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- Sjöholm, Anna, et al.
(författare)
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Does evidence really matter? Professionals’ opinions on the practice of early mobilization after stroke
- 2011
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Ingår i: Journal of multidisciplinary health care. - 1178-2390. ; 2011:4, s. 367-376
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Early mobilization after stroke may be important for a good outcome and it is currently recommended in a range of international guidelines. The evidence base, however, is limited and clear definitions of what constitutes early mobilization are lacking. Aims: To explore stroke care professionals’ opinions about (1) when after stroke, first mobilization should take place, (2) whether early mobilization may affect patients’ final outcome, and (3) what level of evidence they require to be convinced that early mobilization is beneficial. Methods: A nine-item questionnaire was used to interview stroke care professionals during a conference in Sydney, Australia. Results: Among 202 professionals interviewed, 40% were in favor of mobilizing both ischemic and hemorrhagic stroke patients within 24 hours of stroke onset. There was no clear agreement about the optimal time point beyond 24 hours. Most professionals thought that patients’ final motor outcome (76%), cognitive outcome (57%), and risk of depression (75%) depends on being mobilized early. Only 19% required a large randomized controlled trial or a systematic review to be convinced of benefit. Conclusion: The spread in opinion reflects the absence of clear guidelines and knowledge in this important area of stroke recovery and rehabilitation, which suggests further research is required.
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- Sjöholm, Anna, et al.
(författare)
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Sedentary behaviour and physical activity of people with stroke in rehabilitation hospitals
- 2014
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Ingår i: Stroke Research and Treatment. - : Hindawi Publishing Corporation. - 2042-0056 .- 2090-8105.
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Tidskriftsartikel (refereegranskat)abstract
- Background. Sedentary behaviour is associated with health risks, independent of physical activity. This study aimed to investigate patterns of sedentary behaviour and physical activity among stroke survivors in rehabilitation hospitals. Methods. Stroke survivors admitted to four Swedish hospital-based rehabilitation units were recruited ≥7 days since stroke onset and their activity was measured using behavioural mapping. Sedentary behaviour was defined as lying down or sitting supported. Results. 104 patients were observed (53% men). Participants spent an average of 74% (standard deviation, SD 21%) of the observed day in sedentary activities. Continuous sedentary bouts of ≥1 hour represented 44% (SD 32%) of the observed day. A higher proportion (30%, SD 7%) of participants were physically active between 9:00 AM and 12:30 PM, compared to the rest of the observed day (23%, SD 6%, P < 0.0005). Patients had higher odds of being physically active in the hall (odds ratio, OR 1.7, P = 0.001) than in the therapy area. Conclusions. The time stroke survivors spend in stroke rehabilitation units may not be used in the most efficient way to promote maximal recovery. Interventions to promote reduced sedentary time could help improve outcome and these should be tested in clinical trials. © 2014 Anna Sjöholm et al.
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- Skarin, Monica, et al.
(författare)
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A mapping study on physical activity in stroke rehabilitation: Establishing the baseline
- 2013
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 45:10, s. 997-1003
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To establish physical activity level, environment and social interaction in routine stroke rehabilitation practice. Methods: Patients at 4 hospital stroke rehabilitation units in Sweden at least 7 days post-stroke were observed over 1 week-day at 10 min intervals between 08.00 h and 17.00 h. At each observation, physical activity, location and people present were ascertained. Results: Patients (n=104) had a mean age of 70.3 (standard deviation (SD) 14.4) years. Median time since stroke was 19 (range 7-142) days. Patients were alone for 52% of the day, during this time 7% was spent in standing/walking activities. While with a physiotherapist patients were standing/walking for 43% of the time. Using median regression it was found that the median percentage of time spent in standing/walking was associated with gait independence and age. Gait independence increased the median percentage of time spent in standing/walking by 16.5% (95% confidence interval (CI) 12.1-20.9, p<0.001), while an increase of 1 year of age reduced the median percentage of time spent in standing/walking by 0.16% (95% CI -0.31 to -0.01, p < 0.05). Conclusion: Patients had low levels of physical activity and social interaction. This study suggests that there is a huge potential to increase patients' activity level and augment social interaction above current levels.
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- Skarin, Monica, et al.
(författare)
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Acute stroke patient mobilisation practices and concerns. A survey of 202 stroke professionals
- 2009
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Ingår i: European Stroke Conference, Stockholm, Sweden, May.
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Konferensbidrag (refereegranskat)abstract
- Background Stroke unit care is proven to improve outcome for patients. One component responsible for this may be that patients are mobilised earlier and more intensively, but there is lack of unambiguous scientific evidence. Therefore current practices may be driven by historical precedent and/or clinical opinion, and varying approaches to mobilisation are likely. This study sought to determine different health professionals´ beliefs regarding early mobilisation (EM) in acute stroke. EM was defined as intensive out of bed activities within the first 24 hours after stroke onset. Methods A 9 item anonymous questionnaire on benefits and harms with early mobilisation after stroke was used to interview stroke care professionals during the integrated Stroke Society of Australasia (SSA) and Australasian Nursing and Allied Health Conference in Sydney in August 2008. Data were collected using personal digital assistants. Five point Likert scales sought levels of agreement with harm and benefit of EM. Results The survey was completed by 202 professionals, representing 38% of all conference attendees. 65% were females, 50% under 40 years old, 46% worked in an acute stroke unit and 31% in rehabilitation, 35% were nurses, 26% were medical doctors, 19% were physiotherapists and 12% were occupational therapists. Two thirds had less than 10 years experience in stroke care overall. Sixty percent of professionals had concerns about possible harm of early mobilisation and more so for hemorrhagic (59%) than ischemic (23%) stroke (p<0.001). Cardiovascular stability was the major concern (12% ischemic, 34% hemorrhagic). Conclusion Our results show that most professionals had concerns about early mobilisation of stroke patients and these concerns were stronger for hemorrhagic than for ischemic stroke patients. This is surprising given the lack of evidence to support such a dichotomy and the potential harms of bed-confining hemorrhagic stroke patients.
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- Skarin, Monica, et al.
(författare)
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'Better wear out sheets than shoes': a survey of 202 stroke professionals' early mobilisation practices and concerns
- 2011
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Ingår i: International Journal of Stroke. - 1747-4949. ; 6:1, s. 10-15
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Tidskriftsartikel (refereegranskat)abstract
- Background Stroke unit care improves the outcome for patients. One component responsible for this may be that patients are mobilised earlier and more intensively. An ongoing randomised controlled trial is investigating the potential benefits of early mobilisation, but currently there is limited evidence for the practice. Therefore, current practices may be driven by historical precedent and/or clinical opinion, and varying approaches to mobilisation are likely. This study aims to examine different health professionals' concerns regarding early mobilisation in acute stroke. In this study, early mobilisation was defined as frequent out of bed activities within the first 24 h after stroke onset. Methods A nine-item anonymous questionnaire exploring benefits and harms with early mobilisation after stroke was used during interviews of stroke care professionals attending the annual Australasian stroke conference in 2008. Results The survey was completed by 202 professionals, representing 38% of all conference attendees. Sixty-five per cent were females, 50% under 40-years old, 46% worked in acute stroke and 31% in rehabilitation. Thirty-five per cent were nurses, 26% medical doctors, 19% physiotherapists and 12% occupational therapists. Two-thirds had <10-years experience with stroke. Sixty per cent of the surveyed professionals had concerns about early mobilisation and there were significantly more professionals concerned about early mobilisation for haemorrhagic (59%) than ischaemic (23%) stroke patients. Conclusion Our study shows that most clinicians had concerns in relation to early mobilisation of stroke patients and more clinicians had concerns for haemorrhagic than for ischaemic stroke. The evidence underlying these concerns is shallow.
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