Five studies were included in the review: one RCT; three before-and-after studies; and one case study. The number of participants was not reported.
The included studies appeared to have been methodologically weak.
The RCT found no significant differences in total length of hospital stay, rehabilitation therapy, anxiety or mortality between the integrated care pathway group and those who received conventional multidisciplinary team care. Patients who received multidisciplinary team care improved significantly faster between four and 12 weeks (p<0.01); there was no significant difference in recovery at 26 weeks. A significantly greater proportion of patients in the integrated care pathway group were screened for visual or sensory inattention (p=0.015) and nutritional assessment (p<0.001); there were no significant differences in a number of other outcomes relating to care and patient measures. Overall, integrated care pathway-led stroke management was associated with a poorer quality of life than that achieved by multidisciplinary team care (various measures to assess quality of life were reported).
One before-and-after study found inconsistent evidence in total length of stay between the integrated care pathway intervention and control groups. This study also reported that the number of urinary tract infections was significantly reduced (p<0.05) in the integrated care pathway intervention group compared to controls, and that the introduction of the integrated care pathways reduced contractual losses to the hospital. Other outcomes were non-significant.
Another before-and-after study reported that the proportion of patients receiving a brain CT scan within 24 hours of stroke was significantly increased in integrated care pathway-managed patients (p=0.0017). There were also significant increases in the provision of investigations to establish the aetiology of cerebral infarct (p<0.05) and the use of prophylactic measures to prevent deep venous thrombosis (p=0.0026). There was no significant difference in the number of patients receiving preventative drug therapy at discharge. Average length of stay was reduced in integrated care pathway-managed patients, but the difference was not significant.
The third before-and-after study found that patients in the integrated care pathway group were more likely to receive a CT brain scan within 24 hours and 48 hours (p=0.02 for both) than patients in the control group. There were no significant differences for carotid duplex scan, echocardiography, cerebral angiography, use of medications or the provision of other types of therapy (dietician assessment, occupational therapy, speech and language therapy) or nursing interventions. There was also no difference in the length of stay between groups. A number of patient outcomes were also measured; there were fewer UTIs in the integrated care pathway group (p=0.03).
The case study reported how an integrated care pathway may be utilised effectively.