John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. The Cochrane Stroke Group has produced nearly 200 systematic reviews over the last two decades and many of these have been updated multiple times. Among these is a review of the effects of early discharge services, which was published first in 2001. It was updated in July 2017 and lead author and one of the Co-ordinating Editors for Cochrane Stroke, Peter Langhorne from the University of Glasgow in Scotland, describes these latest findings in this podcast.

Peter: People who experience a stroke are usually admitted to hospital for diagnostic tests, immediate medical treatment and rehabilitation. In recent years, services have been developed to offer stroke patients an earlier discharge home and provide rehabilitation in or near their home. These are called Early Supported Discharge, or ESD, services and are usually provided by a multi-disciplinary team of therapists, nurses and doctors who work together to manage the patient’s rehabilitation needs. The main aim is to allow the patient to go home from hospital earlier than is usually possible and to receive more rehabilitation in the familiar environment of their own home.
After an extensive search, we identified 17 clinical trials from nine countries that had included over 2,400 stroke patients. These patients tended to have a moderate degree of disability but were sufficiently well to consider returning home. There were several different approaches to delivering ESD services, with varying degrees of multi-disciplinary coordination; from close coordination to no multi-disciplinary team input.
Across all the trials identified, ESD services appeared to reduce the length of stay in hospital by approximately five days. People who received these services were also more likely to be independent in daily activities and to be living at home six months after their stroke. Information was less complete for other outcomes such as mood and quality of life, and we could not identify any clear hazards from ESD services. It was difficult to compare the costs of ESD services across the various studies but, on average, they did not appear to result in substantial additional costs.
In a series of additional analyses, we found that results appeared better if the ESD team had a well co-ordinated multi-disciplinary staffing and if the service was targeted at people with mild-moderate disability.
In summary, we’ve found that appropriately resourced ESD services provided by a co-ordinated multi-disciplinary team can reduce the length of time that stroke patients spend in hospital and reduce their long-term disability, but results are inconclusive for services that do not have a co-ordinated multi-disciplinary team input.

John: If you would like to read more about the specific types of early supported discharge service that have been tested in the trials in Peter’s review, just go to Cochrane Library dot com and run a simple search for 'ESD'.