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Evaluation of an extended stroke rehabilitation service (EXTRAS): a multicentre randomized controlled trial

Lookup NU author(s): Dr Lisa Shaw, Dr Richard Francis, Denise Howel, Dr Peter McMeekin, Dr Christopher Price, Elaine Stamp, Professor Luke Vale, Professor Helen Rodgers

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This is the authors' accepted manuscript of a conference proceedings (inc. abstract) that has been published in its final definitive form by Sage Publications Ltd, 2019.

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Abstract

Background: Stroke survivors frequently report unmet needs in the longer term but there is limited evidence to guide provision of ongoing rehabilitation. Method: This study was a randomized controlled trial involving 19 UK centres which provided early supported discharge (ESD). Adult stroke patients were individually randomized to receive extended stroke rehabilitation service (EXTRAS) or usual care (1:1). EXTRAS involved five rehabilitation reviews provided by an ESD team member between 1 and 18 months postESD. Reviews consisted of a semi-structured assessment of rehabilitation needs followed by goal-setting and action planning. The primary outcome was performance in extended activities of daily living (Nottingham Extended Activities of Daily Living (NEADL) scale) at 24months. Secondary outcomes included satisfaction with services, quality-adjusted life-year (QALYs) and costs. Analyses were ‘intention to treat’. Results/Findings: A total of 573 participants were randomized (EXTRAS n=285, usual care n=288). Mean 24-month NEADL scores were EXTRAS 40.0 (SD 18.1) and usual care 37.2 (SD 18.5) giving an adjusted mean difference of 1.8 (95% confidence interval (CI) –0.7 to 4.2). At 24months, patients in the intervention group were more satisfied with the services they received (97.7% vs. 87.5%, difference 10.2% (95% CI 5.3– 15.0)). EXTRAS provided more QALYs (0.07, 95% CI 0.01–0.12) and when combined with costs, there was a 90% chance of EXTRAS being costeffective at conventional thresholds of willingness to pay (£20,000 per QALY). Conclusion: EXTRAS did not improve stroke survivors’ performance in extended activities of daily living. However, due to the impact on costs and QALYs, EXTRAS has a high probability of being cost-effective at conventional thresholds of NHS willingness to pay.


Publication metadata

Author(s): Shaw L, Cant R, Drummond A, Ford GA, Forster A, Francis R, Hills K, Howel D, Laverty A, McKevitt C, McMeekin P, Price C, Stamp E, Stevens E, Vale L, Rodgers H

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: The Society for Research in Rehabilitation Winter 2019 Meeting

Year of Conference: 2019

Pages: 1540–1556

Print publication date: 01/09/2019

Online publication date: 27/08/2019

Acceptance date: 01/07/2019

Date deposited: 21/11/2019

Publisher: Sage Publications Ltd

URL: https://doi.org/10.1177/0269215519843983

DOI: 10.1177/0269215519843983


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