| 1. |
- Blomgren, Charlotte, et al.
(författare)
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Long-term performance of instrumental activities of daily living in young and middle-aged stroke survivors-Impact of cognitive dysfunction, emotional problems and fatigue.
- 2019
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Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 14:5
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Tidskriftsartikel (refereegranskat)abstract
- With an upward trend in the number of people who return home to independent living after stroke, the ability to perform more complex activities is becoming an increasingly important long-term outcome after stroke. Although associations between Instrumental Activities of Daily Living (IADL) and cognitive dysfunction, emotional problems, and fatigue have been reported, less is known about the long-term impact of these stroke consequences on the performance of everyday activities in young and middle-aged stroke survivors.To explore the impact of cognitive dysfunction, emotional problems, and fatigue on long-term performance of instrumental activities of daily living in young and middle-aged stroke survivors.Data on stroke survivors, aged 18-69 at index stroke, were collected from the Sahlgrenska Academy Study on Ischaemic Stroke. IADL outcome was assessed using the Frenchay Activities Index (FAI), and the impact of chosen variables was assessed using Spearman´s rank-order correlation and logistic regression.Seven years after index stroke, 296 stroke survivors (median age of 64) were included in this study. Cognitive dysfunction showed the strongest correlations with FAI outcome and independently explained worse outcome on FAI summary score and the domain of work/leisure activities. Fatigue was independently explanatory of worse outcome on FAI summary score and domestic chores, while depressive symptoms independently explained worse outcome on work/leisure activities. In a subgroup with only those participants who had no or minimal residual neurological deficits at follow-up (NIHSS score 0), cognitive dysfunction independently explained worse outcome on FAI summary score and work/leisure activities. Depressive symptoms independently explained worse outcome on FAI summary score and domestic chores.Our results show that in young and middle-aged stroke survivors, cognitive dysfunction, depressive symptoms, and fatigue negatively impact performance of IADL even at seven years post stroke onset. Further, we have shown that an impact of both cognitive dysfunction and depressive symptoms can be found also among stroke survivors with mild or no remaining neurological deficits.
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| 2. |
- Broeren, Jurgen, et al.
(författare)
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Virtual rehabilitation after stroke.
- 2008
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Ingår i: Studies in health technology and informatics. - 0926-9630 .- 1879-8365. ; 136, s. 77-82
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this project was to investigate the effects of Virtual Reality technology and haptics for stroke rehabilitation. Twenty-nine stroke subjects, 17 women, and 12 men aged 44-85 years, participated in three different studies. All participants responded favorable to the use of the VR activity station. A change of attitude took place after the subjects were exposed to playing computer games. The general experience with the VR application approach suggests that this treatment concept is promising in stroke rehabilitation, with a wide range of applicability.
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| 3. |
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| 4. |
- Gerafi, Joel, et al.
(författare)
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Neglect and aphasia in the acute phase as predictors of functional outcome 7 years after ischemic stroke
- 2017
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 24:11, s. 1407-1415
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 EAN Background and purpose: Visuospatial inattention (VSI) and language impairment (LI) are often present early after stroke and associations with an unfavorable short-term functional outcome have been reported. The purpose of this study was to investigate whether a screening of VSI and LI as indicators of cortical symptoms early after stroke could predict long-term functional outcomes. Methods: A consecutive cohort of 375 patients with ischemic stroke was assessed for the occurrence of VSI at a median of 7 days after admission (interquartile range, 1–5 days) using the Star Cancellation Test and for LI (within the first 7 days) with the language item in the Scandinavian Stroke Scale. Seven years later, functional outcomes were assessed by the modified Rankin scale and Frenchay Activities Index in 235 survivors without recurrent stroke. Relationships between baseline predictors and functional outcome at 7 years were analyzed with bivariate correlations and multiple categorical regressions with optimal scaling. Results: The regression model significantly explained variance in the modified Rankin scale (R 2 = 0.435, P < 0.001) and identified VSI (P = 0.001) and neurological deficits (P < 0.001; Scandinavian Stroke Scale score without the language item) as the significant independent predictors. The model for Frenchay Activities Index was also significant (R 2 = 0.269, P < 0.001) with VSI (P = 0.035) and neurological deficits (P < 0.001) as significant independent predictors. Conclusions: Visuospatial inattention at acute stroke has an independent impact on long-term functional outcomes. Early recognition may enable targeted rehabilitative interventions.
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| 5. |
- Blomgren, Charlotte, et al.
(författare)
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Long-term performance of instrumental activities of daily living (IADL) in young and middle-aged stroke survivors: Results from SAHLSIS outcome
- 2018
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 25:2, s. 119-126
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although stroke prevalence is increasing and large proportions of stroke survivors are expected to live many years after stroke onset, research on the long-term consequences of stroke for instrumental activities of daily living (IADL) is limited. Aim: To explore performance of IADL seven years post-stroke onset and identify predictors of long-term IADL performance based on commonly employed acute measures and demographic characteristics in young and middle-aged stroke survivors. Methods: Data on stroke survivors were collected from SAHLSIS. IADL performance was assessed at 7 years using the Frenchay Activities Index (FAI). Demographic data and baseline measures were assessed as predictors of FAI outcome, using logistic regression. Results: 237 stroke survivors with a median age of 63 at follow-up were included. Participants had predominantly suffered a mild stroke and > 90% lived at home with no community services. Mean FAI was 25.7(score range 0-45), indicating reduced levels of participation in IADL. Frequency of performance of IADL was lowest for work/leisure activities. Gender, cohabitation status, initial stroke severity and baseline score on mRS were independently associated with IADL outcome. Conclusions: Reduced levels of participation in IADL persist many years after stroke onset and indicate a need to adapt a long-term perspective on stroke rehabilitation.
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| 6. |
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| 7. |
- Broeren, Jurgen, et al.
(författare)
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Virtual rehabilitation in an activity centre for community-dwelling persons with stroke. The possibilities of 3-dimensional computer games.
- 2008
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Ingår i: Cerebrovascular diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9786 .- 1015-9770. ; 26:3, s. 289-96
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The main purpose of this study was to place a virtual reality (VR) system, designed to assess and to promote motor performance in the affected upper extremity in subjects after stroke, in a nonhospital environment. We also wanted to investigate if playing computer games resulted in improved motor function in persons with prior stroke. METHODS: The intervention involved 11 patients after stroke who received extra rehabilitation by training on a computer 3 times a week during a 4-week period. The control group involved 11 patients after stroke who continued their previous rehabilitation (no extra computer training) during this period. The mean age of all was 68 years (range = 47-85) and the average time after stroke 66 months (range = 15-140). The VR training consisted of challenging games, which provided a range of difficulty levels that allow practice to be fun and motivating. An additional group of 11 right-handed aged matched individuals without history of neurological or psychiatric illnesses served as reference subjects. RESULTS: All the participants reported that they were novel computer game players. After an initial introduction they learned to use the VR system quickly. The treatment group demonstrated improvements in motor outcome for the trained upper extremity, but this was not detected in real-life activities. CONCLUSIONS: The results of this research suggest the usefulness of computer games in training motor performance. VR can be used beneficially not only by younger participants but also by older persons to enhance their motor performance after stroke.
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| 8. |
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| 9. |
- Claesson, Lisbeth, 1955, et al.
(författare)
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Characteristics of elderly people readmitted to the hospital during the first year after stroke. The Göteborg 70+ stroke study.
- 2002
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Ingår i: Cerebrovascular diseases (Basel, Switzerland). - 1015-9770. ; 14:3-4, s. 169-76
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Readmissions after acute stroke vary over time and with age and comorbidity. Knowledge of the reasons for readmissions and characteristics of readmitted patients is sparse. This 1-year prospective study examined whether readmissions were related to severity of the index stroke or to comorbidity and explored outcomes in readmitted patients with respect to daily life activities and health-related quality of life. METHODS: The study included 216 elderly patients (aged >/=70 years) discharged to their homes or a nursing home after index stroke. The main outcomes were readmission rates and reported diagnoses, performance of daily life activities and health-related quality of life. RESULTS: Nearly half (45%) of the patients were readmitted to the hospital after being discharged to their homes. One readmission was most common, and stroke-related diagnoses were most frequently reported as the reason for readmission. Different forms of heart disease were the next most common reason. The readmitted patients were significantly more dependent in daily life activities, and health-related quality of life was significantly lower among this group. CONCLUSIONS: Recurrent stroke and sequelae after stroke were major factors behind readmissions, followed by heart disease in elderly stroke patients. The readmitted patients were more dependent in daily life activities and reported a lower health-related quality of life compared with not readmitted patients.
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| 10. |
- Claesson, Lisbeth, 1955, et al.
(författare)
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Cognitive impairment after stroke - impact on activities of daily living and costs of care for elderly people. The Göteborg 70+ Stroke Study.
- 2005
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Ingår i: Cerebrovascular diseases (Basel, Switzerland). - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 19:2, s. 102-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The economic burden of stroke is substantial and is likely to increase with an increasing number of elderly individuals in the population. There is thus a need for information on the use of health care resources and costs among these elderly stroke patients. We examined the impact of the cognitive impairments on the ability to perform activities of daily living (ADL) and utilization and costs of health care in a cohort of elderly stroke patients. METHODS: One hundred and forty-nine patients aged >/=70 years with acute stroke were included. The patients were assessed regarding their ability to carry out ADL and health resource utilization and cost during the first year after stroke. Cognitive impairments were assessed 18 months after the index stroke. RESULTS: Stroke severity in acute stroke and cognitive impairment at 18 months after stroke onset was associated with impairment in ADL and increased costs for utilisation of care during the first year. Patients with cognitive impairment were more dependent on personal assistance in ADL. Costs per patient during the study were three times higher for patients with cognitive impairment. Hospital care, institutional living and different kinds of support from society accounted for the highest costs. CONCLUSIONS: Costs of care utilisation during the first year after stroke were associated with cognitive impairments, stroke severity and dependence in ADL. The results should be interpreted cautiously as the assessment of cognitive function was made 18 months after stroke onset and costs were estimated for the first year after stroke.
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| 11. |
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| 12. |
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| 13. |
- Claesson, Lisbeth, 1955, et al.
(författare)
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Comparison of visual acuity charts identifying visual impairment among older people outside the eye clinic
- 2013
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 35:16, s. 1394-1400
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Evaluate the construct validity and describe sensitivity, specificity and predictive value of two short charts of visual acuity (VA) and examine whether these can identify and detect signs of visual impairment among older people. Method: The study included 43 persons, >65 years, with age related eye disease, living in their own homes. An ophthalmologist assessed the individuals' VA at an eye clinic with the 5 m KM chart. A research assistant assessed individuals' VA by the 1 m KM chart and the Visual Acuity Screening Test in their home environment. Results: All persons with a VA level of <0.5 were correctly identified by both instruments. The instruments have good positive and negative predictive values for the 1 m KM chart (73% and 100%) and for the Visual Acuity Screening Test (69% and 100%). The construct validity between the instruments was good, but the assessment at the eye clinic assessed the participants as having higher VA level. Conclusions: Both instruments have good construct validity, considering they were carried out in poorer lighting conditions and a good predictive value for screening out VA levels <0.5. The 1 m KM chart showed the best agreement with the 5 m KM chart.
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| 14. |
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| 15. |
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| 16. |
- Claesson, Lisbeth, 1955, et al.
(författare)
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Hospital re-admissions in relation to acute stroke unit care versus conventional care in elderly patients the first year after stroke: the Göteborg 70+ Stroke study.
- 2003
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Ingår i: Age and ageing. - 0002-0729. ; 32:1, s. 109-13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: re-hospitalisation after discharge following index stroke varies over time and with age and comorbidity. There is little knowledge about whether stroke unit care reduces the need of re-admissions. OBJECTIVES: to examine whether stroke unit care as compared with care in general medical wards was associated with fewer re-hospitalisations for conditions judged to be secondary to acute stroke and to identify the influence of stroke severity on re-admission rates. DESIGN:we conducted a one-year randomised study to compare the outcome of treatment at an acute stroke unit in a care continuum with the outcome of treatment at general medical wards. SETTINGS: acute and geriatric hospitals in Göteborg, Sweden. SUBJECTS: 216 elderly patients aged >or=70 years discharged to their own homes or to institutionalised living after index stroke. METHODS: comparison of comorbidity classified according to Charlson's morbidity index, re-admission rates, length of hospital stay, number of re-admissions and diagnoses between a group treated at a stroke unit and a group treated at general wards. RESULTS: the re-admission rates, length of hospital stay and causes of re-admissions did not differ between the two groups. Complications related to the damage to the brain and concomitant heart disease were the most common causes of re-admissions in both groups. Index stroke severity did not influence the re-admission rates. CONCLUSIONS: re-admissions for conditions judged to be secondary to acute stroke were equal in the two groups in this prospective study.
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| 17. |
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| 18. |
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| 19. |
- Claesson, Lisbeth, 1955, et al.
(författare)
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Measures of order consistency between paired ordinal data: application to the Functional Independence Measure and Sunnaas index of ADL.
- 2001
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Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - 1650-1977. ; 33:3, s. 137-44
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to evaluate the inter-item consistency between corresponding items in the Functional Independent Measure (FIM) and Sunnaas index of ADL (SI) by means of a statistical approach that takes account of the nonmetric properties of ordinal data. The ADL dependence in 204 stroke patients was assessed by interview 3 months after the onset of stroke. The result showed that the inter-item consistency between the FIM and SI were high for many items, but operational differences between some FIM and SI items were also identified. The statistical evaluation demonstrated that some of the ordered categorical levels of the seven-point item scales in the FIM could be aggregated into four levels without loss of information.
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| 20. |
- Claesson, Lisbeth, 1955, et al.
(författare)
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Resource utilization and costs of stroke unit care integrated in a care continuum: A 1-year controlled, prospective, randomized study in elderly patients: the Göteborg 70+ Stroke Study.
- 2000
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Ingår i: Stroke; a journal of cerebral circulation. - : Lippincott Williams & Wilkins. - 1524-4628 .- 0039-2499. ; 31:11, s. 2569-77
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The aim of the present study was to examine resource utilization during a 12-month period after acute stroke in elderly patients randomized to care in an acute stroke unit integrated with a care continuum compared with conventional care in general medical wards. A secondary aim was to describe costs related to the severity of stroke. METHODS: Two hundred forty-nine consecutive patients aged >/=70 years with acute stroke within 7 days before admission, living in their own homes in Göteborg, Sweden, without recognized need of care were randomized to 2 groups: 166 patients were assigned to nonintensive stroke unit care with a care continuum, and 83 patients were assigned to conventional care. There was no difference in mortality or the proportion of patients living at home after 1 year. Main outcomes were costs from inpatient care, outpatient care, and informal care. RESULTS: Mean annual cost per patient was 170, 000 Swedish crowns (SEK) (equivalent to $25,373) and 191,000 SEK ($28,507) in the stroke unit and the general medical ward groups, respectively (P:=NS). Seventy percent of the total cost was for inpatient care, and 30% was for outpatient and informal care. For patients with mild, moderate, and severe stroke, the mean annual costs per patient were 107,000 SEK ($15,970), 263,000 SEK ($39, 254), and 220,000 SEK ($32,836), respectively (P:<0.001). There was no statistical difference in age or nonstroke diagnosis. CONCLUSIONS: The total costs the first year did not differ significantly between the treatment groups in this prospective study. The total annual cost per patient showed a very large variation, which was related to stroke severity at onset and not to age or nonstroke diagnoses. Costs other than those for hospital care constituted a substantial fraction of total costs and must be taken into account when organizing the management of stroke patients. The high variability in costs necessitates a larger study to assess long-term cost effectiveness.
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| 21. |
- Claesson, Lisbeth, 1955
(författare)
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Stroke hos äldre personer
- 2007
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Ingår i: Strokerummet, Vårdalsinstitutet.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 22. |
- Claesson, Lisbeth, 1955
(författare)
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Stroke in elderly people. A randomised study of stroke unit care. Evaluation of health care utilisation and costs
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to evaluate stroke unit care for elderly patients, aged > 70 years, in daily life activities, health-related quality of life and costs, to describe patients´ conditions from the perspectives of re-admissions to hospital care and to identify the consequences of cognitive impairments on daily life activities and costs.I-II. Two hundred and forty-nine patients aged > 70 years with acute stroke within seven days before admission and living at home were entered consecutively into the study and randomised to two groups: 166 patients (intervention) were assigned to a non-intensive stroke unit care with a care continuum including stroke unit in geriatric wards for patients needing long rehabilitation time and 83 patients (control) were assigned to general medical wards. Outcome measures were patients at home after one year, ability in daily life activities (ADL), health-related quality of life, use of resources and costs of health care. Two registered occupational therapists not involved in the design of the study and the treatment of the patients made all evaluations of the study outcome.Sixty-one percent of the patients in the stroke unit group and 59% in the general medical ward group were at home after one year. There were no significant differences in survival rates, ability in daily life activities and health-related quality of life. The mean annual cost per patient was 170 000 Swedish crowns (SEK) and 191 000 SEK in the stroke unit and the general medical wards, respectively (not statistical significant). Seventy percent of the total cost was for in-patient care, and 30% was for outpatient care, social service and informal care. The costs varied greatly depending on the severity of the stroke. III. Two hundred and sixteen patients were discharged to their homes or to nursing homes after acute stroke. Nearly half of these patients were re-admitted to hospital care. One re-admission was most common. Stroke-related diagnoses, followed by heart disease, were most frequently reasons for re-admission. The re-admitted patients were significantly more dependent in daily life activities and reported a lower health-related quality of life as compared to patients who were not re-admitted. IV. Cognitive impairment was assessed one and a half year after acute stroke. Patients with cognitive impairment were more dependent on personal assistance in ADL. Costs per patients during the study were three times higher for patient's with cognitive impairment. Hospital care, institutional living and different kinds of support from society were associated with the highest costs.V. Evaluations were made of concordance on the item level between the assessments of ADL by the Functional Independence Measure (FIM) and Sunnaas Index of ADL. The concordance was high for many items, but operational differences were identified between some FIM and SI items. In some of the items the seven-point item scale in the FIM could be reduced to four levels without loss of information.
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| 23. |
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| 24. |
- Dahlgren, A, et al.
(författare)
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Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein-Bell ADL Scale.
- 2007
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 45:7, s. 475-84
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Cross-sectional study. OBJECTIVES: (1) To examine whether the Klein-Bell ADL Scale (K-B Scale) discriminates cervical spinal cord injury (SCI) patients in daily activities and to explore its applicability in this group of patients. (2) To examine the association between basic ADL and upper extremity function. (3) To investigate if grip ability can be discerned in the scale. SETTING: Spinal Cord Injury Unit, Sahlgrenska University Hospital, Göteborg, Sweden. METHODS: Fifty-five patients with cervical SCI with no prior reconstructive hand surgery were included in the study. Analyses of the patient's independence were made according to the K-B Scale. Three additional analyses were carried out, the first examined whether the use of assistive devices and house and car adaptations influenced independence. The last two used different approaches to investigate whether arm and grip function could be detected in the K-B scale. RESULTS: Raw score in the K-B Scale can discriminate for independence in daily activities but the scale's weight scheme does not function for cervical SCI patients. Assistive devices and car and house adaptations can compensate for dependence in daily activities. Lack of grip function decreases the patient's ability to become independent. Diagnosis-related activities cannot be assessed in all items. CONCLUSION: The K-B Scale's raw score was useful assessing daily activities in cervical SCI patients. Its reliability in conjunction with arm and grip function in patients with cervical SCI has yet to be proven.
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| 25. |
- Dahlgren, Annika, 1964, et al.
(författare)
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Linking the Klein-Bell ADL Scale to the International Classification of Functioning, Disability, and Health (ICF) : Linking an ADL scale to the ICF
- 2013
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 45:4, s. 351-7
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The main objective of this study was to link the Klein-Bell Activities of Daily Living (KB) Scale to the International Classification of Functioning, Disability and Health (ICF), in order to validate the KB Scale content-wise. Design: A qualitative approach was used with directed content analysis. Methods: Concepts in the KB Scale items were linked to ICF categories according to established rules. This was followed by 4 analyses: examination of the linked categories' frequency distribution; comparison of these categories with Core Sets for spinal cord injury (SCI) and occupational therapists; calculation of content density, content diversity and range of linked categories; and calculation of agreement between two independent linkage versions. Results: All except one identified KB Scale concept could be linked to ICF categories. The occupational therapists Core Sets were most consistent with linked categories in the KB Scale. Content density, content diversity and range varied between the different KB Scale dimensions. Agreement was reliable for the whole KB Scale and for 5 of 6 dimensions. Conclusion: The ICF has provided a valuable reference to identify and quantify the concepts in the KB Scale. Furthermore, comparison between the KB Scale and ICF Core Sets provides insights into areas covered by these instruments.
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