Stroke patients in the UK currently lose access to structured rehabilitation once Early Supported Discharge ends, typically a few weeks after leaving hospital. This trial tests whether an extended service—phone-based assessments and goal-setting at 1, 3, 6, 12, and 18 months—can improve patients’ ability to carry out everyday activities like shopping, cooking, or managing finances. The problem is clear: longer-term stroke rehabilitation services exist patchily, if at all, because no one has proved they work in a large, rigorous trial. Without evidence, NHS commissioners have little basis to fund them. This multicentre randomised controlled trial will recruit 510 patients across 12 or more NHS stroke services, comparing the extended service against usual care. The primary outcome is the Nottingham Extended Activities of Daily Living Scale at 24 months. If the intervention proves effective, the NHS could adopt a low-cost, scalable model that maintains contact with stroke survivors long after discharge. That would directly reduce disability and carer strain, and improve quality of life for thousands of people each year. If it does not, the trial will still provide robust evidence to stop investing in ineffective services. Either way, the result will shape how the NHS allocates rehabilitation resources for years to come.
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Development of longer term stroke rehabilitation services are limited by lack of evidence of effectiveness for specific interventions and service models. This study will evaluate a new extended stroke rehabilitation service which will commence when Early Supported Discharge (ESD) ends. Study design: Multicentre randomised controlled trial with health economic and process evaluations. Setting: Twelve or more NHS stroke services. Participants: Adults with a new stroke (and carer if appropriate) being discharged from hospital under the care of an ESD team. Study intervention treatment: An extended stroke rehabilitation service provided following completion of ESD. A senior ESD team member will undertake a structured assessment and goal setting focussing upon extended activities of daily living at 1, 3, 6, 12 and 18 months. Assessments will usually be undertaken by telephone. Study control treatment: Usual care post ESD. Usual care may involve referral of patients to a range of rehabilitation services upon completion of ESD in accordance with local clinical practice. Randomisation: Central independent web based service. Primary outcome: Nottingham Extended Activities of Daily Living Scale at 24 months post randomisation. Secondary outcomes: For patients: health status (Oxford Handicap Scale), quality of life (Euroqol EQ-5D), mood (Hospital Anxiety and Depression Scale), experience of services and resource use (adaptation of the Client Service Receipt Inventory) at 12 and 24 months post randomisation. For carers: quality of life (Euroqol EQ-5D), carer stress (Caregiver Strain Index) and experience of services at 12 and 24 months post randomisation. Blinding: Outcomes by blinded assessor. Process evaluation: Semi-structured interviews with a subsample of study participants and staff to gain insight into their perceptions and experience of study treatments. Sample size: Allowing for 25% attrition, 510 participants are needed to provide 90% power to detect a difference in mean Nottingham EADL score of 6 with a 5% significance level.
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