Royal College of Surgeons in Ireland
Effectiveness of interventions to support the transition home after acute stroke. a systematic review and meta-analysis.pdf (2.59 MB)

Effectiveness of interventions to support the transition home after acute stroke: a systematic review and meta-analysis

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journal contribution
posted on 2022-11-09, 17:55 authored by Geraldine O'CallaghanGeraldine O'Callaghan, Martin Fahy, Paul Murphy, Peter Langhorne, Rose Galvin, Frances HorganFrances Horgan

Background: Effective support interventions to manage the transition to home after stroke are still mostly unknown.

Aim: The purpose of this systematic review was to investigate the effectiveness of support interventions at transition from organised stroke services to independent living at home.

Methods: The Cochrane Central Register of Controlled Trials, six databases including MEDLINE and Embase, trial registries, grey literature, and Google Scholar were all searched, up to June 2021. We included randomised controlled trials enrolling people with stroke to receive either standard care or any type of support intervention from organised stroke services to home. The primary outcome was functional status. Two authors determined eligibility, extracted data, evaluated risk of bias (ROB2), and verified the evidence (GRADE). Where possible we performed meta-analyses using Risk Ratios (RR) or Mean Differences (MD).

Results: We included 17 studies. Support interventions led to important improvements in functional status, as determined by the Barthel Index up, to 3-months (MD 7.87 points, 95%CI:6.84 to 19.16; 620 participants; five studies; I2 = 77%). Results showed modest but significant functional gains in the medium to long-term (6-12 month follow up, MD 2.91 points, 95%CI:0.03 to 5.81; 1207 participants; six studies; I2 = 84%). Certainty of evidence was low. Support interventions may enhance quality of life for up to 3-months (MD 1.3,95% CI:0.84 to 1.76), and reduce depression (SMD -0.1,95% CI:-0.29 to - 0.05) and anxiety (MD -1.18,95% CI:-1.84 to - 0.52) at 6-12 months. Effects on further secondary outcomes are still unclear.

Conclusions: Incorporating support interventions as people who have experienced a stroke transition from hospital to home can improve functional status and other outcomes. Due to study heterogeneity, the essential components of effective transition of care interventions are still unknown. Adoption of core outcome sets in stroke research would allow for greater comparison across studies. Application of a development and evaluation framework engaging stakeholders would increase understanding of priorities for stroke survivors, and inform the key components of an intervention at transition from hospital-to-home.

Trial registration: CRD42021237397 -


Health Research Board (HRB) in Ireland through the Collaborative Doctoral Award Scheme (HRB-CDA-2019-004)


Associated research data files

The datasets generated and/or analysed during the current study are available in the Zenodo repository, https:// zenodo. org/ search? page= 1& size= 20&q=67793 71


The original article is available at

Published Citation

O'Callaghan G. et al. Effectiveness of interventions to support the transition home after acute stroke: a systematic review and meta-analysis. BMC Health Serv Res. 2022;22(1):1095.

Publication Date

28 August 2022

PubMed ID



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  • School of Physiotherapy


BioMed Central


  • Published Version (Version of Record)