Abstract Background and aims Specialist community-based Stroke Rehabilitation (SSR), delivered through Early Supported Discharge (ESD) and Community Stroke Rehabilitation (CSR), is increasingly provided within the Integrated Community Stroke Service model. This study aims to describe trends and case-mix and to evaluate the long-term impact of SSR on survival and other post-stroke outcomes. Methods Linked data of the South London Stroke Register to the Sentinel Stroke National Audit Programme between 2013 and 2024 is used. SSR was defined as receipt of specialist ESD, CSR, or combined ESD–CSR services. Descriptive methods were used to compare case-mix. Survival up to five years post-stroke was examined using Kaplan–Meier curves and Cox proportional hazards models. Outcomes included functional independence, Instrumental activities of daily living, cognitive impairment, depression and anxiety, and quality of life. Long-term outcomes were evaluated using doubly robust estimation with propensity score matching. Results Among 1,910 stroke survivors, 64% received SSR. SSR increased over time and was common among those with moderate functional disability at discharge (P 0.00), Black ethnic groups (P 0.00), and those living in private houses (P 0.00). SSR associated with shorter inpatient stays and higher five-year survival (Log-rank test, P 0.0034) or reduced risk of death (hazard ratio 0.62; 95% CI 0.51–0.76). SSR improved functional dependency at 3 months and 1 year post-stroke, with Barthel Index scores increasing by 2.7 and 2.1 points, respectively (P 0.001), but no significant effects on other long-term outcomes. Conclusions SSR is associated with improved survival and functional outcomes following stroke, supporting continued investment in integrated community stroke rehabilitation services. Conflict of interest All authors: Nothing to disclose.
Kalansooriya et al. (Fri,) studied this question.