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- Alt Murphy, Margit, 1970, et al.
(författare)
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SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol.
- 2011
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Ingår i: BMC neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area. METHODS/DESIGN: A sample of 120 participants with a first-ever stroke and impaired upper extremity function will be consecutively included from an acute stroke unit and followed longitudinally for one year. Assessments are performed at eight occasions: at day 3 and 10, week 3, 4 and 6, month 3, 6 and 12 after onset of stroke. The primary clinical outcome measures are Action Research Arm Test and Fugl-Meyer Assessment for Upper Extremity. As additional measures, two new computer based objective methods with kinematic analysis of arm movements are used. The ABILHAND questionnaire of manual ability, Stroke Impact Scale, grip strength, spasticity, pain, passive range of motion and cognitive function will be assessed as well. At one year follow up, two patient reported outcomes, Impact on Participation and Autonomy and EuroQol Quality of Life Scale, will be added to cover the status of participation and aspects of health related quality of life. DISCUSSION: This study comprises a non-selected population with first ever stroke and impaired arm function. Measurements are performed both using traditional clinical assessments as well as computer based measurement systems providing objective kinematic data. The ICF classification of functioning, disability and health is used as framework for the selection of assessment measures. The study design with several repeated measurements on motor function will give us more confident information about the recovery patterns after stroke. This knowledge is essential both for optimizing rehabilitation planning as well as providing important information to the patient about the recovery perspectives. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01115348.
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| 3. |
- Opheim, Arve, 1962, et al.
(författare)
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What comes first, spasticity, reduced range of motion or pain in patients after stroke?
- 2013
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Ingår i: Journal of Rehabilitation Medicine. Presented at the 3rd Baltic and North Sea Conference on Physical & Rehabilitation Medicine, the 118th Congress of the German Society for Physical Medicine & Rehabilitation, and the annual Congress for the Austrian Society for Physical Medicine & Rehabilitation. September 2013, Hannover, Germany. - : Medical Journals Sweden AB. - 1650-1977. ; 45
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Pain, reduced range of motion (ROM) and reduced motor function has been found to be associated with spasticity in persons with stroke, but the developments of these impairments over time are less known. The aim of the study was to describe the development of spasticity, pain, ROM, sensibility and sensory motor function in persons with first stroke during the first year after stroke. Method 117 patients with first ever stroke was recruited for the study. No selections apart from reduced arm function on day 3 were made. The patients were assessed six times during the first year, at day 3, 10, week 4, month 3, 6 and 12. Upper limb spasticity was assessed with the modified Ashworth scale (MAS), and a MAS score ≥ 1 was regarded as presence of spasticity. Sensory motor function was assessed with the Fugl-Meyer Upper-Extremity scale (FM-UE). The presence of pain, reduced sensibility and range of motion (ROM) was regarded if lower than maximum scores on the non-motor domains of the FM-UE. Results The proportion of persons with spasticity increased from 0.25 at day 3 to 0.44 at week 4 and was stable up to 12 months. Sensory motor function improved from 28 (SD 25) at day 3 to 47 (SD 23) at 3 months and was stable up to 12 months. The proportion of persons with reduced ROM was 0.45 at day 3, was stable up to 3 months and increased at 6 and 12 months, 0.55 and 0.61, respectively. The proportion of patients with reduced sensibility decreased from 0.55 at day 3 to 0.36 at 12 months. Discussion Pain, spasticity and sensory motor function seemed to develop in about parallel the first 3 months. The proportion of persons with pain continued to increase during the first year. The proportion of patients with reduced ROM was unchanged during the first three months, but increased at 6 and 12 months. Based on this, reduced upper limb ROM seems secondary to pain and spasticity.
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| 5. |
- Persson, Hanna C, 1979, et al.
(författare)
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Armfunktion inom 72 timmar efter förstagångsstroke i en oselekterad patientgrupp, samt vårdförlopp och utfall vid utskrivning. En del av SALGOT-studien.
- 2013
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Ingår i: Sjukgymnastdagarna 2013. Göteborg 2-4 oktober 2013..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund och syfte Nedsatt funktion i övre extremitet efter en stroke har rapporterats förekomma akut hos 70-80%. Akutvården förändras med fler som vårdas på strokeenhet så väl som behandlas med trombolys. Syftet var att i en oselekterad patientgrupp med förstagångsstroke, undersöka vårdförlopp och utskrivningsstatus samt förekomst av nedsatt arm och handfunktion inom 72 timmar efter insjuknande. Ett andra syfte var att undersöka faktorer som associeras med nedsatt övre extremitet och dess påverkan på utfallet. Metoder Inklusionskriterier var: förstagångsstroke, över 18 år, boende i geografiskt upptagningsområde, på strokeenheten inom 72 timmar efter insjuknade, ingen tidigare nedsatt funktion i övre extremitet. Via journalgranskning samlades bakgrundsdata, arm och handfunktion, utfall av stroke och sjukhusvård. Infarkter klassificerades enligt Bamford och med TOAST. Resultat och diskussion Av screenade 969 patienter med förstagångsstroke uppfyllde 642 inklusionskriterierna. Vid ankomst bedömdes patientens funktion med NIHSS, medelvärde 6.0. Förekomst av nedsatt arm och handfunktion inom 72 timmar efter insjuknade var 48%, vilket också samvarierade med ålder (p<0.004), vårdtid (p<0.001) och dödlighet inom akutvården (p<0.001). Det var 89% av patienterna som lades in direkt på strokeenheten och 77% kom till sjukhuset på insjuknadedagen. Medelvårdtiden på strokenheten var 10 dagar och 57% utskrevs till hemmet. Dödligheten inom 72 timmar var 5%. Konklusion Nedsatt arm och handfunktion inom 72 timmar efter insjuknande i förstagångsstroke förekommer hos 48% av patienterna. Nedsatt övre extremitet associerar med högre ålder, längre vårdtider inom strokeenheten och högre dödlighet i akutvården.
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- Persson, Hanna C, 1979, et al.
(författare)
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Outcome and upper extremity function within 72 hours after first occasion of stroke in an unselected population at a stroke unit. A part of the SALGOT study.
- 2012
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Ingår i: BMC neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Reduced upper extremity function is one of the most common impairments after stroke and has previously been reported in approximately 70-80% of patients in the acute stage. Acute care for stroke has changes over the last years, with more people being admitted to a stroke unit as well as use of thrombolysis. The aim of the present study was to describe baseline characteristics, care pathway and discharge status in an unselected group of patients with first occasion of stroke who were at a stroke unit within 72 hours after stroke and also to investigate the frequency of impaired arm and hand function. A second aim was to explore factors associated with impaired upper extremity function and the impact of impairment on the patient's outcome. METHODS: Patients over 18 years of age with first ever stroke, living in a geographical catchment area, being at the stroke unit within 72 hours after onset, with no prior upper extremity impairment were included. Baseline characteristics, arm and hand function within 72 hours, stroke outcome and care pathway in the acute phase were described, by gathering information retrospectively from the patients' charts. Ischemic strokes were categorized according to the Bamford classification and the Trial of Org 10172 in Acute Stroke Treatment criteria. RESULTS: Of the 969 patients with first ever stroke who were screened, 642 patients fulfilled the inclusion criteria. According to the National Institutes of Health Stroke Scale (NIHSS), the patients had a mean score of 5.6, median 3.0, at arrival to the hospital. Ischemic stroke was most frequent in the anterior circulation (87.7%). Within 72 hours after stroke onset 48.0% of the patients had impaired arm and hand function and this was positively associated with higher age (p < 0.004), longer stay in the acute care (p < 0.001) and mortality in acute care (p < 0.001). Directly admitted to the stroke unit were 89.1% of the patients and 77.1% received hospital care on same day as stroke onset. Mean length of stay in the stroke unit was 9.9 days, 56.8% of the patients were discharged directly home from the stroke unit. Mortality within 72 hours after stroke onset was 5.0%. CONCLUSION: Impaired arm and hand function is present in 48% of the patients in a non selected population with first ever stroke, estimated within 72 hours after onset. This is less than previously reported. Impaired arm and hand function early after stroke is associated with higher age, longer stay in the acute care, and higher mortality within the acute hospital care.
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- Persson, Hanna C, 1979, et al.
(författare)
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Patientens skattade arm och handstyrka i korrelation till objektiva mätningar 10 dagar efter en förstagångsstroke; en del av SALGOT-studien.
- 2013
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Ingår i: Sjukgymnastdagarna 2013. Göteborg 2-4 oktober 2013.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund och syfte Kunskap om patientens förståelse av funktionsnedsättning efter stroke är bristfällig. Få studier finns, varav ingen som omfattar akut skede. Syftet med studien var att undersöka patientens upplevad arm och handstyrka 10 dagar efter insjunkande i stroke och hur denna korrelerar till objektiva mätningar. Metoder Etthundra patienter med förstagångsstroke och nedsatt arm och handfunktion 3 dagar efter insjuknade, boende i Göteborgsområdet, undersöktes från studien Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT). 10 dagar efter insjuknade, skattade patienten sin funktion i övre extremitet på två delmoment av Stroke Impact Scale; styrka i arm respektive i hand i afficierad sida. Övre extremitet bedömdes med greppstryka mätt med JAMAR samt med aktivitetsskalan Action Research Arm Test (ARAT). Korrelationsberäkningar genomfördes. Resultat Hög korrelation visades mellan patientrapporterade styrka i hand och i greppstryka mätt med JAMAR; roh 0.86 and i arm; rho 0.81. Hög korrelation fanns även mellan patientrapporterade styrka i hand och med ARAT; rho 0.83 och i armen; rho 0.79. Samtliga korrelationer med signifikansnivå på p<0.05. Konklusion Denna studie visar att 80% av de patienterna deltog, redan 10 dagar efter stroke klarar att korrekt skatta styrkan i påverkad arm och hand. Detta indikerar på att det finns god överensstämmelse mellan patientens skattade styrka och objektiva mätningar redan tidigt efter stroke.
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| 8. |
- Persson, Hanna C, 1979, et al.
(författare)
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PREDICTION OF ARM FUNCTION WITHIN ONE YEAR AFTER STROKE USING A SHORT ASSESSMENT
- 2014
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Ingår i: The 8th World Congress for NeuroRehabilitation. ; Ref no 319:PP-156
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: A clinical test is needed, with the possibility through an early assessment to correctly predict clinical relevant arm function in patients with stroke, which would be appropriate for the patient, staff and when planning for future care and rehabilitation. Aims: There are two purposes of the present study. First; investigate if items from the Action Research Arm Test (ARAT) can be extracted to create a diagnostic test easy to perform in the clinic during the acute stage of stroke with the possibility to predict upper limb function and activity, second; assess the new test’s possibility to predict sufficient motor function ability to drink from a glass with the impaired arm. Methods: In the study 112 patients were assessed at day 3, day 10, week 4 and month 12 after stroke onset. Clinically feasible items from the ARAT able to detect sufficient motor function ability to drink from a glass with the impaired arm during the first year after stroke were selected in a structure process. An appropriate cut-off for the diagnostic test was chosen with Receiver Operation Characteristic (ROC) curves. In the second step the chosen items’ possibility to predict upper extremity function and activity were tested with 2-way contingency table. Results: Two items from ARAT; “Pour water from glass to glass” and “Place hand on top of head” were structured selected to a diagnostic test with a total sum of 0-6 p. A cut-off level of 0-1/2-6 p was identified, having an Area Under the Curve (AUC) of 0.91-0.99 presented in the ROC-curves. The percent of correctly predicted patients over all were between 80.8% and 96.4% in the different test occasions. The diagnostic test had the ability to correctly predict motor function of patients having some dexterity at day 3, Negative Predictive Value (NPV) day 10, 0.98, week 4 and month 12 1.0. The Positive Predictive Value (PPV) was high day 10, 0.95, but lower thereafter; week 4, 0.77, month 12, 0.61. From assessments week 4, the PPV/NPV in month 12 were 0.79/1.0. Conclusions: It is possible to, from a short assessment (two items from ARAT) at day 3 post stroke predict sufficient motor function ability to drink from a glass with the paretic arm during the first year. The percentage of correct over all prediction varies between 81 -94%. Keywords: prognosis, stroke, upper extremity
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| 9. |
- Persson, Hanna C, 1979, et al.
(författare)
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UPPER EXTREMITY TEN DAYS AFTER FIRST OCCASION OF STROKE; PATIENT PERCIEVED STRENGTH CORRELATING TO OBJECTIVE MEASUREMENTS. A PART OF THE SALGOT STUDY.
- 2013
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Ingår i: 7TH ISPRM WORLD CONGRESS. International Society of Physical and Rehabilitation Medicine, June 16-20, 2013, Bejing.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective To investigate the patient’s perception of arm and hand strength ten days after stroke onset and correlate this to objective measurements. Method One hundred patients with stroke and impaired upper extremity within 3 days after onset were investigated from the Stroke Arm Longitudinal Study at the University of GOThenburg (SALGOT). Ten days after onset, the patients estimated their function in the upper extremity on the Stroke Impact Scale; items regarding the strength of the arm and grip in the hand. Upper extremity function was assessed with grip strength measurement JAMAR and the activity scale Action Research Arm Test (ARAT). The correlations were calculated. Results High correlations were found between patient reported strength in the hand and grip strength (JAMAR); rho 0.86 and in the arm; rho 0.81. High correlation were also found between patient reported strength in the hand and the ARAT; rho 0.83 and in the arm; rho 0.79, all with a significant level of p < 0.01. Implication/Impact on Rehabilitation The results from the present study indicate that only 10 days after stroke over 80% of the participated patients, can correctly evaluate their strength in impaired limb. The patients’ understanding of the capacity is important for the rehabilitation and in planning for the future. Awareness of impaired function in the upper extremity is not previously described in this early stage after a stroke.
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