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Pulse Home Health Care practices skilled health care procedures firmly rooted in the latest research and best practice policies. We routinely mail bulletins to physicians and other medical referral sources to highlight how we help patients and to explain the scientific basis for different services. On our home health website we share selected physician bulletins about Pulse's Home Health Services. If you have questions about how home health could help you, please contact us today.

New England Journal of Medicine - May 2011

America's Largest Stroke Rehab Study

Home Health Website ArticlesAt rehab facilities, physical therapy after a stroke often involves locomotor training, including the use of high-tech, body-weight supported treadmill stepping.  America’s largest stroke rehabilitation study to date finds that basic in-home physical therapy for stroke rehabilitation accomplishes results equal to high-tech locomotor training.  The results were published May 26 in the New England Journal of Medicine.  Pamela Duncan, PT, PhD, and colleagues hypothesized that locomotor training, including the use of body-weight-supported treadmill stepping, would achieve superior results to in-home physical therapy for stroke rehabilitation.  They recruited 400 stroke survivors and randomized them into three treatment groups: (1) locomotor training within two months of the stroke, (2) locomotor training within six months of the stroke, and (3) in-home, low-tech physical therapy within two months of the stroke. 

In a later interview, Duncan stated they were surprised to find that all three groups achieved the same results at one-year follow-up.  Between the three groups, there were no differences in improvement in walking speed, motor recovery, balance, functional status, social participation, or quality of life.  Fifty-two percent of all participants had increased functional walking distance at one year.  All patients received 36 training sessions spread over 12 to 16 weeks - a time frame equating to two home health episodes.  Researchers also measured fewer serious adverse events among the homecare group (2.2% among the early locomotor group, 3.5% among the later locomotor group, and 1.6% among the home therapy group).  The in-home group had fewer instances of dizziness and fainting.  In addition, the in-home therapy group proved less likely to drop out of the program (3% vs. 13%) and more likely to adhere to home exercise programs. 

This study adds to the long list of research demonstrating that effective stroke rehabilitation can happen more than six months after the stroke.  This study also demonstrates that in-home stroke rehabilitation is both safe and effective.  Authors go on to comment that their findings support the hypothesis that lower-cost, in-home therapy should be chosen over high-tech, facility-based stroke rehabilitation.  However, the choice is not either or, and the findings of Peter Langhorne published by the Lancet in 2005 suggest a combined strategy.   

Langhorne and colleagues combined 11 studies on stroke rehabilitation covering 1,597 cases.  Similarly, they found that stroke survivors discharged early to home care had statistically fewer deaths and less dependence.  However, they did not conclude that patients should skip in-patient rehabilitation.  On the contrary, Langhorne and colleagues found that best results were achieved when patients received both, inpatient rehabilitation followed promptly by home-based rehabilitation. 

Pulse Home Health Care invites all physicians to refer patients with rehab potential for in-home stroke rehabilitation.  We will combine the services of physical therapists, occupational therapists, speech therapists, home health nurses, medical social work, and home health aides to create a comprehensive stroke rehabilitation program for your patients.

 

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