Study designs of evaluations included in the review
Meta-analysis, randomised controlled trials (RCTs), non-RCTs, cohort studies, case-control studies, before and after studies (using a before and after comparison of an intervention). Economic analyses were also considered for inclusion in the review. Studies were excluded if they included a sample size less than 50, participation rate less than 50%, follow-up rate less than 50%, and published as a letter or abstract only. Only studies which included a control group were included in the intervention sections. The follow-up period ranged from 3 to 19 months.
Specific interventions included in the review
Early discharge, home based rehabilitation and community base interventions. Control usually involved conventional care, hospital based rehabilitation or no access to the community programme. The type of community based interventions investigated by included studies were occupational therapy in the home setting, access to specialised nursing care, social support, additional out-patient rehabilitation, and community based programme to improve patient and post hospital care. The review also investigated the impact of stroke patients orientated interventions on carer health.
Participants included in the review
Patients who have had a stroke and their carers. Studies were excluded if less than 50% or a non-defined proportion of the study population had a stroke. Where given, the mean age range of included patients was 67-75.
Outcomes assessed in the review
Any patient or carer related outcomes reported by the study were included in the review. The specific outcome measures used included early discharge, mortality, readmission, stroke recurrence, length of hospital stay, living status, health of the patient or carer and rehabilitation outcomes. The measures used to assess outcomes within included studies were the Barthel index, Beck's depression inventory, Brunnstrom's motor rating, Centre for Epidemiologic Studies-depression scale, Dartmouth Coop Function Charts, ESCROW, extended activities of daily living, family assessment device, Frenchay activities index, general health questionnaire, geriatric depression scale, hospital anxiety and depression scale, Jebsen hand function evaluation, Katz activities of daily living, Lindmark motor capacity assessment, Motor club assessment, Nine hole peg test, sickness impact profile, social support inventory for stroke survivors, state trait anxiety inventory.
How were decisions on the relevance of primary studies made?
A single reviewer assessed identified articles for inclusion using the previously stated criteria.