| 1. |
- Abzhandadze, Tamar, 1980, et al.
(författare)
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Barriers to cognitive screening in acute stroke units
- 2021
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive impairment is common after stroke. However, not all patients with stroke undergo cognitive screening, despite recommendations. The aim of this retrospective, explorative study was to examine the barriers to cognitive screening in acute stroke units. Data were retrieved from two Swedish Stroke registries. The outcome variable was cognitive screening during the stay at acute stroke units. Forty-three candidate explanatory variables were considered for analysis, encompassing sociodemographic factors and stroke-related outcomes during the stay at acute stroke units. The Least Absolute Shrinkage and Selection Operator and decision-tree methods were used. Of the 1120 patients (56% male, mean age: 72 years, 50% with mild stroke), 44% did not undergo cognitive screening. Walking 10 m post-stroke was the most important attribute for decisions regarding cognitive screening. The classification accuracy, sensitivity, and specificity of the model were 70% (95% CI 63-75%), 71% (63-78%), and 67% (55-77%), respectively. Patient-related parameters that influenced cognitive screening with a valid and reliable screening instrument in acute stroke units included new stroke during the hospitalisation, aphasia at admission, mobility problems, impaired verbal output skills, and planned discharge to another care facility. The barriers to cognitive screening were both patient- and organisation-related, suggesting the need for patient-tailored cognitive screening tools as well as the implementation and systematic adherence to guidelines.
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| 2. |
- Abzhandadze, Tamar, 1980, et al.
(författare)
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Feasibility of Cognitive Functions Screened With the Montreal Cognitive Assessment in Determining ADL Dependence Early After Stroke
- 2018
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Ingår i: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the feasibility of assessing cognitive function using the Montreal Cognitive Assessment (MoCA) given 36-48 h post stroke to explain dependence in activities of daily living (ADL). Methods: This is a cross-sectional, exploratory study. Cognitive function and basic ADL were assessed with the MoCA and the Barthel Index (BI), respectively, within 36-48 h of admission. Neurological functions were assessed with the National Institute of Health Stroke Scale (NIHSS) upon admittance to the hospital. Binary logistic regression analyses were performed to assess the feasibility of the MoCA in explaining ADL dependence. Results: Data were available for 550 patients (42% females, mean age 69 years). Moderate correlations (r(s) > +0.30, p < 0.001) were found between the total score on the BI, MoCA, and visuospatial/executive functions. The regression analysis model including only MoCA as an independent variable had a high sensitivity for explaining ADL dependence. However, the model with independent variables of MoCA, NIHSS, and age had the best area under the curve value (0.74). Conclusions: Cognitive functions assessed with the MoCA partly explain ADL dependence 36-48 h post stroke. Stroke-related neurological deficits and age should be additional considerations.
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| 3. |
- Abzhandadze, Tamar, 1980, et al.
(författare)
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Very Early MoCA Can Predict Functional Dependence at 3 Months After Stroke: A Longitudinal, Cohort Study.
- 2019
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Ingår i: Frontiers in neurology. - : Frontiers Media SA. - 1664-2295. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: After a stroke, cognitive impairment is commonly associated with poor functional outcomes. The primary aim of this study was to investigate if cognitive function, assessed with the Montreal Cognitive Assessment (MoCA) 36-48 h after stroke, could predict functional dependence 3 months later. The secondary aim was to identify an optimal threshold for the MoCA score that could predict functional dependence. Materials and Methods: This was a longitudinal cohort study. The research database from a stroke unit at the Sahlgrenska University Hospital was linked with the Swedish Stroke Register-Riksstroke. Cognitive function and activities of daily living (ADL) were assessed with the MoCA and the Barthel Index (BI), respectively, 36-48 h after stroke. Functional outcome 3 months after stroke was studied with the modified Rankin Scale. The predictive characteristics of the MoCA were investigated using logistic regression analyses. Receiver operating characteristic curves (AUC) were used for identifying the optimal cutoff score on the MoCA for predicting functional dependence. The MoCA score that had equal sensitivity and specificity was chosen as the optimal score for predicting functional dependence. Results: A total of 305 participants were included in the study (mean age: 68.8 years, n = 179 men). The MoCA quartiles were a significant predictor of functional dependence 3 months after stroke as an individual variable (p < 0.001, AUC = 0.72) and when adjusted for covariates such as age at stroke onset, living arrangement prior to stroke, and ADL measured with BI within 36-48 h after stroke (p = 0.01, AUC = 0.84). The MoCA score of ≤23 for impaired cognition had equal sensitivity and specificity for predicting functional dependence 3 months after stroke. Discussion and Conclusion: Cognitive function assessed with the MoCA within 36-48 h after stroke could predict functional dependence 3 months later. The participants with MoCA scores ≤23 for impaired cognition were more likely to be functionally dependent.
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| 4. |
- Algurén, Beatrix, 1977, et al.
(författare)
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Facilitators and barriers of stroke survivors in the earlypost-stroke phase.
- 2009
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 31:19, s. 1584-1591
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. To identify facilitators and barriers among persons with first-ever stroke discharged to the home in the first 3 months post-stroke by means of ICF categories. Method. Stroke survivors were interviewed using semi-structured questions based on the ICF categories of Environmental factors of the Comprehensive ICF Core Set for Stroke (extended version) at 6 weeks and at 3 months post-stroke. Results. The study sample exists of 67 stroke survivors with an average age of 71 years (51% women). Eleven environmental factors from the ICF chapters ‘support and relationship’, ‘products and technology’ and ‘services, systems and policies’ were experienced to be facilitators and only ‘physical geography’ was experienced as a barrier by 50% or more of the participants in the study. Conclusions. It was possible to document facilitators and barriers among stroke survivors in a structured way using ICF categories. The high number of experienced facilitators gives an idea of how well stroke care functions in Sweden. There is a great need for further studies examining environmental factors in the post-stroke phase.
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| 5. |
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| 6. |
- Algurén, Beatrix, 1977, et al.
(författare)
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Functioning of stroke survivors--A validation of the ICF core set for stroke in Sweden.
- 2010
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Ingår i: Disability and rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 32:7, s. 551-9
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To validate the body functions and activities and participation part of the extended International Classification of Functioning, Disability, and Health (ICF) core set for stroke with a Swedish population in the first 3 months post-stroke. METHOD: At 6 weeks and at 3 months post-stroke, stroke survivors were evaluated by 59 ICF categories of body functions, 59 categories of activities and participation from the stroke ICF core set (extended version). RESULTS: The study sample included 99 stroke survivors (54% women) with an average age of 72 years. Statistical significant problems were identified in 28 ICF categories of body functions and in 41 ICF categories of activities and participation at both time points, at 6 weeks and at 3 months. About 17 ICF categories were reported as problems in independent (i.e. modified Rankin Scale (mRS) < or =2) and about 34 categories in dependent (i.e. mRS > 2) stroke survivors. CONCLUSIONS: The results suggest a possible reduction of the stroke ICF core set from 59 to 28 categories of body functions and from 59 to 41 categories of activities and participation. Hence, feasibility of the core set for multiprofessional assessment increases and the core set might find more integration in clinical practice. The number of problems in mobility and self-care mainly distinguished between independent and dependent stroke survivors.
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| 9. |
- 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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| 10. |
- Ashman Kröönström, Linda, 1982, et al.
(författare)
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Symptoms, care consumption, and healthcare costs in hospitalized patients during the first wave of the COVID-19 pandemic.
- 2023
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Ingår i: PloS one. - 1932-6203. ; 18:9
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to assess symptomatology post discharge from the hospital in patients with COVID-19 treated during the first wave of the COVID-19 pandemic, and to follow care consumption and healthcare costs six months post discharge.This study was a descriptive observational study over time. Data were retrieved from the Sahlgrenska University (SU) hospital registry for patients admitted to an SU hospital during March 2020 to August 2020. Of these, 1014 received a questionnaire approximately six weeks post discharge regarding symptoms. Data regarding care consumption were retrieved from the registry in the Region Västra Götaland for 529 (52.2%) patients who completed the questionnaire. Of these, 466 patients were included in the analysis of care consumption.There was a reported decrease in mobility from admission to discharge in both men (p = 0.02) and women (p = 0.01). The costs of inpatient care amounted to a total of 9 601 459.20 Euro (EUR). Symptoms were reported in 436 (93.6%) patients post discharge, of which weight loss during COVID-19 was most common in both men (n = 220, 77.5%) and women (n = 107, 58.8%). During six-month follow-up, 409 (87%) patients consumed care. Of the registered visits, 868 (27.1%) were related to a COVID-19 diagnosis. The total sum of outpatient care (i.e. visits with a registered COVID-19 diagnosis) was 77 311.30 EUR.At discharge from the hospital, there was a decrease in mobility. Most patients had remaining sequelae post discharge. At six months post discharge, nearly 90% of patients had consumed care, with approximately 20% related to COVID-19. This indicates a persisting need for rehabilitation post discharge from hospital in patients treated for COVID-19.
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