Clinical Guidelines for Acute Stroke Management - Living on the EDge

equires a home visit. Factors to consider include the
reported environmental barriers at home, specific
physical and/or cognitive impairments, risk of falls and
the needs and desires of the patient and the family.
The need <strong>for</strong> home modifications or assistive
equipment may also be determined, and appropriate
modifications and/or assistive equipment
recommended.
There is no stroke-specific evidence regarding the
effectiveness of this approach, and very little evidence
in other populations. One systematic review included
four RCTs regarding the use of an Occupational
Therapy home visit. 453 No clear evidence was found
on the effectiveness of pre-discharge home visits <strong>for</strong>
people with stroke, or indeed <strong>for</strong> older people
preparing to go home. However, such interventions
may influence quality of life, number of falls and patient
autonomy. 453 Home assessment and modification has
been found to reduce falls in elderly people in the
community 454, 455 but it is unclear if this same benefit
exists <strong>for</strong> stroke patients discharged from an acute
hospital. Further robust studies are there<strong>for</strong>e required
to determine which sub-groups benefit from home
visits, since this is a time consuming and costly
intervention.
CONSUMER
8.2 PRE-DISCHARGE NEEDS ASSESSMENT GRADE LEVEL RATING
a) Be<strong>for</strong>e discharge, people with stroke and their carers should have ✓ – 9.5/10
the opportunity to identify and discuss their post-discharge needs
(e.g. physical, emotional, social and financial) with relevant
members of the interdisciplinary team.
b) Be<strong>for</strong>e discharge all patients should be assessed to determine ✓ – –
the need <strong>for</strong> a home visit prior to discharge from hospital.
c) If needed, a home assessment should be carried out to ensure C Level I 453 –
safety and community access.
8.3 Carer training
Carers often report feeling inadequately trained, poorly
in<strong>for</strong>med, and dissatisfied with the extent of support
available after discharge. Evidence from a recent, high
quality trial suggests that carers benefit from
undertaking training prior to discharge in a range of
activities related to care, including personal care
techniques, communication, physical handling and
transfers, ongoing prevention of functional decline and
other specific stroke-related problems. 56
Section 8 Discharge Planning, Transfer of Care and Integrated Community Care
CONSUMER
8.3 CARER TRAINING GRADE LEVEL RATING
Relevant members of the interdisciplinary team should provide specific
training <strong>for</strong> carers be<strong>for</strong>e the person’s discharge home.
This should include training, as necessary, in:
• personal care techniques, communication strategies, physical B Level II 56 9.5/10
handling techniques, ongoing prevention and other specific
stroke-related problems;
• safe swallowing and appropriate dietary modifications. ✓ – 9.5/10
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