| 1. |
- Ekstrand, Elisabeth, et al.
(författare)
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The physiotherapy clinical outcome variables scale predicts length of hospital stay, discharge destination and future home facility in the acute comprehensive stroke unit.
- 2008
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 40:7, s. 524-528
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aims of this study were: to follow the course of recovery of motor function following acute stroke, as assessed by the Physiotherapy Clinical Outcome Variables Scale (COVS), and; to investigate the ability of this instrument to predict length of hospital stay, discharge destination and future home facility. METHODS: In this prospective longitudinal study, COVS was registered at admission and discharge from an acute stroke unit and at 3 months post-stroke onset. SUBJECTS: Sixty subjects were recruited consecutively from a sample of patients after first-ever acute stroke, and of these, 50 received follow-up assessment. OUTCOME VARIABLES: Length of hospital stay, discharge destination and home facility 3 months post-stroke. RESULTS: The overall COVS scores increased significantly during the 3-month follow-up. The admission COVS score correlated negatively with length of stay. A cut-off at 50 points and 41 points could predict discharge destination and future home facility, respectively. CONCLUSION: COVS measures improvements and can predict length of hospital stay, discharge destination and future home facility. Thus, it could be used in early prediction for effective planning of the acute stroke unit services and efficient discharge planning.
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| 2. |
- Hägg, Mary, 1954-
(författare)
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Sensorimotor Brain Plasticity in Stroke Patients with Dysphagia : A Methodological Study on Investigation and Treatment
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- AimsThe aims of the thesis were to validate investigation instruments for stroke patients with dysphagia, and to improve oropharyngeal dysphagia therapies.Methods/ResultsA Lip Force Meter, LF 100, affirmed excellent intra- and inter-reliability, sensitivity and specificity. Controls had significantly stronger lip force (LF) and swallowing capacity (SC) than stroke patients. A normal lower limit of LF was set to 15 Newton. Dysphagia symptoms improved in 7 stroke patients after a 5-week sensorimotor stimulation therapy comprising manual body and facial regulation in combination with palatal plate application. Impaired LF and impaired SC were parallel phenomena in 22 acute stroke patients and did not differ regardless of presence or absence of facial palsy. LF and SC improved and were parallel phenomena in 30 stroke patients and did not differ regardless of presence or absence of facial palsy, time lag between stroke attack and start of treatment, or age. SC was normalized in 19 of 30 dysphagia patients after a 5-8-week daily lip muscle self-training with an oral screen. ConclusionsLF100 is an appropriate and reliable instrument for measuring lip force. Dysphagia improvement, by body and facial sensorimotor stimulation in combination with palatal plate application, or by training with an oral screen is excellent examples of brain plasticity and cortical reorganisation. . Swallowing capacity and lip force in stroke patients are parallel phenomena. A sub clinical facial paresis seems to be present in most stroke patients. Training with an oral screen can improve LF and SC in stroke patients with oropharyngeal dysphagia.
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| 3. |
- Khan, Farhad, et al.
(författare)
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Seasonal Patterns of Incidence and Case Fatality of Stroke in Malmö, Sweden: The STROMA Study.
- 2005
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Ingår i: Neuroepidemiology. - : S. Karger AG. - 1423-0208 .- 0251-5350. ; 24:1-2, s. 26-31
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies on the temporal variation in stroke incidence have reported inconsistent results. Few have studied the temporal variations in case fatality. No study on incidence and case fatality of stroke by season in Sweden has been found. This study explores the weekly, monthly and seasonal variations in incidence and 28-day case fatality of stroke. Methods: A total of 7,129 patients with first-ever stroke during the period 1989-1999 were retrieved from the Stroke Register of Malmo, Sweden. chi(2) test was performed to test the seasonal differences and Poisson regression analysis was used to calculate the case fatality ratios adjusted for sex and age. Results: The stroke cases were on the whole randomly distributed over the study period of 4,017 days. Incidence of all types of stroke, intracerebral hemorrhage and subarachnoid hemorrhage showed no variation by season, month or weekday, but incidence of cerebral infarction for the total population was higher in autumn and winter. Twenty-eight-day case fatality (930 fatal events, 13%) clustered significantly over the study period. Winter emerged as the peak season among men (12.5%), women (17.2%) and total population (15.1%). No consistent variation of incidence and case fatality of stroke by month or weekday was found. Conclusion: Case fatality after stroke demonstrates a seasonal variation with a peak in winter. Incidence of stroke showed no consistent association with season, month or weekday.
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| 4. |
- Pessah-Rasmussen, Hélène, et al.
(författare)
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Early supported discharge after stroke and continued rehabilitation at home coordinated and delivered by a stroke unit in an urban area.
- 2009
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Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 41:6, s. 482-488
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore the characteristics and outcome of patients after stroke admitted to early supported discharge (ESD) services, and to investigate changes over time. STUDY POPULATIONS: Patients admitted between June 1997 and September 1998 and participating in a follow-up study (n = 87) and all patients admitted in 2005-06 (n = 226). Background populations: All stroke cases in Malmö alive 3 months after stroke in June 1997 to September 1998 (n = 514) and 2005-06 (n = 1353). RESULTS: There were no differences in age, gender, proportion living alone or Katz Index distribution between the 2 study populations. The Katz Index improved between start and end of ESD (p < 0.001). Patients admitted to ESD services did not differ from the background populations with regard to gender or age, but were less often living alone in 2005-06 (p = 0.002). The mean duration of the ESD input was shorter in 2005-06 (p < 0.001). In 1997-98 the participants were satisfied with most of the dimensions of care; the proportion of patients having activity limitations decreased during the first 6 months after stroke. CONCLUSION: The use of ESD was feasible in the routine setting of an urban stroke unit. The input of the ESD services per patient decreased over time, perhaps indicating an improvement in use of healthcare resources.
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| 5. |
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| 6. |
- Wendel, Kerstin, et al.
(författare)
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Long-term cognitive functional limitations post stroke: objective assessment compared with self-evaluations and spouse reports.
- 2008
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Ingår i: International Journal of Rehabilitation Research. - 1473-5660. ; 31:3, s. 231-239
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Tidskriftsartikel (refereegranskat)abstract
- This study was part of a Swedish interdisciplinary research project targeting accessibility problems in public transport for people with cognitive functional limitations (CFLs). The objective was to describe and compare different assessment perspectives of long-term CFLs among community citizens having had CFLs in the acute stroke phase but with moderate physical limitations. Eighty-four participants in ordinary housing 18-36 months post stroke, initially sampled from a national quality stroke register, received data collection home-visits. The Cognistat screening instrument was used for an objective assessment, and a study-specific questionnaire for self-evaluations of CFLs. A revised form of the latter questionnaire was used for reports from spouses of a subset of 30 participants. The agreement between self-evaluated CFLs and spouse reports was analysed by percentage agreement and Cohen's kappa, whereas differences in ratings were tested by McNemar's test, as were differences between objective and self-evaluated/spouse-reported occurrence of CFLs. Regardless of the different perspectives applied, CFLs were frequent. In absence of significant difference in ratings, the percentage agreement between self-evaluations and spouse reports was good or very good, whereas kappa values were less encouraging. Overall, participants and spouses expressed more CFLs, as compared with the screening. Most consistency was demonstrated for the area of calculation. When researchers and clinicians solely rely on cognitive screenings in their investigations, there is a considerable risk for underestimations of CFLs.
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| 7. |
- Zia, Elisabet, et al.
(författare)
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Blood pressure in relation to the incidence of cerebral infarction and intracerebral Hemorrhage - Hypertensive hemorrhage: Debated nomenclature is still relevant
- 2007
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Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 38:10, s. 2681-2685
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose - Data regarding the association between blood pressure level and incidence of stroke subtype, especially primary intracerebral hemorrhage (PICH) subtypes, is sparse. This population- based study explored the relationship between blood pressure and the incidence of cerebral infarction, and PICH, with lobar and nonlobar location. Methods - Risk factors were assessed in 27 702 men and women without prior stroke from the city of Malmo, Sweden. Results - Mean age was 58.1 years. In all, 701 subjects had stroke (613 cerebral infarction and 88 PICH) during the follow- up period (mean, 7.5 years). The age- and sex- standardized incidences of cerebral infarction in subjects with hypertension grade 3 (>= 180/ 110 mm Hg) and normal blood pressure (< 140/ 90 mm Hg) were 6.8 and 1.7 per 1000 person- years, respectively. Compared with the normotensive group, the adjusted relative risk of cerebral infarction was 3.4 (95% CI: 2.6 to 4.5) in subjects with hypertension grade 3. The corresponding incidences of lobar PICH were 0.5 versus 0.08 per 1000 person- years, respectively (adjusted relative risk: 9.2, 95% CI: 2.6 to 32.6) and for nonlobar PICH 1.6 versus 0.09 per 1000 person- years, respectively (adjusted relative risk: 25.9, 95% CI: 8.2 to 82.3). Conclusions - The incidence of hemorrhagic and ischemic stroke increased progressively with increasing blood pressure. Although hypertension was associated with substantially higher incidence rates and absolute numbers of cerebral infarction, which is most important in the public health perspective, the relationship with nonlobar PICH was strongest in terms of relative risks.
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| 8. |
- Zia, Elisabet, et al.
(författare)
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Risk factors for primary intracerebral hemorrhage : a population-based nested case-control study
- 2006
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Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1421-9786 .- 1015-9770. ; 21:1-2, s. 18-25
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: In this population-based study, risk factors for primary intracerebral hemorrhage (PICH) and PICH subtypes were explored in a nested case-control design.METHOD: Risk factors were determined in 22,444 men and 10,902 women (mean age 47 years) who participated in a health-screening programme between 1974 and 1991. 147 subjects with CT or autopsy-verified first-ever PICH during the follow-up period (mean 14 years) were compared with 1,029 stroke-free controls, matched for age, sex and screening-year.RESULTS: As compared to controls, PICH cases had significantly higher blood pressure (135/91 vs. 127/85 mm Hg), triglycerides (1.7 vs. 1.4 mmol/l), BMI (25.5 vs. 24.8) and shorter stature (1.73 vs. 1.74 m). Diabetes (6.9 vs. 2.8 %) and history of psychiatric morbidity (19.7 vs. 11.0 %) were more common in PICH cases and more of them were living alone (35.4 vs. 25.5%). After adjustment in a backward logistic regression model, high systolic blood pressure, diabetes, high triglycerides, short stature and psychiatric morbidity remained significantly associated with PICH. As compared to the control group, high systolic blood pressure was significantly associated both with nonlobar and lobar PICH. Diabetes and psychiatric morbidity were associated with nonlobar PICH. Smoking doubled the risk for lobar PICH, but was unrelated to nonlobar PICH.CONCLUSION: In this prospective population-based study, hypertension, diabetes, height, triglycerides and psychiatric morbidity were risk factors for PICH. Smoking was a risk factor for lobar PICH only.
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| 9. |
- Zia, Elisabet, et al.
(författare)
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Three-Year Survival and Stroke Recurrence Rates in Patients With Primary Intracerebral Hemorrhage.
- 2009
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Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 40, s. 3567-3573
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: There are few studies on the prognosis after primary intracerebral hemorrhages, and they reported big differences in mortality rates. Our aim was to evaluate mortality and stroke recurrence rates in relation to hemorrhage characteristics, demographic and clinical factors, in a large unselected patient cohort. METHODS: We analyzed consecutive cases of first-ever primary intracerebral hemorrhages from 1993 to 2000 in a prospective stroke register covering the Malmö region, Sweden (population approximately 250 000). Mortality rates during 28 days and 3 years of follow-up and recurrence rates were analyzed. RESULTS: A total of 474 cases were identified (46% women). In patients <75 years of age, 20% of the women and 23% of the men died within 28 days (P=0.38). The corresponding figures in patients >/=75 years were 26% and 41%, respectively (P=0.02). Male sex was an independent risk factor both for 28-day (OR, 1.5; 95% CI, 1.008 to 2.2) and 3-year mortality (OR, 1.7; 95% CI, 1.3 to 2.3). Other independent predictors of death were high age, central and brain stem hemorrhage location, intraventricular hemorrhage, increased volume, and decreased consciousness level. The recurrence rate was 5.1 per 100 person-years, 2.3 per 100 person-years for intracerebral hemorrhage and 2.8 per 100 person-years for cerebral infarction. Only age >65 years was significantly related to recurrent stroke. CONCLUSIONS: Women had better survival than men after primary intracerebral hemorrhages. The difference is largely explained by a higher 28-day mortality in male patients >75 years. However, the underlying reasons are yet to be explored.
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