| 1. |
- Algurén, Beatrix
(författare)
-
Functioning after stroke : An application of the International Classification of Functioning,Disability and Health (ICF)
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective. The overall aim of this thesis was to evaluate the biopsychosocial consequences after stroke and test the validity of the ICF Core Sets for Stroke during one year post-stroke. Material and Methods. Studies I, II and III were based on data from a prospective cohort study with 120 stroke survivors who were recruited at admission to stroke units in western Sweden and were followed-up at six weeks, three months and one year after stroke event. Repeated assessments were done through face-to-face interviews consisting of a battery of questions based on the Stroke ICF Core Set (59 categories of Body Functions, 59 of Activities and Participation and 37 of Environmental Factors) and several questionnaires (EuroQol-5D (EQ-5D), Stroke Impact Scale (SIS), Medical Outcome Study Short Form 36 (SF-36), Self administered Comorbidity Questionnaire (SCQ), information on health care and social services utilization and spouse support). Study IV was based on data from the multi-center cross-sectional validation study of the Stroke ICF Core Set with 757 stroke survivors from China, Germany, Italy and Sweden. Results. Study I: A total of 28 of 59 ICF categories of Body Functions and a total of 41 of 59 categories of Activities and Participation were significant problems for stroke survivors at six weeks and three months. These categories showed a good discriminative ability to distinguish between independent (≤ 2 on modified Ranking Scale (mRS)) and dependent (> 2 on mRS) stroke survivors. Study II: Most stroke survivors felt satisfied with their stroke care and rehabilitation during three months post-stroke. Frequently perceived environmental facilitators could be documented with eleven of 37 ICF categories of Environmental Factors. Only physical geography, such as hills, was a common perceived barrier. Study III: Independent factors of health-related quality of life (HRQoL) varied over time. Almost all variance in HRQoL was explained by categories within Body Functions and within Activities and Participation during the first three months, while at one year only half of the variance could be explained by categories within either Body Functions or Environmental Factors. Problems with personal and energy functions, as well as limited recreational activities, were recurringly associated with poorer HRQoL. Study IV: It was possible to integrate ICF categories of Body Functions and Structures, Activities and Participation into a cross-cultural measurement with good reliability providing summary scores of the overall functioning of stroke survivors. However, the five-point ICF qualifier scale was not consistently applicable. Conclusions. The results of the present thesis showed that the ICF,particularly the ICF Core Set for Stroke, was a valid and practical tool for documenting the multi-faceted biopsychosocial problems and consequences after stroke structured with one common terminology throughout the long chain of care and rehabilitation. The opportunity to integrate ICF categories of Body Functions and Structures, Activities and Participation into a measurement provides new possibilities for monitoring, following-up and comparing overall functioning after stroke.
|
|
| 2. |
- Chruzander, Charlotte, et al.
(författare)
-
Longitudinal changes in sickness absence and disability pension, and associations between disability pension and disease-specific and contextual factors and functioning, in people with multiple sclerosis.
- 2016
-
Ingår i: Journal of the Neurological Sciences. - : Elsevier BV. - 0022-510X .- 1878-5883. ; 367, s. 319-325
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Even though it is well known that disability due to MS is highly associated with employment status, the long-term longitudinal perspective on sickness absence and disability pension over the MS trajectory is lacking. In addition, further knowledge of risk factors for future disability pension is needed.OBJECTIVES: To explore long-term longitudinal changes in the prevalence of sickness absence and disability pension in people with MS (PwMS), as well as to explore associations between disease-specific factors, contextual factors and functioning, and the outcome of future full-time disability pension.METHODS: A prospective, population-based survival cohort study, with a nine year follow-up, including 114 PwMS was conducted by combining face-to-face collected data and register-based data.RESULTS: The prevalence of full-time disability pension increased from 20% to 50%, however 24% of the PwMS had no disability pension at all at end of follow-up. Sex, age, disease severity and impaired manual dexterity were associated with future full-time disability pension.CONCLUSIONS: The large increase in prevalence of PwMS on full-time disability pension during the MS trajectory, calls for the development and implementation of evidence-based interventions, aiming at keeping PwMS in the work force. Modifiable factors, such as manual dexterity should be targeted in such interventions.
|
|
| 3. |
- Forsberg, Anette, 1965-, et al.
(författare)
-
Balancing everyday life two years after falling ill with Guillain-Barre syndrome : a qualitative study
- 2015
-
Ingår i: Clinical Rehabilitation. - London, United Kingdom : Sage Publications. - 0269-2155 .- 1477-0873. ; 29:6, s. 601-610
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim was to describe experiences of disability in everyday life and managing the recovery process two years after falling ill with Guillain-Barré syndrome.Design: Qualitative interview study.Methods: Interviews were conducted with 35 persons (22 male, mean age 50 years) two years after the onset of Guillain-Barré syndrome. The interviews were transcribed verbatim and analysed using content analysis.Results: The analysis revealed four categories and an overall theme: ‘Striving for balance in everyday life’. The participants described persistent lived body restrictions that affected their arms, legs, and face. Bodily symptoms and loss of energy limited or restricted many everyday activities. In connection with healthcare, both satisfaction and feeling vulnerable in a critical situation were described. Experiences of the recovery process varied. The participants described acceptance and reappraisal of a new life situation despite their limitations, and having gained the knowledge that life can change suddenly. However, they also expressed disappointment following an overly positive prognosis in the early stages, and over a continuous wait for recovery. For some participants life had returned to as before.Conclusion: The participants experienced limitations in everyday life and decreased functioning in several parts of the body. The recovery process may still be ongoing two years after onset. Rehabilitation intervention with an extended focus on supporting individualized coping processes could facilitate ways to live with persistent disability.
|
|
| 4. |
- Forsberg, Anette, 1965-, et al.
(författare)
-
Disability and health-rated quality of life in Guillain-Barré syndrome during the first two years after onset : a prospective study
- 2005
-
Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 19:8, s. 900-909
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe changes in disability and health-related quality of life in patients with Guillain-Barré syndrome in Sweden during the first two years after onset.SUBJECTS: Forty-four patients were recruited from eight different hospitals, and 42 of them (mean age 52 years) were followed for two years. Evaluations were performed, primarily as home visits, at two weeks, two months, six months, one year and two years after onset.MAIN MEASURES: Disability was measured using the Katz Personal and Extended Activities of Daily Living Indexes, the Barthel Index, the Frenchay Activity Index and assessments of work capacity; health-related quality of life using the Sickness impact Profile.RESULTS: At two weeks, one year and two years after onset of Guillain-Barré syndrome, 76%, 14% and 12% of patients were dependent in personal activities of daily life (ADL); and 98%, 28% and 26% were dependent in instrumental ADL. At two weeks, all of the patients that were working before onset were unable to work owing to Guillain-Barré syndrome; at two years, 17% were unable to work. At two weeks, scores on Sickness Impact Profile were elevated in all dimensions; at two years, they remained elevated in the physical dimension and in the categories home management, work and recreation and pastimes.CONCLUSIONS: The impact of Guillain-Barré syndrome on ADL, work, social activities and health-related quality is considerable two years after onset and presumably persists beyond this time point.
|
|
| 5. |
- Forsberg, Anette, et al.
(författare)
-
Falling ill with Guillain-Barré syndrome : patients' experiences during the initial phase.
- 2008
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 22:2, s. 220-226
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Research describing the personal experiences of Guillain-Barré syndrome (GBS) is limited, but is important for identifying the patients' need of support. The aim of this study was to describe experiences of falling ill with GBS, with the focus on the onset of disease, the diagnosis and the illness progress during hospital care. METHODS: The study included 35 persons, 20-78 years old. They were interviewed 2 years after the onset of GBS. The interviews were analysed using qualitative content analysis. RESULTS: The onset was described as either an incomprehensible, prolonged, increasing deterioration with puzzling sensations or as a frightening, rapid onset with a sudden loss of body control. The majority of the persons relied heavily on the reassurance of a positive prognosis, and expressed immense confidence in being able to recover. During the early phase at the hospital, a rapid and steady course of improvement inspired hope in many persons. In contrast, even in this early phase of hospital care some individuals expressed doubts of a slow recovery. Feelings of fear and insecurity were evident when losing body functions, thus causing helplessness. Sensations of pain, numbness and lost body image increased their vulnerability. Half of the ventilator-treated persons expressed vivid memories of scary hallucinations. CONCLUSION: The onset is characterized by an incomprehensible bodily deterioration or a frightening, rapid paralysis. In the initial phase, there is hope for recovery, which for many individuals is reinforced by a steady recovery. In contrast, early psychosocial support may be necessary for some persons with an alarmingly slow recovery.
|
|
| 6. |
- Forsberg, Anette, 1965-, et al.
(författare)
-
Impairment in Guillain-Barré syndrome during the first 2 years after onset : A prospective study
- 2004
-
Ingår i: Journal of the Neurological Sciences. - : Elsevier BV. - 0022-510X .- 1878-5883. ; 227:1, s. 131-138
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo provide a comprehensive description of impairment in patients with Guillain–Barré syndrome (GBS) in Sweden during the first 2 years after disease onset.MethodsIn this prospective multi-centre study, 42 patients, mean age 52 years, were evaluated at 2 weeks, 2 months, 6 months, 1 year and 2 years. Evaluations made use of validated, reliable measures of muscle strength, grip strength, finger dexterity, balance, facial-muscle function, respiratory function, gait, motor performance and sensory examination, and included patients' owns assessments of pain, fatigue and paraesthesia.ResultsMechanical ventilation was required in 21% of patients. At 2 weeks, 1 year and 2 years after GBS onset: 100%, 62% and 55% of patients had submaximal overall muscle strength; 98%, 38% and 31% subnormal grip strength; and 38%, 14% and 12% affected facial-muscle function. At the same time points, 62%, 10% and 7% of patients were unable to walk 10 m independently; and affected sensation was detected in 93%, 55% and 52%.ConclusionsRecovery occurred mainly during the first year after onset. At 2 years, motor impairment and sensory impairment were each still detectable in more than 50% of patients. We conclude that residual impairment is significant, somatically widespread and, likely, persistent.
|
|
| 7. |
- Forsberg, Anette, 1965-, et al.
(författare)
-
Residual disability 10 years after falling ill in Guillain-Barré syndrome : a prospective follow-up study
- 2012
-
Ingår i: Journal of the Neurological Sciences. - Amsterdam, Netherlands : Elsevier. - 0022-510X .- 1878-5883. ; 317:1-2, s. 74-79
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe residual disability 10years after onset of Guillain-Barré syndrome (GBS) and longitudinal changes from 2weeks after onset until 10years afterwards. The Erasmus GBS Outcome score (EGOS) was applied for predicting prognosis at 2 and 10years.Methods: Twenty-nine patients, mean age at onset 49years, were followed prospectively from 2weeks to 10years after GBS onset. Measures included; GBS disability score, EGOS, Barthel Index, Frenchay Activity Index, Sickness Impact Profile (SIP), Overall Neuropathy Limitations Scale (ONLS), Walk-12, and Fatigue Severity Scale.Results: At 10years, the facial paralysis found in 5 participants at 2years was still present, 11 participants (38%) experienced paresthesia, 6 (21%) had limitations in their arms, and 15 (52%) had limitations in walking. Decreased health-related quality of life on comparison to the general population was seen in the physical dimension of SIP at 10years. The median EGOS at 2weeks was 4.5, which correlated highly only with the Barthel Index at 2years and the ONLS arm scale at 10years.Conclusion: The residual disabilities at 1-2years comprised mainly of reduced walking ability, and are still persistent 10years after GBS onset. For some individuals, facial paralysis caused major disability. The EGOS only partly predicted residual disability at 2 and 10years after onset.
|
|
| 8. |
- Forsberg, Anette, 1965-, et al.
(författare)
-
Use of health-care, patient satisfaction and burden of care in Guillain-Barré syndrome
- 2006
-
Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 38:4, s. 230-236
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to investigate, in an unselected sample of patients with Guillain-Barré syndrome in Sweden, the utilization of healthcare resources, satisfaction with these resources, informal help and the burden of care on family caregivers during the first 2 years after onset.SUBJECTS: Forty-four patients were enrolled from 8 hospitals, and 42 of them were followed for 2 years.METHODS: Data on the utilization of hospital inpatient and outpatient care, primary care and community-based services were collected via computerized registry information, medical records and a specific protocol. Patient satisfaction and the burden on family caregivers were studied using questionnaires.RESULTS: Forty-one patients required inpatient hospitalization for a mean of 82 days. Patients with persistent dependency during activities of daily living had significantly longer hospital stays and more days of outpatient rehabilitation. The majority of patients were satisfied with their care, but dissatisfaction was found regarding information and finances. At 2 years after onset, 26% of patients still depended on informal help. The spouses expressed increased concern and responsibility for household and family.CONCLUSION: Patients with persistent disability due to Guillain-Barré syndrome were found to have long-term need for services from the healthcare system and informal help.
|
|
| 9. |
- Hammer, Ann M., 1957-
(författare)
-
Forced use on arm function after stroke : clinically rated and self-reported outcome and measurement during the sub-acute phase
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to evaluate the effectiveness of forced use on arm and hand recovery after stroke by applying a restraining sling on the non-affected arm and to investigate psychometric properties of selected upper limb measures.Papers I and II reported a randomised trial with 1- and 3-month follow-ups. Thirty patients 1 to 6 months after stroke were included and received regular training for 2 weeks of intervention. The forced-use group had in addition a restraining sling on the non-paretic arm. Outcome measures were the Fugl-Meyer Assessment, the Modified Ashworth scale, the 16-hole peg test, grip force, the Action Research Arm test, and the Motor Assessment Scale (Paper I), and the Motor Activity Log (MAL) (Paper II). Results in Papers I and II showed no statistical difference in change between groups. Both groups improved over time.Paper III assessed the responsiveness of the MAL and its cross-sectional and longitudinal validity. The MAL was responsive to change, with Standardised Response Means and Responsiveness Ratios larger than 1.0. Correlations between the MAL and the other measures were mostly close to 0.50.Paper IV investigated test–retest intra-rater reliability of measuring grip force with Grippit, and assessed relationships between grip forces of both hands, and between sustained and peak grip force. The paretic hand needs to score a change of 10% or 50 N to exceed the measurement error. The mean ratio between sides was 0.66, and between sustained and peak grip force, 0.80–0.84.In conclusion, this thesis provides preliminary evidence that forced use does not generate greater improvement on upper limb motor impairment, capacity, and performance of activity than regular rehabilitation. The findings indicate that the MAL is a responsive measure of daily hand use in patients with stroke. Correlations of construct validity indicated that daily hand use might need to be measured separately from body function and activity capacity. The coefficients calculated for repeatability and reproducibility were acceptable, and the Grippit instrument can be recommended.
|
|
| 10. |
- Johansson, Sverker, et al.
(författare)
-
The Swedish occupational fatigue inventory in people with multiple sclerosis
- 2008
-
Ingår i: Journal of Rehabilitation Medicine. - Oslo : Taylor & Francis. - 1650-1977 .- 1651-2081. ; 40:9, s. 737-743
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the applicability of the Swedish Occupational Fatigue Inventory and its ability to identify different dimensions of fatigue in people with multiple sclerosis with varying, degrees of disease severity, and the correlation of each of its 5 dimensions with the Fatigue Severity Scale.Design: An observational. prospective study.Subjects: Two hundred and nineteen outpatients: 59.5% had mild. 170%, moderate and 23.5% severe disease severity; 83%, received immunomodulatory treatment.Methods: Both questionnaires were administered at inclusion, and at 12 and 24 months. Analyses of internal consistency. item-total correlation, factor analysis and tests of correlations were performed.Results: The instrument was completed by 97% of subjects. Internal consistency was satisfactory in the dimensions Lack of energy, Lack of motivation and Sleepiness, but not in Physical exertion and Physical discomfort. Factor analysis revealed that all but 3 items (2 in Physical exertion, 1 in Physical discomfort) loaded satisfactorily in 5 dimensions. Correlations between the dimensions and the Fatigue Severity Scale were low, except for a moderate correlation found for Lack of energy.Conclusion: The dimensions Lack of energy, Lack of motivation and Sleepiness appear applicable for use in people with multiple sclerosis. Further development of the physical dimensions and studies on the instrument's capacity to measure changes are needed.
|
|
| 11. |
- Palmcrantz, Susanne, et al.
(författare)
-
Assessing feasibility and acceptability of study procedures : getting ready for implementation of national stroke guidelines in out-patient health care
- 2015
-
Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 15
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Even though Swedish national guidelines for stroke care (SNGSC) have been accessible for nearly a decade access to stroke rehabilitation in out-patient health care vary considerably. In order to aid future interventions studies for implementation of SNGSC, this study assessed the feasibility and acceptability of study procedures including analysis of the context in out-patient health care settings.METHODS: The feasibility and acceptability of recruitment, observations and interviews with managers, staff and patients were assessed, as well as the feasibility of surveying health care records.RESULTS: To identify patients from the the hospitals was feasible but not from out-patient care where a need to relieve clinical staff of the recruitment process was identified. Assessing adherence to guidelines and standardized evaluations of patient outcomes through health care records was found to be feasible and suitable assessment tools to evaluate patient outcome were identified. Interviews were found to be a feasible and acceptable tool to survey the context of the health care setting.CONCLUSION: In this feasibility study a variety of qualitative and quantitative data collection procedures and measures were tested. The results indicate what can be used as a set of feasible and acceptable data collection procedures and suitable measures for studying implementation of stroke guidelines in an out-patient health care context.
|
|
| 12. |
- Palmcrantz, Susanne, et al.
(författare)
-
Differences between younger and older individuals in their use of care and rehabilitation but not in self-perceived global recovery 1 year after stroke
- 2012
-
Ingår i: Journal of the Neurological Sciences. - : Elsevier BV. - 0022-510X .- 1878-5883. ; 321:1-2, s. 29-34
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Although priorities in Swedish stroke care should be based on the ethical principles of equal care and greatest support to those in greatest need, being of working age (younger) or retired (older) might influence expectations on recovery and the provision of care and rehabilitation.Method: Information regarding the use of care and rehabilitation during the 1st year after stroke was retrieved from the Stockholm County Council database and the medical data was taken from the medical records. The Barthel Index was used for self-ratings of dependence pre-stroke, and the Stroke Impact Scale was used to assess self-perceived disability and a global rating of recovery at 12 months. One hundred and ninety-two individuals were included.Results: Results showed that the younger group received more care and rehabilitation than the older group. In the older group, comorbid conditions and pre-stroke dependence, estimated in accordance with the Barthel Index, were more common. The older group reported larger impact on self-perceived disability regarding strength, mobility, self-care and domestic life, while self-perceived global recovery did not differ between the groups.Conclusion: Younger individuals received more care and rehabilitation, which indicates structural inequality in the provision of health care resources. However, as no difference in self-perceived global recovery was found between the groups; the disparity in the provision of health care may also be a consequence of greatest support being given to those in greatest need. By demonstrating the necessity of involving self-rated assessments of stroke impact at different points in time and in different age groups, the results of this study add to previous knowledge of age-related differences in the provision of health care and stroke outcome. Furthermore. this suggests a way to approach evaluation of equality in the provision of health care.
|
|
| 13. |
- Sommerfeld, Dis Kathryn, et al.
(författare)
-
Changes in functioning between days 5 and 10 after stroke in elderly
- 2011
-
Ingår i: Physical & Occupational Therapy in Geriatrics. - : Informa UK Limited. - 0270-3181 .- 1541-3152. ; 29:2, s. 77-89
-
Tidskriftsartikel (refereegranskat)abstract
- The objectives were to describe changes in consciousness, specific mental and perceptual functions, and mobility between days 5 and 10, in patients ≥65 years, still hospitalized after acute stroke, and to identify whether these changes correspond to a clinically meaningful improvement. The Glasgow Coma Scale (GCS), Mini-Mental State Examination, Line and Letter Cancellation Tests, Block Test, and Rivermead Mobility Index (RMI) were used for assessment 5 and 10 days after stroke in 100 patients. To identify clinically meaningful improvements, an external criterion for self-care, the Barthel Index, was used. Only the GCS and the RMI could be assessed in all patients. Small or no improvements were seen in the tested functions between days 5 and 10 after stroke. Only the RMI showed a clinically meaningful improvement. The RMI was more sensitive to change compared with the other tests and could be recommended to identify improvements among these patients at this time point after stroke onset.
|
|
| 14. |
- Tistad, Malin, et al.
(författare)
-
Shorter length of stay in the stroke unit : comparison between the 1990s and 2000s
- 2012
-
Ingår i: Topics in Stroke Rehabilitation. - : Informa UK Limited. - 1074-9357 .- 1945-5119. ; 19:2, s. 172-181
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The process ruling length of stay (LOS) in hospitals is complex, and changes over time in LOS have not been explored. The purpose of the study was to examine differences in LOS, use of and satisfaction with health-related services, and capacity in activities of daily living (ADLs) during the first year post stroke in 2 groups of patients with mild to moderate stroke who received care in the same stroke unit.Method: The patients (1993/96, n=40; 2006/07, n=43) in this study received care in the stroke unit at Karolinska University Hospital, Huddinge, Sweden. Data on LOS and on the use of health-related services were collected from the Stockholm County Council computerized registers. Satisfaction with health-related services was assessed using a questionnaire covering different dimensions of care, while ADLs were assessed using Katz Extended Index of ADL.Results: The LOS in the stroke unit was shorter in the 2006-2007 group (median 8 days) compared to the 1993-1996 group (13 days) (P < .001). Both groups were equally satisfied with health-related services received. A larger proportion of patients were independent in ADLs 3 months post stroke in the 2006-2007 group, but no difference was seen at 6 or 12 months post stroke.Conclusion: It seems possible to reduce the number of days spent in the stroke unit after mild to moderate stroke and instead spend days in a rehabilitation unit, and yet achieve similar patient satisfaction and faster recovery in ADL.
|
|
| 15. |
- Widén Holmqvist, Lotta
(författare)
-
Development and evaluation of rehabilitation at home after stroke in south-west Stockholm
- 1997
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden (population 8.8 million) the great majority of patients with acute stroke are admitted to hospital. Each year 10 000-12 000 patients develop persistent disability. This thesis consists of a set of consecutive studies on: 1) the estimated need for late stroke rehabilitation and the basis for such an intervention among non-institutionalized individuals in south-west Stockholm (SWS); 2) the feasibility and health-economic implications of rehabilitation at home after acute stroke; 3) an experimental evaluation of rehabilitation at home for moderately disabled stroke patients. On the basis of telephone interviews, we estimated the prevalent need for late stroke rehabilitation as being at least one per 1000 in SWS. The average duration of hospital stay for such patients was 95 days. Social and leisure activities were identified as the most promising goals for late rehabilitation programmes. We concluded that early rehabilitation in the community, linked to post-acute stroke care with reduction of hospital stay, would be functionally and socially advantageous and cost-effective for more than 25% of the incident stroke cases. A pilot study of rehabilitation at home after stroke at the Department of Neurology at Huddinge Hospital in SWS showed that the target group embraced patients who were independent in feeding and continent, had mental function within normal limits, and residual motor and/or speech dysfunction one week after acute stroke. The most important components of the rehabilitation programme were: 1) training at home, consisting of task- specific activities, based on the patients' personal interests; 2) one therapist being selected as case-manager; 3) education and individual counselling being offered to all spouses; and 4) emphasis on adherence to structured training between therapy sessions. Home rehabilitation patients had a mean duration of hospital stay of 14 days and on average received 11 home visits. During the first year after stroke, the average per capita cost of health care for these patients was 127 730 SEK, broken down as follows: hospital care, 50%; family caregivers, 18%; rehabilitation at home, 10%; out-patient visits to physicians and nurses, 9%; home-help service, 7%; auxiliary equipment, 2%; medication, 2%; home adaptation, 1%; and transportation service, under 1%. Based on the results of the pilot study, we proposed and conducted a randomized controlled trial (on-going and currently at the 3-month follow-up stage) of rehabilitation at home for moderately disabled stroke patients. A total of 81 patients were followed-up at 3 months. Overall, there were no statistically significant differences in patient outcome. Multivariate logistic regression suggested a positive effect for the home rehabilitation group (HRG) in social activity, activities of daily living, motor capacity, manual dexterity and walking. A 52% reduction in bed-days was observed, from 29 days in the routine rehabilitation group to 14 days in the HRG, associated with a small increase (3 visits/patient) in total number of out-patient visits to physicians and nurses. After discharge, the mean number of home visits in the HRG was 10. No major differences in use of home help, impact on family caregivers in the form of time devoted to helping the patient or subjective well- being of spouses were found. Patient satisfaction favoured the HRG, with a significant difference in active participation in rehabilitation programme planning. The above led us to conclude that early supported discharge with continuity of rehabilitation at home could be the rehabilitation service of choice for the majority of moderately disabled stroke patients, provided that follow-up at 6 and 12 months confirm the suggested enhanced effectiveness, the considerable reduction in use of health care and low impact on family caregivers. Rehabilitation at home after stroke could become an important component of stroke units. This research strategy may be useful for developing stroke rehabilitation in Scandinavian and other populations.
|
|
