“OPTIMIZING RECOVERY AFTER STROKE: OUTPATIENT VERSUS HOME-BASED REHABILITATION IN PATIENTS AT RISK FOR POOR OUTCOMES”

Abstract

Aim of the Study: To compare the effectiveness of outpatient physiotherapy versus structured home-based rehabilitation in improving functional and clinical outcomes among patients at risk of poor recovery after stroke.

Objectives of the Study: To evaluate changes in functional independence, balance, gait speed and patient-reported recovery over four months, to document adherence, safety and feasibility of both rehabilitation models and to describe and standardize detailed treatment protocols for each setting.

Methodology: A randomized controlled trial was conducted at Health & Wellness Physio Rehab Center. Forty-two patients (21 per group) within 2 weeks to 6 months post-stroke and identified as at risk of poor outcome were randomized to receive either outpatient physiotherapy (60-minute sessions, three times per week for 16 weeks) or a structured home-based program (daily self-practice with one supervised session per week). Primary outcome was changed in Functional Independence Measure (FIM); secondary outcomes included Berg Balance Scale, 10-Meter Walk Test, Stroke Impact Scale, upper limb function and mood. Assessments were performed at baseline and four months by blinded assessors.

Results: At four months, the outpatient group showed a mean FIM gain of 25.37 ± 8.72 versus 16.51 ± 10.02 in the home-based group (p = 0.004). Balance improvement (Berg Balance Scale) was also greater in the outpatient group (10.27 ± 4.20 vs. 6.13 ± 5.16; p = 0.007). Gait speed increased more in the outpatient group but did not reach significance (p = 0.066). Stroke Impact Scale scores improved by 19.50 ± 8.50 in the outpatient group compared with 10.41 ± 10.42 in the home group (p = 0.003). Adherence was higher in the outpatient group; adverse events were minor and similar between groups.

Conclusion: Outpatient physiotherapy delivered at high supervised intensity produced significantly greater gains in functional independence, balance and patient-reported recovery compared with a structured home-based program in patients at risk of poor post-stroke outcomes. Home-based rehabilitation remains a valuable alternative when outpatient therapy is not feasible but may yield smaller improvements in this high-risk group.