In-Home Stroke Rehab

Equivalent to Center-Based Stroke Rehab 

At rehab facilities, physical therapy after a stroke often involves locomotor training, including the use of high-tech, body-weight-supported treadmill stepping. America’s largest stroke rehabilitation study to date finds that basic in-home physical therapy for stroke rehabilitation accomplishes results equal to center-based, high-tech locomotor training with fewer adverse events.¹ Pamela Duncan, PT, PhD, and colleagues hypothesized that locomotor training, including the use of body-weight-supported treadmill stepping, would achieve superior results to in-home physical therapy for stroke re-habilitation. They recruited 408 stroke survivors and randomized them into three treatment groups: (1) locomotor training within 2 months of the stroke; (2) locomotor training within 6 months of the stroke; and (3) in-home, low-tech physical therapy within 2 months of the stroke. 

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In a later interview, Duncan stated they were surprised to find that all three groups achieved similar results at one-year follow-up. Between the three groups, there were no differences in improvement in walking speed, motor recovery, balance, functional status, social participation, or quality of life. Fifty-two percent of all participants had increased functional walking distance at one year. All patients received 36 training sessions spread over 12 to 16 weeks - a time frame equivalent to two home health episodes. Researchers also measured fewer serious adverse events among the homecare group (2.2% among the early locomotor group, 3.5% among the later locomotor group, and 1.6% among the home therapy group). The in-home group had fewer instances of dizziness and fainting. In addition, the in-home therapy group proved less likely to drop out of the program (3% vs. 13%) and more likely to adhere to home exercise programs.

By providing rehabilitation past the six-month mark, this study adds to a body of evidence pointing out that effective stroke rehabilitation can happen more than six months after the stroke.²⁻⁵ This study also demonstrates that in-home stroke rehabilitation is both safe and effective. Authors go on to comment that their findings support the hypothesis that lower-cost, in-home therapy should be chosen over high-tech, facility-based stroke rehabilitation. However, the choice is not either or, and the findings of Peter Langhorne published by the Lancet in 2005 suggest a combined strategy.⁶

Langhorne and colleagues combined 11 studies on stroke rehabilitation covering 1,597 cases. Similarly, they found that stroke survivors discharged early to home care had statistically fewer deaths and less dependence. In their meta-analysis, groups receiving in-home therapy proved six percent more likely to regain independence. However, they did not conclude that patients should skip in-patient rehabilitation. On the contrary, Langhorne and colleagues found that best results were achieved when patients received both, inpatient rehabilitation followed promptly by home-based rehabilitation. 
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Five Star Home Health invites all physicians to refer patients with rehab potential for in-home stroke rehabilitation. We will combine the services of physical therapists, occupational therapists, speech therapists, home health nurses, medical social work, and home health aides to create a comprehensive stroke rehabilitation program for your patient. If patients are receiving inpatient rehabilitation, our stroke rehabilitation services delivered promptly after discharge will continue and improve upon results achieved when patients are discharged to self-care. For patients not receiving inpatient services, in-home stroke rehab has been shown safer than and as effective as in-patient rehab with the significant advantages of higher patient adherence, patient convenience, and Medicare paying 100% with no out-of-pocket for patients.

Want more information about in-home stroke rehabilitation? Click here to email us or call 310-642-0026.

​References 

1. Fritz J, Childs J, Wainner R, Flynn T. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs. Spine. 2012; 37 (25): 2114-21. 
2. Gelhorn A, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy. Spine. 2012; 37 (9): 775-782. 
3. Machado L, Kamper S, Herbert R, et al. Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatology (Oxford). 2009; 48: 520-7. 
4. Costa L, Maher C, McAuley J, et al. Prognosis for patients with chronic low back pain: inception cohort study. BMJ. 2009; 339: b3829. 
5. Oliveira V, Ferreira P, Maher C, et al. Effectiveness of self-management of low back pain: systematic review with meta-analysis. Arthritis Care & Research. 2012; 64 (11): 1739-1748. 
6. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147: 478-91.