Primary objective of this study is to determine whether a case management of stroke patients after discharge to home or to nursing home results in improving physical and cognitive capacity one year after discharge.
In a randomized trial, the project Participative rehabilitation process management "Stroke in Saxony-Anhalt" (PaReSiS) implements a case management trial, explicitly including all providers in the course of illness, treatment and rehabilitation. To achieve this, patients in the intervention group have the opportunity to choose, specifically and according to their own needs, from the offers of a web portal and a telephone hotline, from individual counselling and info sessions as well as from home visits. Patients in the control group receive patient-information-notes beyond primary care. There will be qualitative interviews with the persons concerned and/or their relatives in both groups in order to validate the instruments.
- Case management Behavioral
Intervention Desc: Usual stroke aftercare plus patient-information-notes ARM 1: Kind: Experimental Label: 1 ARM 2: Kind: Experimental Label: 2 ARM 3: Kind: Experimental Label: Case management Description: Case management with patient-information-notes, telephone hotline, individual counselling using home visits, e-mail and telephone contact, web portal ARM 4: Kind: Experimental Label: usual care Description: Usual stroke aftercare plus patient-information-notes
- Allocation: Randomized
- Masking: Single Blind (Outcomes Assessor)
- Purpose: Health Services Research
- Endpoint: Efficacy Study
- Intervention: Parallel Assignment
|Type||Measure||Time Frame||Safety Issue|
|Primary||Physical and cognitive capacity using the Functional Independence Measure (FIM)||at 1 year after discharge||No|
|Secondary||Health related quality of life, depression, mortality, recurrent stroke and/or TIA/PRIND||three days before discharge home - one year after intervention begins||No|
|Primary||physical scale of the Stroke Impact Scale 3.0||before discharge from acute care, four weeks after discharge from the hospital or rehabilitation (in case of referral to a medical rehabilitation) immediately before randomization (baseline assessment), and 12 months after randomization||No|