| 1. |
- Hofers, Wiebke, et al.
(författare)
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Organisation of services and systems of care in paediatric spinal cord injury rehabilitation in seven countries: a survey with a descriptive cross-sectional design
- 2022
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Ingår i: Spinal Cord. - : SPRINGERNATURE. - 1362-4393 .- 1476-5624. ; 60:4, s. 339-347
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Tidskriftsartikel (refereegranskat)abstract
- Study design International multicentre cross-sectional study. Objectives To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI. Setting Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI < 18 years of age. Methods An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data. Results The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family. Conclusions As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.
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| 2. |
- Irgens, Ingebjorg, et al.
(författare)
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Cost-utility analysis and impact on the environment of videoconference in pressure injury. A randomized controlled trial in individuals with spinal cord injury
- 2024
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Ingår i: SPINAL CORD SERIES AND CASES. - 2058-6124. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Study designA prospective randomized controlled trial (RCT) in persons with spinal cord injury (SCI) and ongoing pressure injury (PI).ObjectivesThe main aim was to perform a cost-utility analysis (CUA) alongside the RCT comparing regular care to regular care with additional videoconference consultations. Secondary aims were to assess costs and greenhouse gas emission related to transportation in the two study groups.SettingTwo spinal cord units in Norway.MethodsParticipants were allocated to a regular care group (RCG) and a regular care group with additional videoconference (VCG), in a 1-year follow-up between 2016 and 2018. Costs were prospectively collected, and health-related quality of life (HRQoL) data were collected at baseline and 12 months. The outcome was quality-adjusted life years (QALYs), derived from the EQ-5D-5L questionnaire. Results are reported as incremental cost-effectiveness ratio (ICER), expressed as the cost per additional QALY gained. Transportation related costs and environmental emissions were compared by t-tests.ResultsThere were 56 participants included, 28 in each group. Of these 27 in the VCG and 26 in the RCG completed. Three participants died. The mean cost per patient was euro 8819 in the VCG and euro 3607 in the RCG, with 0.1 QALYs gained in the VCG. No significant differences were identified regarding HRQoL or secondary outcomes.ConclusionThe VCG costs euro 5212 more for an additional 0.1 QALYs, giving an ICER of euro 52,120 per QALY. No significant differences were found regarding transportation-related costs, or emission of greenhouse gases.
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| 3. |
- Langhammer, Birgitta, et al.
(författare)
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An evaluation of two different exercis regimes during the first year following stroke : a randomised controlled trail
- 2009
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Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 25:2, s. 55-68
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this randomised controlled trial was to evaluate the effects of two different exercise approaches during the first 12 months post stroke on Instrumental Activities of Daily Living (IADL), motor function, gait performance, balance, grip strength, and muscle tone. This study is a double-blind longitudinal randomised trial of first-time-ever stroke patients. Seventy-five patients were included: 35 in an intervention group and 40 in a self-initiated exercise group. After discharge from acute rehabilitation, patients assigned in the intervention group had physiotherapy for a minimum amount of 80 hours during the first year. Patients in the self-initiated exercise group were not recommended any specific therapy besides treatment when needed. Main outcome measures were Instrumental Activities of Daily Living according to Fillenbaum, Motor Assessment Scale, 6-Minute Walk Test, Berg Balance Scale, Timed Up-and-Go Test, grip strength, Modified Ashworth Scale, and pulse monitoring. The patients were tested on admission, at discharge, and after 3, 6, and 12 months post stroke by an experienced investigator, blinded to group assignment. Twelve months post stroke showed higher levels of independence in all items of the Instrumental Activities of Daily Living Test and improvements in the results of Motor Assessment Scale, 6-Minute Walk Test, Berg Balance Scale, Timed Up-and-Go, and grip strength in both groups. Only a few significant differences were seen between groups, and they were in favour of the self-initiated exercise group (e.g., ability to use the telephone independently). Attending examination sessions following each intervention phase appeared to be strong motivators for training, irrespective of group allocation.
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| 4. |
- Langhammer, Birgitta, et al.
(författare)
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Baseline walking ability as an indicator of overall walking ability and ADL at 3, 6, and 12 months after acute stroke
- 2022
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Ingår i: European Journal of Physiotherapy. - : Taylor & Francis. - 2167-9169 .- 2167-9177. ; 24:5, s. 311-319
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To evaluate to what extent baseline walking ability was predictive of activity levels and if categorising into groups of ability or capacity was equally informative. Methods The data were collected from a randomised controlled study where the results were neutral. The trial was registered in ClinicalTrials.gov Identifier: NCT00311025. The sample (n = 75) was divided at baseline into two models of sub-groups, one related to ability based on the Functional Ambulation Category (FAC), the other to capacity based on maximal gait speed: <= 0.4, 0.5 - 0.8 and >= 0.8 m/s. Outcome measures used were 6-min Walk-Test, Motor assessment Scale 5 and Barthel Index (BI). Tests were performed baseline on admission, at discharge, 3, 6, and 12 months post debut. Results Both models of walking, ability (FAC) or capacity (gait speed) were significant contributors to BI independence at 3, 6, and 12 months. The capacity model was explanatory for the independence of ADL function with 58, 49, and 54%, respectively, and the ability model was slightly less explanatory with a prediction of 56, 49, and 44%, respectively. Conclusion Baseline walking ability is predictive for independence in ADL, and a quantitative evaluation may be preferable for accuracy.
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| 5. |
- Langhammer, Birgitta, et al.
(författare)
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Exercise and health-related quality of life during the first year following acute stroke : A randomized controlled trial
- 2008
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Ingår i: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 22:2, s. 135-145
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the impact of two different physiotherapy exercise regimes in patients after acute stroke on health-related quality of life (HRQoL) and to investigate how the degree of motor and balance function, gait capacity, activities of daily living and instrumental activities of daily living influenced HRQoL. Methods: A longitudinal randomized controlled stratified trial of two interventions: the intensive exercise groups with scheduled intensive training during four periods of the first year after stroke and the regular exercise group with self-initiated training. Results: There was a tendency of better HRQoL in the regular exercise group on NHP total score (p = 0.05). Patients with low scores in activities of daily living, balance and motor function and inability to perform 6-minute walk test on admission, scored lower on self-perceived health than patients with high scores and ability to perform the walking test. At 1 year post-stroke, total scores on NHP were moderately associated with motor function (r = -0.63), balance (r = -0.56), gait (r = -0.57), activities of daily living (r = -0.57) and instrumental activities of daily living (r = -0.49-0.58). The physical mobility sub-scale of NHP had the strongest association ranging from r = -0.47-0.82. Conclusion: The regular exercise group with self-initiated training seemed to enhance HRQoL more than the intensive exercise group with scheduled intensive training. The degree of motor function, balance, walking capacity and independence in activities of daily living is of importance for perceived HRQoL.
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| 6. |
- Langhammer, Birgitta, et al.
(författare)
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Factors enhancing activities of daily living after stroke in specialized rehabilitation. An observational multicenter study within the Sunnaas International Network.
- 2017
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Ingår i: European journal of physical and rehabilitation medicine. - 1973-9095. ; 53:5, s. 725-34
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Tidskriftsartikel (refereegranskat)abstract
- Stroke may lead to serious, long-term disability. Consequently, many individuals with stroke will be in need of rehabilitation, and some of specialized rehabilitation. The content and organization of rehabilitation vary within and between countries, reflecting the preferences, customs, traditions, and values of a society or community, that may have an impact on outcomes.The main aim of the present study was to evaluate the influence of team models in specialized rehabilitation on outcomes as measured by stroke patients' performance in ADL, at a standardized time and at discharge in the various specialized rehabilitation clinics. Secondary aims were to identify explanatory factors for possible differences in ADL changes at standardized time points.A prospective descriptive cross-sectional explorative, multicentre study.Specialized rehabilitation clinics in Norway, China, the United States, Russia, Israel, Palestine, and Sweden, in total nine clinics.Persons with stroke.Outcomes measures were the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale (NIHSS), both on admission and at discharge from the inpatient rehabilitation unit, and Barthel Index (BI) or alternatively Functional Independence Measure (FIM), on admittance, 18-22 days into rehabilitation, at discharge, and at 6 and 12 months after discharge.In total 230 persons with stroke from nine clinics were recruited. There were significant differences in change scores of ADL from admittance to standardized time point 18-22 days into rehabilitation, (p<0.001, r2= 0.19) and when controlled for baseline NIHSS and mRS (p<0.001, r2 = 0.18; p=0.01, r2 = 0.9 respectively). Analysis divided into intra-, multi- and interdisciplinary models showed significant differences at 18-22 days (p=0.02) and at discharge (p<0.001), indicating a more favourable outcome in ADL with the multi- disciplinary model. The linear regression analysis explained 55 % of the changes in ADL (R2= 0.55) at the standardized time point and 48% (R2 = 0.48) at discharge. Main explanatory factors were disability (mRS) and severity (NIHSS), team models, hours in therapy, and location at discharge. ADL was maintained for the majority of participants at 6 and 12 months post discharge. The correlations mRS / ADL (r=-0.68, p<0.0001), NIHSS / ADL (r=-0.55, p<0.0001) and NIHSS / mRS (r=0.46, p<0.0001) disclosed medium to large associations at 18-22 days into rehabilitation.The study indicates that the organisation of services in specialized rehabilitation after stroke has a major impact on improvement of ADL outcomes. Main positive predictive factors were models of teamwork, with the multidisciplinary model as most beneficial, and concentrated hours of therapy. Negative predictors were the level of baseline severity and disability post stroke.The results indicate that organization of services should be at target to optimize patients' outcomes in rehabilitation. Furthermore, that concentrated hour's related to specific goals in therapy are preferable to optimize functional recovery.
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| 7. |
- Langhammer, Birgitta, et al.
(författare)
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Physiotherapy and physical functioning post-stroke : Exercise habits and functioning 4 years later? Long-term follow-up after a 1-year long-term intervention period: A randomized controlled trial
- 2014
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Ingår i: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 28:11, s. 1396-1405
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Physical activity is mandatory if patients are to remain healthy and independent after stroke. Objective: Maintenance of motor function, tone, grip strength, balance, mobility, gait, independence in personal and instrumental activities of daily living, health-related quality-of-life and an active lifestyle 4 years post-stroke. Methods: A prospective randomized controlled trial. Results: Four years post-stroke, 37 of the 75 participating persons were eligible for follow-up; 19 (54.3%) from the intensive exercise group and 18 (45%) from the regular exercise group. Both groups were performing equally well with no significant differences in total scores on the BI (p=0.3), MAS (p=0.4), BBS (p=0.1), TUG (p=0.08), 6MWT (p=0.1), bilateral grip strength (affected hand, p=0.8; non-affected hand, p=0.9) nor in the items of NHP (p>0.005). Independence in performing the IADL was 40%, while 60% had help from relatives or community-based services. Conclusion: This longitudinal study shows that persons with stroke in two groups with different exercise regimes during the first year after stroke did not differ in long-term outcomes. Both groups maintained function and had a relatively active life style 4 years after the acute incident. The results underline the importance of follow-up testing and encouragement to exercise, to motivate and sustain physical activity patterns, to maintain physical function, not only in the acute but also in the chronic phase of stroke.
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| 8. |
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| 9. |
- Langhammer, Birgitta, et al.
(författare)
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Return to work after specialized rehabilitation-An explorative longitudinal study in a cohort of severely disabled persons with stroke in seven countries: The Sunnaas International Network stroke study.
- 2018
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Ingår i: Brain and behavior. - : Wiley. - 2162-3279. ; 8:8
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Tidskriftsartikel (refereegranskat)abstract
- Stroke may impose disabilities with severe consequences for the individual, with physical, psychological, social, and work-related consequences. The objective with the current study was to investigate to what extent persons with stroke were able to return to work, to maintain their financial situation, and to describe the follow-up services and participation in social networks and recreational activities.The design was a prospective, descriptive study of specialized stroke rehabilitation in nine rehabilitation centers in seven countries. Semistructured interviews, which focused on the return to work, the financial situation, follow-up services, the maintenance of recreational activities, and networks, were performed 6 and 12months post discharge from rehabilitation.The working rate before the onset of stroke ranged from 27% to 86%. At 12 months post stroke, the return to work varied from 11% to 43%. Consequently, many reported a reduced financial situation from 10% to 70% at 6months and from 10% to 80% at 12months. Access to postrehabilitation follow-up services varied in the different countries from 24% to 100% at 6months and from 21% to 100% at 12months. Physical therapy was the most common follow-up services reported. Persons with stroke were less active in recreational activities and experienced reduced social networks. Associations between results from the semistructured interviews and related themes in LiSat-11 were small to moderate. The study shows that education, age, and disability are predictors for return to work. Differences between countries were observed in the extent of unemployment.In this international multicentre study, return to work after severe stroke and specialized/comprehensive rehabilitation was possible, depending on the extent of the disability, age, and education. Altered financial situation, reduced social networks, and reduced satisfaction with life were common psychosocial situations for these patients.
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| 10. |
- Langhammer, Birgitta, et al.
(författare)
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Stroke patients and long-term training: is it worthwhile? : A randomized comparison of two different training strategies after rehabilitation
- 2007
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 21:6, s. 495-510
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To find out if there were any differences in improvement and maintenance of motor function, activity of daily living and grip strength between patients with first-ever stroke receiving two different strategies of physical exercise during the first year after stroke. Design: A longitudinal randomized controlled stratified trial. Setting: Rehabilitation institutions, community, patients' homes and nursing homes. Subjects: Seventy-five male and female first-time-ever stroke patients: 35 in an intensive exercise group and 40 in a regular exercise group. Intervention: The intensive exercise group received physiotherapy with focus on intensive exercises in four periods during the first year after stroke. The regular exercise group patients were followed up according to their subjective needs during the corresponding year. Main outcome measures: Motor Assessment Scale, Barthel Index of Activities of Daily Living, and grip strength. Results: Both groups improved significantly up to six months when function stabilized. The groups did not differ significantly on any test occasions. The difference of improvement from admission to discharge was significant in favour of the intensive exercise group, in the Motor Assessment Scale total score (intensive exercise group 7.5; regular exercise group 1.7, P = 0.01), and in the Barthel Index of Activities of Daily Living total score (17.4 versus 8.9, P = 0.04). Conclusion: Motor function, activities of daily living functions and grip strength improved initially and were maintained during the first year after stroke in all patients irrespective of exercise regime. This indicates the importance of motivation for regular exercise in the first year following stroke, achieved by regular check-ups.
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