What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis

• Published in: International journal of environmental research and public health Vol. 14; no. 5; p. 510
• Main Authors: Wang, Yuncui, Yang, Fen, Shi, Hao, Yang, Chongming, Hu, Hui
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 10.05.2017; MDPI
• Subjects: Activities of Daily Living; Adult; Bias; Caregivers; Clinical trials; Confidence intervals; Design; Discharge; Health care; Health education; Home Care Services - organization & administration; Hospitals; Humans; Intervention; Meta-analysis; Mortality; Patient Care Team - organization & administration; Patients; Primary care; Randomized Controlled Trials as Topic; Rehabilitation; Risk; Statistical analysis; Stroke; Stroke - mortality; Stroke Rehabilitation - methods; Studies; Subacute care; Transitional Care - organization & administration; meta-analysis; mortality; ADL; interventions; transitional care; stroke
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph14050510

Stroke is a major cause of disability and mortality worldwide; yet; prior to this study; there had been no sufficient evidence to support the effectiveness of various transitional care interventions (TCI) on the disability and mortality of stroke survivors. This meta-analysis aimed to assess the effectiveness of TCI in reducing mortality and improving the activities of daily life (ADL) of stroke patients. PubMed; Web of Science; OVID; EMBASE; CINAHL; and Sino-Med were searched for articles published before November 2016. Thirty-one randomized controlled trials (RCTs) were identified in the study. This analysis showed that the total effect of TCI on reducing mortality was limited (Risk Ratio (RR) = 0.86; 95% Confidence Interval (CI): 0.75-0.98); that only home-visiting programs could reduce mortality rates (RR = 0.34; 95% CI: 0.17-0.67) compared with usual care; and that the best intervention was led by a multidisciplinary team (MT) ≤3 months (RR = 0.19; 95% CI: 0.05-0.71). In addition; home-visiting programs also produced ADL benefit (RR = 0.56; 95% CI: 0.31-0.81). Overall; there was a statistically significant difference in improving patients' independence between TCI and usual care (RR = 1.12; 95% CI: 1.02-1.23). However; none of the interventions was effective when they were differentiated in the analysis. It is the conclusion of this study that home-visiting programs; especially those led by MTs; should receive the greatest consideration by healthcare systems or providers for implementing TCI to stroke survivors.