CAN REHABILITATION IN THE HOME SETTING REDUCE THE BURDEN OF CARE FOR THE NEXT-OF-KIN OF STROKE VICTIMS? 1

Can rehabilitation in the home setting reduce the burden of care for the next-of-kin of stroke victims?. Background: More evidence of the efficacy of caregiver interventions is needed. The aim of this study was to evaluate whether counselling in the home setting reduces the care giver burden. Methods: Thirtysix patients after stroke, median age 53 years, with a close family member, were selected for an evaluation of the burden of care and 35 participated. They were part of a randomized controlled trial, comparing rehabilitation in the home setting with outpatient rehabili tation. In the home setting, counselling about the stroke and its consequences was included. Assessments with the Care giver Burden scale were made at 3 weeks, 3 months and one year after discharge. Results: The burden of the 2 groups did not differ. After the intervention, there was a tendency to a lower burden for the home setting. The burden for the home setting was then unchanged from 3 weeks to 1 year, while outpatient rehabilitation showed a reduced burden over time. For the home setting, significant correlations to activity level were seen after the intervention. Conclusion: A positive effect of counselling was seen, as the home setting burden tends to be lower after the intervention, while outpatient rehabilitation seems to adjust with time. The results suggest that counselling reduces burden and the remaining burden is associated with the patient's ability. Journal of Rehabilitation Medicin

White book on physical and rehabilitation medicine (PRM) in Europe. Chapter 10. Science and research in PRM: Specificities and challenges

In the context of the White Book of Physical and Rehabilitation Medicine (PRM), this paper deals with Research, the future of PRM. PRM students and specialists are mainly involved in biomedical research, investigating the biological processes, the causes of diseases, their medical diagnosis, the evaluation of their consequences on functioning, disability and health and the effects of health interventions at an individual and a societal level. Most of the current PRM research, often interdisciplinary, originates from applied research which, using existing knowledge, is directed towards specific goals. Translational medical research, research and development, implementation research and clinical impact research are in this field. PRM physicians, mainly master or PhD students, are nowadays increasing their participation in basic research and in pre-clinical trials. PRM physicians are involved in primary research, which is an original first hand research, but also in secondary research, which is the analysis and interpretation of primary research publications in a field, with a specific methodology. Secondary research remains an important activity of the UEMS PRM section and it will be the field of the new created Cochrane Rehabilitation. Secondary research with interest for persons with disabilities, will be developed world wide on the basis of evidence based medicine, with the participation of PRM physicians and of all other health and social professionals involved in rehabilitation. The development of research activities with interest for PRM in Europe is a challenge for the future, which has to be faced now. The European PRM schools, the European master and PhD program with their supporting research and clinical facilities, the European PRM organizations with their websites, the PRM scientific journals and European congresses are a strong basis to develop research activities, together with the development of Cochrane Rehabilitation field and of our cooperation with European high level research facilities, European and international scientific societies in different fields. PRM will be a leader in this field of research

Balance in single-limb stance after surgically treated ankle fractures: a 14-month follow-up

BACKGROUND: The maintenance of postural control is fundamental for different types of physical activity. This can be measured by having subjects stand on one leg on a force plate. Many studies assessing standing balance have previously been carried out in patients with ankle ligament injuries but not in patients with ankle fractures. The aim of this study was to evaluate whether patients operated on because of an ankle fracture had impaired postural control compared to an uninjured age- and gender-matched control group. METHODS: Fifty-four individuals (patients) operated on because of an ankle fracture were examined 14 months postoperatively. Muscle strength, ankle mobility, and single-limb stance on a force-platform were measured. Average speed of centre of pressure movements and number of movements exceeding 10 mm from the mean value of centre of pressure were registered in the frontal and sagittal planes on a force-platform. Fifty-four age- and gender-matched uninjured individuals (controls) were examined in the single-limb stance test only. The paired Student t-test was used for comparisons between patients' injured and uninjured legs and between side-matched legs within the controls. The independent Student t-test was used for comparisons between patients and controls. The Chi-square test, and when applicable, Fisher's exact test were used for comparisons between groups. Multiple logistic regression was performed to identify factors associated with belonging to the group unable to complete the single-limb stance test on the force-platform. RESULTS: Fourteen of the 54 patients (26%) did not manage to complete the single-limb stance test on the force-platform, whereas all controls managed this (p < 0.001). Age over 45 years was the only factor significantly associated with not managing the test. When not adjusted for age, decreased strength in the ankle plantar flexors and dorsiflexors was significantly associated with not managing the test. In the 40 patients who managed to complete the single-limb stance test no differences were found between the results of patients' injured leg and the side-matched leg of the controls regarding average speed and the number of centre of pressure movements. CONCLUSION: One in four patients operated on because of an ankle fracture had impaired postural control compared to an age- and gender-matched control group. Age over 45 years and decreased strength in the ankle plantar flexors and dorsiflexors were found to be associated with decreased balance performance. Further, longitudinal studies are required to evaluate whether muscle and balance training in the rehabilitation phase may improve postural control

Effects of a training program after surgically treated ankle fracture: a prospective randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Despite conflicting results after surgically treated ankle fractures few studies have evaluated the effects of different types of training programs performed after plaster removal. The aim of this study was to evaluate the effects of a 12-week standardised but individually suited training program (training group) versus usual care (control group) after plaster removal in adults with surgically treated ankle fractures.</p> <p>Methods</p> <p>In total, 110 men and women, 18-64 years of age, with surgically treated ankle fracture were included and randomised to either a 12-week training program or to a control group. Six and twelve months after the injury the subjects were examined by the same physiotherapist who was blinded to the treatment group. The main outcome measure was the Olerud-Molander Ankle Score (OMAS) which rates symptoms and subjectively scored function. Secondary outcome measures were: quality of life (SF-36), timed walking tests, ankle mobility tests, muscle strength tests and radiological status.</p> <p>Results</p> <p>52 patients were randomised to the training group and 58 to the control group. Five patients dropped out before the six-month follow-up resulting in 50 patients in the training group and 55 in the control group. Nine patients dropped out between the six- and twelve-month follow-up resulting in 48 patients in both groups. When analysing the results in a mixed model analysis on repeated measures including interaction between age-group and treatment effect the training group demonstrated significantly improved results compared to the control group in subjects younger than 40 years of age regarding OMAS (p = 0.028), muscle strength in the plantar flexors (p = 0.029) and dorsiflexors (p = 0.030).</p> <p>Conclusion</p> <p>The results of this study suggest that when adjusting for interaction between age-group and treatment effect the training model employed in this study was superior to usual care in patients under the age of 40. However, as only three out of nine outcome measures showed a difference, the beneficial effect from an additional standardised individually suited training program can be expected to be limited. There is need for further studies to elucidate how a training program should be designed to increase and optimise function in patients middle-aged or older.</p> <p>Trial Registration</p> <p>Current Controlled Trials ACTRN12609000327280</p

Return to work after specialized rehabilitation-An explorative longitudinal study in a cohort of severely disabled persons with stroke in seven countries: The Sunnaas International Network stroke study.

Introduction: Stroke may impose disabilities with severe consequences for the individual, with physical, psychological, social, and work- related consequences. The objective with the current study was to investigate to what extent persons with stroke were able to return to work, to maintain their financial situation, and to describe the follow- up services and participation in social networks and recreational activities. Methods: The design was a prospective, descriptive study of specialized stroke rehabilitation in nine rehabilitation centers in seven countries. Semistructured interviews, which focused on the return to work, the financial situation, follow- up services, the maintenance of recreational activities, and networks, were performed 6 and 12 months post discharge from rehabilitation. Results: The working rate before the onset of stroke ranged from 27% to 86%. At 12 months post stroke, the return to work varied from 11% to 43%. Consequently, many reported a reduced financial situation from 10% to 70% at 6 months and from 10% to 80% at 12 months. Access to postrehabilitation follow- up services varied in the different countries from 24% to 100% at 6 months and from 21% to 100% at 12 months. Physical therapy was the most common follow- up services reported. Persons with stroke were less active in recreational activities and experienced reduced social networks. Associations between results from the semistructured interviews and related themes in LiSat- 11 were small to moderate. The study shows that education, age, and disability are predictors for return to work. Differences between countries were observed in the extent of unemployment. Conclusions: In this international multicentre study, return to work after severe stroke and specialized/comprehensive rehabilitation was possible, depending on the extent of the disability, age, and education. Altered financial situation, reduced social networks, and reduced satisfaction with life were common psychosocial situations for these patients

Return to work after specialized rehabilitation-An explorative longitudinal study in a cohort of severely disabled persons with stroke in seven countries: The Sunnaas International Network stroke study.

Introduction: Stroke may impose disabilities with severe consequences for the individual, with physical, psychological, social, and work‐related consequences. The objective with the current study was to investigate to what extent persons with stroke were able to return to work, to maintain their financial situation, and to describe the follow‐up services and participation in social networks and recreational activities. Methods: The design was a prospective, descriptive study of specialized stroke rehabilitation in nine rehabilitation centers in seven countries. Semistructured interviews, which focused on the return to work, the financial situation, follow‐up services, the maintenance of recreational activities, and networks, were performed 6 and 12 months post discharge from rehabilitation. Results: The working rate before the onset of stroke ranged from 27% to 86%. At 12 months post stroke, the return to work varied from 11% to 43%. Consequently, many reported a reduced financial situation from 10% to 70% at 6 months and from 10% to 80% at 12 months. Access to postrehabilitation follow‐up services varied in the different countries from 24% to 100% at 6 months and from 21% to 100% at 12 months. Physical therapy was the most common follow‐up services reported. Persons with stroke were less active in recreational activities and experienced reduced social networks. Associations between results from the semistructured interviews and related themes in LiSat‐11 were small to moderate. The study shows that education, age, and disability are predictors for return to work. Differences between countries were observed in the extent of unemployment. Conclusions: In this international multicentre study, return to work after severe stroke and specialized/comprehensive rehabilitation was possible, depending on the extent of the disability, age, and education. Altered financial situation, reduced social networks, and reduced satisfaction with life were common psychosocial situations for these patients

Protocol of the Sunnaas International (SIN) Stroke Project an International Multicenter Study of Specialized Rehabilitation for Stroke Patients

Rationale: Stroke is leading cause of serious, long-term disability in adults. Consequently, many individuals with stroke are in need of specialized rehabilitation. However, the content of specialized rehabilitation may vary. Aims: To describe the content of specialized stroke rehabilitation, and possible influence on the physical and social functioning after specialized rehabilitation, in nine rehabilitation institutions representing seven different countries. Design: The design is a prospective, descriptive study of the specialized rehabilitation of stroke patients in rehabilitation institutions in Norway, PR China, the United States, Russia, Israel, Palestine and Sweden. Patients with a primary diagnosis of stroke consecutively attending an institution for specialized rehabilitation will be invited to enroll in the study. Study Outcomes: General descriptive data of the rehabilitation centers, the content of their programs for specialized rehabilitation for stroke patients, and descriptive data of enrolled patients will be registered. Primary outcome measures are the Barthel Index (BI), alternatively, the Functional Independence Measure (FIM), which reflect performance of the activities of daily living. Secondary outcome measures are the Life Satisfaction Scale (LISAT-11), the Modified Rankin Scale (MRS), the National Institutes of Health Stroke Scale (NIHSS) and a semistructured questionnaire with focus on the social situation. Tests will be performed on admission to rehabilitation, 18-22 days into rehabilitation, at discharge, six and twelve months after discharge. Discussion: The study will contribute to the knowledge about the content of specialized stroke rehabilitation with examples from nine clinics in seven different countries. The study will highlight how the different models of specialized rehabilitation may influence patients’ outcomes. Data from all sites will target what physical and psychosocial situations persons with stroke face in different settings. The international aspects of specialized stroke rehabilitation may serve as background for the discussion on the optimal rehabilitation services for stroke patients. © 2014 Langhammer B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

An international multicenter study of specialized rehabilitation for stroke patients . Protocol of the Sunnaas InterNational (SIN) stroke project

Rationale: Stroke is leading cause of serious, long-term disability in adults. Consequently, many individuals with stroke are in need of specialized rehabilitation. However, the content of specialized rehabilitation may vary. Aims: To describe the content of specialized stroke rehabilitation, and possible influence on the physical and social functioning after specialized rehabilitation, in nine rehabilitation institutions representing seven different countries. Design: The design is a prospective, descriptive study of the specialized rehabilitation of stroke patients in rehabilitation institutions in Norway, PR China, the United States, Russia, Israel, Palestine and Sweden. Patients with a primary diagnosis of stroke consecutively attending an institution for specialized rehabilitation will be invited to enroll in the study. Study Outcomes: General descriptive data of the rehabilitation centers, the content of their programs for specialized rehabilitation for stroke patients, and descriptive data of enrolled patients will be registered. Primary outcome measures are the Barthel Index (BI), alternatively, the Functional Independence Measure (FIM), which reflect performance of the activities of daily living. Secondary outcome measures are the Life Satisfaction Scale (LISAT-11), the Modified Rankin Scale (MRS), the National Institutes of Health Stroke Scale (NIHSS) and a semistructured questionnaire with focus on the social situation. Tests will be performed on admission to rehabilitation, 18-22 days into rehabilitation, at discharge, six and twelve months after discharge. Discussion: The study will contribute to the knowledge about the content of specialized stroke rehabilitation with examples from nine clinics in seven different countries. The study will highlight how the different models of specialized rehabilitation may influence patients’ outcomes. Data from all sites will target what physical and psychosocial situations persons with stroke face in different settings. The international aspects of specialized stroke rehabilitation may serve as background for the discussion on the optimal rehabilitation services for stroke patients