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Collaborative evaluation of rehabilitation in stroke across Europe

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Summary of scientific results: Title: Depression and anxiety after stroke. A comparison of four European rehabilitation centres. Background and purpose: Large variation exists between studies reporting prevalence and risk factors of depression and anxiety after stroke. The aims of this study were to compare the prevalence and severity of both affective disorders between four European rehabilitation centres and to determine predictors and time course. Methods: In total, 532 consecutive stroke patients were recruited. The Hospital Anxiety and Depression Scale was assessed at two, four and six months after stroke. Prevalence and severity were compared across centres using Chi²- and Kruskal-Wallis tests, respectively. Predictors and time course were examined using linear mixed models. Results: Severity and prevalence (21%-38%) of depression and anxiety (15%-30%) was similar across centres. Stroke severity, functional and motor impairment and sensory deficit were associated with the severity of both affective disorders. Cognitive disorder, dysarthria, pre-stroke Barthel Index and age were also associated with the severity of depression; living alone prior stroke with the severity of anxiety. In the multivariable models only initial functional impairment was retained. After correction for predictors of both affective disorders, levels of depression were stable over time; anxiety levels decreased. Conclusion: Prevalence and severity of depression and anxiety were similar in four European centres up to six months after stroke. As many patients risk becoming depressed or anxious in that period, monitoring for both affective disorders is needed. The multivariable models indicated a strong association between initial functional disability and both depression and anxiety, suggesting that psychological and functional recovery after stroke are closely intertwined. Summary of dissemination activities: this result was written out in a scientific paper that will be submitted to the journal 'Clinical Rehabilitation'. Furthermore, the results were presented at the international Stroke congress we organised in Leuven on the 10th and 11th February 2006. For details see: http://faber.kuleuven.be/onderzoek/dep3/neuro/cerise/index.htm The results were also presented on the 27th of April at a National congresses on Rehabilitation in Interlaken (Switzerland), on the 18th of May at the European Congress of Physical and Rehabilitation Medicine in Madrid (Spain). The results were also presented and discussed in the participating centres in Leuven (Belgium) on the 21st of March, Zurzach (Switzerland) on the 26th April and Herzogenaurach (Germany) on the 27th April 2006. The results will also be presented in Nottingham (UK) at a later stage. More dissemination activities are planned in the coming months at international conferences. However, at this time, it is not possible to specify in detail because abstracts have to be submitted to the scientific committee, who then in turn has to accept the paper for presentation.
Purpose: The aim of this study was to compare the time allocated to therapeutic activities (TA) and non-therapeutic activities (NTA) of physiotherapists (PT) and occupational therapists (OT) in stroke rehabilitation units in four European countries. Method: Therapists documented their activities in 15 minutes periods for two weeks. They recorded: activity, number of patients, number of stroke patients, involvement of other people, location and frequency of each activity. Kruskal-Wallis tests and negative binomial regression models were used to compare activities between professional groups and between units. Results: The average proportion of TA per day ranged between 32.9% and 66.1% and was higher for PT than for OT in each unit. For OT, significant differences emerged between the units in the proportion of time allocated to TA compared to NTA with British OTs spending significantly less time in TA. In the Belgian unit, three times less time was spent on patient-related co-ordination activities (e.g. administration, ward rounds) compared to the British and Swiss units. Conclusions: Time allocation differed between PT and OT and between units, affecting the time available for TA. Further investigation is necessary to study the effect of work organisation in stroke rehabilitation units on the efficiency of rehabilitation regimes. Summary of dissemination activities: this result was written out in a scientific paper, accepted for publication in the journal 'Disability and Rehabilitation', 2006. Furthermore, the results were presented at the international Stroke congress we organised in Leuven on the 10th and 11th February 2006. For details see: http://faber.kuleuven.be/onderzoek/dep3/neuro/cerise/index.htm The results were also presented on the 27th of April at a National congresses on Rehabilitation in Interlaken (Switzerland), on the 18th of May at the European Congress of Physical and Rehabilitation Medicine in Madrid (Spain). The results were also presented and discussed in the participating centres in Leuven (Belgium) on the 21st of March, Zurzach (Switzerland) on the 26th April and Herzogenaurach (Germany) on the 27th April 2006. The results will also be presented in Nottingham (UK) at a later stage. More dissemination activities are planned in the coming months at international conferences. However, at this time, it is not possible to specify in detail because abstracts have to be submitted to the scientific committee, who then in turn has to accept the paper for presentation.
Use of time by stroke patients: a comparison of four European rehabilitation centres Scientific results: Background and purpose: Differences exist between European countries in the proportion of patients who die or become dependent after stroke. The aim of the present study was to identify differences in the use of time by stroke patients in four rehabilitation centres in four European countries. Methods: In each of the four centres, 60 randomly selected stroke patients were observed at 10-minute intervals using behavioural mapping. Observations took place on 30 weekdays selected at random, on equal number of morning, afternoon and evening sessions. A logistic generalized estimating equation model with correction for differences in case mix and multiple testing was used for the analysis. Results: Overall time available from different professions was the highest in the UK, but patients in the UK spent on average only one hour a day in therapy. This was significantly less than patients in Belgium and Germany, who spent about two hours, and patients in Switzerland who spent nearly three hours a day in therapy. In all centres, patients spent less than half their time in interactions and more than 72 percent of the time in non-therapeutic activities. Conclusions: Important differences in the use of time were established, which appeared dependent on management decisions rather than the number of staff available. Patients in the Swiss and German centres spent more time in therapy, possibly due to the structured organization of rehabilitation. Further studies will verify whether this has an effect on outcome. Summary of dissemination activities: this result was written out in a scientific paper, that has been published in the journal 'Stroke', 2005, volume 36: page 1977-1983. Furthermore, the results were presented at the international Stroke congress we organised in Leuven on the 10th and 11th February 2006.For details see: http://faber.kuleuven.be/onderzoek/dep3/neuro/cerise/index.htm The results were also presented on the 27th of April at a National congresses on Rehabilitation in Interlaken (Switzerland), on the 18th of May at the European Congress of Physical and Rehabilitation Medicine in Madrid (Spain). The results were also presented and discussed in the participating centres in Leuven (Belgium) on the 21st of March, Zurzach (Switzerland) on the 26th April and Herzogenaurach (Germany) on the 27th April 2006. The results will also be presented in Nottingham (UK) at a later stage. More dissemination activities are planned in the coming months at international conferences. However, at this time, it is not possible to specify in detail because abstracts have to be submitted to the scientific committee, who then in turn has to accept the paper for presentation.
Scientific summary of the result: Title: Motor and functional recovery after stroke. A comparison of four European rehabilitation centres. Background and purpose: Outcome after stroke differs across European countries. The components of stroke rehabilitation critical for patients' outcome are not well known. The aim of this study was to compare motor and functional recovery after stroke between four European rehabilitation centres (BE, UK, CH, DE) and to interpret the findings in the context of previously established differences in therapy input. Methods: In four centres, 532 consecutively admitted stroke patients were recruited. On admission and at two, four and six months after stroke, the Barthel Index (BI), Rivermead Motor Assessment-Gross Function (RMA-GF) and Nottingham Extended Activities of Daily Living (NEADL, except on admission) were assessed. Data were analysed using random effects ordinal logistic models with adjustment for case-mix. Results: In the UK centre, patients were more likely to stay in a lower RMA-GF-class compared to patients in the German centre (Ä OR=2.4; 95%CI: 1.3-4.3). In the Swiss center, patients were significantly less likely to stay in a lower NEADL-class compared to patients in the UK centre (Ä OR=0.7; 95%CI: 0.5-0.9). However, UK patients were less likely to stay in a lower BI-class compared to the German patients (OR=0.6; 95%CI: 0.4-0.8). In the Belgian centre, patients did not achieve the level of the Swiss or German centres for BI and NEADL. Conclusion: Overall recovery was better in the Swiss and German centres compared to the UK and Belgian centres, with the exception of self- care recovery in the UK. In the German and Swiss centres, patients received considerably more therapy per day. This was not in the first place a consequence of higher staffing levels but of a more structured rehabilitation programme. Summary of dissemination activities: this result was written out in a scientific paper that will be submitted to the journal 'Stroke'. Furthermore, the results were presented at the international Stroke congress we organised in Leuven on the 10th and 11th February 2006. For details see: http://faber.kuleuven.be/onderzoek/dep3/neuro/cerise/index.htm The results were also presented on the 27th of April at a National congress on Rehabilitation in Interlaken (Switzerland), on the 18th of May at the European Congress of Physical and Rehabilitation Medicine in Madrid (Spain). The results were also presented and discussed in the participating centres in Leuven (Belgium) on the 21st of March, Zurzach (Switzerland) on the 26th April and Herzogenaurach (Germany) on the 27th April 2006. The results will also be presented in Nottingham (UK) at a later stage. More dissemination activities are planned in the coming months at international conferences. However, at this time, it is not possible to specify in detail because abstracts have to be submitted to the scientific committee, who then in turn has to accept the paper for presentation.
Summary scientific results: Title: Stroke rehabilitation in Europe. What do physiotherapists and occupational therapists actually do? Background and purpose: Physiotherapy (PT) and occupational therapy (OT) are key components of stroke rehabilitation. Little is known about their content. This study aimed to define and compare the content of PT and OT for stroke patients between four European rehabilitation centres. Methods: In each centre, fifteen individual PT- and 15 OT-sessions of patients fitting predetermined criteria were videotaped. The content was recorded using a list comprising 12 therapeutic categories. A generalized estimating equation model was fitted to the relative frequency of each category resulting in odds ratios. Results: Comparison of PT and OT between centres revealed significant differences for only two of the twelve categories: ambulatory exercises and selective movements. Comparison of the two therapeutic disciplines on the pooled data of the four centres, revealed that ambulatory exercises, transfers, exercises & balance in standing and lying occurred significantly more often in PT-sessions. ADL, domestic activities, leisure activities and sensory, perceptual training & cognition occurred significantly more often in OT-sessions. Conclusion: This study revealed that the content of each therapeutic discipline was consistent between the four centres. PT and OT proved to be distinct professions with clear demarcation of roles. Summary of dissemination activities: this result was written out in a scientific paper, that has been accepted for publication in the journal 'Stroke' in March 2006 and will be published in June 2006. An online version of the publication is already available. Furthermore, the results were presented at the international Stroke congress we organised in Leuven on the 10th and 11th February 2006. For details see: http://faber.kuleuven.be/onderzoek/dep3/neuro/cerise/index.htm The results were also presented on the 27th of April at a National congresses on Rehabilitation in Interlaken (Switzerland), on the 18th of May at the European Congress of Physical and Rehabilitation Medicine in Madrid (Spain). The results were also presented and discussed in the participating centres in Leuven (Belgium) on the 21st of March, Zurzach (Switzerland) on the 26th April and Herzogenaurach (Germany) on the 27th April 2006. The results will also be presented in Nottingham (UK) at a later stage. More dissemination activities are planned in the coming months at international conferences. However, at this time, it is not possible to specify in detail because abstracts have to be submitted to the scientific committee, who then in turn has to accept the paper for presentation
Scientific summary: Title: Defining the content of individual physiotherapy and occupational therapy sessions for stroke patients in an inpatient rehabilitation setting. Inter-rater reliability of a scoring list. Objective: To develop a scoring list to define the content of individual physiotherapy and occupational therapy sessions for stroke patients in inpatient rehabilitation and to verify the iterated reliability of the scoring list. Design: A scoring list was developed consisting of 12 categories and 49 subcategories of therapeutic activities. In each of four European rehabilitation centres, a researcher recorded and scored five physiotherapy and five occupational therapy sessions. These forty treatment sessions were also scored by the first author. The scores of the researchers were compared with those of the first author. Settings and subjects: Forty stroke patients in four European rehabilitation centres. Results: The treatment sessions had a mean duration of 39.5 +/- 14.0 minutes. Comparing the frequency of occurrence of the categories resulted in intra-class correlation coefficients (ICC), indicating high reliability for eight categories, good reliability for one category, and fair for two categories. One category was not observed. Spearman rank correlation coefficients (Rs) were high to very high for 24 subcategories and moderate for four. For 21 subcategories, Rs could not be calculated because they contained too few observations. The average point-to-point percentage agreement in time of the treatment sessions equalled 76.6 +/- 16.2%. Conclusions: The developed scoring list is a helpful and reliable tool to unravel and compare the content of individual physiotherapy and occupational therapy sessions for stroke patients in inpatient rehabilitation settings in various European countries. The results encourage further use of the list in future research and practice aiming to improve evidence-based stroke rehabilitation. Summary of dissemination activities: this result was written out in a scientific paper that is currently in review in the journal 'Clinical rehabilitation'. Furthermore, the results were presented at the international Stroke congress we organised in Leuven on the 10th and 11th February 2006. For details see:http://faber.kuleuven.be/onderzoek/dep3/neuro/cerise/index.htm The results were also presented on the 27th of April at a National congress on Rehabilitation in Interlaken (Switzerland), on the 18th of May at the European Congress of Physical and Rehabilitation Medicine in Madrid (Spain). The results were also presented and discussed in the participating centres in Leuven (Belgium) on the 21st of March, Zurzach (Switzerland) on the 26th April and Herzogenaurach (Germany) on the 27th April 2006. The results will also be presented in Nottingham (UK) at a later stage. More dissemination activities are planned in the coming months at international conferences. However, at this time, it is not possible to specify in detail because abstracts have to be submitted to the scientific committee, who then in turn has to accept the paper for presentation.
Objective: To explore the clinical and non-clinical factors on decision-making concerning admission to European stroke rehabilitation units (SRUs). Design: Observational study on case-mix at intake combined with questionnaires and semi-structured interviews with the medical consultants (MC) of each SRU. Patients/Settings Clinical data gathered on 532 first-ever stroke patients. MCs of six SRUs in four European countries (United Kingdom, Belgium, Germany and Switzerland) Methods: Standardised clinical assessments within two days after admission. Questionnaires to each MC followed by a qualitative round of semi-structured interviews. Results: Case-mix of stroke patients was significantly different between SRUs. Clinical criteria for admission were seldom explicit and were evaluated differently between the SRUs. In the British SRUs, diagnosis of stroke was the only criterion for admission to SRU. In the Belgian, German and Swiss SRUs, pre-morbid conditions were taken into account in admission decisions. The likelihood of discharge home was considered highly important in the Swiss SRU. Conclusion: Case-mix differences at intake could be linked to different appraisals of clinical and non-clinical factors of stroke patients. The findings urge to be more explicit about decision-making processes at admission to provide a more comprehensive insight into the interplay between context and process of care. Summary of dissemination activities: this result was written out in a scientific paper that has been accepted for publication by the 'Journal of Rehabilitation Medicine', in May 2006. Furthermore, the results were presented at the international Stroke congress we organised in Leuven on the 10th and 11th February 2006.For details see: http://faber.kuleuven.be/onderzoek/dep3/neuro/cerise/index.htm The results were also presented on the 27th of April at a National congresses on Rehabilitation in Interlaken (Switzerland), on the 18th of May at the European Congress of Physical and Rehabilitation Medicine in Madrid (Spain). The results were also presented and discussed in the participating centres in Leuven (Belgium) on the 21st of March, Zurzach (Switzerland) on the 26th April and Herzogenaurach (Germany) on the 27th April 2006. The results will also be presented in Nottingham (UK) at a later stage. More dissemination activities are planned in the coming months at international conferences. However, at this time, it is not possible to specify in detail because abstracts have to be submitted to the scientific committee, who then in turn has to accept the paper for presentation.