The aim of the HOME Rehab trial is to determine the clinical effectiveness and cost effectiveness of an occupational therapy home-based discharge planning intervention compared to in-hospital pre-discharge planning.
Assessing the value of home-based discharge planning
Transitioning from hospital to home is a critical time for stroke survivors, and some return to hospital soon after discharge. Successful reintegration back to the home environment is critical to improving long-term community participation and quality of life, as well as minimising the societal costs for attendant care.
The majority of clinical practice guidelines around the world recommend pre-discharge home visits for stroke rehabilitation. However, there is little data to support this and pre-discharge occupational therapy assessment for stroke patients (including home visits) has been identified as a major area requiring research.
The HOME Rehab Trial has been designed to address this gap in knowledge regarding the effectiveness of home-based discharge planning.
Study timeline and design
The HOME Rehab Trial is a 4-year study. A total of 360 patients will be recruited over a 3-year period commencing in 2018. Participants will be recruited from rehabilitation sites across Australia
Our current sites include:
- Alfred Health (including Caulfield and Sandringham hospitals, VIC
- Alfred Health (Caulfield Hospital, VIC)
- Austin Health (including Repatriation and Royal Talbot hospitals, VIC)
- Mt Wilga Private Hospital, NSW
- Flinders Medical Centre, SA
- Hampstead Rehabilitation Centre, SA
The HOME Rehab Trial is a two-armed parallel-design randomised controlled trial. Once baseline measures have been completed, participants will be randomised (concealed) to either:
- Hospital based consolation (control group)
- Home based consultation (experimental group)
The primary outcome of the HOME Rehab Trial is participation in meaningful activities, as measured by the Nottingham Extended Activities of Daily Living
Secondary outcomes of the HOME Rehab Trial include:
- Hospital readmission
- Activity performance in activities of daily living (e.g. self-care) and community tasks
Clinician guidance for the HOME Rehab Trial
All participants who are enrolled in the HOME Rehab Trial will receive additional occupational therapy focused on preparing for the transition from hospital to home. These include:
Family-led home environment assessment
An occupational therapist from the research team will meet with the participant and their family as soon as possible after randomisation. They will educate the family in how to take photos and measure key areas of the home to assist with equipment prescription and home modification prescriptions. All information gathered will be shared with the ward treating occupational therapist and the rehabilitation team.
In-hospital consultation
An occupational therapy led family discussion will take place in the hospital in preparation for discharge to the home environment. This will be based on the Discharge Planning Assessment Tool, which produces scores on confidence and assesses potential problems in areas of daily participation. An occupational therapist from the research team will lead this consultation. All information gathered will be shared with the ward treating occupational therapist and the rehabilitation team.
Rehabilitation recommendations
Using information gathered during the home-based assessment, a list of recommendations will be developed by the research occupational therapist with the treating team. These will shape the participant’s inpatient rehabilitation program.
Discharge
Before the participant is discharged, the rehabilitation recommendations will be provided to the participant and the treating team.
For patients who are randomised to the home based occupational therapy discharge planning (experimental group), the Research Occupational Therapist will plan their first post-discharge home visit with the participant (and their family as applicable) for the first week post-discharge.
Participant information and consent forms
- Screening tool for prospective participants
Alfred Health (Caulfield Hospital, VIC)
- Information/Consent Form for adult providing own consent
- Information/Consent Form for person responsible/medical treatment decision maker consenting on behalf of participant
Austin Health (including Repatriation and Royal Talbot hospitals, VIC)
- Information/Consent Form for adult providing own consent
- Information/Consent Form for person responsible/medical treatment decision maker consenting on behalf of participant
Mt Wilga Private Hospital, NSW
Flinders Medical Centre, SA
Hampstead Rehabilitation Centre, SA
More information
If you would like:
- More information about the trial
- To register an interest in becoming a participating Occupational Therapy team
- To register an interest for one of your patients in the trial
Please contact the HOME Rehab Trial National Trial Coordinator.
