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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. |
- Björkdahl, Ann, 1959, et al.
(författare)
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Effect of very early supported discharge versus usual care on activi-ties of daily living ability after mild stroke: a randomized controlled trial.
- 2023
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Ingår i: Journal of rehabilitation medicine. - 1651-2081. ; 55
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Tidskriftsartikel (refereegranskat)abstract
- To examine the ability to perform basic and instrumental activities of daily life after very early supported discharge vs usual discharge and referral routine during the first year after mild stroke.A secondary analysis of data from the Gothenburg Very Early Supported Discharge randomized controlled trial. Patients: A total of 104 patients (56% men; mean (standard deviation) age 75 (11) years) who had experienced a first stroke classified as mild.The primary outcome was the Activities of Daily Living Taxonomy score. Stroke Impact Scale (activities of daily living, and mobility) scores was a secondary measure. Patients were randomized to either very early supported discharge with 4 weeks of home rehabilitation provided by a multidisciplinary stroke team, or a control group discharged according to usual routine (referral to primary care when needed). Assessments were performed at discharge, 4 weeks post-discharge, and 3 and 12 months post-stroke.Instrumental activities of the Activities of Daily Living Taxonomy scores (the lower the better) in the very early supported discharge and control groups were median 4 and 6 (p=0.039) at 4 weeks post-discharge and 3 and 4.5 (p=0.013 at 3 months post-stroke, respectively. Stroke Impact Scale (Mobility) median scores (the higher the better) in the very early supported discharge and control groups at 3 months were 97 and 86 (p=0.040), respectively. There were no group differences in the 2 outcomes at 12 months post-stroke.Compared with usual discharge routine, team-based rehabilitation during the first month at home is beneficial for instrumental activity in the subacute phase, in patients with mild stroke. One year post-stroke both groups show equal results.
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| 5. |
- Danielsson, Anna, 1957, et al.
(författare)
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PREVALENCE OF ANXIETY WITHIN THE FIRST YEAR AFTER STROKE: A SYSTEMATIC REVIEW AND METAANALYSIS
- 2018
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Ingår i: European stroke journal. Vol. 3 Issue 1_suppl.. - : SAGE Publications. - 2396-9873 .- 2396-9881.
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Konferensbidrag (refereegranskat)abstract
- Background and Aims: Anxiety is associated with decreased quality of life and depression, but gets less attention than other psychological consequences after stroke. The aim was to estimate prevalence of anxiety in the first year after stroke. Method: Searches in EMBASE, MEDLINE, PsycINFO, Cochrane Library, Amed and CINAHL were conducted in May 2015 and April 2017. Included were studies of populations with a hemorrhagic or ischemic stroke or transient ischemic attack, anxiety categorized on a rating scale during the first year after stroke. Two reviewers independently screened and included studies and assessed quality using a checklist. Studies using the Hospital Anxiety and Depression Scale – Anxiety (n 31) were included in a meta- analysis using the random effects model. Heterogeneity was assessed using the Q-test and I2 was used to estimate heterogeneity. Results: Of 4453 titles screened, 37 studies were included comprising 13756 participants with mean ages from 52 to 79 years, assessed within 2 weeks to 1 year after stroke. Most studies were of medium quality. The pooled prevalence of anxiety within the first year was 29.3% [(95% CI 24.8 – 33.8), (I2¼97%, p<0.00001)] which is higher than previously shown. Frequency 0-2 weeks post stroke was 34.8% (95% CI 24.9 – 44.6%), 2 weeks -3 months 23.2 (95% CI 16.3–30.1%) and 3 -12 months 35.6% (95% CI 17.7–54.3. Conclusion: One third of the stroke population may have an anxiety disorder and the prevalence seems to increase, why routine screening may be worth considering in order to provide appropriate interventions.
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| 6. |
- Danielsson, Anna, 1957, et al.
(författare)
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Self-perceived mobility in the first year after mild stroke – a comparison between Very Early Supported Discharge and ordinary discharge routine
- 2022
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Ingår i: 12th World Congress for Neurorehabilitation, Wien, 14-17 dec 2022.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: People with mild stroke mostly present with good basic but may experience difficulties with complex ADL activities. Knowledge about effects of common rehabilitation interventions after mild stroke is scarce. Objective: To investigate perceived mobility after Very Early Supported Discharge (VESD) compared to standard discharge. Methods: At an inpatient stroke unit 140 participants (39% women) were included day 2 post stroke. Inclusion criteria: stroke according to WHO criteria, age >18 years, living ≤30 min from the hospital, NIHSS score 0-16, Barthel Index score 50-100 and Montreal Cognitive Assessment <26 if BI=100. Exclusion criteria: life expectancy <1 year, non-communicating in Swedish prior stroke. Patients were randomised to VESD delivered at home by occupational therapist, physiotherapist and nurse from the stroke unit, for 4 weeks or to a control group discharged according to standard routine. VESD was focused on individual goals in personal care, transfers, household and leisure activities. The control group received standard rehabilitation as needed. The Mobility domain (0-100) of the Stroke Impact Scale (SIS) was administered 5 days after onset, 3 and 12 months after discharge. Results: Participants’ mean age was 74 (SD 11) year and NIHSS score median 2 (min-max 0-11). Mean (SD) SIS Mobility was 71.2 (22,7) and 73.6 (23.6) at baseline, in the VESD and control groups respectively. At the 3-month follow up SIS mobility score was significantly higher in the VESD group, 89.6 (15.0) compared to the controls’ 80.9 (21.3), p 0.027. There was no group difference at 12 months after discharge with 85.0 (18.1) and 86.6 (16.8), respectively. We conclude that stroke specialised team rehabilitation at home in the subacute phase may be beneficial for both basic and more demanding mobility situations in the first months, in people with mild stroke.
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| 7. |
- Danielsson, Anna, 1957, et al.
(författare)
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Self-perceived mobility in the first year after stroke in relation to observer based clinical measures
- 2020
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Ingår i: WFNR & SOFMER congress 7–11 October 2020.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Questions: To what extent do people with stroke experience mobility difficulties during the first year after onset? Is self-perceived mobility associated with perceived strength and clinical measures of mobility? Methods: At an inpatient stroke unit 140 participants were recruited. Inclusion criteria were confirmed stroke according to WHO criteria, > 18 years of age, living within 30 min from the hospital, day 2 NIHSS score 0-16, Barthel Index (BI) score 50-100 and MOCA index <26 if BI=100. Exclusion criteria were life expectancy < 1 year and inability to communicate in Swedish prior stroke. Stroke Impact Scale (SIS 3.0) domains for strength and mobility (score 0-100) and Timed Up and Go (TUG, s) at 1 week, 3 months and 1 year after onset were analysed with addition of the motor domain of Fugl-Meyer Assessment (FMA, score 0-100) at week 1 and 1 year. Standard linear regression was carried out with SIS mobility as dependent and SIS strength, TUG and FMA as independent variables. Results: Participants’ mean age was 74 (SD 11) years, 39% were women. Their initial motor function on FMA scored 90. SIS mobility score was 73 (SD 23) at 1 week, 85 (SD 19) at 3 months and 86 (SD 17) at 1 year. At 1 week 28% of the variation in SIS mobility was explained by a model including SIS strength, FMA and TUG with significant contribution from TUG only. At 3 months 40% of the variation in SIS mobility was explained by significant contribution from SIS strength and TUG. At 1 year post stroke, 56% of the variation in perceived mobility was explained by significant contribution from TUG and SIS strength, but not from FMA. Addition of sex and age did not change the explanatory values of the models. Conclusion: People with mildly impaired motor function experienced mobility difficulties that decreased, but still persisted one year after stroke. The pure measure of motor function was not related to self-perceived mobility. Perceived mobility was significantly associated with clinical mobility measures and self-perceived extremity strength. The results highlight the importance of including patient reported outcomes in rehabilitation.
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| 8. |
- Johansson Buvarp, Dongni, et al.
(författare)
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A cohort study on longitudinal changes in postural balance during the first year after stroke
- 2022
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Ingår i: Bmc Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Many patients with strokes report increased incidence of fall that can be due to impaired postural balance. The recovery of balance in patients with varying degrees of impairments and activity limitations is less studied, and whether individuals with mild paresis can recover their balance faster is unclear. Better knowledge about factors influencing the recovery of postural balance can be used to guide clinical management after stroke to provide the right rehabilitation to the right person at the right time, and thus to avoid potential fall incidences. Objective This study aims to examine longitudinal changes in postural balance during the first year after stroke. Methods Postural balance was assessed using the Berg Balance Scale (BBS) within 5 days, 1, 2, and 3 months and 1-year post-stroke. Stroke severity was stratified using a cluster analysis by including multidimensional baseline measures. A longitudinal mixed-effect model was constructed to analyze changes in proportional balance impairment by stroke severity over time. Individuals with a cut-off of BBS below 45 scores were identified through a classification algorithm using baseline predictors. Results A total of 135 patients were stratified to mild stroke (77 [57%] patients) or moderate stroke (58 [43%] patients). Ninety-three patients were included in the longitudinal analysis. Significant recovery was found at 1-year for moderate stroke (48% recovery from the initial impaired postural balance, adjusted P < 0.001), but not for mild stroke, after adjusting for age and cognition. Both stroke severities had a maximal recovery in postural balance at 3 months post-stroke, but the moderate stroke group deteriorated after that. Patients with higher age and worse cognition had more severe balance impairments. The classification model achieved a sensitivity of 0.95 (95% confidence interval [CI]: 0.91-0.98) and a specificity of 0.99 (95% CI: 0.98-1.0) for classifying individuals with BBS below 45 points. Conclusions This study indicates that continuous improvements in postural balance ends at 3 months regardless for mild or moderate stroke groups, and patients with moderate stroke significantly deteriorate in postural balance after 3 months.
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| 9. |
- Johansson Buvarp, Dongni, et al.
(författare)
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A prospective cohort study on longitudinal trajectories of cognitive function after stroke.
- 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
- The study aimed to determine longitudinal trajectories of cognitive function during the first year after stroke. The Montreal Cognitive Assessment (MoCA) was used to screen cognitive function at 36-48h, 3-months, and 12-months post-stroke. Individuals who shared similar trajectories were classified by applying the group-based trajectory models. Data from 94 patients were included in the analysis. Three cognitive functioning groups were identified by the trajectory models: high [14 patients (15%)], medium [58 (62%)] and low [22 (23%)]. For the high and medium groups, cognitive function improved at 12months, but this did not occur in the low group. After age, sex and education matching to the normative MoCA from the Swedish population, 52 patients (55%) were found to be cognitively impaired at baseline, and few patients had recovered at 12months. The impact on memory differs between cognitive functioning groups, whereas the impact on activities of daily living was not different. Patients with the poorest cognitive function did not improve at one-year poststroke and were prone to severe memory problems. These findings may help to increase focus on long-term rehabilitation plans for those patients, and more accurately assess their needs and difficulties experienced in daily living.
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| 10. |
- Johansson Buvarp, Dongni, et al.
(författare)
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Predicting Longitudinal Progression in Functional Mobility After Stroke A Prospective Cohort Study
- 2020
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Ingår i: Stroke. - : Ovid Technologies (Wolters Kluwer Health). - 0039-2499 .- 1524-4628. ; 51:7, s. 2179-2187
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: A majority of people with stroke remain impaired in their functional mobility. The aim of the study was to determine longitudinal changes in functional mobility after stroke. Methods: The study was of a longitudinal and prospective design. The functional mobility was assessed using the Timed Up-and-Go test on 5 different occasions: 5 days after onset, within 24 hours after discharge, 1 month after discharge, 3 months, and 1 year poststroke. Stroke severity was stratified based on impairments and activity limitations using a baseline cluster analysis. A multilevel model was developed to predict longitudinal progression in functional mobility based on stroke severity. Results: One-hundred-thirty-five patients were included at baseline. Two distinct subgroups (moderate stroke [52%] and mild stroke [48%]) were identified based on impairments and activity limitations using clustering. Ninety-one patients were included in the longitudinal analysis. After controlling for age and cognition, significant improvements in functional mobility were found in the moderate stroke group between baseline and 1 year poststroke (mean difference in Timed Up-and-Go test time, -6.4 s, adjustedP<0.001). Patients with moderate stroke had a maximum rate of improvement in functional mobility during the first 3 months poststroke and then declined significantly at 1 year (12% increase in Timed Up-and-Go test time, adjustedP=0.025). Younger patients had better functional mobility. Although there was also a slight improvement in the mild stroke group, it was not statistically significant. Conclusions: The recovery of functional mobility differs between mild and moderate stroke. Patients with moderate stroke improved their functional mobility during the first 3 months, after which it decreased significantly. These findings suggest that long-term rehabilitation is desirable to maintain and perhaps increase the gained functional mobility. Older patients and those with moderate impairments and activity limitations have particular needs. Registration: URL:. Unique identifier: NCT01622205.
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