Search

Background: Treatment at stroke units is superior to treatment at other types of wards. The objective of the present study is to determine the effect size of stroke unit care in subgroups of patients with stroke. This information might be useful in a formal priority setting.Methods: All acute strokes reported to the Swedish Stroke Register from 2001 through 2005 were followed until January 2007. The subgroups were age (18-64, 65-74, 75-84, 85+ years and above), sex (male, female), stroke subtype (intracerebral haemorrhage, cerebral infarction and unspecified stroke) and level of consciousness (conscious, reduced, unconscious). Cox proportional hazards and logistic regression analyses were used to estimate the risk for death, institutional living or dependency.Results: 105,043 patients were registered at 86 hospitals. 79,689 patients (76%) were treated in stroke units and 25,354 patients (24%) in other types of wards. Stroke unit care was associated with better long-term survival in all subgroups. The best relative effect was seen among the following subgroups: age 18-64 years (hazard ratio (HR) for death 0.53; 0.49 to 0.58), intracerebral haemorrhage (HR 0.61; 0.58 to 0.65) and unconsciousness (HR 0.70; 0.66 to 0.75). Stroke unit care was also associated with reduced risk for death or institutional living after 3 months.Conclusions: Stroke unit care was associated with better long-term survival in all subgroups, but younger patients, patients with intracerebral haemorrhage and patients who were unconscious had the best relative effect and may be given the highest priority to this form of care. [ABSTRACT FROM AUTHOR]

Background: Reported improvements in outcome in stroke patients treated in hospital are often attributed to advances in stroke care. However, secular trends in patient characteristics that are present already on admission to hospital may also contribute to improved outcome., Methods: Time trends for baseline data (289,854 stroke admittances) in Riks-Stroke, the Swedish national quality register for stroke care, were analyzed for the years 1995 through 2008. The following data were included: number of strokes for each year, age, sex, risk factors, stroke subtype, stroke severity, functional status and need of external home service before the stroke., Results: The number of annually reported strokes increased until 2005. The proportion of recurrent strokes decreased from 28.0 to 25.9%. The mean age at first-ever stroke increased in women, but not in men. The proportion of smokers dropped, and the proportion of patients who had treated hypertension increased. The stroke severity decreased in men. The prestroke functional status (walking, dressing, toileting) improved in both sexes over these years. More patients lived alone in 2008 than in 1995, and more had home help service., Conclusions: Many baseline parameters in Riks-Stroke have changed over the years. This has consequences for the interpretation of outcome data. Some changes may be due to inclusion bias, others due to alterations in general health, evolution of vascular risk factors or demographics., (Copyright (c) 2010 S. Karger AG, Basel.)

The National Board of Health and Welfare together with Riks-Stroke (the Swedish National Registry for Quality Assessment of Acute Stroke Care) initiated a follow-up 2 years after a stroke event in 10,303 individuals, registrated in Riks-Stroke during the first 6 months of 2001. The aim was to evaluate the health status of the patients and the burden and needs of the spouses. 6,695 patients (65 percent) were alive. 4,729 patients (71 percent) answered the questionnaire. 2,367 spouses answered a separate questionnaire. This study was compared with an almost identical study performed four years earlier. The results showed that more patients lived at home and were satisfied with help and support. Rehabilitation was still deficient for 30 percent, and more patients were highly dependent on support from next-of-kin. Thirty percent could stay alone less than half a day. These results will be used for improving rehabilitation for the stroke patients and support for their spouses.

Background and Purpose: Depression after stroke is often described as underdiagnosed and undertreated. However, there are few data on self-reported depression and use of antidepressants in stroke patients at large., Materials and Methods: In the Swedish national quality assessment register, Riks-Stroke, 15 747 stroke survivors are recorded. They were asked about depressive mood and antidepressant treatment 3 months after stroke. Age-specific prevalence of antidepressant use after stroke was calculated., Results: At 3 months after stroke, 12.4% of male and 16.4% of female stroke survivors reported that they always or often felt depressed. In a multiple logistic regression model, female sex, age younger than 65 years, living alone, having had a recurrent stroke, being dependent on others, and institutional living 3 months after stroke were independent predictors of self-reported depression. Antidepressant medication was used by 22.5% of men and 28.1% of women who had had a stroke. Of patients using antidepressant drugs, 67.5% did not report depressive mood. However, 8.4% of the entire cohort reported depressive mood but no treatment with antidepressants. When compared with the general population, approximately twice as many of the stroke patients were using antidepressant treatment., Conclusions: In this national survey, 1 in 7 patients reported that they felt depressed and the use of antidepressant drugs after stroke was common. The widespread use of antidepressants challenges the contention that antidepressants are generally underused after stroke. However, the substantial proportion reporting depressive mood but not using treatment with antidepressants suggests that patient selection for treatment should be more precise.

In order to study the need for medical care among elderly stroke patients, a prospective registration of cerebrovascular diseases started on January 1, 1986 in Enköping-Håbo health service district, Sweden. This article reports the design of the stroke register and the registration procedures, the annual events of stroke, both first-ever and recurrent, during 1986-1988 and the fatality rate with special regard to the very old population. The annual incidence of first-ever stroke was 0.33/1,000 among persons younger than 65 years of age, 10.6/1,000 among persons aged 65-84 years, and 34.5/1,000 among persons aged 85 years and older. The fatality rate of first-ever strokes was 7.5% within one month for persons younger than 65 years of age, 20.3% in the age-group 65-84 years, and 41% for the population 85 years and older. These results are compared with a similar Swedish study from Söderhamn and four comparable international studies. The results from this study gave a basis for designing special care programs in hospital and in home-care also for old stroke patients.

The cumulative structure of personal daily activities (Katz' Index of ADL) and four well-defined instrumental activities (cooking, transportation, shopping, and cleaning) have been studied in a population of 76-year-olds (N = 659) in Gothenburg, Sweden. Sixty-five percent of the population were independent, 22% were dependent in instrumental activities, and 13% were dependent in both instrumental and personal activities. No person was dependent in personal ADL and independent in instrumental ADL. The internal consistency and the coefficient of scalability were well above the acceptance level, which indicated an internal reliability and validity of the new scale. The frequency of personal and home-assistance care, type of accommodation, self-assessment of self-care and domestic activities were compared with the level of dependence in ADL and indicated external validity. This cumulative instrument of ADL can be used to describe and compare the level of disability in elderly populations and to define the need for personal assistance in home care among disabled persons.

The predictive validity of Katz' Index of ADL (Activities of Daily Living) regarding length of hospital stay, discharge to own home or death within one month, and its reproducibility in clinical practice was studied prospectively in Södertälje and in Enköping, Sweden. The Södertälje study included 124 consecutive patients, who were all assessed on days 5-7 after stroke by an occupational therapist. The Enköping study included 106 consecutive patients, who were assessed similarly by trained nurses. Ninety-six and 94%, respectively, of patients in grades A-C on days 5-7 after stroke were discharged to their own homes within one month. Ninety-six and 92%, respectively, of patients in grades D-G stayed in hospital longer than one month or died. Sixty-two and 68%, respectively, of patients in grade G died within one month. The instrument is now used as a valid tool for early prognosis of stroke outcome in order to facilitate the planning of care and rehabilitation in clinical practice.

Cerebrovascular diseases with neurological deficits can be supposed to be a risk factor for oral health problems. 29 patients who were admitted consecutively to the Hospital of Enköping, Sweden, due to an acute history of stroke, were followed up with regard to their oral health at two weeks and at three months after admission. Only four patients had signs of a bad oral health, and three of them had dentures. There will be a long-term follow-up at 18 months after stroke.

In order to initiate early activation and counteract the negative effects of bed rest, 71 patients acutely admitted to hospital with a confirmed stroke were randomized to either training or control wards. Sixty-three persons participated in a first orthostatic tolerance test on days 5-7 after admission, which was replicated on days 10-12. A third test was performed three months later. Regular stand-ups were initiated on days 1-2 after admission to hospital and were continued for 1-2 weeks. The trained group had a lower increase in heart rate during tilting and a lower proportion of severely disabled patients on days 5-7 compared with the control group. This difference was statistically significant but cannot be proved to be a result from the regular stand-ups. Still, this minimum type of early activation can be recommended for acute stroke patients, mainly those with a cerebral infarction, who are able to cooperate with the nursing staff.

Katz' Index of ADL has been supplemented by five well-defined instrumental activities, namely cooking, washing, transportation, cleaning, and shopping. Eighty-five persons, mainly elderly, who had consecutively consulted a district occupational therapist, were assessed in their homes in order to study the reliability, the scalability, and the validity of the expanded index. The inter-observer reliability was high. The coefficient of scalability was well above the acceptance level, indicating construct validity. No person was dependent in personal ADL and totally independent in instrumental ADL. Persons who were dependent in both personal and instrumental ADL were older and lived in sheltered accommodation more often than persons who were dependent only in instrumental ADL, indicating external validity. This study shows that there was a cumulative relationship between certain well-defined instrumental activities and between personal and instrumental activities. This supplemented index can be useful for assessing and differentiating the need for personal assistance and homecare among disabled elderly people.

This article deals with the Katz Index of Independence in Activities of Daily Living and presents a study of its reliability and validity carried out at a Department of Internal Medicine in Sweden. Enrolled nurses assessed independently 100 aged patients. Scalability and interobserver variability were tested with Guttman scale-analysis. The results indicated that the activities are ranked according to a cumulative scale and that the index is reliable. Patients independent in ADL had shorter hospitalization and were discharged home more often than were the dependent patients. This indicates that the scale is valid. One year later most dependent patients were either dead or living in institutions: thus the index has a predictive potential. The systematic errors of scale were used to refine the index for use in short-term care. It is recommended as a basic measure of functional ability among aged abled or disabled patients also in short-term care.

In order to study the value of Katz' Index of ADL (Activities of Daily Living) for monitoring ADL-status among elderly persons receiving home-care, and to study their use of short-term hospital care, 40 consecutive recipients of a home-care subsidy in a health service district were followed during a period of six months. A licensed practical nurse visited them monthly, assessed their ADL-performance, and recorded their use of short-term hospital care. Twenty-seven persons changed in ADL-grade: 8 improved, 13 deteriorated, and 6 changed temporarily between the first and the final observation. Twenty-one persons were admitted to short-term hospital care; 19 of these changed in ADL-grade. The medical conditions that motivated hospital admission were serious and required hospital resources. The Index of ADL was found to monitor changes in ADL-status and is used today as a common language of disability between caretakers in the home and in hospital care.

Aged and disabled patients' need for coordinated services has increased the importance of a common language for their ability to perform the activities of daily living (ADL). This article aims at presenting Katz's Index of ADL and the use of it in six selected studies in order to show the availability for different purposes in divergent contexts. Katz's index is based on developmental principles and includes six common personal activities ordered into a cumulative scale. The use of the instrument provided both qualitative and quantitative information about disability among rather severely disabled patients in short-term and long-term hospital care, in nursing homes, in day-care and in home-care. The level of disability among the less disabled persons, who were independent in all of the six activities, were not differentiated by the index. A supplement of instrumental activities based on the same developmental principles is required, before a common language also for less disabled people can be established.