Pragmatic multicenter randomized controlled study on early supported discharge after stroke in Korea: the KOMPACT study

Abstract

Background: Early supported discharge (ESD) has shown benefits in post-acute stroke care in Western countries; however, its effectiveness in Asian healthcare systems remains unclear.

Objectives: To investigate the efficacy and economic impact of ESD compared with conventional rehabilitation (CR) in Korean patients recovering from acute stroke.

Methods: The Korean Model for post-acute comprehensive rehabilitation (KOMPACT) study was a multicenter, single-blind, randomized controlled trial. Patients with mild-to-moderate stroke (modified Rankin Scale 1-3) were randomly assigned to the ESD or CR groups. ESD included 4 weeks of home-based rehabilitation and liaison services, including welfare applications and community care. Outcomes were assessed at baseline, 1 month after discharge, and 3 months after stroke. T-test, Chi-Square test, and Fisher's exact test were used to compare the outcomes between two groups.

Results: Sixty-seven patients were enrolled, 61 (mean [SD] age, 66 [12] years, female n=13) of whom completed the study. No significant differences were found in the clinical outcomes, including functional dependence, between the groups. The ESD group (n=30) showed greater improvement in depressive symptoms from baseline to 3 months than the CR group (n=31) (p=0.025). Length of stay (17.8 days vs 18.3 days) and total deductible costs (2657.3 US dollars vs 2140.5 US dollars) did not significantly differ between the groups. However, one hospital site reported significantly lower rehabilitation costs for ESD. Patient and caregiver satisfaction were significantly higher in the ESD group in most domains.

Conclusion: ESD for Korean patients recovering from mild-to-moderate acute stroke showed clinical and economic outcomes comparable to those of CR, with potential benefits of mood improvement and higher patient satisfaction. These findings suggest that ESD could be a feasible transitional care model in the Korean healthcare system. Nonetheless, further research with larger sample sizes and more extended follow-up periods is needed to confirm ESD's long-term effects.

Registrations: URL: https://www.

Clinicaltrials: gov; Identifier: NCT04720820.

Keywords: Early supported discharge; Korea; Quality of life; Randomized controlled trials; Stroke; Transitional care.