Home-based Stroke Rehabilitation

July 2014 Journal Club: Siemonsma, P., Dopp, C., Alpay, L., Tak, E., van Meeteren, N and Chorus, A. (2014) Determinants influencing the implementation of home-based stroke rehabilitation: A systematic review. Disability and Rehabilitation. (Early Online) DOI: 0.3109/09638288.2014.885091

Purpose: Home-based rehabilitation is a promising alternative to regular center-based stroke rehabilitation. The objective of this study was to identify what is currently known about determinants that influence the implementation of home-based stroke rehabilitation (HBSR) in clinical practice.

Methods: A systematic review of determinants of HBSR was conducted, using a framework for innovation (including determinants related to the innovation, the user, the organization, and the socio-political context). Reviews, meta-analyses, and qualitative studies were included. Studies were selected if they concerned: home-based rehabilitation of stroke patient’s (motor) function, changes in in-person service delivery (> 24 h to 12 months post-stroke) and determinants of implementation.

Results: A total of 88 studies were identified, of which 7 studies met the inclusion criteria. Identified determinants of implementation of HBSR were: intervention effectiveness, the exact nature of the medical condition, satisfaction with services, coordination of services, inter-professional collaborations, availability of appropriate training equipment, and costs. However, none of the studies had the primary aim to identify determinants of implementation.

Conclusion: A more complete and detailed overview of existing determinants of HBSR is needed to assist professionals and organizations in decision-making on HBSR implementation and development of suitable strategies for implementation.

Implications for Rehabilitation

  • Committed professionals and a smooth transfer to the home-environment are essential elements for home-based rehabilitation or early supported discharge.
  • The determinants related to the client include age, needs, stability and severity of the stroke as well as the living conditions.
  • Clients and care givers should be involved in the recovery process including the decision for early discharge and home-based rehabilitation.
  • It is necessary that essential therapy equipment be provided and that the travel times and costs of therapists are reimbursed.