TY - JOUR
T1 - Effectiveness of interventions to support the transition home after acute stroke
T2 - a systematic review and meta-analysis
AU - O’Callaghan, Geraldine
AU - Fahy, Martin
AU - Murphy, Paul
AU - Langhorne, Peter
AU - Galvin, Rose
AU - Horgan, Frances
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Effective support interventions to manage the transition to home after stroke are still mostly unknown. Aim: The purpose of this systematic review was to investigate the effectiveness of support interventions at transition from organised stroke services to independent living at home. Methods: The Cochrane Central Register of Controlled Trials, six databases including MEDLINE and Embase, trial registries, grey literature, and Google Scholar were all searched, up to June 2021. We included randomised controlled trials enrolling people with stroke to receive either standard care or any type of support intervention from organised stroke services to home. The primary outcome was functional status. Two authors determined eligibility, extracted data, evaluated risk of bias (ROB2), and verified the evidence (GRADE). Where possible we performed meta-analyses using Risk Ratios (RR) or Mean Differences (MD). Results: We included 17 studies. Support interventions led to important improvements in functional status, as determined by the Barthel Index up, to 3-months (MD 7.87 points, 95%CI:6.84 to 19.16; 620 participants; five studies; I2 = 77%). Results showed modest but significant functional gains in the medium to long-term (6–12 month follow up, MD 2.91 points, 95%CI:0.03 to 5.81; 1207 participants; six studies; I2 = 84%). Certainty of evidence was low. Support interventions may enhance quality of life for up to 3-months (MD 1.3,95% CI:0.84 to 1.76), and reduce depression (SMD -0.1,95% CI:-0.29 to − 0.05) and anxiety (MD -1.18,95% CI:-1.84 to − 0.52) at 6–12 months. Effects on further secondary outcomes are still unclear. Conclusions: Incorporating support interventions as people who have experienced a stroke transition from hospital to home can improve functional status and other outcomes. Due to study heterogeneity, the essential components of effective transition of care interventions are still unknown. Adoption of core outcome sets in stroke research would allow for greater comparison across studies. Application of a development and evaluation framework engaging stakeholders would increase understanding of priorities for stroke survivors, and inform the key components of an intervention at transition from hospital-to-home. Trial registration: CRD42021237397 - https://www.crd.york.ac.uk/prospero
AB - Background: Effective support interventions to manage the transition to home after stroke are still mostly unknown. Aim: The purpose of this systematic review was to investigate the effectiveness of support interventions at transition from organised stroke services to independent living at home. Methods: The Cochrane Central Register of Controlled Trials, six databases including MEDLINE and Embase, trial registries, grey literature, and Google Scholar were all searched, up to June 2021. We included randomised controlled trials enrolling people with stroke to receive either standard care or any type of support intervention from organised stroke services to home. The primary outcome was functional status. Two authors determined eligibility, extracted data, evaluated risk of bias (ROB2), and verified the evidence (GRADE). Where possible we performed meta-analyses using Risk Ratios (RR) or Mean Differences (MD). Results: We included 17 studies. Support interventions led to important improvements in functional status, as determined by the Barthel Index up, to 3-months (MD 7.87 points, 95%CI:6.84 to 19.16; 620 participants; five studies; I2 = 77%). Results showed modest but significant functional gains in the medium to long-term (6–12 month follow up, MD 2.91 points, 95%CI:0.03 to 5.81; 1207 participants; six studies; I2 = 84%). Certainty of evidence was low. Support interventions may enhance quality of life for up to 3-months (MD 1.3,95% CI:0.84 to 1.76), and reduce depression (SMD -0.1,95% CI:-0.29 to − 0.05) and anxiety (MD -1.18,95% CI:-1.84 to − 0.52) at 6–12 months. Effects on further secondary outcomes are still unclear. Conclusions: Incorporating support interventions as people who have experienced a stroke transition from hospital to home can improve functional status and other outcomes. Due to study heterogeneity, the essential components of effective transition of care interventions are still unknown. Adoption of core outcome sets in stroke research would allow for greater comparison across studies. Application of a development and evaluation framework engaging stakeholders would increase understanding of priorities for stroke survivors, and inform the key components of an intervention at transition from hospital-to-home. Trial registration: CRD42021237397 - https://www.crd.york.ac.uk/prospero
KW - Intervention effectiveness
KW - Meta-analysis
KW - Stroke
KW - Systematic review
KW - Transition
UR - http://www.scopus.com/inward/record.url?scp=85136864690&partnerID=8YFLogxK
U2 - 10.1186/s12913-022-08473-6
DO - 10.1186/s12913-022-08473-6
M3 - Article
C2 - 36031608
AN - SCOPUS:85136864690
SN - 1472-6963
VL - 22
SP - 1095
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 1095
ER -