Follow-up of a controlled trial of domiciliary stroke rehabilitation (DOMINO Study)

Abstract

The DOMINO study compared domiciliary and hospital-based rehabilitation services for stroke patients after discharge from hospital, stratified by the hospital ward at discharge. No difference between the services had been found at 6 months, but home therapy was better than outpatient department therapy at improving household ability and leisure activity in the patients discharged from the Stroke Unit (SU), and attendance at a day hospital may have been better than a domiciliary service at preventing death or institutionalization for patients discharged from Health Care of the Elderly (HCE) wards. We report the follow-up of the patients between 6 months and 1 year after discharge, during which time few patients received further treatment and little change in health or function occurred. Over this period the benefits of domiciliary rehabilitation in the SU group were lost, largely because the patients who had been treated in outpatient departments continued to improve. Between 6 months and 1 year the numbers of HCE patients in the two treatment groups who died or were institutionalized were similar, but the advantage of day hospital attendance was still evident at 1 year.