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- Persson, Carina Ulla, 1970, et al.
(författare)
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Responsiveness of a modified version of the postural assessment scale for stroke patients and longitudinal change in postural control after stroke- Postural Stroke Study in Gothenburg (POSTGOT) -
- 2013
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Ingår i: Journal of neuroengineering and rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Responsiveness data certify that a change in a measurement output represents a real change, not a measurement error or biological variability. The objective was to evaluate the responsiveness of the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) in patients with a first event of stroke. An additional aim was to estimate the change in postural control during the first 12 months after stroke onset. METHODS: The SwePASS assessments were conducted during the first week and 3, 6 and 12 months after stroke in 90 patients. Svensson's method, Relative Position (RP), Relative Concentration (RC) and Relative Rank Variance (RV), were used to estimate the scale's responsiveness and the patients' change in postural control over time. RESULTS: From the first week to 3 months after stroke, the patients improved in terms of postural control with 2 to 12 times larger systematic changes in Relative Position (RP), for which 9 items and the total score showed a significant responsiveness to change when compared to the interrater reliability measurement error of the SwePASS reported in a previous study. When SwePASS was used to assess change in postural control between the first week and 3 months, 74% of the patients received higher scores while 10% received lower scores, RP 0.31 (95% CI 0.219-0.402). The corresponding figures between 3 and 6 and between 6 and 12 months were 37% and 16%, RP 0.09 (95% CI 0.030-0.152), and 18% and 26%, RP -0.07 (95% CI -0.134- (-0.010)), respectively. CONCLUSIONS: The SwePASS is responsive to change. Postural control evaluated using the SwePASS showed an improvement during the first 6 months after stroke. The measurement property, in the form of responsiveness, shows that the SwePASS scoring method can be considered for use in rehabilitation when assessing postural control in patients after stroke, especially during the first 3 months.
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| 2. |
- Persson, Carina Ulla, 1970, et al.
(författare)
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Timed Up & Go as a measure for longitudinal change in mobility after stroke - Postural Stroke Study in Gothenburg (POSTGOT)
- 2014
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Ingår i: Journal of NeuroEngineering and Rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 11:83
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background A frequently used clinical test to assess mobility after stroke is the Timed Up & Go. Knowledge regarding whether or not the Timed Up & Go is able to detect change over time in patients with stroke, whether improvements in mobility exist after the first three months and whether or not longitudinal change in mobility after stroke depend on the patients’ age, is limited or unclear. The objectives were to investigate the distribution-based responsiveness of the Timed Up & Go (TUG) during the first three months after a first event of stroke, to measure the longitudinal change in TUG time during the first year after stroke and to establish whether recovery in TUG time differs between different age groups. Methods Ninety-one patients with first-ever stroke were assessed using the Timed Up & Go at the 1st week and at 3, 6 and 12 months after stroke. The non-parametric sign-test, the parametric t-test and a mixed model approach to linear regression for repeated measurements (Proc mixed) were used for the statistical analyses. Results The median TUG time was reduced from 17 to 12 seconds (p < 0.001) between the 1st week and 3 months. No further improvement was seen between 3 and 12 months after stroke. In a mixed model approach to linear regression, there was a significant age difference. Patients at age 80 and above tended to deteriorate in terms of TUG time between 3 and 12 months after stroke, while patients < 80 years did not (p = 0.011 for the interaction between age group and time). Conclusion The Timed Up & Go demonstrates ability to detect change in mobility over time in patients with stroke. A significant improvement in TUG time from the 1st week to 3 months after stroke was found, as expected, but thereafter no statistically significant change was detected. After 3 months, patients ≥80 years tended to deteriorate in terms of TUG time, while the younger patients did not.
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| 4. |
- Alt Murphy, Margit, 1970, et al.
(författare)
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SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol.
- 2011
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Ingår i: BMC neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area. METHODS/DESIGN: A sample of 120 participants with a first-ever stroke and impaired upper extremity function will be consecutively included from an acute stroke unit and followed longitudinally for one year. Assessments are performed at eight occasions: at day 3 and 10, week 3, 4 and 6, month 3, 6 and 12 after onset of stroke. The primary clinical outcome measures are Action Research Arm Test and Fugl-Meyer Assessment for Upper Extremity. As additional measures, two new computer based objective methods with kinematic analysis of arm movements are used. The ABILHAND questionnaire of manual ability, Stroke Impact Scale, grip strength, spasticity, pain, passive range of motion and cognitive function will be assessed as well. At one year follow up, two patient reported outcomes, Impact on Participation and Autonomy and EuroQol Quality of Life Scale, will be added to cover the status of participation and aspects of health related quality of life. DISCUSSION: This study comprises a non-selected population with first ever stroke and impaired arm function. Measurements are performed both using traditional clinical assessments as well as computer based measurement systems providing objective kinematic data. The ICF classification of functioning, disability and health is used as framework for the selection of assessment measures. The study design with several repeated measurements on motor function will give us more confident information about the recovery patterns after stroke. This knowledge is essential both for optimizing rehabilitation planning as well as providing important information to the patient about the recovery perspectives. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01115348.
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| 5. |
- Björkdahl, Ann, 1959, et al.
(författare)
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Effect of very early supported discharge versus usual care on activi-ties of daily living ability after mild stroke: a randomized controlled trial.
- 2023
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Ingår i: Journal of rehabilitation medicine. - 1651-2081. ; 55
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Tidskriftsartikel (refereegranskat)abstract
- To examine the ability to perform basic and instrumental activities of daily life after very early supported discharge vs usual discharge and referral routine during the first year after mild stroke.A secondary analysis of data from the Gothenburg Very Early Supported Discharge randomized controlled trial. Patients: A total of 104 patients (56% men; mean (standard deviation) age 75 (11) years) who had experienced a first stroke classified as mild.The primary outcome was the Activities of Daily Living Taxonomy score. Stroke Impact Scale (activities of daily living, and mobility) scores was a secondary measure. Patients were randomized to either very early supported discharge with 4 weeks of home rehabilitation provided by a multidisciplinary stroke team, or a control group discharged according to usual routine (referral to primary care when needed). Assessments were performed at discharge, 4 weeks post-discharge, and 3 and 12 months post-stroke.Instrumental activities of the Activities of Daily Living Taxonomy scores (the lower the better) in the very early supported discharge and control groups were median 4 and 6 (p=0.039) at 4 weeks post-discharge and 3 and 4.5 (p=0.013 at 3 months post-stroke, respectively. Stroke Impact Scale (Mobility) median scores (the higher the better) in the very early supported discharge and control groups at 3 months were 97 and 86 (p=0.040), respectively. There were no group differences in the 2 outcomes at 12 months post-stroke.Compared with usual discharge routine, team-based rehabilitation during the first month at home is beneficial for instrumental activity in the subacute phase, in patients with mild stroke. One year post-stroke both groups show equal results.
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| 6. |
- Chen, Eric, et al.
(författare)
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Levels of physical activity in acute stroke patients treated at a stroke unit: A prospective, observational study.
- 2020
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Ingår i: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 52:4
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Tidskriftsartikel (refereegranskat)abstract
- A prospective, observational study to describe levels of physical activity in patients with stroke on day 2 and day 5 or 6 after admission to a comprehensive stroke unit in Sweden.The study was performed at the stroke unit at Sahlgrenska University Hospital during a period of 4 months between 2017 and 2018. Consecutive patients with stroke were observed for 1 min every 10 min while the multidisciplinary team was at work. The level of physical activity, location and the people present were noted at each time-point.A total of 46 patients were observed on day 2, of whom 29 were observed a second time on day 5 or 6. Patients were in bed half of the time and engaged in upright activity for less than 10% of day 2. Patients spent 73% of day 2 in the bedroom and 56% of this day alone. Over time, there was a significant shift of 10% from "in bed" activity to "sitting" (p§lt;0.001).Patients are physically inactive, alone and in their rooms for a majority of the time during the first days at a comprehensive stroke unit. There is some increase in physical activity during the first week after admission.
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| 7. |
- Danielsson, Anna, 1957, et al.
(författare)
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Comparison of energy cost of walking with and without a carbon composite ankle foot orthosis in stroke subjects
- 2010
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Ingår i: 13th ISPO World Congress, 10-15 May 2010, Leipzig, Germany.
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Konferensbidrag (refereegranskat)abstract
- 13th ISPO World Congress Poster [3009] Abstract [207] | Topic: Orthotics Author: Danielsson, Anna (Göteborg SE) Dr. University of Gothenburg, Institute of Neuroscience and Physiology - Clinical Neuroscience and Rehabilitation Title: Comparison of Energy Cost of Walking with and without a Carbon Composite Ankle Foot Orthosis in Stroke Subjects Coauthors: Sunnerhagen KS, Willén C Summary: Oxygen cost, gait speed and perceived exertion was measured in 10 subjects with stroke walking with and without a carbon composite ankle foot orthosis. Walking with ankle foot orthosis was statistically less energy demanding and the speed somewhat higher compared to unbraced walking. Introduction: The opinions on effects of AFOs on functional outcome after stroke are inconsistent and the clinical significance of changes reported has been questioned. The improved walking velocity with an AFO as compared to unbraced walking seen in some studies may involve a reduction in energy cost. To our knowledge, only two studies report reduced energy cost with the use of an AFO. The aim was to measure and compare the energy expenditure and walking speed with and without a carbon composite AFO in stroke subjects. Methods: Ten persons with prior stroke, habituated to a carbon composite AFO were included. First the self-selected speeds on a tredmill without (speed I) and with (speed II) the AFO were determined in randomised order. The energy expenditure and heart rate were estimated with a stationary, computerized system for breath-by-breath analysis. Two measurements of energy expenditure were carried out with and without the AFO in randomized order at speed I. A third measurement was made with the AFO at speed II. Each trial lasted for five minutes. The measurements were repeated in reversed order once within one week. The energy cost per minute was divided by walking speed for estimation of energy cost per distance. Data was analysed with Wilcoxons sign rank test. Results: The mean self-selected walking speed was 20% higher (p = 0.027) with the ankle foot orthosis than without. Walking at speed I with an AFO was 4% less energy demanding (VO2 mL•kg-1•min-1) (p=0.028) than walking without AFO at the same speed. The energy cost (VO2 mL•kg-1•m-1) at speed I was also significantly lower with the AFO (p = 0.037) than without. Heart rate or perceived exertion did not differ between the two conditions. There was no significant difference in energy expenditure (VO2 mL•kg-1•min-1) between walking at speed I without AFO and speed II with AFO. However, the energy cost (VO2 mL•kg-1•m-1), was 12% lower (p=0.024) with the AFO. Heart rate and perceived exertion showed no difference between the two conditions. Conclusion: A carbon composite ankle foot orthosis may decrease energy demands and increase walking speed after stroke. The differences in energy cost seen in this study were small and not clinically significant whereas an increase in walking speed might have some impact on walking capacity. Further studies on the effects of an AFO on walking ability after stroke are wanted. References: Franceschini M, Massucci M, Ferrari L, Agosti M, Paroli C. Effects of an ankle-foot orthosis on spatiotemporal parameters and energy cost of hemiparetic gait. Clin Rehabil 2003;17(4):368-72. Corcoran PJ, Jebsen RH, Brengelmann GL, Simons BC. Effects of plastic and metal leg braces on speed and energy cost of hemiparetic ambulation. Arch Phys Med Rehabil 1970;51(2):69-77. de Wit DC, Buurke JH, Nijlant JM, Ijzerman MJ, Hermens HJ. The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: a randomized controlled trial. Clin Rehabil 2004;18(5):550-7 Leung J, Moseley A. Impact of ankle-foot orthoses on gait and leg muscle activity in adults with hemiplegia: systematic literature review. Physiotherapy 2003;89(1):39-55. Danielsson A, Sunnerhagen KS. Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis. J Rehabil Med 2004;36:165-8.
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| 9. |
- Danielsson, Anna, 1957, et al.
(författare)
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Energy cost during walking - a comparison of two measurement methods
- 2005
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Ingår i: European Stroke Conference, Bologna, Italy 25-28 may 2005.
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Konferensbidrag (refereegranskat)abstract
- Background and purpose Many persons with stroke walk slowly with increased energy cost. Efficient gait is an important rehabilitation goal. Measurement of energy cost adds valuable information to gait analysis in evaluation of exercise, orthoses and walking aids. Direct measurement of oxygen uptake (VO2) is golden standard, but clinically practicable methods are needed. Physiological Cost Index (PCI)1 is a clinical method based on the relation between VO2 and heart rate. The reliability and validity of PCI in stroke patients has not been investigated. The aim was to compare energy cost measured by VO2 with PCI-value, in persons with stroke and healthy reference persons. Methods 20 persons with stroke and hemiparesis and 16 healthy, reference persons 30-63 years of age were included. Individual, self-selected walking speed on a treadmill was determined. VO2 was measured by breath-by-breath analysis and heart rate by electrocardiography at rest and during 5 minutes of walking on the treadmill at the predetermined self-selected speed. Mean values from two sessions were used. PCI was calculated as the heart rate difference between rest and walking, divided by gait speed. Spearman’s rank correlation between VO2 and PCI was calculated. Results Gait speed on the treadmill was 0,48 and 1,01 m/s, in the stroke and reference group respectively. VO2 was 9,1 and 11,4 ml/kg/min, with an energy cost of 0,41 and 0,19 ml/kg/m, in the stroke and reference group respectively. PCI was 0,76 and 0,30 heartbeats/m, in the stroke and reference group respectively. The correlation coefficient between VO2/m and PCI was ρ = 0,70 for the stroke group and ρ = 0,83 for the reference group. Conclusion Both VO2 and PCI were increased in the stroke group compared to the healthy reference group. VO2 and PCI were correlated in both groups. The stroke group had a large variability, why measurement of VO2 is recommended for research purposes. PCI needs further investigation before conclusions about the applicability for stroke patients can be drawn. 1 MacGregor J. The evaluation of patient performance using long-term ambulatory monitoring technique in the domiciliary environment. Physiotherapy 1981;67(2):30-33.
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| 10. |
- Danielsson, Anna, 1957, et al.
(författare)
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Energy cost,walking habits and physical activity late after stroke
- 2008
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Ingår i: Neurorehabilitation & Neural repair. ; 22:5
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Konferensbidrag (refereegranskat)abstract
- Background: The aim was to investigate if walking energy cost and walking distance late after stroke were influenced by the physical environment, walking habits, physical activity or perceived difficulties. Methods: Included were 31 subjects with a mean age of 59.7 years and time since stroke 7-10 years. Heart rate and distance were measured during in- and outdoor walking for 6 minutes. The energy cost was assessed by the Physiological Cost Index (PCI). Assessments were made by the Physical Activity Scale for the Elderly, Stroke Impact Scale and a questionnaire on walking habits. Data were analyzed with linear regression. Results: Walking speeds and distances were reduced and the PCI was elevated compared to reference values. There were no differences between in- and outdoor walking. Sex, body mass index and perceived difficulty explained 24% of the variation in PCI (not statistically significant). Body mass index, physical activity level and perceived difficulty explained 48% of the variation in walking distance (p <0.05). Conclusions: Late after stroke, perceived difficulties may influence walking distance and energy cost. In this study the impact of the physical environment was not significant. The level of physical activity was associated with walking distance. Assessment of physical activity may be of importance after stroke and support should be given to increase physical activity when needed.
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