Validity of the Barrow Neurological Institute (BNI) screen for higher cerebral functions in stroke patients with good functional outcome

Cognitive impairments are often under diagnosed in stroke patients with good functional outcome. There is a need for a cognitive screening instrument that is sufficiently sensitive to cognitive impairments in these stroke patients. For this goal, we tested the feasibility and validity of the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS). Stroke patients with good functional outcome (Barthel Index 19/20) within 1 year poststroke were administered the BNIS and a brief neuropsychological assessment (NPA) including tests for perception, language, memory, attention, reasoning, and executive functioning. We compared the BNIS with the NPA to investigate its feasibility, internal consistency, floor and ceiling effects, concurrent validity, sensitivity and specificity. Fifty-four stroke patients were included. It took significantly less time to administer the BNIS (median = 16 minutes) than the NPA (median = 32.7 minutes). The BNIS showed good internal consistency (alpha = .82) and no floor or ceiling effects. The recommended cutoff values yielded good sensitivity and low to good specificity, depending on age. Except for perception (Spearman correlation .33), BNIS domain scores were significantly (0.44-0.55) associated with matching neuropsychological tests. This study provides promising results for the BNIS as a measure to detect cognitive impairments in stroke patients with good functional outcome

Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury

PURPOSES: The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI) and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. METHODS: The transmural care model was developed in cooperation with the Dutch Association of Spinal Cord Injured Patients, community nurses, general practitioners, rehabilitation nurses, rehabilitation managers, physiatrists and researchers. The core component of the care model consists of a transmural nurse, who ‘liaises’ between people with SCI living in the community, professional primary care professionals and the rehabilitation centre. The transmural care model provides a job description containing activities to support people with SCI and their family/partners and activities to promote continuity of care. The transmural care model was implemented in two Dutch rehabilitation centres. The following three aspects, as experienced by the transmural nurses, were evaluated: the extent to which the care model was implemented; enabling factors and barriers for implementation; strength and weakness of the care model. RESULTS: The transmural care model was not implemented in all its details, with a clear difference between the two rehabilitation centres. Enabling factors and barriers for implementation were found at three levels: 1. the level of the individual professional (e.g. competencies, attitude and motivation), 2. the organisational and financing level (e.g. availability of facilities and finances), and 3. the social context (the opinion of colleagues, managers and other professionals involved with the care). The most important weakness experienced was that there was not enough time to put all the activities into practice. The strength of the care model lies in the combination of support of patients after discharge, support of and cooperation with primary care professionals, and feedback of experiences to the clinical rehabilitation teams. CONCLUSION: We recommend further improving and implementing the care model and encourage other care professionals and researchers to share their implementation experiences of follow-up care innovations for people with SCI

A longitudinal cohort study on quality of life in stroke patients and their partners: Restore4Stroke Cohort

BACKGROUND: Stroke is a major cause of disability in the Western world. Its long-term consequences have a negative impact on the quality of life of both the patients and their partners. AIM: The aim of the Restore4Stroke Cohort study is to investigate the changes in quality of life of stroke patients and their partners over time, and to determine factors predicting quality of life in several domains, especially personal and environmental factors. METHOD: Multicentre prospective longitudinal cohort study. Inclusion and the first assessment take place during hospital stay in the first week post-stroke. Follow-up assessments take place at two months, six months, one year, and two years post-stroke. Recruitment of 500 patients from stroke units in six participation hospitals is foreseen. If the patient has a partner, he or she is also asked to participate in the study. OUTCOMES: The main outcome is quality of life, considered from a health-related quality of life and domain-specific quality of life perspective. Factors predicting long-term quality of life will be determined by taking into account the health condition (pre-stroke health condition and stroke-related health condition), personal factors (e.g. coping and illness cognitions), and environmental factors (e.g. caregiver burden and social support). DISCUSSION: This study is expected to provide information about the changes in quality of life of stroke patients and their partners over time. Furthermore, the identification of factors predicting quality of life can be used to improve rehabilitation care and develop new interventions for stroke patients and their partners

Toward standardized reporting for a cohort study on functioning: The Swiss Spinal Cord Injury Cohort Study

OBJECTIVE: Functioning is an important outcome to measure in cohort studies. Clear and operational outcomes are needed to judge the quality of a cohort study. This paper outlines guiding principles for reporting functioning in cohort studies and addresses some outstanding issues.DESIGN: Principles of how to standardize reporting of data from a cohort study on functioning, by deriving scores that are most useful for further statistical analysis and reporting, are outlined. The Swiss Spinal Cord Injury Cohort Study Community Survey serves as a case in point to provide a practical application of these principles.METHODS AND RESULTS: Development of reporting scores must be conceptually coherent and metrically sound. The International Classification of Functioning, Disability and Health (ICF) can serve as the frame of reference for this, with its categories serving as reference units for reporting. To derive a score for further statistical analysis and reporting, items measuring a single latent trait must be invariant across groups. The Rasch measurement model is well suited to test these assumptions.CONCLUSION: Our approach is a valuable guide for researchers and clinicians, as it fosters comparability of data, strengthens the comprehensiveness of scope, and provides invariant, interval-scaled data for further statistical analyses of functioning.<br/

Physical fitness in people with a spinal cord injury: the association with complications and duration of rehabilitation.

Objective: To assess the association between physical fitness and its recovery over time on the one hand, and complications and duration of phases of rehabilitation on the other. Design and setting: Prospective cohort study at eight rehabilitation centres. Subjects: People with a spinal cord injury were assessed four times: at the start of active rehabilitation (n = 110), three months later (n = 92), at discharge (n = 137) and a year after discharge from inpatient rehabilitation (n = 91). Main measures: Physical fitness was defined as aerobic capacity, determined at each occasion by the peak oxygen uptake (peak V

Social skills: A resource for more social support, lower depression levels, higher quality of life and participation in individuals with spinal cord injury?

Objective: to examine the relevance of social skills and their different dimensions (i.e. expressivity, sensitivity and control) in relation to social support, depression, participation and quality of life (QoL) in individuals with spinal cord injury (SCI).Design: cross-sectional data collection within Swiss Spinal Cord Injury Cohort (SwiSCI).Setting: community-based.Participants: a total of 503 individuals with SCI.Interventions: not applicable.Main Outcome Measures: depression, participation and QoL were measured using the Hospital Anxiety and Depression Scale (HADS), the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) and 5 selected items of the World Health Organization Quality of Life Scale (WHOQOL-BREF). The Social Skills Inventory (SSI), and the Social Support Questionnaire (SSQ6) were used to assess social skills (expressivity, sensitivity, control) and social support.Results: structural equation modeling was conducted. In model 1 (chi-square 27.81, df=19, p=.087, RMSEA=.033, 90% CI=.000–.052) social skills as a latent variable was related to social support (?=.31/R2=.10), depression (?=-.31/Total R2=.42) and QoL (?=.46/R2=.25). Social support partially mediated the effect of social skills on QoL (indirect effect: ?=.04, p=.02) but not on depression or participation. In model 2 (chi-square of 27.96, df=19, p=.084, RMSEA=.031, 90%CI=.000–.053) the social skills dimension expressivity showed a path coefficient of ?=.20 to social support and ?=.18 to QoL. Sensitivity showed a negative path coefficient to QoL (?=-.15) and control a path coefficient of ?=-.15 to depression and ?=.24 to QoL.Conclusions: social skills are a resource related to more social support, lower depression scores and higher QoL<br/