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- Langhammer, Birgitta, et al.
(författare)
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Factors enhancing activities of daily living after stroke in specialized rehabilitation. An observational multicenter study within the Sunnaas International Network.
- 2017
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Ingår i: European journal of physical and rehabilitation medicine. - 1973-9095. ; 53:5, s. 725-34
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Tidskriftsartikel (refereegranskat)abstract
- Stroke may lead to serious, long-term disability. Consequently, many individuals with stroke will be in need of rehabilitation, and some of specialized rehabilitation. The content and organization of rehabilitation vary within and between countries, reflecting the preferences, customs, traditions, and values of a society or community, that may have an impact on outcomes.The main aim of the present study was to evaluate the influence of team models in specialized rehabilitation on outcomes as measured by stroke patients' performance in ADL, at a standardized time and at discharge in the various specialized rehabilitation clinics. Secondary aims were to identify explanatory factors for possible differences in ADL changes at standardized time points.A prospective descriptive cross-sectional explorative, multicentre study.Specialized rehabilitation clinics in Norway, China, the United States, Russia, Israel, Palestine, and Sweden, in total nine clinics.Persons with stroke.Outcomes measures were the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale (NIHSS), both on admission and at discharge from the inpatient rehabilitation unit, and Barthel Index (BI) or alternatively Functional Independence Measure (FIM), on admittance, 18-22 days into rehabilitation, at discharge, and at 6 and 12 months after discharge.In total 230 persons with stroke from nine clinics were recruited. There were significant differences in change scores of ADL from admittance to standardized time point 18-22 days into rehabilitation, (p<0.001, r2= 0.19) and when controlled for baseline NIHSS and mRS (p<0.001, r2 = 0.18; p=0.01, r2 = 0.9 respectively). Analysis divided into intra-, multi- and interdisciplinary models showed significant differences at 18-22 days (p=0.02) and at discharge (p<0.001), indicating a more favourable outcome in ADL with the multi- disciplinary model. The linear regression analysis explained 55 % of the changes in ADL (R2= 0.55) at the standardized time point and 48% (R2 = 0.48) at discharge. Main explanatory factors were disability (mRS) and severity (NIHSS), team models, hours in therapy, and location at discharge. ADL was maintained for the majority of participants at 6 and 12 months post discharge. The correlations mRS / ADL (r=-0.68, p<0.0001), NIHSS / ADL (r=-0.55, p<0.0001) and NIHSS / mRS (r=0.46, p<0.0001) disclosed medium to large associations at 18-22 days into rehabilitation.The study indicates that the organisation of services in specialized rehabilitation after stroke has a major impact on improvement of ADL outcomes. Main positive predictive factors were models of teamwork, with the multidisciplinary model as most beneficial, and concentrated hours of therapy. Negative predictors were the level of baseline severity and disability post stroke.The results indicate that organization of services should be at target to optimize patients' outcomes in rehabilitation. Furthermore, that concentrated hour's related to specific goals in therapy are preferable to optimize functional recovery.
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| 2. |
- Langhammer, Birgitta, et al.
(författare)
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Return to work after specialized rehabilitation-An explorative longitudinal study in a cohort of severely disabled persons with stroke in seven countries: The Sunnaas International Network stroke study.
- 2018
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Ingår i: Brain and behavior. - : Wiley. - 2162-3279. ; 8:8
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Tidskriftsartikel (refereegranskat)abstract
- Stroke may impose disabilities with severe consequences for the individual, with physical, psychological, social, and work-related consequences. The objective with the current study was to investigate to what extent persons with stroke were able to return to work, to maintain their financial situation, and to describe the follow-up services and participation in social networks and recreational activities.The design was a prospective, descriptive study of specialized stroke rehabilitation in nine rehabilitation centers in seven countries. Semistructured interviews, which focused on the return to work, the financial situation, follow-up services, the maintenance of recreational activities, and networks, were performed 6 and 12months post discharge from rehabilitation.The working rate before the onset of stroke ranged from 27% to 86%. At 12 months post stroke, the return to work varied from 11% to 43%. Consequently, many reported a reduced financial situation from 10% to 70% at 6months and from 10% to 80% at 12months. Access to postrehabilitation follow-up services varied in the different countries from 24% to 100% at 6months and from 21% to 100% at 12months. Physical therapy was the most common follow-up services reported. Persons with stroke were less active in recreational activities and experienced reduced social networks. Associations between results from the semistructured interviews and related themes in LiSat-11 were small to moderate. The study shows that education, age, and disability are predictors for return to work. Differences between countries were observed in the extent of unemployment.In this international multicentre study, return to work after severe stroke and specialized/comprehensive rehabilitation was possible, depending on the extent of the disability, age, and education. Altered financial situation, reduced social networks, and reduced satisfaction with life were common psychosocial situations for these patients.
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