LAUSR

A clinical trial by Chen et al.1 sought to investigate the comparative effectiveness of subacute poststroke rehabilitation delivered in the home compared to delivered in an outpatient department. This question is important as there are postulated positives and negatives for each delivery style. From a therapeutic point of view, outpatient models arguably enable closer professional input and access to therapeutic equipment and environments; home delivery offers a more naturalistic or ecologically valid setting, potentially avoiding issues of failure to transfer learning. Economically, outpatient services potentially allow a greater throughput for therapists because the burden of travel time is on the patient and supporters and the setting allows groupwork as a further economic measure; however, home therapy could reduce the investment for bricks and mortar investment in dedicated rehabilitation centers. The personal factors for and against are also mixed—the literature reports that some people with stroke value a visit to experts whereas others value the reduced burden of travel and appointment-keeping and appreciate the increased potential for family and supporters to be part of the rehabilitation process when it is conducted in the home. Therefore, it is important to clarify the relative effectiveness to ensure best-practice service provision for the benefit of all stakeholders.