New Delhi, Nov. 3: Home-based care for survivors of strokes when appropriately supervised appears to be as good as expensive hospital-based rehabilitation, a 13-city research study in India has suggested.
The two-year study which tracked the progress of 1,250 survivors of stroke has found that patients who had received home-based rehabilitation had similar levels of improvement or disability as those who received usual care.
Neurologists and public health specialists are considering the results as important given India's large number of stroke patients, the lack of appropriate stroke facilities in the country, and the fragmented nature of rehabilitation services that survivors currently receive.
"We find that family members can provide a cocoon of care for rehabilitation, but only when supervised and as a supplement to good clinical care during the acute phase of the stroke," said G.V.S. Murthy, director of the Indian Institute of Public Health, Hyderabad. "Without supervision, stand-alone family care does not help much."
The researchers set out with the hypothesis that that home-based care, if well supervised and followed with rigour, may result in reduced mortality and disability and help lower cost of rehabilitation. This was based on the assumption that repeated visits to the hospital would add to stress to the patient and expose them to hospital-linked infections.
However, the study has found that home-based care did not improve the health outcome over hospital visits - both groups of patients on average had similar levels of disability or improvements.
Doctors say the results highlight the need for India to invest in stroke care and stroke rehabilitation. Public health experts estimate that India currently has only about 35 well-equipped stroke facilities with equipment, medicines and staff with appropriate expertise to manage strokes during the acute phase.
Patients with stroke have the best chance of recovery if they receive appropriate treatment within three hours of the onset of symptoms. Murthy said the country might need about 500 stroke clinics for most patients to be able to easily access such treatment within three hours.
In the study, Murthy and neurologists from 14 hospitals in 13 cities - Bangalore, Calcutta, Chandigarh, Chennai, Guntur, Guwahati, Hyderabad, Kochi, Ludhiana, New Delhi, Tezpur, Trivandrum, and Vellore - followed up stroke survivors recommended rehabilitation at home or usual standards of care.
"Currently, rehabilitation is very fragmented - some will seek hospital-based rehabilitation for periods of three to six months, some ask physiotherapists to come home, and some just rely on untrained family-based rehabilitation" said Jeyeraj Pandian, a neurologist at the Christian Medical College, Ludhiana.
The study found that supervised home-based rehabilitation - facilitated through a special manual of exercises and recommendations that family members had to read to work with the stroke survivors - had almost the same effect on patients as the usual standards of care.
The supervised home-based care was found completely safe and is likely to reduce the costs of hospital-based rehabilitation services, the researchers said. The current costs of stroke treatment and rehabilitation range anywhere from Rs 90,000 to Rs 600,000, depending on hospitals where the services are sought, Pandian said.
However, some medical experts say the role of expert supervision should not be underestimated in stroke rehabilitation. "Neuro-rehabilitation is an advanced science - family caregivers will need constant supervision from physiotherapists specially trained for this," said Rajesh Aggarwal, a New Delhi-based physiotherapist.