What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis

Yuncui Wang, Fen Yang, Hao Shi, Chongming Yang, Hui Hu, Yuncui Wang, Fen Yang, Hao Shi, Chongming Yang, Hui Hu

Abstract

Stroke is a major cause of disability and mortality worldwide; yet; prior to this study; there had been no sufficient evidence to support the effectiveness of various transitional care interventions (TCI) on the disability and mortality of stroke survivors. This meta-analysis aimed to assess the effectiveness of TCI in reducing mortality and improving the activities of daily life (ADL) of stroke patients. PubMed; Web of Science; OVID; EMBASE; CINAHL; and Sino-Med were searched for articles published before November 2016. Thirty-one randomized controlled trials (RCTs) were identified in the study. This analysis showed that the total effect of TCI on reducing mortality was limited (Risk Ratio (RR) = 0.86; 95% Confidence Interval (CI): 0.75-0.98); that only home-visiting programs could reduce mortality rates (RR = 0.34; 95% CI: 0.17-0.67) compared with usual care; and that the best intervention was led by a multidisciplinary team (MT) ≤3 months (RR = 0.19; 95% CI: 0.05-0.71). In addition; home-visiting programs also produced ADL benefit (RR = 0.56; 95% CI: 0.31-0.81). Overall; there was a statistically significant difference in improving patients' independence between TCI and usual care (RR = 1.12; 95% CI: 1.02-1.23). However; none of the interventions was effective when they were differentiated in the analysis. It is the conclusion of this study that home-visiting programs; especially those led by MTs; should receive the greatest consideration by healthcare systems or providers for implementing TCI to stroke survivors.

Keywords: ADL; interventions; meta-analysis; mortality; stroke; transitional care.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of literature search and screening process.
Figure 2
Figure 2
Mortality rate for home-visiting programs compared with usual care, by subcategory of home-visiting program and follow-up time.
Figure 3
Figure 3
Proportion of patients with BI score ≥95 (considered independent) for transitional care interventions compared with usual care, by intervention category and follow-up time.
Figure 4
Figure 4
Activities of daily life (ADL) (measured by BI score ranging from 0 to 100) of patients for transitional care interventions compared with usual care, by intervention category and follow-up time.

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