Stroke Rehabilitation Research

The WISE Study: What is the Impact of Stroke ESD?



This three-year multi-site study will investigate the implementation and effectiveness of stroke Early Supported Discharge services across England.

Stroke Early Supported Discharge (ESD) services facilitate discharge from hospital and delivery of specialist rehabilitation in patients’ homes and at an equivalent intensity to that provided in stroke units.

Clinical trials have shown that ESD services can reduce the length of hospital stay and the risk of dependency and improve long-term patient outcomes. Following recommendations in UK national policy documents and clinical guidelines there has been widespread implementation of ESD services across England. However, the type of ESD service patients receive on the ground is variable and in some regions ESD is still not offered at all.

Study aim

The study aims to assess the impact of implementing ESD in real world conditions and investigate which models of ESD are effective in practice. Are the benefits suggested by randomised controlled trials still evident in clinical practice?


Conducted under a realist evaluation framework, this mixed methods project will involve two phases:

Phase 1

National stroke audit data that have been routinely collected by hospital and community services across England will be examined to address the following questions:

  1. How effective is ESD when implemented at scale, in practice?
  2. What ESD models exist and how do they relate to evidence based recommendations?
  3. What site, model and patient characteristics influence effectiveness?
  4. What are the cost-consequences of adopted ESD models?

Phase 2

We will interview NHS staff members to gain a better understanding of how ESD services operate in practice, identify factors contributing to the adoption and implementation of ESD models as well as contextual influences to their effectiveness and sustainability. Stroke survivors will also be asked about their experiences of ESD services and what matters to them the most.

Findings will drive improvements in stroke services across England and internationally leading to provision of efficient, evidence based care and better patient recovery.


1. What services are we evaluating?

Early supported discharge (ESD) services provide early, home based rehabilitation for stroke survivors. They allow stroke survivors to leave hospital more quickly and receive intensive rehabilitation by a team of therapists, nurses and doctors. In this way, they can reduce the length of stay in the hospital and support stroke survivors in achieving independence.

2. What are the aims of the project?

Research suggests that patients who received ESD spent less time in the hospital and had better recovery that patients who did not. A variety of ESD services have now been set up across England. This study will investigate whether these services offer the same benefits to patients as those identified in research studies. We will compare different types of ESD services across England to try and understand if some are better than others.

3. Who will be invited to take part?

We will interview stroke survivors, clinicians, senior managers and commissioners.

4. How many participants do you need?

We will conduct phase 2 over six sites and include up to 48 staff interviews and 12 ESD team group interviews. In addition we will conduct 30 stroke patient interviews across two sites.

5. How long will the study run for?  
The study will run for 3.3 years from October 2017 to February 2021
6. How is the study funded?

The study is funded by a NIHR Health Services and Delivery Research (HS&DR) programme grant.



Project Lead: Dr Rebecca Fisher

Co-Applicants: Dr Rebecca Fisher, Prof Marion Walker, Prof Peter Langhorne, Prof Tom Robinson, Prof Sarah Lewis, Prof Justin Waring, Dr Claudia Geue, Mrs Alexandra Hoffman, Prof Anthony Rudd

Research Fellows: Dr Niki Chouliara, Dr Adrian Byrne, Dr Trudi Cameron


Dr Rebecca Fisher
T: 0115 82 30240

Dr Niki Chouliara
T: 0115 82 30473

Dr Adrian Byrne
T: 0115 82 30224

Dr Trudi M Cameron
T: 0115 82 30962

Stroke Rehabilitation Research

The University of Nottingham
School of Medicine

telephone: +44 (0) 115 823 0246