐based treatment

Total hospital bed days ‐ Median (IQR)
T: 15 (8.0 to 22.0); C: 30 (17.3 to 48.5)
Median difference ‐15 (95% CI ‐22.0 to ‐6.0)
Readmission stay (days) ‐ Median (IQR)
T: 6.0 (3.0 to 39.0); C: 4.0 (1.0 to 29.0)
Median difference 2.0 (95% CI ‐7.0 to 18.0)

Length of home‐based rehabilitation ‐ Median (range)
T: 5 weeks (1 to 19 weeks)

Stroke Unit total days ‐ Mean (SD)
T: 12.9 (10.3); C: 13.6 (15.0)

Difference ‐0.7 (95% CI ‐7.1 to 5.7)
Stroke unit + rehabilitation clinics total days ‐ Mean (SD)
T: 23.5 (30.5); C: 30.5 (44.8)

Difference ‐7.0 (95% CI ‐26.1 to 12.1)

T: N = 31, C: N = 31

Hospital stay ‐ Median days
T: 22 ; C: 31; P = 0.09

No SD provided; P value provided by authors

Hospital stay ‐ Mean days

T: 42; C: 50

Hospital stay ‐ Median days

T: 31; C: 32

No SD provided for hospital stay

Stroke unit days ‐ Mean
T: 11; C: 11
Stroke unit + rehabilitation days ‐ Mean
T: 18.6; C: 31.1, P = 0.03

No SD provided

P value for days in unit and rehabilitation provided by authors

Hospital length of stay days ‐ Mean (SD)
T: 9.8 (5.3); C: 12.4 (7.4)

Difference ‐2.6 (95% CI ‐5.0 to ‐0.2)
Hospital length of stay + rehabilitation hospital days ‐ Mean (SD)

T: 9.8 (5.3); C: 16.1 (14.6)

Difference ‐6.3 (95% CI ‐10.4 to ‐2.2)

T: N = 58, C: N = 56

Hospital length of stay ‐ Median (IQR)
T: 13 (8 ‐ 25); C: 22 (10 ‐ 57); P = 0.02

Hospital at home length of stay ‐ Median (range)

9 weeks (1 to 44 weeks)

Length of stay to randomisation ‐ Mean (SD)
T: 22 (25); C: 25 (30)
Length of stay from randomisation to discharge

Mean (SD)
T: 12 (19); C: 18 (24)
Mean difference ‐6 days (95% CI ‐10.7 to ‐1.32)

Median (range)
T: 6 (0 ‐ 49); C: 12 (0 ‐ 236), P < 0.0001 (95% CI for median ‐6 to ‐2)

No data for hospital at home length of stay
CI for median difference reported by authors

T: N = 167; C: N = 164

Hospital length of stay ‐ Mean (range)
T:14 (5 ‐ 33); C: 29 (5 ‐ 136); P = 0.0008

Cost and use of other services

Cost

Hospital costs 6 months post‐randomisation ‐ Mean (SD)/patient

T: AUD 3142 (AUD 2743); C: AUD 7820 (AUD 6018)
Mean difference AUD ‐4678 (95% CI ‐6680 to ‐2676)

Home‐based rehabilitation 6 months post‐randomisation ‐ Mean (SD)/patient

T: AUD 2985 (AUD 1659); C: AUD 79 (0)
Mean difference AUD 2906 (95% CI 2389 to 3424)

Community services 6 months post‐randomisation ‐ Mean (SD)/patient

T: AUD 778 (AUD 1415); C: AUD 1460 (AUD 2502)
Mean difference AUD ‐682 (95% CI ‐1552 to 187)
Caregiver time 6 months post‐randomisation ‐ Mean (SD)/patient

T: AUD 1135 (AUD 402); C: AUD 695 (AUD 1020)
Mean difference AUD 440 (95% CI ‐89 to 969)

Total 6 months post‐randomisation ‐ Mean (SD)/patient

T: AUD 8040 (AUD 4439); C: AUD 10,054 (AUD 7676)
Mean difference AUD ‐2013 (95% CI ‐4696 to 669)

Sensitivity analysis: impact on health care costs

Initial hospital costs 75% of baseline
T: AUD 7255 (AUD 785); C: AUD 8099 (AUD ‐1955)
Initial hospital costs 50% of baseline
T: AUD 6469 (AUD ‐1571); C: AUD 6144 (AUD ‐3910)
Home‐based rehabilitation at 25% increased cost
T: AUD 8787 (AUD 747); C: AUD 10,074 (AUD 20)
Home‐based rehabilitation at 50% increased cost
T: AUD 9533 (AUD 1493); C: AUD 10,093 (AUD 39)
Home‐based rehabilitation at 75% of baseline
T: AUD 7294 (AUD ‐746); C: AUD 10,034 (AUD ‐20)
Patients with mild disability (Barthel Index score 91 ‐ 100)
T: AUD 565 (AUD ‐2475); C: AUD 8165 (AUD ‐1889)

Costs calculated for each patient's use of healthcare resources

in the 6 months from randomisation,

with an average per patient cost used

if detailed information on patients was not available.

Costs in Australian dollars (AUD) 1997/1998

6 months ‐ Mean cost per patient (SD)
Hospital in patients
T: GBP 7831 (GBP 5000); C: GBP 9864 (GBP 8198)
Difference 95% CI GBP ‐2407 to GBP 6472.5, P = 0.74
All community services
T: GBP 3468 (GBP 4612); C: GBP 3655 (GBP 4531)
Difference 95% CI GBP ‐2917.8 to GBP 3292.6, P = 0.96
Combined package
T: GBP 11,759 (GBP 8600); C: GBP 13,337 (GBP 11,182)
Difference 95% CI GBP ‐5035.6 to GBP 8189.1, P = 0.92

Health service perspective, financial accounts

were used to cost hospital care;

costs collected from patients using a service use questionnaire

and unit costs of health and social care to cost hospital at home care

Resources months ‐ Mean cost per patient (SD)

Post‐randomisation acute care bed days
T: CAD 1383.28 (CAD 1599.97); C: CAD 2220.25 (CAD 2321.9)
Rehabilitation bed days
T: CAD 136.7 (CAD 1041.1); C: CAD 1061.89 (CAD 3484.24)
Readmission bed days
T: CAD 364.03 (CAD 1794.84); C: CAD 1793.01 (CAD 5504.66)
Home intervention
T: CAD 942.87 (CAD 505.45); C: 0
CLSC visits
T: CAD 124.83 (CAD 259.85); C: CAD 144.76 (CAD 280.09)
Outpatient visits
T: CAD 381.31 (CAD 760.17); C: CAD 730.7 (CAD 947.93)

ER visits
T: CAD 62.07 (CAD 117.93); C: CAD 61.72 (CAD 162.14)
Physician billings
T: CAD 539.67 (CAD 545.74); C: CAD 764.96 (CAD 724.83)
Total costs
T: CAD 7784.25 (CAD 3858.36); C: CAD 11,065.2 (CAD 7504.19)
Difference CAD ‐3280.95, P = 0.0001

Healthcare perspective at the patient level

Unit costs included overhead costs

and an allowance for the opportunity cost of buildings and land

Cost for 3 months follow‐up included

Costs in Canadian dollars (CAD)

Average annual cost
T: GBP 811,984 (GBP 4862 per patient)
C: GBP 1,040,276 (GBP 6343 per patient)
Cost of non‐inpatient care
T: GBP 323,625 (GBP 1938 per patient)
C: GBP 178,526 (GBP 1089 per patient)
Total healthcare costs
T: GBP 1,135,609 (GBP 6800 per patient)
C: GBP 1,218,802 (GBP 7432 per patient)

Difference GBP ‐632.00

Cost data in GBP (UK £), financial year 1997

Costs calculated at the level of the patient

by using data from provider departments

and other published sources

No SD or P value provided, not possible to calculate CI

Use of other services

Use of community services
T: 28/42 (67%); C: 30/44 (68%)
Difference 1% (95% CI ‐21% to 18%)

Provision of district nursing
3 months ‐ N (%)
T: 13 (36.1); C: 7 (22), P = 0.15
6 months ‐ N (%)
T: 9 (26.5); C: 6 (19.4), P = 0.50

Provision of home care
3 months ‐ N (%)
T: 16 (44.4); C: 13 (40.6), P = 0.60
6 months ‐ N (%)
T: 17 (50); C: 14 (45.2), P = 0.70

Provision of occupational therapy
3 months ‐ N (%)
T: 7 (19); C: 5 (15.6), P = 0.60
6 months ‐ N (%)
T: 2 (5.9); C: 4 (12.9), P = 0.33

Provision of physiotherapy
3 months ‐ N (%)
T: 22 (61.1); C: 14 (43.8), P = 0.09
6 months ‐ N (%)
T: 17 (50); C: 11 (35.5), P = 0.24

N at 3 months: T: 34, C: 32

N at 6 months: T: 34, C: 31

Physiotherapist
T: 6; C: 9
Occupational therapist
T: 4; C: 5
Speech therapy
T: 2; C: 2.5
Nursing visits
T: 2.5; C: 4

Mean number of visits from each healthcare professional

Although more visits on average in the control group,

the proportion of patients receiving care in this group was less,

7 patients receiving extended rehabilitation account for the increased visits

All patients in the intervention group received nursing visits,

compared with 52% in the control group;

75% in the intervention group received physiotherapy,

compared with 50% in the control group

Functional status ‐ older people a mix of conditions, including COPD

Functional status

Functional status

At enrolment ‐ Mean (SD)
T: 75.46 (22.1); C: 78.47 (19.13); P = 0.50
Baseline ‐ Mean (SD)
T: 100.31 (16.94); C: 78.94 (16.01); P < 0.001
At 1 month ‐ Mean (SD)
T: 100.93 (22.68); C: 105.47 (17.06); P = 0.36
At 6 months ‐ Mean (SD)
T: 102.96 (23.8); C: 106.35 (14.43); P = 0.53

Functional independence measure (FIM)

Start of rehabilitation phase post‐randomisation

Authors interpret as indication that intervention group

required additional days in the acute ward,

in order to be more independent before going home

ADL *

At 3 months
Mean difference 1.2 (95% CI 0.4 to 1.9)
At 12 months
Mean difference 0.2 (95% CI ‐0.7 to 1.1)

Extended ADL total **
At 3 months
Mean difference 3.1 (95% CI ‐0.1 to 6.3)
At 12 months
Mean difference 3.0 (95% CI ‐0.4 to 6.5)

Nottingham Extended ADL sections ^
Mobility

At 3 months
Mean difference 0.3 (95% CI ‐0.8 to 1.4)
At 12 months
Mean difference 0.3 (95% CI ‐0.9 to 1.4)

Kitchen
At 3 months
Mean difference 1.2 (95% CI 0.2 to 2.3)
At 12 months
Mean difference 0.7 (95% CI ‐0.4 to 1.8)

Domestic
At 3 months
Mean difference 1.1 (95% CI 0.2 to 2.0)
At 12 months
Mean difference 1.4 (95% CI 0.4 to 2.4)

Leisure
At 3 months
Mean difference 0.5 (95% CI ‐0.3 to 1.3)
At 12 months
Mean difference 0.6 (95% CI ‐0.3 to 1.5

* Barthel Index

Score: 0 to 20; 0 = worse score

** Score: 0 to 66; 0 = worse score

^ Score: 0 to 18; 0 = worse score

Functional status
At 6 months ‐ Mean (N)
T: 16.4 (21); C: 15.0 (26)

Barthel Index (higher score: more independence)
No P value given, insufficient data to calculate CI

Functional status *

10 day ‐ Mean (SD)
T: 6.36 (13.68); C: 8.73 (14.79)
Difference ‐2.37 (95% CI ‐5.78 to 1.04)

30 days ‐ Mean (SD)
T: 11.29 (13.16); C: 11.94 (13.34)
Difference ‐0.65 (95% CI ‐3.93 to 2.63)

90 day ‐ Mean (SD)
T: 13.09 (16.75); C: 14.25 (14.28)
Difference ‐1.17 (95% CI‐5.06 to 2.73)

Functional status ‐ physical **

10 day ‐ Mean (SD)
T: 5.69 (13.12); C: 7.58 (14.4)
Difference ‐1.89 (95% CI ‐5.19 to 1.41)

30 days ‐ Mean (SD)
T: 10.75 (12.56); C: 11.19 (12.73)
Difference ‐0.44 (95% CI ‐3.57 to 2.69)

90 day ‐ Mean (SD)
T: 12.6 (14.98); C: 13.35 (13.32)
Difference ‐0.76 (95% CI‐4.30 to 2.79)

Instrumental activities of daily living ^

10 day ‐ Mean (SD)
T: 0.62 (2.83); C: 0.96 (2.97)
Difference ‐0.34 (95% CI ‐1.04 to 0.35)
30 days ‐ Mean (SD)
T: 2.01 (2.95); C: 1.50 (2.95)
Difference 0.51 (95% CI ‐0.22 to 1.24)
90 day ‐ Mean (SD)
T: 2.69 (3.31); C: 2.5 (3.47)
Difference 0.20 (95% CI‐0.65 to 1.04)

* Functional independence measure (FIM)

** Functional independence measure ‐ Physical

^ Instrumental activities of daily living

All values calculated as changes from baseline

Functional status
At 6 weeks ‐ Median *
T: 16; C: 15
At 12 weeks ‐ Median
T: 15; C: 15
At 6 weeks ‐ Median ^
T: 13; C: 9
At 12 weeks ‐ Median
T: 13; C: 9

* Barthel Index (0 ‐ 20)
No P values given, insufficient data to calculate CI

^ Rivermead Score (9 ‐ 27) (higher score indicating better outcome)

Measure of domestic abilities

No P values given, insufficient data to calculate CI

4 weeks ‐ Mean (SD)
T: 1.5 (2.93); C: 1.0 (2.82)

Difference 0.5 (95% CI ‐0.31 to 1.31)
3 months
T: 1.9 (3.22); C: 1.7 (2.68)

Difference 0.2 (95% CI ‐0.66 to 1.06)

Barthel Index

N at 4 weeks: T: 152, C: 69

N at 3 months: T: 141, C: 60

3 months ‐ Mean change from baseline
T: ‐1.71; C: 1.27
Difference 0.44 (95% CI ‐2.09 to 1.21)

Elderly medical patients

Barthel Index, scale 0 to 20 (low score: high dependence)

Similar scores for both groups at 1‐month follow‐up

Barthel Index

No other data reported

Falls

Days 0 ‐ 10
T: 11/143 (8.1%); C: 8/142 (5.6%), P = 0.70
Days 11 ‐ 30
T: 8/143 (6.2%); C: 6/142 (4.8%), P = 0.59
Days 31 ‐ 90
T: 14/143 (10.9%); C: 18/142 (14.4%), P = 0.44
Total falls by 3 months
T: 33/143 (23%); C: 32/142 (22.5%), P = 0.11

Patient‐reported outcomes

Quality of life/self‐reported health status: Older people with a mix of conditions

EQ‐5D (‐0.59 to 1)
3 months
Mean difference 0.07 (95% CI ‐0.01 to 0.14)
12 months
Mean difference 0.02 (95% CI ‐0.06 to 0.09)

Self‐reported health status

5 levels (1: no problems; 5: extreme problems)

Self‐reported recovery
10 days
T: 25/128 (19.5%); C: 27/129 (20.9%), P = 0.78
30 days
T: 39/121 (32.2%); C: 30/124 (24.2%), P = 0.16
90 days
T: 63/112 (56.3%); C: 53/116 (45.7%), P = 0.11

SF 36 *
Physical component scale ‐ Mean (SD)
T: 34.8 (10.7); C: 34.4 (9.9)

Difference 0.4 (95% CI ‐2.20 to 3.00)

Mental component scale ‐ Mean (SD)
T: 53.4 (10.5); C: 52.1 (12.0)

Difference 1.3 (95% CI ‐1.55 to 4.15)

* Short form survey of self‐reported health status

36 items, higher scores better health status

T: N = 121, C: N = 120

EQ‐5D after adjustment for baseline differences
4 weeks
Mean difference 0.00 (95% CI ‐0.09 to 0.10)
3 months
Mean difference ‐0.04 (95% CI ‐0.13 to 0.06)

EQ‐5D

Dartmouth COOP charts

Physical fitness
T: 0.06; C: 0.00

Mean difference: 0.06 (95% CI ‐0.32 to 0.43)

Feelings
T: 0.26; C: 0.00

Mean difference: 0.26 (95% CI ‐0.43 to 0.95)

Daily activities
T: 0.39; C: 0.38

Mean difference: 0.01 (95% CI ‐0.64 to 0.67)

Social activities
T: ‐0.10; C: 0.32
Mean difference ‐0.42 (95% CI ‐1.15 to 0.29)

Pain
T: 0.39; C: 0.35
Mean difference: 0.04 (95% CI ‐0.78 to 0.86)

Change in health
T: 0.92; C: 0.19
Mean difference: ‐0.27 (95% CI ‐1.06 to 0.53)

Overall health
T: ‐0.03; C: 0.16
Mean difference: ‐0.19 (95% CI ‐0.63 to 0.26)

Social support
T: 0.13; C: ‐0.05
Mean difference: 0.18 (95% CI ‐0.30 to 0.67)

Quality of life
T: 0.16; C: 0.35
Mean difference: ‐0.19 (95% CI‐0.70 to 0.32)

Functional status
T: ‐1.71; C: 1.27
Mean difference: 0.44 (95% CI ‐2.09 to 1.21)

Dartmouth COOP charts

Each domain scored 1 ‐ 5

(low score: better quality of life)

Mean change at 3 months from baseline
Mean difference, 95% CI

Elderly medical patients

Similar scores for both groups at 1‐month follow‐up

Minnesota Living With Heart Failure Questionnaire

Scores 0 ‐ 105; lower scores: better quality of life

No data reported

Quality of life/self‐reported health status: Older people with COPD

Respiratory symptom ‐ Mean (SD)
T: 12.1 (17.3); C: 11.6 (12.8)

St George's Respiratory Questionnaire

Dartmouth COOP charts *

Physical fitness
T: 0.40; C: ‐0.45
Mean difference: 0.22 (95% CI 95% CI ‐0.81 to 1.25)

Feelings
T: ‐0.45; C: 0.18
Mean difference: ‐0.63 (95% CI ‐2.13 to 0.86)

Daily activities
T: 0.00; C: 1.09
Mean difference: ‐1.09 (95% CI ‐2.27 to 0.08)

Social activities
T: ‐0.82; C: 0.18
Mean difference: ‐1.00 (95% CI ‐2.48 to 0.48)

Pain
T: 0.73; C: 0.67
Mean difference: 0.06 (95% CI ‐1.24 to 1.36)

Change in health
T: 0.36; C: 0.73
Mean difference: ‐0.37 (95% CI ‐2.02 to 1.29)

Overall health
T: ‐0.18; C: 0.09
Mean difference: ‐0.27 (95% CI ‐1.03 to 0.48)

Social support
T: 0.00; C: 0.18
Mean difference: ‐0.18 (95% CI ‐1.33 to 0.97)

Quality of life
T: 0.18; C: 0.54
Mean difference: ‐0.36 (95% CI ‐1.22 to 0.49)

CRD questionnaire **
Dyspnea, scale 5 ‐ 35
T: 0.94; C: ‐3.85
Mean difference: 0.79 (95% CI ‐2.07 to 11.65)

Fatigue, scale 4 ‐ 28
T: ‐0.40; C: ‐4.78
Mean difference: 4.38 (95% CI ‐0.31 to 9.07)

Emotion, scale 7 ‐ 49
T: ‐0.80; C: ‐8.66
Mean difference: 7.86 (95% CI ‐2.16 to 17.89)

Mastery, scale 4 ‐ 28
T: 0.00; C: ‐1.44
Mean difference: 1.44 (95% CI ‐5.93 to 8.82)

* Dartmouth COOP charts

Scale 1 ‐ 5 (low score: better quality of life)

Mean change at 3 months from baseline
Mean difference, 95% CI

Patients with COPD

Feelings ‐ follow‐up data for:
treatment n = 10
control n = 11

** Chronic Respiratory Disease Questionnaire
(low score: low level of functioning)

Treatment n = 10
Control n = 9

No data reported

Chronic Respiratory Questionnaire

CCQ ‐ Mean (SD)

T: 2.70 (1.32); C: 2.41 (1.14)

Mean difference: 0.29 (95% CI −0.12 to 0.70)

EQ‐5D ‐ Mean change from baseline (SE)

T: 0.008 (0.039); C: ‐0.036 (0.0047), P = 0.64

Clinical COPD Questionnaire

10 items, total score 0 ‐ 6 (higher score: worse health‐related quality of life)

Mean change at 3 months from baseline

Cognitive functioning

MMSE *
1 month ‐ Mean (SD)
T: 23.89 (6.42); C: 24.52 (5.97), P = 0.66

6 months ‐ Mean (SD)
T: 23.22 (6.9); C: 25.18 (5.01), P = 0.24

CAM **
OR for delirium in T during rehabilitation phase

0.17 95% CI 0.03 to 0.65
Days of delirium during acute phase mean (SD)
T: 3 (1.4); C: 2 (2.5), P = 0.62

* Mini Mental State Examination (MMSE)

30‐item questionnaire

Lower scores: more impairment

** Confusion assessment method for assessing delirium

MMSE

10‐day ‐ Mean change from baseline (SD)
T: 0.04 (3.01); C: ‐0.01 (2.87)
Difference ‐0.05 (95% CI ‐0.67 to 0.77)
30 days ‐ Mean change from baseline (SD)
T: 0.36 (2.89); C: 0.34 (2.77)
Difference ‐0.02 (95% CI ‐0.70 to 0.74)
90‐day ‐ Mean change from baseline (SD)
T: 0.20 (3.55); C: 0.72 (3.03)
Difference ‐0.44 (95% CI‐1.38 to 0.35)

At 10 days: T: N = 125; C: N = 129

At 30 days: T: N = 117; C: N = 121

At 90 days: T: N = 117; C: N = 109

Cognitive status
6 weeks ‐ Median
T: 8; C: 8

12 weeks ‐ Median
T: 9; C: 8

MMSE
At discharge from hospital ‐ Mean (SD)
T: 21.7 (7.1); C: 21 (7.3)
Mean difference 0 (95% CI ‐1.2 to 2.1)

Abbreviated Mental Test score (0 ‐ 10)

Higher score: better outcome

No P value given

Insufficient data to calculate CI

Delirium

T: 2/29 (6.9%); C: 2/25 (8%), P = 0.88

Confusion assessment method for assessing delirium

Similar scores between groups at 1 month follow‐up

MMSE

No other data provided

Psychological well‐being

GDS
At 1 month
T: 8.84 (6.07); C: 8.17 (5.73), P = 0.63
At 6 months
T: 7.8 (5.6); C=7.14 (3.96), P = 0.62

Geriatric Depression Scale

Higher scores: more symptoms of depression

GHQ

3 months
Mean difference ‐2.4 (95% CI ‐4.1 to ‐0.7)
12 months
Mean difference ‐1.9 (95% CI ‐3.5 to ‐0.4)

General Health Questionnaire

Higher scores: worse mental health

Psychological well‐being
6 months ‐ Mean
T: 12.4 (N = 21); C: 12.1 (N = 25)

Philadelphia Geriatric Center Morale Score

Higher score: better outcome

No P value given

Insufficient data to calculate CI

FIM ‐ mental subscale

10‐day ‐ Mean change from baseline (SD)
T: 0.67 (2.47); C: 1.16 (3.34)
Difference ‐0.49 (95% CI ‐1.19 to 0.22)
30 days ‐ Mean change from baseline (SD)
T: 0.53 (2.20); C: 0.74 (2.44)
Difference ‐0.21 (95% CI ‐0.79 to 0.36)
90 day ‐ Mean change from baseline (SD)
T: 0.46 (3.19); C: 0.90 (4.19)
Difference ‐0.41 (95% CI‐1.34 to 0.52)

Functional Independence Measure ‐ mental subscale

At 10 days: T: N = 134; C: N = 134

At 30 days: T: N = 126; C: N = 125

At 90 days: T: N = 124; C: N = 123

Psychological well‐being:
At 6 weeks ‐ Median
T: 10; C: 12
12 weeks ‐ Median
T: 13; C: 9.5

Philadelphia Geriatric Center Morale Score

Higher score: better outcome

No P value given

Insufficient data to calculate CI

Elderly medical patients

Psychological well‐being
Baseline ‐ Mean SD
T: 6.54 (2.28); C: 7.93 (2.67)
3 months ‐ Mean SD
T: 0.16 (2.66); C: 0.73 (2.24)
Difference ‐0.88 (95% CI ‐2.1 to 0.33)

Chronic obstructive airways disease

Psychological well‐being
Baseline ‐ Mean SD
T: 7.61 (2.4); C: 7.7 (2.68)
3 months ‐ Mean SD
T: 0.4 (2.32); C: 1.00 (2.93)

Difference ‐0.6 (95% CI ‐3.03 to 1.83)

Philadelphia Geriatric Center Morale Score

Higher score: better outcome

Similar scores between groups at 1‐month follow‐up

Zung Self‐Rating Depression Scale

20 items, score 20 to 80 (higher scores: more depression symptoms)

No other data provided

Patients' place of residence at follow‐up (not included in meta‐analysis)

6 weeks

Home
T: 24/29 (82.7%): C: 10/25 (40%)

Observed difference: 42.7% (95% CI 20% to 66%)

Residential care
T: 0/29 (0%); C: 3/25 (12%)
Observed difference ‐12% (95% CI ‐24.7% to 0.74%)

12 weeks

Home

T: 21/29 (72%); C: 11/25 (44%)

Observed difference 28% (95% CI 3% to 54%)

Residential care at 12 weeks
T: 1/29 (3.4%); C: 4/25 (16%)
Observed difference ‐12.6% (95% CI ‐28.4% to 3.28%)

At home at 1 month

T : 26/26 (100%); C: 23/26 (88%)

Difference 12% (95% CI ‐3.3 to 28.9)

Patient satisfaction and preference for place of care

Patient satisfaction ‐ Mean (SD)
T: 4.66 (0.64); C: 4.06 (0.94), P = 0.006

5‐point scale (1 = low, 5 = high)

Good/excellent rating of the service
T: 93/112 (83%); C: 87/120 (72.5%)
P = 0.05

Did not feel under pressure
T: 111/116 (95.7%); C: 105/115 (91.3%)
P = 0.18

Would recommend to others
T: 110/116 (94.8%); C: 111/115 (96.5%)
P = 0.53

30‐item satisfaction survey

(not described)

3 overview questions reported in the paper

Preferred hospital at home

T: 26/30 (87%); C: 16/30 (53%)
Difference: 33%, 95% CI 18% to 55%

Questionnaire not described

Elderly medical patients
Patient preference *
At discharge
T: 81%; C: 40%
Difference 41% (95% CI 20% to 62%)

Patient satisfaction **
At discharge from hospital at home, or hospital
T: 2.54 (4.74); C: 22.10 (4.68)
Difference 0.44 (95% CI ‐3.86 to 4.75)

Chronic obstructive pulmonary disease
Patient preference
At discharge
T: 73%; C: 54.5%
Difference 18.5% (95% CI ‐21.3% to 57.7%)

Patient satisfaction
At discharge from hospital at home, or hospital
T: 25.0 (3.11); C: 24.66 (3.05)
Difference 0.83 (95% CI ‐5.23 to 6.89)

* Patient preference ‐ patients reporting they had received their preferred place of care

** Patient satisfaction ‐ using modified version of satisfaction scale developed by Pound 1994, maximum score of 33, indication of high level of satisfaction

95% of the patients reported being 'completely satisfied'

Treatment group only

79/122 replied to the questionnaire

Overall satisfaction at 3 months

T: 70%; C: 72%

Patient preference at 3 months*

T: 59%; C: 35%

3‐part questionnaire: open‐ended questions (3 things patients were more satisfied and dissatisfied about);

Quantitative (15 questions about the treatment received); and dichotomous question about preferred place of treatment.

Overall score calculated for 41% and 49% of patients in T and C group, respectively.

* Percentage of participants preferring to receive treatment at home

Caregiver outcomes

Caregiver satisfaction

Mean (SD)
T: 4.47 (0.86); C: 4.08 (1.04), P = 0.19

Caregiver satisfaction
5‐point scale (1 = low, 5 = high)

GHQ
3 months

Mean difference ‐2.0 (95% CI ‐3.8 to ‐0.1)
12 months
Mean difference ‐1.1 (95% CI ‐3.7 to 1.5)

General Health Questionnaire

Higher scores = worse mental health

Relative satisfaction *
Good/excellent rating of service
T: 46/69 (67%); C: 24/58 (41.4%), P = 0.004

Did not feel under pressure
T: 57/69 (82.6%); C: 34/55 (61.8%); P = 0.009

Would recommend to others
T: 62/63 (98.4%); C: 51/57 (89.5%), P = 0.03

Caregiver strain **
Mean (SD)
T: 4.6 (3.6); C: 6.2 (3.7), P = 0.02

30‐item satisfaction survey

(not described)

* 3 overview questions reported in the paper

** Carer Strain Index

13‐item scale, range 0 ‐ 13

higher score: more strain

Carer preferred hospital at home
T: 17/20 (85%); C: 6/14 (43%)
Difference 42% (95% CI 12% to 72%)

Elderly medical patients

Carer Strain Index:
T: 0.96; C: ‐0.22
Difference 1.17 (95% CI ‐0.47 to 2.82)

Carers reporting they had received their preferred place of care ‐ 3 months
T: 78%; C: 70%
Difference 8% (95% CI ‐16.6% to 33.8%)

Chronic obstructive pulmonary disease

Carer Strain Index
T: ‐0.33; C: 2.75
Difference ‐3.08 (95% CI ‐8.19 to 2.02)

Carers reporting they had received their preferred place of care ‐ 3 months
T: 87.5%; C: 71.4%
Difference 16.1%, 95% CI ‐24.5% to 56.6%

Carer Strain Index ‐ mean change from baseline

Reduction in stress levels at 1 month follow‐up

in favour of the treatment group (P = 0.017)

Relative Stress Scale

15 items, scores 0 ‐ 60, higher scores: more stress

No other data provided

Caregiver strain ‐ Mean (SE)

T: 3.84 (0.50); C: 3.50 (0.55)

Difference ‐0.34 (95% CI ‐1.31 to 1.81)

Preference for being cared for at home

T: 60%; C: 36%, P = 0.03

Carer Strain Index

3 months follow‐up

Staff views

General Practitioner satisfaction ‐ Mean (SD)
T: 4.06 (0.96); C: 3.78 (0.97), P = 0.41

5 point scale (1=low, 5=high)

No increase in demand of service: 65%

Decreased demand for service: 33%

Increased demand in service: 2%

For T group only

Questionnaire not described

50% response rate

Length of stay

Inpatient days (including readmission days) and hospital at home length of stay (not included in meta‐analysis)

Acute ward inpatient length of stay ‐ Mean (SD)
T: 18.73 (11.39); C: 17.03 (8.68), P = 0.45
Rehabilitation length of stay
T: 15.97 (9.37); C: 23.09 (19.41), P = 0.02

Total length of stay from admission to end of rehabilitation ‐ Mean (SD)

T: 34.91 (15.37); C: 40.09 (23.22); P = 0.19

Initial stay ‐ Mean (range)
T: 3.2 (1 to 16); C: 6.1 (1 to 13)
Additional days due to readmission
T: 8.75; C: 7.83
Difference 0.92 (95% CI ‐6.5 to 8.3)

Length of stay from randomisation to discharge ‐ Median (IQR) [Mean]
T: 6 (4 to 13) [12]; C: 13 (6 to 24) [21]
Median difference 4 (95% CI 3 to 7)
Length of stay from randomisation to 3 months ‐ Median (IQR) [Mean]
T: 9 (4 to 22) [17]; C: 18 (7 to 34) [23]
Median difference 5 (95% CI 2 to 8)
Length of stay from randomisation to 12 months ‐ Median (IQR) [Mean]
T: 15 (6 to 45) [29]; C: 21 (9 to 50) [39]
Median difference 4 (95% CI 1 to 9)

Visits from EDRS ‐ Median (IQR) [Mean]
T: 8 (5 to 31) [22]

Days in care ‐ Mean

T: 9.2; C: 12.2; P < 0.05

No SD provided

P value provided by authors

Days between randomisation and discharge home ‐ Median
T: 5; C: 11; P = 0.002

P value provided by authors

No data for total days of care

Hospital length of stay at 12 weeks ‐ Mean
T: 22.4; C: 44.8

No P value given, insufficient data to calculate CI

No data for total days of care

Days in care ‐ Mean
T: 5.9; C: 7.4; P = 0.14

No SD provided

P value provided by authors

Total length of stay ‐ Median
T: 7; C: 5
Median difference 2 days P < 0.01
Hospital at home visits ‐ Mean
T: 3.8 C: N/A

Only the treatment group received home visits

Total length of stay ‐ hospital plus hospital at home

Total length of stay (IPD) ‐ Mean (SD)
T: 23.5 (15.6); C: 17.7 (18.3)
Difference 5.76 days (95% CI 1.11 to 10.4)

Total length of stay ‐ Mean (SD)
T: 53.8 (26.59); C: 50.12 (23.11)
Difference 3.68 days (95% CI ‐8.77 to 16.1)

T: N = 50; C: N = 25

Total days of care (hospital plus hospital at home)

Elderly medical ‐ Mean (SD)
T: 21.88 (18.30); C: 13.20 (14.19)
Difference 8.67 days (95% CI 1.90 to 15.45)

Chronic obstructive pulmonary disease ‐ Mean (SD)
T: 12.27 (3.69); C: 12.12 (7.49)
Difference 0.15 (95% CI ‐4.21 to 4.51)

Cost and resource use

Cost

Overall Cost
Acute + rehabilitation phase ‐ Mean (SD) in AUD
T: AUD 18,147 (AUD 9816); C: AUD 25,042 (AUD 15,041)
P = 0.01
In GBP
T: GBP 7680 (GBP 4154); C: GBP 10598 (GBP 6365)
Rehabilitation phase overall cost in AUD
T: AUD 5961 (AUD 3210);
C: AUD 14,413 (AUD 12,631)
P < 0.001
In GBP
T: GBP 2523 (GBP 1347)
C: GBP 6100 (GBP 5345)

Details of methods used to calculate costs not available.

Costs provided in AUD and GBP

Total mean cost per case at 12 months

T: GBP 8361 (GBP 540) ± GBP 1059

C: GBP 10,088 (GBP 713) ± GBP 398

Difference GBP ‐1727, (95% CI ± GBP 2481), P = 0.054

Healthcare service perspective

Resource use quantified using data collected from service providers for 12 months post‐randomisation and on recorded client contact time for hospital at home. Cost of the initial hospital admission and readmissions was estimated based on length of stay and cost/bed day by clinical specialty using NHS costs 2000/2001. Referrals to social services included in the costs.

Total costs per patient ‐ Mean

T: NZD 6524, C: NZD 3525, P < 0.001

Direct costs of healthcare and support services in 30 days following randomisation.

Includes hospital‐related costs (calculated based on expenditure by department)

and any payment made by patients for primary care.

Costs in New Zealand dollars (NZD)

SD not provided by authors, not possible to calculate CI; P value provided by authors

Total costs per patient ‐ Mean (SD)

T: USD 138.57 (USD 72.87): C: USD 951.24 (USD 715.14); P < 0.001

Mean difference: USD ‐812.67 (95% CI ‐1033.33 to ‐592.02)

Total costs per patient for each group, excluding first 24 hours of care

Costs in US dollars (USD)

Elderly medical patients

Hospital costs per patient

Median (IQR); Mean (SD)
T: GBP 913.76 (GBP 243.31 to GBP 2045.68); GBP 1376.38 (GBP 1370)

C: GBP 1366.16 (GBP 629.1 to GBP 2033.5); GBP 1654.2 (GBP 1501.4)
P = 0.21

Hospital at home costs ‐ Mean (SD)
T: GBP 793.4 (811.4)

Total health service costs

Median (IQR); Mean (SD)
T: GBP 1705.3 (GBP 913.83 to GBP 3121.55); GBP 2279.74 (GBP 1765.4)
C: GBP 1388.8 (GBP 645.1 to £2094.9); GBP 1712.6 (GBP 1518)

P = 0.09

Chronic Obstructive Pulmonary Disease

Hospital costs per patient

Median (IQR)
T: GBP 1389.53 (GBP 821.65 to GBP 1993.97);
Cl: GBP 1198 (GBP 712 to GBP 1508.2)

P = 0.56

Hospital at home costs ‐ Mean (SD)
T: GBP 710.6 (GBP 526.5)

Total health service costs

Median (IQR)
T: GBP 2379.7 (GBP 1458.1 to GBP 2759.1)
C: GBP 1247.6 (GBP 772.5 to GBP 1619.2)

Median difference GBP 1132.10, P < 0.01

Mann Whitney U test
Cost data financial year 1994/1995.

Health service perspective, dependency scores developed to account for the different resources used

during a patient's inpatient admission.

Costs calculated at the patient level.

Costs at 3 months follow‐up

Costs in GBP

Mean cost to the health service

T: GBP 877.00,

C: GBP 1753

Cost data financial year 97/98
Costs based on average cost per bed day in the respiratory unit. GP costs calculated from unit costs estimated by Personal & Social Services Research Unit, Kent

Healthcare costs

T: EUR 4129; C: EUR 4297

Difference EUR ‐168 95% (CI ‐1253 to 922)

Societal perspective

T: EUR 6304; C: EUR 5395

Difference EUR 908 (95% CI ‐552 to 2296)

Costs calculated from healthcare (direct health costs 3 months after randomisation) and societal perspective (direct health costs, non‐healthcare costs and loss of productivity)

Costs in euros (EUR)

Use of other services

Attending geriatric day hospital
T: 21/185 (11%); C: 57/185 (31%)
RR 0.47 (95% CI 0.23 to 0.56)
Hospital outpatient visits ‐ Mean
T: 3.4; C: 3.3; P = 0.85
GP visits ‐ Mean

T: 6; C: 6.7, P = 0.16

Results for 12 months follow‐up

Home care at 6 weeks
T: 2/24 (8.3%); C: 8/10 (80%)
Observed difference: ‐71.7% (95% CI ‐99% to ‐4%)
District nurse visits at 12 weeks

T: 11/21 (52.4%); C: 3/11 (27.3%)
Observed difference: 25.1% (95% CI ‐9% to 59%)
Receipt of social services over 12 months
T: 145/185 (78%); C: 151/185 (82%)
RR 0.96 (95% CI 0.87 to 1.06)

Emergency room visits

T: 2/29 (6.9%); C: 0/30 (0%)

Observed difference 6.9% (95% CI ‐8.3 to 24.2)

3 months follow‐up

Mortality

T: 21/107 (19.6%); C: 16/98 (16.3%)

Difference: ‐3.8% (95% CI ‐19.6% to 23.5%)

Mortality at 12‐month follow‐up

T: 12/160 (7.5%); C: 6/81 (7.4%)
Difference: 0.1% (95% CI ‐7% to 7%)

Hip replacements
T: 0/37; C: 1/49
Knee replacements
T: 0/47; C: 0/39
Hysterectomy
T: 0/114; C: 0/124

Mortality at 3‐month follow‐up

Hospital readmission

Recovering from a hip fracture

4 months ‐ Mean (range)
T: 0.22 (0.07 to 0.46); C: 0.22 (0.01 to 0.45)

Recovering from a knee replacement

Readmission ‐ total
T: 1/32; C: 1/28, P = 0.92
Readmission days ‐ Mean (range)
T: 0.22 (0.01 to 0.045); C: 0.27 (0.07 to 0.46)

Follow‐up time not specified

4‐month follow‐up for readmission days

A mix of orthopaedic surgical procedures

Mean (SD)

T: 5.6 (13.84); C: 4.8 (12.17)
Difference 0.8 (95% CI ‐2.78 to 4.38)

Total
T: 42/159 (26.4%); C: 17/81 (21%)
Difference 5.4% (95% CI ‐5.8% to 16.6%)

Readmission days at 3 months

(mix of surgical and medical patients)

Recovering from a hernia or varicose veins

At 2 to 3 weeks:
T: 0/117 (0%); C: 2/121 (1.65%)
Difference 1.65% (95% CI ‐3.92% to 0.62%)

Knee replacement
T: 4/47 (8.5%); C: 1/39 (2.6%)
Difference 5.9% (95% CI‐3.5 to 15.3%)
Hip replacement
T: 2/37 (5.4%); C: 1/49 (2.0%)
Difference 3.4% (95% CI ‐4.9% to 11.7%)
Hysterectomy
T: 7/114 (6.1%); C: 13/124 (10.5%)
Difference ‐4.3% (95% CI ‐11.3% to 2.6%)

3‐month follow‐up

Functional status

Modified Barthel Index ‐ Median (range)
T: 11.00 (5.5 to 16.0); C: 8.0 (‐2.5 to 13.5)
Median difference in change score 3.00, P < 0.05

Falls efficacy scale ‐ Median (range)
T: 90.5 (80.5 to 98); C: 79.5 (40.0 to 92.5), P < 0.05

Functional status at 4 months

(median change from baseline, 25th & 75th percentile)

Functional status
T: 1.9; C: 1.7
Difference 0.17, 95% CI ‐0.76 to 1.10

Barthel Index:
Scale 0 ‐ 20 (low score: high level of dependence)

3‐month follow‐up

Patient outcomes: Quality of life/self‐reported health status

SF‐36 PCS ‐ Mean (SD) *
T: 47.4 (11.8); C: 49 (11.7)
Difference ‐0.5 (95% CI ‐5.8 to 4.8), P = 0.85
SF36 MCS ‐ Mean (SD) **
T: 48.9 (8.2); C: 49.2 (8.6)
Difference 0.6 (95% CI ‐2.7 to 3.8), P = 0.73

* SF‐36 PCS: Physical component score

** SF‐36 MCS: Mental component score

12‐week follow‐up

SF36 PCS ‐ Median (range)

T: ‐3.4 (‐14.9 to 8.1); C: ‐3.9 (‐19.5 to 11.7)

SF36 MCS ‐ Median (range)
T: 0.01; C: ‐11.7 (‐23.4 to 0.05)

Change from baseline, 25th & 75th percentile; no data reported

SF 36 physical component scale

Dartmouth COOP Charts *

Physical fitness
Difference ‐0.05 (95% CI ‐0.28 to 0.19)

Feelings
Difference ‐0.09 (95% CI ‐0.50 to 0.32)

Daily activities
Difference ‐0.04 (95% CI ‐0.47 to 0.38)

Social activities
Difference 0.07 (95% CI ‐0.38 to 0.52)

Change in health
Difference ‐0.01 (95% CI ‐0.34 to 0.31)

Overall health
Difference 0.10 (95% CI ‐0.21 to 0.42)

EQ 5D scores **
Difference ‐0.04 (95% CI ‐0.13 to 0.06)

EQ 5D thermometer ^
At 3 months:
Difference ‐4.6 (95% CI ‐11.0 to 2.0)

* Dartmouth COOP charts: 5‐point Likert‐type scaling, with descriptors and cartoon illustrations of levels 1 through 5. 1 = no impairment, 5 = most impaired.

** EQ 5D scores: possible range 5 ‐ 15
^ EQ 5D thermometer: possible range 0 ‐ 100

Scores at 3‐month follow‐up

Hip replacement
Physical fitness
T: 0.42; C: 0.51
Difference ‐0.09 (95% CI ‐0.48 to 0.29)

Feelings
T: 1.03; C: 0.78
Difference 0.25 (95% CI ‐0.29 to 0.79)

Daily activities
T: 1.00; C: 0.93
Difference 0.07 (95% CI‐0.39 to 0.53)

Social activities
T: 1.43; C: 1.02
Difference 0.41 (95% CI ‐0.15 to 0.97)

Pain
T: 1.54; C: 1.69
Difference ‐0.15 (95% CI ‐0.78 to 0.49)

Change in health
T: 0.74; C: 0.13
Difference 0.61 (95% CI 0.02 to 1.20)

Overall health
Difference 0.10 (95% CI ‐0.35 to 0.55)

Social support
T: 0.26; C: 0.40
Difference ‐0.14 (95% CI ‐0.57 to 0.28)

Quality of life
T: 0.97; C: 0.47
Difference 0.50 (95% CI 0.13 to 0.88)

Oxford Hip Score *
T: 4.77; C: 3.13
Difference 1.64 (95% CI ‐1.23 to 4.5)

Knee replacement
Physical fitness
T: 0.19; C: 0.29
Difference ‐0.10 (95% CI ‐0.49 to 0.29)

Feelings
T: 0.51; C: 0.37
Difference 0.14 (95% CI ‐0.50 to 0.78)

Daily activities
T: 0.68; C: 0.91
Difference ‐0.23 (95% CI ‐0.71 to 0.26)

Social activities
T: 0.98; C: 0.91
Difference 0.07 (95% CI ‐0.61 to 0.74)

Pain
T: 1.02; C: 1.06
Difference ‐0.04 (95% CI ‐0.62 to 0.53)

Change in health
T: 0.48; C: 0.62
Difference ‐0.14 (95% CI ‐0.73 to 0.45)

Overall health
T: ‐0.11; C: 0.15
Difference ‐0.26 (95% CI ‐0.65 to 0.12)

Social support
T: 0.18; C: ‐0.03
Difference 0.21 (95% CI ‐0.33 to 0.74)

Quality of life
T: 0.42; C: 0.40
Difference 0.02 (95% CI ‐0.37 to 0.41)

Bristol knee score *
T: ‐3.00; C: ‐4.06
Difference 1.06 (95% CI ‐1.58 to 3.70)

Hysterectomy
Physical fitness
T: 0.04; C: 0.04
Difference 0.00, 95% CI ‐0.43 to 0.44
Feelings
T: 0.70; C: 0.84
Difference ‐0.14 (95% CI ‐0.48 to 0.19)
Daily activities
T: 0.52; C: 0.45
Difference 0.07 (95% CI ‐0.25 to 0.38)
Social activities
T: 0.56; C: 0.52
Difference 0.04 (95% CI ‐0.30 to 0.38)
Pain
T: 1.22; C:1.20
Difference 0.02 (95% CI ‐0.42 to 0.48)
Change in health
T: 1.45; C: 1.36
Difference 0.09 (95% CI ‐0.22 to 0.40)
Overall health
T: 1.09; C: 0.82
Difference 0.27 (95% CI ‐0.06 to 0.58)
Social support:
T: 0.48; C:0.42
Difference 0.06 (95% CI ‐0.27 to 0.37)
Quality of life
T: 0.65; C: 0.67
Difference ‐0.02 (95% CI ‐0.30 to 0.27)
SF‐36 physical functioning
T: ‐4.82; C: ‐3.02
Difference ‐1.80 (95% CI ‐8.28 to 4.69)

HIP REPLACEMENT
Dartmouth COOP charts:
Scale 1 ‐ 5 (low score: good quality of life)
Follow‐up data at 3 months for:

Treatment = 36
Control = 45
* Oxford hip score

Baseline score measured at 1 month.

Scale 12 ‐ 60 (high score: high level of impairment)
KNEE REPLACEMENT
Dartmouth COOP charts:
Scale 1 ‐ 5 (low score: good quality of life)
Follow‐up data at 3 months for:

Treatment = 45
Control = 35
*Bristol knee score

Baseline score done at 1 month

Scale 0 ‐ 50 (low score: poor level of functioning)
HYSTERECTOMY
Dartmouth COOP charts:
Scale 1 ‐ 5 (low score: good quality of life)
Follow‐up data at 3 months for:

Treatment = 45
Control = 35

Clinical complications

All clinical complications ‐ 7 days post‐surgery
T: 7/56 (12.5%); C: 5/49 (10.2%)
Observed difference: 2.3% (95% CI ‐9.8% to 14%)
Varicose veins
T 8/61 (13.1%); C: 0/58 (0%)
Observed difference: 13.1% (95% CI 5% to 22%)

Hernia

In‐hospital clinical events
T: 20/65 (30%); C: 8/32 (25%); P = 0.55

All clinical complications at 2 ‐ 3 weeks
T: 27/117 (23.1%); C: 17/121 (14%)
Observed difference: 9.1% (95% CI ‐19% to 1%)

Conditions were combined

Patient satisfaction

T: 76/117 (64.9%); C: 62/107 (57.9%)
Observed difference: 7% (95% CI ‐6% to 20%)

Results at 14 days follow‐up

Patients were asked if they were content with their length of stay in hospital

Median score (25th & 75th percentile)
T: 21.0 (19.0 to 23.0); C: 20.0 (18.0 to 22.0)

Only 20% of those with a fracture were eligible and agreed to enter trial

Quality of service (excellent)
T: 50.7%; C: 44.6%
Difference 6.1% (95% CI ‐8.6% to 20.8%)

Received needed services (all of the time)
T 63%; C: 60%
Difference 3.0% (95% CI ‐11.5% to 17.4%)

Content with care (all of the time)
T: 69.6; C: 56.9
Difference 12.7 (95% CI ‐1.6 to 27.0)

Received all help needed (yes)
T: 83.8; C:75.4
Difference 8.4 (95% CI ‐3.7 to 20.6)

Discussions with staff (excellent)
T: 47.4; C: 27.7
Difference 19.7 (95% CI 5.9 to 33.5)

Involved in decision‐making (as much as wanted)
T: 79.4; C: 71.5
Difference 7.7 (95% CI ‐5.7 to 21.1)

Information about illness (as much as wanted)
T: 76.7; C:80.0
Difference ‐3.3 (95% CI ‐15.7 to 9.2)

Information on treatment (as much as wanted)
T: 77.5; C:80.7
Difference ‐3.2 (95% CI ‐11.2 to 17.8)

Privacy (as much as wanted)
T: 84.7; C: 88.1
Difference ‐3.4 (95% CI ‐13.7 to 6.9)

Informal practical support (as much as wanted)
T: 87; C: 93.2
Difference ‐6.2 (95% CI ‐14.8 to 2.4)

Informal emotional support (as much as wanted)
T: 93.9; C: 96.6
Difference ‐2.7 (95% CI ‐8.9 to 3.5)

Patient satisfaction measured at 4 weeks follow‐up

Advantages seen by patients

T: 108/117 (92.3%); C: 95/121 (78.5%)
Difference 13.8% (95% CI 5% to 23%)

Disadvantages seen by patients for caregivers
T: 39/117 (33.3%); C 14/121 (11.6%)

Difference 21.8% (95% CI 11.5% to 32%)

At discharge from hospital at home, or hospital
T: 25.0 (3.11); C: 24.66 (3.05)
Difference 0.83 (95% CI ‐5.23 to 6.89)

Hip replacement
Patient satisfaction *
At discharge from hospital at home, or hospital
T: 27.2 (5.2); C: 25 (4.7)
Difference 2.2 (95% CI ‐2.63 to 7.02)

Patient preference **
At discharge from place of care:
T: 85.7%; C: 50%
Difference 35.7% (95% CI 16.7% to 54.8%)

Knee replacement
Patient satisfaction *
At discharge from hospital at home, or hospital
T: 27.8 (4.1); C: 25.00 (5.19)
Difference 2.77 (95% CI ‐1.91 to 7.46)

Patient preference **
At discharge from place of care
Difference 34% (95% CI 14% to 54%)


Hysterectomy
Resumption of domestic duties
At discharge from hospital at home, or hospital
Difference ‐0.15 (95% CI ‐0.35 to 0.05)

Resume parental responsibilities before feeling well enough ^
At discharge from hospital at home, or hospital:
Difference ‐0.24 (95% CI ‐0.46 to ‐0.02)

Patient preference **
At discharge from place of care
T: 85.15%; C: 66.7%
Difference 19% (95% CI 8% to 30%)

* Modified version of satisfaction scale (Pound 1994)

Maximum score of 33

(higher score: more satisfied)

** Patient preference:

patients reporting they received preferred place of care

^ Resumption of domestic duties/parental responsibilities: patients were asked to agree/disagree on a 0 ‐ 3 scale (3: high level of agreement)

Caregiver outcomes

Difference between groups reported as significant in favour of the control group

No P value given, insufficient data to calculate CI

SF36 Physical component scale ‐ Median (IQR) *
T: ‐0.9 (‐7.1 to 5.3); C: 5.2 (‐16.4 to 6.0)
SF 36 Mental component scale ‐ Median (IQR)
T: 3.7 (‐2.5 to 9.9); C: ‐4.7 (‐19.8 to 10.3)
Caregiver Strain Index ‐ Median (IQR) **

T: 1.0 (0 to 4.0); C: 2.0 (0 to 6.8)
Carer time spent ‐ Median (IQR)
T: 18.6% (6.3 to 30.9); C: 22.1% (9.6 to 34.7)

4‐month follow‐up

* SF 36, higher score: greater improvement

** Carer Strain Index, a lower score; improvement

Advantages seen by caregivers for others
T: 31/117 (26.5%); C:12/121 (9.9%)

Observed difference: 16.6% (95% CI 6.9% to 26%)

Advantages seen by caregivers for patients
T: 97/117 (83%); C: 98/121 (81%)
Observed difference 1.9% (95% CI ‐7.8% to 11.7%)

Advantages seen by caregivers for themselves
T: 79/117 (67.5%); C: 86/121 (71.1%)
Observed difference ‐ 3.6% (95% CI ‐15.3% to 8.2%)
Disadvantages seen by caregivers for patients
T: 26/117 (22.2%); C: 14/121 (11.6%)

Observed difference: 10.6% (95% CI 1.2% to 20%)

Disadvantages seen by caregivers for themselves
T: 38/117 (32.5%); C: 12/121 (9.9%)

Observed difference 22.6% (95% CI 12% to 33%)

Disadvantages seen by caregivers for others
T: 5/117 (4.3%), C: 6/121 (4.9%)
Observed difference ‐0.7% (95% CI ‐6% to 4.6%)

Results reported at 1‐week follow‐up

Hip replacement

Carer Strain Index ‐ Median
T: 0.00; C: 1.00, Mann Whitney P = 0.34

Carer satisfaction ‐ Mean (SD)
T: 18.2 (2.5); C: 18.8 (2.5)
Difference ‐0.68 (95% CI ‐4.09 to 2.75)

Carer preference at 3 months
Difference: 18.9% (95% CI ‐1.36% to 39.2%)

Knee replacement

Carer Strain Index
T: 0.25; C:‐0.58
Difference 0.83 (95% CI ‐0.79 to 2.45)

Carer satisfaction
T: 19.57 (3.46); C: 18.2 (3.9)
Difference 1.37 (95% CI ‐2.55 to 5.29)

Carer preference at 3 months
T: 87.5%; C: 71.4%
Difference: 16.1% (95% CI ‐24.5% to 56.6%)

Hysterectomy

Carer Strain Index
T: 0.15; C: 0.28
Difference ‐0.13 (95% CI ‐0.77 to 0.52)

Carer satisfaction
Resumption of domestic duties
Difference ‐0.15 (95% CI ‐0.35 to 0.05)
Resumption of parental responsibilities

Difference ‐0.24 (95% CI ‐0.46 to ‐0.02)

Carer preference at 3 months
Difference 19% (95% CI 8% to 30%)

Hip replacement

Carer Strain Index

Median change from baseline at 3 months
Carer satisfaction

Modified version of satisfaction scale (Pound 1994)

Scale 0 ‐ 24 (higher score: more satisfied)

Caregiver preference:

Report of preferred place of care

Knee replacement and hysterectomy
Carer Strain Index

Mean change from baseline at 3 months
Carer satisfaction

Modified version of satisfaction scale (Pound 1994)

Scale 0 ‐ 24 (higher score:, more satisfied)

Caregiver preference:

Report of preferred place of care

(knee replacement)

Staff views ‐ GP workload

Verbal report

No P value given, insufficient data to calculate CI

Visits to GP
T: 3.3 (2.4 to 30.9); C: 4.5 (3.3 to 5.8)
Use of community services

T: 19/34 (63%); C: 23/32 (77%)

At 4‐month follow‐up

At 3 weeks post‐op
8 minutes extra for day‐care patients

No P value given, insufficient data to calculate CI

Hip replacement
Home and surgery visits:
median difference: GBP 27.35, P < 0.06

Kee replacement
Home and surgery visits:
median difference: GBP 0.00

Hysterectomy
Home and surgery visits:
median difference: GBP 0.00

Mann Whitney test

Length of stay (not included in meta‐analysis)

Total hospital length of stay ‐ Mean (SD)
T: 5.3 (2.68); C: 8.0 (1.78), P < 0.001

Hospital length of stay
T:18.48 (17.1); C: 26.59 (24.61)
Difference ‐8.11 (95% CI ‐14.7 to ‐1.51)
Length of stay post‐randomisation (elective surgical centre)
T: 1.8 (1.7); C: 4.2 (3.12)
Difference ‐2.4 (95% CI ‐4.05 to ‐0.75)
Length of stay post‐randomisation (acute hospital)
T: 3.1 (3.24); C: 13.5 (11.75)
Difference ‐10.4 (95% CI 8.23 to 12.6)
Total length of stay for patients with a surgical condition
T: 28.98 (18.12); C: 26.59 (24.6)

Difference 2.39 (95% CI ‐4.39 to 9.17)
Length of stay post‐randomisation in rehabilitative care ‐ Mean
T: 12.2; C: 16.8

Length of stay for patients with a surgical condition

(data obtained from authors)
Length of stay post‐randomisation

(elective surgical centre, acute hospital, in rehabilitative care ‐ published data)

Mean (SD) unless stated otherwise

Length of hospital stay

Hip replacement
T: 8.11 (5.52); C: 11.87 (4.52)
Difference ‐3.75 (95% CI ‐5.92 to ‐1.58)

Knee replacement
T: 10.28 (4.6); C: 13.31 (4.57)
Difference ‐3.02 (95% CI‐5.01 to ‐1.04)

Hysterectomy
T: 4.34 (1.86); C: 5.79 (2.98)
Difference ‐1.44 (95% CI‐2.09 to ‐0.79)

Total days of care

Hip replacement
T: 14.69 (5.13); C: 11.87 (4.52)
Difference ‐2.84 (95% CI 0.75 to 4.93)

Knee replacement
T: 16 (5.44); C: 13.31 (4.57)
Difference 2.69 (95% CI 0.5 to 4.88)

Hysterectomy
T: 7.45 (2.59); C: 5.79 (2.98)
Difference 1.66 (95% CI 0.94 to 2.39)

Hospital length of stay

Mean (SD) unless stated otherwise
Total days of care

Mean (SD) unless stated otherwise

Cost

Social cost (health service, society, patient)
Difference: GBP 6.90 per male hernia patient,
Difference: GBP 19.62 per female varicose vein patient

No P value given, insufficient data to calculate CI

1971/72 prices

Hospital costs for surgery
T: GBP 5644; C: GBP 5629
Difference GBP 15 (95% CI ‐363 to 457)

Costs of readmission

T: GBP 185; C: GBP 492
Difference GBP ‐306.00 (95% CI ‐758 to 61)
Primary care costs

T: GBP 58; C: GBP 63
Difference GBP ‐5 (95% CI ‐32 to 18)

Cost of hospital visits*
T: GBP 240; C: GBP 198
Difference GBP 42 995% CI ‐45 to 124)

Total costs at 12 weeks**

T: GBP 6127; C: GBP 6381
Difference GBP ‐254 (95% CI ‐919 to 348)

Health service perspective

Costs estimated for each patient

Unit costs obtained from hospital financial figures

and published data

* includes pre‐admission clinic, inpatient care, and home costs

** include inpatient hospital care, home care, primary care,

readmission and home visit costs

Total cost
T: GBP 2516; C: GBP 3292
Difference GBP 750

No estimates of variance, no test of statistical significance,

confidence intervals can not be calculated
Cost data financial year 1996 for community services

Health service costs (for a 48‐hour admission)

T: GBP 16 per patient; C: GBP 46 per patient

No P value given, insufficient data to calculate CI

1975/76 prices

Hip replacement

Hospital costs ‐ Mean (SD)
T: GBP 515.42 (473.20); C: GBP 776.30 (364.53)
Difference: GBP ‐260.88 (95%CI ‐441.56 to ‐80.19)

Hospital at home costs ‐ Mean (SD)
T: GBP 351.24 (240.58); C: N/A

Total health service costs ‐ Mean (SD)
T: GBP 911.39 (563.76); C: GBP 815.70 (347.99)
Difference: GBP 95.69 ratio of geometric mean 1.05 (95% CI 0.87 to 1.27)

Knee replacement

Hospital costs ‐ Mean (SD)
T: GBP 1092.24 (615.27); C: GBP 1348.35 (625.94)
Difference: GBP ‐256.11 (95% CI ‐524.61 to 12.38)

Hospital at home costs ‐ Mean (SD)
T: GBP 348.16 (275.25); C: N/A

Total health service costs ‐ Mean (SD)
T: GBP 1461.62 (666.61); C: GBP 1375.36 (637.76)
Difference: GBP 86.26

Hysterectomy
Hospital costs ‐ Mean (SD)
T: GBP 487.43 (350.20); C: GBP 647.77 (496.27)
Difference: GBP ‐160.34

Hospital at home costs ‐ Mean (SD)
Treatment: GBP 250.18 (273.54); C: N/A

Total health service costs ‐ Mean (SD)
T: GBP 771.78 (408.72); C: GBP 679.39 (439.83)
Difference: GBP 92.39

Cost data financial year 1994/1995

Health service perspective, dependency scores developed

to account for the different resources used during a patient's inpatient admission

Costs calculated at the patient level