What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. Data Sources and Literature Searches
2.2. Study Selection
2.3. Data Extraction and Study Quality Assessment
2.4. Data Synthesis and Analysis
3. Results
3.1. Basic Characteristics of Included Studies
3.2. Methodological Quality
3.3. Interventions Characteristics of Included Studies
3.4. Mortality
3.5. Barthel ADL Index
3.6. Sensitivity Analysis
3.7. Publication Bias
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Category | Definition |
---|---|
Hospital-initiated support | Stroke unit care was combined with early supported discharge (e.g., health education before discharge, discharge action plans, appropriate positioning training, or integrated care pathway service) for patients’ further rehabilitation, and follow-up in close cooperation with the primary healthcare system. |
Home-visiting program | Home visits by healthcare providers, such as a physician, physiotherapist, occupational therapist, nurse, or pharmacist, who educated, reinforced self-care instructions, performed physical examination, or provided other care (e.g., individual counselling, which focused on education, applying information learned in practical situations, and solving problems occurring at home, was offered to the caregiver if needed, and physical therapy, occupational therapy, or medication reconciliation). These interventions were provided by various providers separately or by a multidisciplinary team. |
Structured telephone support | Monitoring, education, or self-care management (e.g., lifestyle counselling and assessment of pharmacological treatment) using simple telephone technology after discharge in a structured format (e.g., series of scheduled calls with a specific goal, structured questioning). |
Outpatient setting- based support | Services provided in a community (e.g., community physiotherapy service, stroke care coordinator service/care, rehabilitation setting, nursing home), except patients’ home. |
Primary education | Patient education (care management) delivered before or at discharge with motivational interviewing or empowerment intervention for self-management, or structured training program for caregivers. |
References | Country | Design | Control Group | Intervention Group | Only First-Ever Stroke | Stroke Subtype Described | Duration of Follow-Up (Month) | BI Score Described | Intervention | ||
---|---|---|---|---|---|---|---|---|---|---|---|
N, Male (%) | Age (Mean, y) | N, Male (%) | Age (Mean, y) | ||||||||
Rasmussen et al. 2016 [34] | Denmark | Single-center | 33 (42.0) | 79 | 38 (42.0) | 78 | NR | No | 3 | Yes | Home-visiting program (MT-led) |
Guidetti et al. 2015 [35] | Sweden | Multicenter | 151 (63.0) | 71 | 129 (57.0) | 74 | No | No | 12 | Yes | Home-visiting program (OP-led) |
Wong et al. 2015 [24] | China | Multicenter | 54 (37.0) | 71.5 | 54 (37.0) | 67.5 | No | Yes | 2 | No | Home-visiting program (OP-led) |
Bertilsson et al. 2014 [36] | Sweden | Multicenter | 151 (63.0) | 71 | 129 (57.0) | 74 | No | No | 3 | Yes | Home-visiting program (OP-led) |
Chaiyawat et al. 2012 [25] | Thailand | Single-center | 30 (43.0) | 66 | 30 (47.0) | 67 | NR | No | 24 | Yes | Home-visiting program (OP-led) |
Thorsen et al. 2005 [19] | Spain | Single-center | 41 (58.3) | 71 | 42 (50.0) | 71 | No | Yes | 60 | No | Home-visiting program (MT-led) |
Donnelly et al. 2004 [30] | UK | Multicenter | 54 (43.0) | 68 | 59 (43.0) | 71 | NR | No | 12 | Yes | Home-visiting program (MT-led) |
Andersen et al. 2002 [27] | Denmark | Multicenter | 48 (56.3) | 68.3 | 54 (44.4) | 69.8 | No | Yes | 6 | Yes | Home-visiting program (MT-led) |
Allen et al. 2002 [37] | USA | Single-center | 46 (46.0) | 72 | 47 (43.0) | 69 | NR | Yes | 3 | Yes | Home-visiting program (MT-led) |
Von Koch et al. 2001 [21] | Sweden | Single-center | 41 (55.0) | 72 | 42 (55.0) | 72 | No | Yes | 12 | No | Home-visiting program (MT-led) |
Anderson et al. 2000 [14] | Australia | Multicenter | 44 (50.0) | 71 | 42 (62.0) | 72 | No | Yes | 6 | Yes | Home-visiting program (MT-led) |
Fjaertoft et al. 2011 [16] | Norway | Single-center | 160 (44.0) | 73.8 | 160 (54.0) | 74 | No | No | 60 | Yes | Hospital-initiated support |
Jones et al. 2005 [38] | UK | Multicenter | 68 (50.0) | 71 | 52 (37.0) | 75 | Yes | No | 6 | Yes | Hospital-initiated support |
Askim et al. 2004 [12] | Norway | Single-center | 31 (54.8) | 76.3 | 31 (51.6.0) | 76.9 | No | Yes | 12 | Yes | Hospital-initiated support |
Fjaertoft et al. 2003 [20] | Norway | Single-center | 160 (44.0) | 73.8 | 160 (54.0) | 74 | No | No | 12 | Yes | Hospital-initiated support |
Fagerberg et al. 2000 [13] | Sweden | Single-center | 83 (46.0) | 79.7 | 167 (34.0) | 80.1 | No | Yes | 12 | No | Hospital-initiated support |
Indredavik et al. 2000 [22] | Norway | Single-center | 160 (44.0) | 73.8 | 16 (54.0) | 74 | No | No | 6 | Yes | Hospital-initiated support |
Sulch et al. 2000 [39] | UK | Single-center | 76 (56.0) | 74 | 76 (46.0) | 75 | NR | Yes | 6 | Yes | Hospital-initiated support |
Irewall et al. 2015 [40] | Sweden | Single-center | 271 (57.2) | 70.1 | 266 (56.8) | 71.5 | No | Yes | 12 | No | Structured telephone support |
Boter et al. 2004 [41] | Netherlands | Multicenter | 273 (48.0) | 63 | 263 (49.0) | 66 | Yes | Yes | 6 | Yes | Structured telephone support |
Sit et al. 2016 [23] | China | Single-center | 105 (52.4) | 70.7 | 105 (52.4) | 67.8 | Yes | Yes | 6 | No | Primary education |
Barker-Collo et al. 2015 [42] | New Zealand | NR | 193 (NR) | NR | 193 (NR) | NR | No | No | 12 | No | Primary education |
Forster et al. 2013 [43] | UK | Multicenter | 478 (32.0) | 60.8 | 450 (31.0) | 61.1 | No | Yes | 12 | No | Primary education |
Watkins et al. 2011 [17] | UK | Single-center | 207 (58.9) | 70 | 204 (57.8) | 70 | No | Yes | 12 | Yes | Primary education |
Watkins et al. 2007 [18] | UK | Single-center | 207 (58.9) | 70 | 204 (57.8) | 70 | No | Yes | 3 | Yes | Primary education |
Forster et al. 2015 [28] | UK | Multicenter | 399 (54.6) | 72.5 | 401 (53.6) | 70.9 | NR | Yes | 12 | No | Outpatient setting-based |
Askim et al. 2010 [10] | Norway | Single-center | 32 (55.2) | 77.6 | 30 (40.4) | 75.4 | No | No | 6 | Yes | Outpatient setting-based |
Langhammer et al. 2007 [26] | Norway | Multicenter | 40 (NR) | 72 | 35 (NR) | 76 | Yes | Yes | 12 | Yes | Outpatient setting-based |
Higgins et al. 2006 [44] | Canada | Multicenter | 44 (59.0) | 71 | 47 (64.0) | 73 | No | Yes | 1.5 | No | Outpatient setting-based |
Sackley et al. 2006 [29] | UK | Multicenter | 55 (18.0) | 86.3 | 63 (17.0) | 88.6 | NR | No | 6 | Yes | Outpatient setting-based |
Green et al. 2002 [45] | UK | Multicenter | 85 (54.0) | 73.5 | 85 (58.0) | 71.5 | NR | No | 9 | Yes | Outpatient setting-based |
References | Randomization Methods Reported | Researcher/Participant Blinded | Allocation Concealment | Blinding of Assessors | Inclusion/Exclusion Criteria Described | Attrition Rate Reported | Participants Lost to Follow Up Described | Intention to Treat Analysis | Similarity at Baseline | Power Analysis | Risk of Bias |
---|---|---|---|---|---|---|---|---|---|---|---|
Rasmussen et al. 2016 [34] | Yes | No | Yes | Yes | Yes | No | Yes | NR | Yes | Yes | Low |
Guidetti et al. 2015 [35] | No | NR | NR | Yes | Yes | No | Yes | Yes | NR | Yes | Unclear |
Wong et al. 2015 [24] | Yes | NR | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Low |
Bertilsson et al. 2014 [36] | NR | NR | NR | Yes | Yes | No | Yes | Yes | NR | Yes | High |
Chaiyawat et al. 2012 [25] | Yes | No | Yes | No | Yes | No | Yes | Yes | Yes | Yes | High |
Thorsen et al. 2005 [19] | Yes | NR | Yes | Yes | Yes | No | Yes | No | Yes | NR | Low |
Donnelly et al. 2004 [30] | Yes | NR | Yes | Yes | Yes | No | Yes | NR | Yes | Yes | Low |
Andersen et al. 2002 [27] | Yes | NR | Yes | Yes | Yes | No | Yes | Yes | Yes | NR | Low |
Allen et al. 2002 [37] | Yes | NR | Yes | No | Yes | No | Yes | NR | Yes | Yes | High |
Von Koch et al. 2001 [21] | Yes | NR | Yes | Yes | Yes | No | Yes | No | Yes | Yes | Low |
Anderson et al. 2000 [14] | Yes | NR | Yes | Yes | Yes | No | Yes | Yes | No | NR | Low |
Fjaertoft et al. 2011 [16] | NR | NR | NR | Yes | Yes | No | Yes | Yes | Yes | No | High |
Jones et al. 2005 [38] | NR | No | NR | NR | Yes | Yes | Yes | Yes | No | Yes | High |
Askim et al. 2004 [12] | Yes | NR | Yes | Yes | Yes | No | Yes | Yes | Yes | NR | Low |
Fjaertoft et al. 2003 [20] | Yes | NR | Yes | Yes | Yes | No | No | Yes | Yes | NR | High |
Fagerberg et al. 2000 [13] | NR | NR | NR | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Unclear |
Indredavik et al. 2000 [22] | NR | NR | NR | Yes | Yes | No | No | Yes | Yes | NR | Unclear |
Sulch et al. 2000 [39] | Yes | NR | Yes | Yes | Yes | No | No | Yes | Yes | Yes | High |
Irewall et al. 2015 [40] | Yes | No | NR | No | Yes | No | Yes | Yes | Yes | Yes | High |
Boter et al. 2004 [41] | Yes | NR | NR | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Unclear |
Sit et al. 2016 [23] | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Low |
Barker-Collo et al. 2015 [42] | Yes | No | NR | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Unclear |
Forster et al. 2013 [43] | Yes | NR | Yes | NR | Yes | Yes | Yes | Yes | Yes | Yes | Unclear |
Watkins et al. 2011 [17] | Yes | NR | Yes | Yes | Yes | No | Yes | Yes | Yes | NR | Low |
Watkins et al. 2007 [18] | Yes | NR | Yes | Yes | Yes | No | Yes | Yes | Yes | NR | Low |
Forster et al. 2015 [28] | Yes | No | NR | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Unclear |
Askim et al. 2010 [10] | Yes | No | NR | Yes | Yes | No | Yes | Yes | No | Yes | Unclear |
Langhammer et al. 2007 [26] | Yes | Yes | NR | NR | Yes | No | Yes | Yes | Yes | Yes | Unclear |
Higgins et al. 2006 [44] | Yes | NR | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Low |
Sackley et al. 2006 [29] | Yes | NR | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Low |
Green et al. 2002 [45] | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Low |
Subcategory | Intervention Group | Control Group | Fixed Effect Model | Random Effect Model | Heterogeneity | ||||
---|---|---|---|---|---|---|---|---|---|
Events | Total | Events | Total | RR (95% CI) | RR (95% CI) | I2 (%) | τ2 | p | |
Total effect of TCI | 331 | 3817 | 380 | 3820 | 0.86 (0.75–0.98) | 0.85 (0.72–1.01) | 17.50 | 0.03 | 0.20 |
≤3 months | 7 | 519 | 28 | 535 | 0.27 (0.12–0.58) | 0.27 (0.12–0.60) | 0.00 | 0.00 | 0.92 |
≥6 months | 324 | 3298 | 352 | 3820 | 0.91 (0.79–1.04) | 0.92 (0.80–1.05) | 1.8 | 0.00 | 0.20 |
Home-visiting program | |||||||||
Total effect | 20 | 666 | 47 | 693 | 0.46 (0.28–0.74) | 0.47 (0.29–0.79) | 0.00 | 0.00 | 0.62 |
≤3 months | 3 | 268 | 16 | 284 | 0.21 (0.07–0.65) | 0.22 (0.07–0.67) | 0.00 | 0.00 | 0.90 |
≥6 months | 17 | 398 | 31 | 409 | 0.58 (0.34–1.00) | 0.58 (0.33–1.01) | 0.00 | 0.00 | 0.59 |
Hospital-initiated support | |||||||||
Total effect | 178 | 805 | 161 | 738 | 0.99 (0.83–1.09) | 0.98 (0.82–1.17) | 0.00 | 0.00 | 0.73 |
≤3 months | - | - | - | - | - | - | - | - | - |
≥6 months | 178 | 805 | 161 | 738 | 0.99 (0.83–1.09) | 0.98 (0.82–1.17) | 0.00 | 0.00 | 0.73 |
Structured telephone support | |||||||||
Total effect | 16 | 529 | 15 | 544 | 1.17 (0.58, 2.38) | 1.17 (0.58, 2.38) | 0.00 | 0.00 | 0.63 |
≤3 months | - | - | - | - | - | - | - | - | - |
≥6 months | 16 | 529 | 15 | 544 | 1.17 (0.58, 2.38) | 1.17 (0.58, 2.38) | 0.00 | 0.00 | 0.63 |
Primary education | |||||||||
Total effect | 76 | 1156 | 94 | 1190 | 0.84 (0.63–1.12) | 0.74 (0.44–1.23) | 44.30 | 0.14 | 0.13 |
≤3 months | 4 | 204 | 12 | 207 | 0.34 (0.11–1.03) | 0.34 (0.11–1.03) | Not applicable for a single study | ||
≥6 month | 72 | 952 | 82 | 983 | 0.92 (0.68–1.24) | 0.86 (0.55–1.36) | 29.00 | 0.07 | 0.24 |
Outpatient setting-based | |||||||||
Total effect | 51 | 661 | 63 | 655 | 0.79 (0.56–1.11) | 0.70 (0.37–1.31) | 46.50 | 0.21 | 0.11 |
≤3 months | 0 | 47 | 0 | 44 | - | - | Not applicable for a single study | ||
≥6 months | 51 | 614 | 63 | 611 | 0.79 (0.56–1.11) | 0.70 (0.37–1.31) | 46.50 | 0.21 | 0.11 |
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Wang, Y.; Yang, F.; Shi, H.; Yang, C.; Hu, H. What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis. Int. J. Environ. Res. Public Health 2017, 14, 510. https://doi.org/10.3390/ijerph14050510
Wang Y, Yang F, Shi H, Yang C, Hu H. What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis. International Journal of Environmental Research and Public Health. 2017; 14(5):510. https://doi.org/10.3390/ijerph14050510
Chicago/Turabian StyleWang, Yuncui, Fen Yang, Hao Shi, Chongming Yang, and Hui Hu. 2017. "What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis" International Journal of Environmental Research and Public Health 14, no. 5: 510. https://doi.org/10.3390/ijerph14050510