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We have identified and summarized 20 systematic reviews on the effects of various types of ambulatory services for patients with chronic diseases, defined as multidisciplinary care at a specialised level provided by a team at the patient's home or in the community, without admitting the patient admitted to hospital. Services can be provided from the hospital, from the municipality or in collaboration.1. Appropriately resourced early supported discharge (ESD) services provided for a selected group of stroke patients can reduce a combined outcome of death and dependency after 6 months, shorten the length of hospital stay and increase the possibility that the patient is independent and has taken up daily activities. There is probably no difference in mortality. ESD services may provide care at modestly lower total costs (versus usual care) for stroke patients with mild or moderate disability.2. For adults with acquired brain damage, heart failure, coronary heart disease, chronic obstructive pulmonary disease, multiple sclerosis, epilepsy and leg ulcer, and for children with various chronic diseases, ambulatory multidisciplinary services are likely to provide some improvements in health outcomes and quality of life, and increased satisfaction with treatment. Many of the studies, however, were small and of moderate methodological quality, so it was difficult to draw firm conclusions. Further research is likely to affect our confidence in the results, and may change the results.3. We need more research to increase the evidence about the effects of ambulatory multidisciplinary services to improve health care for patients with chronic diseases, and to reduce the use of specialist care services.

Ambulatory medical care. --- Chronic diseases.

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The Norwegian Knowledge Centre for the Health Services was commissioned by the Norwegian Directorate of Health to perform a systematic review of the scientific evidence concerning effects of rehabilitation on social and community participation among patients with reduced functional capacity. All patients were included regardless of their diagnosis. According to a parliamentary bill, rehabilitation is defined as: time-limited, planned processes with clear objectives and means, in which several parties cooperate to provide necessary assistance to the user's own efforts to achieve the best possible coping and functional ability, independence and social and community participation. We searched for controlled studies of effect in databases for medical research literature. The criteria for inclusion were:1. Population: patients with reduced functional capacity regardless of diagnosis2. Intervention: multidisciplinary interventions based on the patient's own aims and needs, and where the patients actively participate in their own rehabilitation process3. Outcome: participation socially and/or in the community The search identified 4876 references; we included three controlled clinical trials and three controlled before and after studies in this report. The included studies differed regarding various aspects. The patients had different diagnoses, the professional groups that participated in the multidisciplinary teams varied, the types of patient's participation and which social activities or ways of participating in the community that was addressed all varied between the studies. The studies had different study designs, although they all included a control group. According to the quality assessment tool used the studies were all evaluated to have unclear or high risk of bias. The quality of the documentation for the effect of the intervention is too low for us to draw conclusions on whether rehabilitation contributes to the patients social and community participation. Whether the results can be generalised to other groups or other interventions is unclear. We need larger end better studies before a clearer conclusion can be drawn.

Rehabilitation. --- Patient participation. --- Social participation. --- Communities --- Social aspects.