| 1. |
- Gosman-Hedström, Gunilla, 1947, et al.
(författare)
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Stroke hos äldre och anhörigas situation
- 2004
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Ingår i: 6:e Stroke-Team-Kongressen. Örebro 7-9 Oktober Sweden 2004. (Invited speaker).
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Konferensbidrag (refereegranskat)
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| 2. |
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| 3. |
- Cederfeldt, Marie, 1957, et al.
(författare)
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A longitudinal study of cognitive impairments in relation to activities in daily life
- 2009
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Ingår i: AT-FORUM, Äldres vardag, 6-8 maj-2009, Älvsjömässan i Stockholm.
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Konferensbidrag (refereegranskat)abstract
- Objective: To examine whether there were any differences in recovery in performance of personal activities of daily living (P-ADL) in relation to cognitive impairments pre- and poststroke from discharge to 6 and 12 months in elderly persons. Methods: Forty-five elderly persons after stroke were assessed at discharge from the hospital at 6 and at 12 months. A questionnaire was used to evaluate the person´s prestroke cognitive status. P-ADL was assessed with the Barthel Index. The Mini Mental State Examination and neuropsychological tests were used to measure cognitive functions. Results: Persons with cognitive impairments before and after stroke did not improve in P-ADL from the acute phase until 6 and 12 months, while persons with intact cognition pre- and poststroke did. Conclusion: Since cognitive problems pre- and poststroke hinder recovery in P-ADL, it is important to be aware of the connection between cognitive impairment and activity limitations in planning the optimal rehabilitation. Key words: ADL, cognitive dysfunction, elderly, longitudinal, prestroke, stroke
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| 4. |
- Cederfeldt, Marie, 1957, et al.
(författare)
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Concurrent validity of the Executive Function Performance Test in people with mild stroke
- 2011
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Ingår i: The British Journal of Occupational Therapy. - 0308-0226 .- 1477-6006. ; 74:9, s. 443-449
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Studies have shown that executive dysfunction is common in adults after stroke. Occupational therapists working in acute care assess the performance of activities of daily living; most instruments focus on personal care. However, the assessment of instrumental activities of daily living has been shown to discriminate executive dysfunction more effectively. An instrument for assessing executive dysfunction in more complex activities that is easy to handle in acute care is consequently required for clinical use. The Executive Function Performance Test (EFPT) was recently introduced into Sweden. The purpose of this study was to evaluate the concurrent validity of the EFPT in acute care for patients with mild stroke. Method: Twenty-three patients from an acute stroke unit were assessed with both the EFPT and the Assessment of Motor and Process Skills (AMPS). Results: The correlation between the EFPT and the AMPS assessments was highly significant (p = 0.003) and the concurrent validity was rho = 0.61. Conclusion: Since there is a risk that adult patients with mild stroke are discharged without rehabilitation, and there is a lack of a relevant instrument for occupational therapists that discriminates executive dysfunction in acute stroke care, the EFPT may be a suitable instrument to use with these patients.
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| 5. |
- Cederfeldt, Marie, 1957, et al.
(författare)
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En prospektiv studie om kognitiv nedsättning i relation till aktiviteter i det dagliga livet - Göteborgs Kognitiva Stroke Studie för Äldre
- 2008
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Ingår i: Läkarstämman i Göteborg 2008.
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Konferensbidrag (refereegranskat)abstract
- Det saknas studier om hur kognitiva nedsättningar pre-och poststroke påverkar vardagsaktiviteterna för äldre personer efter ett år. Syftet var att undersöka om det var någon skillnad i P-ADL från akutskedet till 12 månader hos äldre personer efter stroke med eller utan kognitiva nedsättningar pre- och poststroke. Äldre personer drabbade av stroke (n=45) inkluderades. Bedömningar utfördes vid utskrivning, 6 och 12 månader. Medianålderna var 77 år. Åstrands frågeformulär användes för att intervjua anhöriga om patientens kognitiva status prestroke. DSM-III användes också för diagnosen prestroke demens. Bartel Index användes för att bedöma P-ADL. Mini Mental State Examination (MMSE) och ett neuropsykologiskt test batteri användes för att bedöma kognitiv funktion. Resultat: Ej publicerat än
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| 6. |
- Cederfeldt, Marie, 1957, et al.
(författare)
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Influence of cognition on personal activities of daily living (P-ADL) in
- 2007
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Ingår i: Nordisk konferens för arbetsterapeuter i Stockholm 2007.
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Konferensbidrag (refereegranskat)abstract
- This study examines how prestroke dementia and cognitive dysfunction after stroke influence the personal activities of daily living (P-ADL) in elderly patients in the acute phase after stroke. Elderly patients (n = 60) referred to geriatric rehabilitation were included. Assessments were carried out at admission and evaluated at discharge from the geriatric ward. The median age of the group was 77 years. Åstrand’s questionnaire was used to interview a close relative about the patient’s prestroke cognitive status. P-ADL was assessed with the Barthel Index (BI). The Mini Mental State Examination (MMSE) and a neuropsychological test battery were used to measure cognitive functions. Analyses were made using non-parametrical methods. In the acute phase after stroke, neither the presence of prestroke dementia nor the cognitive status after stroke onset among these elderly patients influenced P-ADL at admission or at discharge. Prestroke dementia and cognitive dysfunction’s were found to be common after stroke onset, however this did not have any impact on dependence in P-ADL in these elderly patients at admission or at discharge.
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| 7. |
- Cederfeldt, Marie, 1957, et al.
(författare)
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Influence of cognition on personal activities of daily living (P-ADL) in the acute phase - The Gothenburg Cognitive Stroke Study in Elderly
- 2006
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Ingår i: Läkarstämman i Göteborg 2006.
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Konferensbidrag (refereegranskat)abstract
- This study examines how prestroke dementia and cognitive dysfunction after stroke influence the personal activities of daily living (P-ADL) in elderly patients in the acute phase after stroke. Elderly patients (n = 60) referred to geriatric rehabilitation were included. Assessments were carried out at admission and evaluated at discharge from the geriatric ward. The median age of the group was 77 years. Åstrand’s questionnaire was used to interview a close relative about the patient’s prestroke cognitive status. P-ADL was assessed with the Barthel Index (BI). The Mini Mental State Examination (MMSE) and a neuropsychological test battery were used to measure cognitive functions. Analyses were made using non-parametrical methods. In the acute phase after stroke, neither the presence of prestroke dementia nor the cognitive status after stroke onset among these elderly patients influenced P-ADL at admission or at discharge. Prestroke dementia and cognitive dysfunction’s were found to be common after stroke onset, however this did not have any impact on dependence in P-ADL in these elderly patients at admission or at discharge.
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| 8. |
- Cederfeldt, Marie, 1957, et al.
(författare)
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Influence of cognition on personal activities of daily living (P-ADL) in the acute phase: the Gothenburg Cognitive Stroke Study in Elderly.
- 2009
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Ingår i: Archives of gerontology and geriatrics. - : Elsevier BV. - 1872-6976 .- 0167-4943. ; 49:1, s. 118-22
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Tidskriftsartikel (refereegranskat)abstract
- This study examines how prestroke dementia and cognitive dysfunction after stroke influence the personal activities of daily living (P-ADL) in elderly patients in the acute phase after stroke. Elderly stroke patients (n=60) referred to geriatric rehabilitation were included. Assessments were carried out at admission and evaluated at discharge from the geriatric ward. The median age of the group was 77 years. Astrand's questionnaire was used to interview a close relative about the patient's prestroke cognitive status. P-ADL was assessed with the Barthel Index (BI). The Mini Mental State Examination (MMSE) and a neuropsychological test battery were used to measure cognitive functions. Analyses were made using non-parametrical methods. In the acute phase after stroke, neither the presence of prestroke dementia nor the cognitive status after stroke onset among these elderly patients influenced P-ADL at admission or at discharge. Prestroke dementia and cognitive dysfunction's were found to be common after stroke onset, however this did not have any impact on dependence in P-ADL in these elderly patients at admission or at discharge.
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| 9. |
- Cederfeldt, Marie, 1957, et al.
(författare)
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Inter-rater reliability and face validity of the Executive Function Performance Test (EFPT)
- 2015
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Ingår i: British Journal of Occupational Therapy. - : SAGE Publications. - 0308-0226 .- 1477-6006. ; 78:9, s. 563-569
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Tidskriftsartikel (refereegranskat)abstract
- Occupational therapists need an instrument to assess executive dysfunctions before patients are discharged from acute wards. The Executive Function Performance Test (EFPT) appears to be suitable, since it evaluates dysfunctions in complex activities. The aim of this study was to translate the EFPT from English into Swedish and to evaluate its properties when used with older persons with mild stroke in an acute setting. Method The study consisted of three parts: (1) a translation procedure using a forward and backward method; (2) evaluation of face validity; (3) inter-rater reliability by four raters (two pairs) who made 34 assessments in 17 older patients with mild stroke in an acute ward. Results The inter-rater reliability for the EFPT was good. The median was 88% of the percentage agreement. No occasional disagreement was found between the raters, but there was a systematic disagreement in one out of 20 items. The translation and face validity process resulted in further clarification of the semantic and cultural equivalence of the EFPT, and the manual was changed accordingly. Conclusion This study showed that inter-rater reliability was good and that the EFPT was found to be an interesting assessment, although further research is needed.
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| 10. |
- Cederfeldt, Marie, 1957, et al.
(författare)
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Mellanbedömarreliabilitet av instrumentet Executive Function Performance Test (EFPT)
- 2011
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Ingår i: Poster.
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Konferensbidrag (refereegranskat)abstract
- Bakgrund: Studier har visat att nedsatt exekutiv funktion är vanligt hos personer som fått stroke. Arbetsterapeuter som arbetar inom akutvården bedömer hur patienten klarar aktiviteter i det dagliga livet, men de flesta instrumenten som används är inom personlig vård. Instrument som bedömer mer komplexa aktiviteter har visat sig vara de mest effektiva avseende att upptäcka nedsatt exekutiv funktion. Eftersom instrumentet Assessment of Motor and Process Skills (AMPS) kan vara allt för omfattande att göra i den akuta fasen, skulle det kunna vara användbart att ha ett instrument som är mer lätthanterbart i det akuta skedet. Executive Function Performance Test (EFPT) är ett bedömningsinstrument som nyligen introducerats i Sverige. Studier saknas avseende validitet och reliabilitet utifrån Svenska förhållande. När ett nytt instrument skall användas är det viktigt att det har god validitet och reliabilitet. Syftet med denna studie var att utvärdera innehållsvaliditet och inter-bedömar validitet. Metoden innefattar en “forward” och en “backward” översättning av EFPT och en utvärdering av interbedömar reliabilitet genom att sjutton patienter från en stroke enhet har bedömts av två oberoende arbetsterapeuter. Studien är ett samarbete med kärnsjukhuset i Skövde. Resultatet håller på att analyseras och preliminära resultat kommer att presenteras på AT-forum.
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| 11. |
- Cederfeldt, Marie, 1957, et al.
(författare)
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Recovery in personal care related to cognitive impairment before and after stroke - a one-year follow-up
- 2010
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 122:6, s. 430-437
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective: To examine whether there were any differences in the recovery in performance of personal activities of daily living (P-ADL) in elderly persons in relation to cognitive impairments pre- and poststroke from discharge to 6 and 12 months in elderly persons. Methods: Forty-five elderly persons after stroke were assessed at discharge from hospital and at 6 and at 12 months after stroke onset. A questionnaire posed to the next of kin was used to evaluate the person´s pre- and poststroke cognitive status. P-ADL was assessed with the Barthel Index. The Mini Mental State Examination and neuropsychological tests were used to measure cognitive functions after stroke. The National Institute of Health Stroke Scale was used to measure neurological deficits. Results: Persons with cognitive impairments before and after stroke did not improve in P-ADL from the acute phase until 6 and 12 months, while persons with intact cognition pre- and post stroke did. Conclusion: Since cognitive problems pre- and poststroke hinder recovery in P-ADL, it is important to understand the connection between cognitive impairment and activity limitations when planning the optimal rehabilitation, which could include special compensation strategies, learnt by the patients, cognitive assistive devices and/or appropriate personal support trained in meaningful activities in daily life in their natural environment.
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| 12. |
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| 13. |
- 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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| 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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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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| 20. |
- Dahlin-Ivanoff, Synneve, 1950, et al.
(författare)
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Elderly persons in the risk zone: Design of a multidimensional, health-promoting, randomised three-armed controlled trial for "prefrail" people of 80+ years living at home
- 2010
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Ingår i: BMC geriatrics. - 1471-2318. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: The very old (80+) are often described as a "frail" group that is particularly exposed to diseases and functional disability. They are at great risk of losing the ability to manage their activities of daily living independently. A health-promoting intervention programme might prevent or delay dependence in activities of daily life and the development of functional decline. Studies have shown that those who benefit most from a health-promoting and disease-preventive programme are persons with no, or discrete, activity restrictions. The three-armed study "Elderly in the risk zone" is designed to evaluate if multi-dimensional and multi-professional educational senior meetings are more effective than preventive home visits, and if it is possible to prevent or delay deterioration if an intervention is made when the persons are not so frail. In this paper the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants are presented. METHODS: The study is a randomised three-armed single-blind controlled trial with follow-ups 3 months, 1 and 2 years. The study group should comprise a representative sample of pre-frail 80-year old persons still living at home in two municipalities of Gothenburg. To allow for drop-outs, it was estimated that a total of about 450 persons would need to be included in the study. The participants should live in their ordinary housing and not be dependent on the municipal home help service or care. Further, they should be independent of help from another person in activities of daily living and be cognitively intact, having a score of 25 or higher as assessed with the Mini Mental State Examination (MMSE). DISCUSSION: We believe that the design of the study, the randomisation procedure, outcome measurements and the study protocol meetings should ensure the quality of the study. Furthermore, the multi-dimensionality of the intervention, the involvement of both the professionals and the senior citizens in the planning of the intervention should have the potential to effectively target the heterogeneous needs of the elderly.
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| 21. |
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| 22. |
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| 23. |
- Fagerberg, Björn, 1943, et al.
(författare)
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Effect of acute stroke unit care integrated with care continuum versus conventional treatment: A randomized 1-year study of elderly patients: the Göteborg 70+ Stroke Study.
- 2000
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Ingår i: Stroke; a journal of cerebral circulation. - 1524-4628. ; 31:11, s. 2578-84
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The aim of the study was to compare the effect of conventional treatment with the effect of acute stroke unit care integrated with geriatric stroke unit care continuum. METHODS: A 1-year study was undertaken with 2:1 randomization to stroke unit care or conventional care, with assessment by an independent team. The study was composed of 249 elderly patients (aged >/=70 years) hospitalized for acute stroke, without previous cerebral lesion and without recognized need of care. Main outcome measures were patients at home after 1 year, ability in daily living activities, health-related quality of life score according to questionnaire, death or institutional care, and death or dependence. RESULTS: One hundred two patients (61%) in the stroke unit and 49 patients (59%) in the general ward group were alive and at home after 1 year (95% CI -10% to 16%). There were no significant differences in daily life activities or quality of life. In patients with concomitant cardiac disease, there was a reduction in death or institutional care after 3 months in the stroke unit group compared with the group receiving conventional care (28% versus 49%, respectively; 95% CI -40% to -3%). This effect did not remain after 1 year. Patients seeking care after 24 hours often had mild stroke and lived alone. CONCLUSIONS: There was no effect on the number of patients living at home after 1 year, but after 3 months of stroke unit care, a beneficial effect was found on mortality and the need for institutional care among those with concomitant heart disease. This study involved patients who were considerably older than those investigated in previous randomized studies of acute stroke unit care; thus, these findings will contribute to the specialized register of controlled trials in stroke.
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| 24. |
- Gosman-Hedström, Gunilla, 1947
(författare)
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Anhöriga till äldre personer efter stroke
- 2010
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Ingår i: [Elektronisk] Tillgänglig:www.vardalinstitutet.net/stroke.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 25. |
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| 26. |
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| 35. |
- Gosman-Hedström, Gunilla, 1947
(författare)
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Bedömning av aktivitetsförmåga efter stroke
- 2010
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Ingår i: [Elektronisk] Tillgänglig: www.vardalinstitutet.net/stroke.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 36. |
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| 37. |
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| 38. |
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| 39. |
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| 40. |
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| 41. |
- Gosman-Hedström, Gunilla, 1947, et al.
(författare)
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Consequences of severity at stroke onset for health-related quality of life (HRQL) and informal care: a 1-year follow-up in elderly stroke survivors.
- 2008
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Ingår i: Archives of gerontology and geriatrics. - : Elsevier BV. - 0167-4943. ; 47:1, s. 79-91
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Tidskriftsartikel (refereegranskat)abstract
- Severity of stroke influences the possibility of living at homes after stroke and has been discussed as one possible prognostic factor for functional outcome and future residence. The objective was to explore how severity at stroke onset affects health-related quality of life (HRQL) and informal care among 147 stroke survivors and their spouses living in their own homes 1 year after acute stroke. This study is part of "The Göteborg 70+ Stroke Study" which included 249 elderly persons after acute stroke. One year after stroke 59% of the survivors, 94 women and 53 men, lived in their own homes. This group forms the present study population. They were subdivided according to the severity of stroke at onset, as assessed by Barthel index (BI) ratings in the acute phase. The stroke survivors rated their HRQL and were interviewed in their own homes to assess the effects of stroke on daily life activities and informal care after 1 year. Informal caregivers were found to assist their spouses to a great extent, regardless of severity of stroke. Persons with moderate/severe stroke at onset received more informal as well as more formal help than the ones with mild stroke. As expected, the group with moderate/severe stroke also was more dependent on personal assistance, used more assistive devices (ADs) and rated their HRQL lower. However, persons who were assessed as mild stroke at onset also needed informal care, particularly with more complex tasks. Gender differences were obvious, since many women were living alone after their partner had died, while the men usually had assistance from their spouses. Noteworthy is that informal caregivers assisted their spouses to a large extent, regardless of severity of stroke at onset. Different kind of support programs, extended day rehabilitation centers and more relieve places should be developed. That could possibly improve the life situation for the elderly stroke survivors and their caregivers, generally an elderly spouse.
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| 42. |
- Gosman-Hedström, Gunilla, 1947
(författare)
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Daily life after stroke in elderly people. Evaluation of stroke unit care focusing on daily activities, resource use and costs, assistive devices and health-related quality of life
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The overall aims of this thesis were: a) to compare stroke unit (SU) care and its continuum with care on general wards (GW) for elderly patients, concerning resource use and costs for care and rehabilitation focusing on assistive technology in a one-year follow-up and, b) to explore the use and cost of assistive devices (ADs), ability in daily activities and self-rated health-related quality of life (HRQL) longitudinally.Methods: Two hundred and forty-nine persons >70 years were followed in a randomized, prospective study evaluating SU care after acute stroke. The patients were interviewed and observed four times during the first year by two registered occupational therapists. In two of the studies the patients were followed longitudinally.Results: There were no statistically significant differences in total resource use and costs for care and rehabilitation between the SUs and the GWs during the first year after acute stroke. Costs in relation to the severity at stroke onset showed statistically significant differences, indicating that patients with severe stroke were treated at a higher cost.Informal care widely exceeded the care provided by the community.The total cost of ADs was 2% of the total costs of care and rehabilitation during the first year. One third of the patients had ADs before stroke. After one year the majority of the patients with stroke used ADs. There was a statistically significant difference between the SU group and the GW group in the proportion of patients who had supplementary ADs prescribed between 0-3 months after stroke; the patients at the SU had a higher number of uncomplicated and cheap ADs prescribed. The ADs had a large impact and were prescribed at low cost. Different types of ADs were needed at different stages in the rehabilitation process. Constant routine evaluation of elderly patients with stroke is recommended during the first year after stroke.High concordance was found between the assessments in the Functional Independence Measure (FIMTM) and the Barthel Index (BI). The assessments in the 7-level FIMTM polarize, and the intermediary levels are rarely used, suggesting that a 5-level FIM is sufficient.There were no statistically significant differences between the SU group and the GW group regarding dependence or HRQL as assessed longitudinally. There were statistically significant differences in daily activities and HRQL as assessed with the 5-level FIM and the Nottingham Health Profile (NHP) in patients who used at least one AD and those who did not.Conclusions: Since the majority of the patients with stroke used ADs one year after acute stroke but at relatively low cost, assistive technology must be considered to be one of the best tools for maintaining the highest possible level of daily activity in this patient group. Regular routine evaluations are required both for best use of resources and adaptation to individual needs. The 5-level FIM proved to be useful, but further research into its clinical utility is required. More attention should be paid to the role of spouses as caregivers in stroke survivors, since informal care carries a far greater burden than the care provided by the community. Support schemes of all types are required to relieve the spouses
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| 43. |
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| 44. |
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| 45. |
- Gosman-Hedström, Gunilla, 1947, et al.
(författare)
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Evaluation of a 5-level functional independence measure in a longitudinal study of elderly stroke survivors.
- 2004
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Ingår i: Disability and rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 26:7, s. 410-8
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of the present study was to evaluate a modified 5-level Functional Independence Measure (FIM), by using the assessments from a longitudinal study of elderly stroke survivors. METHOD: One hundred and seventy-three patients were followed longitudinally. Firstly, the 7-level FIM was used at 0-3 days, 3 weeks, and 3 months and then after 1 year following acute stroke. The data, in total 8996 assessments, were presented on the item level. Secondly, the data were recoded with the help of a modified 5-level FIM according to the cut-off levels suggested in a previous study of the same target group. Two registered occupational therapists did the assessments in the patients' natural environment, i.e., in their own homes or in different kinds of assisted living. The data were obtained both by interviews and with the help observations, when the occupational therapist asked the patients to perform specific activities. RESULTS: The assessments on all four occasions were found to polarise when using the 7-level FIM, and the intermediate levels of assistance were more seldom used. After the assessment data were recoded with the modified 5-level FIM, it was shown that it was easier to follow the process of activity by using an instrument with fewer levels. A modified 5-level FIM had enough levels to ensure sensitivity and was easier to handle when evaluating performance of daily activities in a large population study. CONCLUSIONS: A modified 5-level FIM can be useful in large population studies and most likely increase reliability without losing in sensitivity.
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