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Home rehabilitation after stroke. Reviewing the scientific evidence on effects and costs
Linköping University, The Tema Institute. Linköping University, Faculty of Arts and Sciences.
2000 (English)In: International Journal of Technology Assessment in Health Care,, ISSN 0266-4623, Vol. 19, no 3, 842-848 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The question addressed here is whether home rehabilitation after stroke is better and/or less expensive than the more conventional alternatives, i.e., rehabilitation during inpatient care, day care, and outpatient visits--alone or in combinations appropriate to disease stage and patient needs. Home rehabilitation is managed by teams of professionals who train patients at home. METHODS: The scientific literature was systematically searched for controlled studies comparing outcomes and costs of home rehabilitation with the more conventional strategies. RESULTS: The abstracts of 204 papers were evaluated, from which 89 were selected for greater scrutiny. From the 89 studies, we found 7 controlled studies involving 1,487 patients (6 of the 7 were randomized, 4 of the 6 assessed costs). No statistically significant differences, or tendencies toward differences, were revealed as regards the outcome of home rehabilitation versus hospital-based alternatives. Thus, home rehabilitation was neither better nor worse at improving patients' ability to manage on their own or resume social activities. Depression and reduced quality of life were common in all groups of patients and caregivers, irrespective of the rehabilitation strategy. In the four randomized studies that reported on costs, home rehabilitation was found to be less expensive than regular day care, but not less expensive than conventional strategies even though hospital stay was reduced. CONCLUSION: The outcomes and costs of home rehabilitation after stroke seem to be comparable to alternative treatment strategies.

Place, publisher, year, edition, pages
2000. Vol. 19, no 3, 842-848 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13752OAI: diva2:21297
Available from: 2002-12-19 Created: 2002-12-19
In thesis
1. Health economic studies on advanced home care
Open this publication in new window or tab >>Health economic studies on advanced home care
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to examine the cost-effectiveness of specific advanced home care and home rehabilitation interventions and to improve economic evaluation methods when applied to advanced home care. This included a comparison of two alternative ways of administering oxygen at home to patients with chronic hypoxaemia, as well as a review of scientific evidence on costs and effects of home rehabilitation after stroke. Also included were studies on prominent methodological issues in advanced home care - the redistribution of care efforts among caregivers and costing of informal care efforts.

For patients with chronic hypoxaemia, a randomised, controlled trial showed that mobile liquid oxygen was considerably more costly compared to concentrator treatment. However, the treatment effects showed that liquid oxygen had a better impact on patient quality of life. The literature review revealed that the outcomes and costs of home rehabilitation after stroke are equal to those of alternative treatment strategies. Similar results were obtained in a study comparing hospital-based and home-based stroke rehabilitation, which also showed that there is a considerable redistribution of costs between health care providers and social welfare providers. Studies of patients in advanced home care in the county of Östergötland, Sweden, showed that the cost of informal care constitutes a considerable part of the care effort in all costing approaches used. Also, informal care costs were higher among patients who were men, who were younger, who had their own housing and had a cancer diagnosis.

This thesis reveals that advanced home care interventions can differ regarding costs as well as effects, and thus comparisons between alternative home care interventions must also be performed. Further, redistribution effects are important to consider in evaluations. The cost of informal care is substantial in advanced home care. These costs must be included in evaluations with a societal perspective or else the comparisons will be biased.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. 66 p.
Linköping Dissertations on Health and Society, ISSN 1651-1646 ; 2
health economics, economic evaluation, advanced home care, redistribution, cost, informal care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
urn:nbn:se:liu:diva-5405 (URN)91-7373-445-4 (ISBN)
Public defence
2002-11-22, Aulan, Hus 240, Campus US, Linköpings universitet, Linköping, 10:00 (English)
Available from: 2002-12-19 Created: 2002-12-19 Last updated: 2012-01-25Bibliographically approved

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Andersson, A.
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