Stroke is one of the major causes of loss of independence, decreased quality of life and mortality among elderly people [1, 2]. Each year, about 45,000 people in the Netherlands suffer from stroke and associated functional impairments . Almost 56% of stroke patients are 65 years or older .
In contrast to other countries, nursing homes in the Netherlands fulfil an important role in the rehabilitation of older stroke patients . In the Netherlands, 31% of stroke patients are admitted to a geriatric rehabilitation unit in a nursing home after hospital discharge [6–8]. Stroke patients in general are admitted to a geriatric rehabilitation unit in a nursing home when they are over 65 years of age and have coexisting multimorbidity, which means that they are incapable of completing an intensive neurorehabilitation programme in a regular rehabilitation centre.
About half of the stroke patients discharged home after rehabilitation in a nursing home still experience serious impairments in daily functioning one year post stroke, that complicate fulfilling their former social roles [9–12]. Common residual problems of elderly stroke patients are emotional and psychological problems such as depression or cognitive deficits, social problems and health-related problems including rest paralysis and fatigue [13–17]. Besides having negative consequences for the patients, these problems may also increase the care burden and decrease the quality of life of their informal caregivers .
Currently, in the Netherlands there is a lack of tailor-made, specialised multidisciplinary aftercare following rehabilitation in nursing homes . This may result in inadequate coping skills with the remaining physical, cognitive and/or psychosocial impairments in their home environment [20, 21]. These problems may lead to difficulties in the performance of normal day-to-day activities, fulfilling former social roles, maintaining the functional level which has been achieved in the nursing home, and may have negative influence on the burden of care and quality of life of the patient and informal caregiver [22–24]. Eventually, permanent admission to a residential care facility or nursing home could become necessary. However, tailor-made multidisciplinary aftercare may prevent this and contribute to elderly stroke patients living independently in the community as long as possible.
To date, there is no effective aftercare programme available . But research findings in the field of stroke aftercare suggest that adequate aftercare should include, after discharge, follow-up treatment in the patients’ home environment which improves personal independence in daily living . Furthermore, it should include strategies to increase the skills to cope with the remaining physical, cognitive and/or psychosocial impairments, to improve social participation and to maintain functional level after rehabilitation . Support for the informal caregiver is important to decrease the burden of care and improve quality of life.
Based on consideration of shortcomings in current stroke care for older stroke patients and the improvements as suggested in the literature, a multidisciplinary rehabilitation programme for older stroke patients is proposed. This paper presents the design of a multicentre trial evaluating a new multidisciplinary rehabilitation programme for older stroke patients admitted to a geriatric rehabilitation unit of a nursing home.
The primary aim of this study is to evaluate the effect of this new rehabilitation programme on the level of daily activity, functional independence, perceived quality of life and social participation in elderly stroke patients as compared with usual care. In addition, the effect of the programme on the perceived care burden and quality of life of the informal caregiver is assessed.
The aim of the process evaluation is to gain insight into implementation fidelity, programme deliverance and the opinion of the stroke professionals, patients and informal caregivers about the programme. The aim of the economic evaluation is to assess the effects of the programme on health care utilisation and associated costs of elderly stroke patients.