E. Lindeman

COMMUNITY AMBULATION IN PATIENTS WITH CHRONIC STROKE: HOW IS IT RELATED TO GAIT SPEED?

OBJECTIVEnTo explore the strength of the association between gait speed and community ambulation and whether this association is significantly distorted by other variables.nnnDESIGNnCross-sectional study conducted 3 years after stroke.nnnSUBJECTSnA total of 102 patients after first-ever stroke following inpatient rehabilitation who are now living in the community.nnnMETHODSnCommunity ambulation was determined by a self-administered questionnaire with 4 categories. Gait speed was assessed by the 5-m walking test. Possible confounding factors included in the analyses were: age, hemisphere, living alone, history of falls, use of assistive walking devices, executive function (Trail Making Test), depression (Center for Epidemiologic Studies-Depression scale), fatigue (Fatigue Severity Scale), motor function (Motricity Index), standing balance (Berg Balance Scale) and walking endurance (SF36).nnnRESULTSnTwenty-six percent of the patients were non-community walkers or limited community walkers. The optimal cut-off point for community ambulation was 0.66 m/sec, with an area under the curve of 0.85. Although gait speed was significantly related to community ambulation, this association was confounded by balance, motor function, endurance and the use of an assistive walking device. These factors reduced the regression coefficient of gait speed by more than 15%.nnnCONCLUSIONnGait speed is an important factor related to community walking; however, ability to walk in the community is determined by several underlying factors, e.g. balance, motor function, endurance and assistive walking device.

Functional recovery differs between ischaemic and haemorrhagic stroke patients

OBJECTIVEnTo determine whether there is a difference between patients with a cerebral infarction and those with an intracerebral haemorrhage with respect to the development of independence in activities of daily living over the first year post-stroke.nnnMETHODSnPatients after first-ever stroke who were admitted to an inpatient rehabilitation programme were included. The study had a longitudinal design and measurements took place at admission, 8, 10, 12, 26 and 52 weeks post-stroke. The relationship between the development over time of activities of daily living independence, measured by the Barthel Index, and type of stroke was analysed using Generalized Estimating Equations.nnnRESULTSnA total of 229 patients with cerebral infarction and 45 with intracerebral haemorrhage were included. From 12 to 26 weeks post-stroke, patients with cerebral infarction showed a significantly faster recovery. The time window for recovery was more restricted for patients with intracerebral haemorrhage; a statistically significant increase in activities of daily living was found until 10 weeks post-stroke in patients with intracerebral haemorrhage, whereas patients with cerebral infarction showed statistically significant recovery until 26 weeks post-stroke.nnnCONCLUSIONnThe differences in activities of daily living recovery between patients with cerebral infarction and those with intracerebral haemorrhage should be taken into consideration in rehabilitation management.

Individual and population burdens of major trauma in the Netherlands

OBJECTIVEnTo assess the impact of major trauma on individual and population health.nnnMETHODSnData from a regional trauma registry were used, including all trauma fatalities and nonfatal severely injured patients (injury severity score >15) in 1999 and 2000. The impact of fatalities was expressed in terms of years of life lost (YLL). The impact of severe injury on survivors was expressed in terms of years lived with disability (YLD). Disability weights were based on quality of life at 15 months after injury, measured with EuroQol-5D. Disability-adjusted life years (DALYs) were calculated as the sum of YLLs and YLDs.nnnFINDINGSnThere were 567 fatalities and 335 survivors. At the individual level, trauma fatalities (32 YLLs per patient) and nonfatal cases of major trauma (12 YLDs per patient) both led to a substantial loss of healthy life years. Each victim of major trauma contributed an average of 25 DALYs to the burden of disease. At the population level, major trauma caused 10 DALYs per 1000 inhabitants. Road-traffic injury was the main contributor to the population burden of major trauma.nnnCONCLUSIONnBoth at individual and population levels, major trauma has a massive impact on health. Most severely injured victims of road-traffic crashes reach the hospital and have good chances of survival. Injury prevention and trauma care policies should aim at further reduction of both fatalities and permanent consequences among survivors.

Monitoring the functional health status of stroke patients: the value of the Stroke-Adapted Sickness Impact Profile-30

Purpose:u2002To further validate the Stroke-Adapted Sickness Impact Profile-30 (SA-SIP30) and to determine its responsiveness in a stroke rehabilitation population. Method:u2002Data of 122 communicative stroke patients (mean age 57 years), selected for an inpatient rehabilitation programme, were available. All had suffered different types of stroke. Six months and one year post-stroke, the patients completed the SIP68 plus nine stroke-specific questions from the SIP136, enabling us to derive the SA-SIP30 from the questionnaire. We determined internal consistency, construct and clinical validity and responsiveness of the SA-SIP30. Total, physical and psychosocial dimension scores were calculated. Results:u2002Internal consistency was moderate to good (αu200a>u200a0.68) and correlation between the SIP68 and the SA-SIP30 was high (ru200a>u200a0.85), indicating good construct validity for total score and both dimension scores. Clinical validity assessment showed that total and psychosocial dimensions scores were significantly higher for patients with a cortical infarction compared to respectively subarachnoid haemorrhage and subcortical infarction (pu200a<u200a0.05). Effect sizes for the SA-SIP30 were moderate (between 0.56 and 0.65). Conclusions:u2002The SA-SIP30 proved valid and responsive in our stroke rehabilitation population. The major advantages of the SA-SIP30 are the lesser number of items and, therefore, the shorter completion time and the fact that it is a stroke-specific scale to determine health-related functional status.

[Falls: incidence and risk factors after stroke. A systematic literature review].

Falls are common after stroke. This article presents a literature review of the incidence and risk factors of falls and the consequences for professionals working with stroke patients. It is important to consider the specific problems after stroke. Depression and cognitive impairments were found to be risk factors for fall incidents after stroke. In the relevant literature many different risk factors and circumstances are described. When patients move from bed to chair, walk to the bathroom and the first few days after the patient is discharged to another setting, - all these circumstances showed high percentages of falling. A fall during hospital stay is a significant risk factor for future fall incidents. A reliable index to measure the fall risk is not (yet) available. But scores on the Barthel Index and the Timed-Up-and-Go test can be used as fall risk indicators. Fear of falling is an important complication after a fall and therefore it is recommended prior to discharge to inquire about the patients self efficacy in maintaining balance. Few intervention studies use the number of falls as an outcome measure. Exercising balance following a mass training protocol seems to diminish the risk of falling.Falls are common after stroke. This article presents a literature review of the incidence and risk factors ofnfalls and the consequences for professionals working with stroke patients. It is important to consider thenspecific problems after stroke. Depression and cognitive impairments were found to be risk factors for fallnincidents after stroke. In the relevant literature many different risk factors and circumstances arendescribed. When patients move from bed to chair, walk to the bathroom and the first few days after thenpatient is discharged to another setting, - all these circumstances showed high percentages of falling. Anfall during hospital stay is a significant risk factor for future fall incidents. A reliable index to measure thenfall risk is not (yet) available. But scores on the Barthel Index and the Timed-Up-and-Go test can be usednas fall risk indicators. Fear of falling is an important complication after a fall and therefore it isnrecommended prior to discharge to inquire about the patientx92s self efficacy in maintaining balance. Fewnintervention studies use the number of falls as an outcome measure. Exercising balance following a massntraining protocol seems to diminish the risk of falling.SamenvattingValincidenten komen veel voor bij patiënten na een beroerte. Deze literatuurstudie geeft een overzicht van de incidentie en de risicofactoren. Naast algemene valpreventie is het belangrijk rekening te houden met de specifieke problemen die gerelateerd zijn aan een hoger valrisico na een beroerte, zoals een depressie en cognitie stoornissen. Uit de geïncludeerde studies komt een aantal risicofactoren naar voren, zoals het zich verplaatsen van bed naar stoel, lopen naar badkamer en toilet, en de eerste dagen na het ontslag naar huis. Een keer gevallen zijn tijdens de ziekenhuisopname is een significante risicofactor voor latere valincidenten. Een meetinstrument om het risiconiveau betrouwbaar in te schatten is er (nog) niet. Scores op een aantal meetinstrumenten zoals de Barthel Index en de Timed-Up-and-Go test kunnen gebruikt worden als indicatoren voor een verhoogd risico. Na een val kan angst om te vallen ontstaan, waardoor het activiteitenniveau van patiënten vermindert. Het wordt aanbevolen om voor het ontslag naar huis patiënten een test af te nemen naar het vertrouwen in de balanshandhaving bij verschillende activiteiten. In de weinige studies waarin valincidenten een uitkomstmaat zijn, blijkt intensieve oefentherapie gericht op balansverbetering het aantal valincidenten te verminderen.Falls: Incidence and risk factors after stroke. A systematic literature reviewFalls are common after stroke. This article presents a literature review of the incidence and risk factors of falls and the consequences for professionals working with stroke patients. It is important to consider the specific problems after stroke. Depression and cognitive impairments were found to be risk factors for fall incidents after stroke. In the relevant literature many different risk factors and circumstances are described. When patients move from bed to chair, walk to the bathroom and the first few days after the patient is discharged to another setting, - all these circumstances showed high percentages of falling. A fall during hospital stay is a significant risk factor for future fall incidents. A reliable index to measure the fall risk is not (yet) available. But scores on the Barthel Index and the Timed-Up-and-Go test can be used as fall risk indicators. Fear of falling is an important complication after a fall and therefore it is recommended prior to discharge to inquire about the patient’s self efficacy in maintaining balance. Few intervention studies use the number of falls as an outcome measure. Exercising balance following a mass training protocol seems to diminish the risk of falling.

Real-Time Assessment of Fatigue in Patients With Multiple Sclerosis: How Does It Relate to Commonly Used Self-Report Fatigue Questionnaires?

OBJECTIVESn(1) To assess real-time patterns of fatigue; (2) to assess the association between a real-time fatigue score and 3 commonly used questionnaires (Checklist Individual Strength [CIS] fatigue subscale, Modified Fatigue Impact Scale (MFIS), and Fatigue Severity Scale [FSS]); and (3) to establish factors that confound the association between the real-time fatigue score and the conventional fatigue questionnaires in patients with multiple sclerosis (MS).nnnDESIGNnCross-sectional study.nnnSETTINGnMS-specialized outpatient facility.nnnPARTICIPANTSnAmbulant patients with MS (N=165) experiencing severe self-reported fatigue.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnA real-time fatigue score was assessed by sending participants 4 text messages on a particular day (How fatigued do you feel at this moment?; score range, 0-10). Latent class growth mixed modeling was used to determine diurnal patterns of fatigue. Regression analyses were used to assess the association between the mean real-time fatigue score and the CIS fatigue subscale, MFIS, and FSS. Significant associations were tested for candidate confounders (eg, disease severity, work status, sleepiness).nnnRESULTSnFour significantly different fatigue profiles were identified by the real-time fatigue score, namely a stable high (n=79), increasing (n=57), stable low (n=16), and decreasing (n=13). The conventional questionnaires correlated poorly (r<.300) with the real-time fatigue score. The Epworth Sleepiness Scale significantly reduced the regression coefficient between the real-time fatigue score and conventional questionnaires, ranging from 15.4% to 35%.nnnCONCLUSIONSnPerceived fatigue showed 4 different diurnal patterns in patients with MS. Severity of sleepiness is an important confounder to take into account in the assessment of fatigue.

Clinical manifestation of depression after stroke: different from depression in other patients?

s were matched with the following inclusion criteria: studies investigating leadership and mentoring programs for postdoctoral nurses and focusing on research productivity, research skills, collaboration, career development and other outcomes. The methodological quality of the studies was independently appraised by two reviewers using the Center for Evidence Based Medicine for surveys, the Critical Appraisal Skill Program Qualitative Appraisal Checklist for qualitative studies and a critical appraisal list for mixed methods studies in health services research. Data were extracted by two reviewers. Results: 1775 titles and abstracts were screened resulting in 15 studies involving 3855 postdoctoral nurses. Two studies presenting mentoring programs for postdoctoral nurses were identified. Other studies investigated the influence of mentoring on various outcomes. The findings showed positive influence of mentoring on research productivity, including increase in publications and grant writing and research career development and other outcomes. Postdoctoral nurses experience mentoring, mentorship, leadership and peer-support as essential in supporting ongoing research activity. Conclusion: Although there is a lack of studies with robust designs investigating leadership and mentoring programs, our results document substantial evidence of mentoring based on the abundance of descriptive literature describing various positive outcomes of mentoring on research productivity, career development of postdoctoral nurses.Background: Cancer is considered as chronic condition, especially in the older people. Prevalence of cancer is especially high in the Nordic countries and Mediterranean countries. People with cance ...Background: nTo measure the attitudes towards older people and perceptions of working with older people of undergraduate health and social care students in 5 European countries. Questionnaires are one of the most widely used data collection methods. The use of questionnaires constructed and validated in a setting to other setting is an essential aspect in international studies, which have as main objective to compare and deduce similarities and differences within different contexts. There are three main aspects in validation, the linguistic, the cultural and statistic validation,all these three aspects are essential during theprocess. n nMaterials: nTwo questionnaires were used: Attitudes towards Older People Scale (Kogan1966) and Students’ Perception of Working with Older People Scale (Nolan et al, 2006). n nMethods: nFive Countries were involved in the study namely Ireland, Finland, Germany, Latvia, and Italy. Back translation methodology was used in order to translate questionnaire (Linguistic and cultural validation) while a Cronbach was calculate to assess internal validity (statistic validation). n nResults: nStudents (n = 955) completed the two questionnaires. Students’ Perception of Working with Older People Scale, shows a 0.81 a Cronbach for all sample, for Ireland 0.84, Germany, 0.79, Italy 0.79, Finland 0.84 and Latvia 0.59, Attitudes towards Older People Scale shows a 0.83 a Cronbach for all sample,for Ireland 0.85, Germany, 0.83, Italy 0.62, Finland 0.86 and Latvia 0.74. Respondents were generally positive towards older people with few differences between countries. Those with least experience with older people displayed more negative attitudes. Significant relationships were found between positive 50