Design: a) Cluster randomized controlled feasibility study. Interdisciplinary home rehabilitation teams collaborating with the participating stroke units at Karolinska University hospital and Danderyd hospital will be randomised to deliver either the new person-centred transitions or initiation of rehabilitation in the home as usual. Based on core aspects of person-centred transitions identified in phase I and phase 2 and transition designs developed in phase 2 the interface to coordinate the transitions between the stroke-unit and each interdisciplinary team will be identified and organised. Participants: people with mild to moderate stroke, referred to receive rehabilitation at home in participating stroke units, their significant others, staff of the participating stroke units and interdisciplinary teams. Data on satisfaction with the transition process will be collected with the CTM after discharge from the stroke unit. At 3, and 12 months people with stroke will be assessed regarding disability, perceived impact of stroke, participation in social activities, health related quality of life, perceived needs of health services and satisfaction with services received using reliable validated measures and structured interviews. Data on caregiver burden, life satisfaction and informal care will be collected from significant others. Data on use of health care will be obtained from the register at Stockholms Läns Landsting. Analyses comparing outcomes of people who receive the new person-centred transitions and transition as usual will be performed intention to treat. Analyses will include health economic aspects of the new transitions. b) In addition, open ended questions will be asked to the participants with stroke and the significant others pertaining to their experiences of the new person-centred transition and the rehabilitation in the home environment. Members of the participating interdisciplinary teams and staff of the participating stroke units will be interviewed regarding their experiences. The answers will be audio recorded and transcribed verbatim. Analyses: Thematic applied analyses using constant comparisons will be applied to transcripts of the interviews to identify experiences of the ESD and specifically the person-centred transition of the staff in the stroke units and the participating interdisciplinary teams.