Factors associated with fatigue among people who have returned to work after stroke: an exploratory study.

OBJECTIVE: To explore the associations between fatigue impact and (a) personal and stroke-related characteristics, (b) functional impairments and (c) work-related factors among individuals who have returned to work after stroke. DESIGN: A cross-sectional exploratory study. SUBJECTS: 87 working stroke survivors. METHODS: This study comprises data from a postal survey targeting work ability and perceived stroke-related consequences 1 year after stroke. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Factors associated with having fatigue (FSS total score ≥ 4) were identified using univariable and multivariable logistic regression analyses. Three domain-specific multivariable models and 1 final combined model were created. RESULTS: Fatigue was reported by 43% of the participants. Several factors representing all the investigated domains were associated with fatigue. In the final combined regression model, self-perceived low cognitive functioning, low decision control at work and high quantitative job demands had the strongest independent effects on the odds of having fatigue. CONCLUSION: Among people who were working 1 year after stroke, fatigue was associated with both personal and stroke-related characteristics as well as functional impairments and work-related factors. This highlights the complex nature of post-stroke fatigue. Fatigue management interventions should have a comprehensive approach and also consider the work environment.

Perceptions of everyday life during lenient COVID-19 restrictions in Sweden- an interview study.

BACKGROUND: Both COVID-19 and its associated societal restrictions have affected individuals' health and everyday life. In Sweden, more lenient public health restrictions were implemented, with individuals asked to act responsibly in terms of reducing spread of disease. The majority of studies reporting on experiences of Covid-19 restrictions have been in the context of more substantial mandatory rules aimed at reducing social contact, therefore it is important to describe how more lenient restrictions have impacted individuals' well-being. This study aims to describe perceptions of everyday life during the first wave of the COVID-19 pandemic, perceived by individuals with no underlying medical condition, and living with more lenient public health restrictions in Sweden. METHOD: The participants were recruited from individuals who originally had participated in an online survey about life satisfaction, health, and physical activity. Fifteen individuals (median age 49, range 26-76 years, seven women) in various social situations, such as living alone/cohabiting, having children at home, geographical area and size of city were interviewed. Qualitative content analysis was applied to the data. RESULTS: An overall theme "Both hindrances and opportunities in important life domains were experienced within the same person during lenient Covid-19 restrictions" was derived and covered three categories: "New possibilities of flexibility in work and better health", "Life went on as usual with minor adjustments" and "Everyday life changed and became more difficult" together with eight subcategories. For most participants, both facilitating and hindering important domains in life were described. Unexpected findings were positive experiences regarding working from home, physical activities, leisure time activities and the balance between work and leisure time. In areas where only minor adjustments were made, life was perceived as going on as before. On the other hand, restrictions increased worries and were perceived to have negative effects on social participation. CONCLUSION: The impact of the pandemic and lenient restrictions in Sweden on the participants´ everyday life was multifaceted. Both hindrances and opportunities in important life domains were experienced within the same person. An increased flexibility in work- and leisure activities were perceived having positive effects for health and wellbeing and led to a better balance in life.

Experiences of SENSory Relearning of the UPPer Limb (SENSUPP) after Stroke and Perceived Effects: A Qualitative Study.

Recently, it was shown that sensory relearning of the upper limb (SENSUPP) is a promising intervention to improve sensorimotor function after stroke. There is limited knowledge, however, of how participants perceive the training. Here, we explored how persons with sensory impairments in the upper limb experienced the SENSUPP protocol (combined sensory- and motor training and home exercises for 5 weeks) and its effect. Fifteen persons (mean age 59 years; 10 men; >6 months post-stroke) were individually interviewed, and data were analyzed with qualitative content analysis. An overall theme 'Sensory relearning was meaningful and led to improved ability to perform daily hand activities' and two categories with six subcategories emerged. The outpatient training was perceived as meaningful, although the exercises were demanding and required concentration. Support from the therapist was helpful and training in small groups appreciated. The home training was challenging due to lack of support, time, and motivation. Small improvements in sensory function were perceived, whereas increased movement control and ability in performing daily hand activities were reported. In conclusion, the SENSUPP protocol is meaningful and beneficial in improving the functioning of the UL in chronic stroke. Improving compliance to the home training, regular follow-ups, and an exercise diary are recommended.

The effects of virtual reality training in stroke and Parkinson's disease rehabilitation: a systematic review and a perspective on usability.

BACKGROUND: Virtual Reality (VR) training is emerging in the neurorehabilitation field. Technological advancement is often faster than clinical implementation. Previous reviews stressed the study design and methodological weaknesses of research in the field of VR for neurorehabilitation. Clinically relevant conclusions on implementation in particular patient groups are needed. The aim was to update the existing knowledge with the recent evidence on the effects of VR training on functional ability of patients with stroke and Parkinson's Disease (PD). Secondary objective was to analyze the aspects of usability of VR intervention in these populations. METHODS: Systematic literature search (via PubMed, CENTRAL) was conducted from inception to February 29, 2020 to identify suitable articles for two population subcategories. Randomized controlled trials published from 2016 to 2020, investigating the effectiveness of VR on a variety of outcomes contributing to the functional independence were included. Critical Appraisal Skills Programme (CASP) checklist was used for a methodological quality assessment of the primary studies. Given the heterogeneity in types of VR intervention and outcomes, a descriptive synthesis was conducted. RESULTS: A total of 18 randomized controlled trials were included (10 in stroke subcategory, 8 in PD). CASP grading ranged 9-11, suggesting high methodological quality. All studies concluded that overall VR might be as effective as the conventional training, but more motivating. In some studies, VR was found to have a greater effect, taking the high response to treatment and satisfaction into account. CONCLUSIONS: VR training is suggested as an effective intervention to improve the functional ability in stroke and PD patients. Addition of VR into a rehabilitation program might facilitate patient's motivation, participation and improvement, as this method was generally well accepted, and the results of trials were promising. The consideration of disorder-specific aspects should take place during the decision-making of VR implementation.

Work conditions, support, and changing personal priorities are perceived important for return to work and for stay at work after stroke - a qualitative study.

PURPOSE: To explore work related and personal facilitators and barriers for return to work (RTW) and stay at work after stroke. MATERIALS AND METHODS: Twenty individuals post-stroke (median age 52 years; seven women) were interviewed in focus groups. Data were analyzed by using qualitative content analysis. RESULTS: An overall theme "Work conditions, support and changed personal priorities influenced RTW and stay at work after stroke" emerged and covered three categories: "Adjustments and flexibility at the work place facilitated RTW and a sustainable work situation", "Psychosocial support and knowledge about stroke consequences facilitated work and reduced stress", and "Changed view of work and other personal priorities". Physical adjustments at the work place and flexibility in the work schedule were perceived facilitators. Support from family and colleagues were important, whereas lack of knowledge of stroke disabilities at the work place was perceived a barrier. Also changed personal priorities in relation to the work and the current life situation influenced RTW in various ways. CONCLUSIONS: The individual's opportunities to influence the work situation is a key factor for RTW and the ability to stay at work after stroke. Adjustments, flexibility, support, knowledge of stroke, and receptivity to a changed view of work are important for a sustainable work situation.Implications for rehabilitationPhysical adjustments at the work place, a flexible work schedule and support increase the individual's possibility to RTW and maintain a sustainable work situation after stroke.Changed work and life priorities after a stroke need attention in the RTW process.Rehabilitation professionals have an important role in providing knowledge about the disabilities following stroke, and how they impact work ability. Individually tailored recommendations for work place adjustments which enable RTW and a sustainable work situation are warranted.

Perceived work situation and work ability among persons who are working one year after stroke.

OBJECTIVE: To explore how persons who have returned to work perceive their work situation and work ability one year after stroke. DESIGN: Cross-sectional design. SUBJECTS: A total of 88 persons of working age (mean age 52 (standard deviation; SD 8) years, 36% women), with mild to moderate disabilities following stroke, who had returned to work within one year after stroke participated in the study. METHODS: A survey including a questionnaire regarding psychological and social factors at work (QPS Nordic) and 4 questions from the Work Ability Index (WAI) was posted to the participants. RESULTS: According to the QPS Nordic survey, 69-94% of respondents perceived their work duties as well defined, and were content with their work performance. Most participants had good social support at work and at home. Between 51% and 64% of respondents reported that they seldom felt stressed at work, seldom had to work overtime, or that work demands seldom interfered with family life. According to the WAI ≥75% of respondents perceived their work ability as sufficient, and they were rather sure that they would still be working 2 years ahead. CONCLUSION: Persons who have returned to work within one year after stroke appear to be content with their work situation and work ability. Appreciation at work, well-defined and meaningful work duties and support seem to be important for a sustainable work situation.

Fatigue in men and women who have returned to work after stroke: Assessed with the Fatigue Severity Scale and Mental Fatigue Scale.

OBJECTIVE: To assess the occurrence of self-reported fatigue among men and women who have returned to work after stroke, and the association between 2 fatigue rating scales. DESIGN: A cross-sectional study. SUBJECTS: A total of 91 adults (58 men/33 women, mean age 53 years) with mild to moderate disability. METHODS: Questionnaires were posted to participants approximately one year after stroke. Fatigue was assessed with the Fatigue Severity Scale (FSS) and the Mental Fatigue Scale (MFS). RESULTS: In total, 58% of the women and 33% of the men reported fatigue on the FSS (total score ≥ 4), and 46% of the women and 28% of the men reported mental fatigue on the MFS (total score ≥ 10.5). Being easily fatigued, decreased motivation, mental fatigability and sensitivity to stress were the most reported problems. FSS and MFS were moderately associated (rho 0.517-0.732). CONCLUSION: Fatigue is common among persons who have returned to work after stroke, and interferes with daily life. The long-term consequences of fatigue should be addressed after stroke, especially in women. The FSS and the MFS can be used in combination, as they provide information on different aspects of fatigue.

Self-Perceived Life Satisfaction during the First Wave of the COVID-19 Pandemic in Sweden: A Cross-Sectional Study.

Currently, there is limited knowledge on how the Swedish strategy with more lenient public health restrictions during the COVID-19 pandemic has influenced people's life satisfaction. Here, we investigated self-reported life satisfaction during the first wave of the pandemic in Sweden, and perceived changes in life satisfaction in relation to various sociodemographic factors. A total of 1082 people (mean age 48 (SD 12.2); 82% women) responded to an online survey during autumn 2020 including the "Life Satisfaction Questionnaire-11". A majority (69%) were satisfied with life as a whole, and with other important life domains, with the exception of contact with friends and sexual life. An equal share reported that life as a whole had either deteriorated (28%) or improved (29%). Of those that perceived a deterioration, 95% considered it to be due to the pandemic. Regarding deteriorated satisfaction with life as a whole, higher odds were found in the following groups: having no children living at home; being middle aged; having other sources of income than being employed; and having a chronic disease. The Swedish strategy might have contributed to the high proportion of satisfied people. Those who perceived a deterioration in life satisfaction may, however, need attention from Swedish Welfare Authorities.

Falls After Stroke: A Follow-up after Ten Years in Lund Stroke Register.

OBJECTIVES: To evaluate incidence of self-reported falls and associated factors in a ten-year perspective after stroke. METHODS: From a population-based cohort of first-ever stroke patients (n = 416) included in the Lund Stroke Register between March 1, 2001, and February 28, 2002, we performed a follow up of all 145 survivors ten years after stroke. We collected data on age, gender, main stroke type, living and housing situation, general health status (question 1 in the Short Form Health Survey (SF-36), dizziness, physical activity, Barthel Index, mobility aids, moving ability inside/outside, and health-related quality of life as defined by the EuroQol 3 dimension scale (EQ-5D-3L). Factors that may relate to falls were compared between those who had experienced falls after stroke or not. RESULTS: Ten years after stroke, 49 patients (34 %) reported falls and 96 patients (66 %) reported no falls. Compared to patients with no falls, those who reported falls were older (median age 83.3 years vs 75.6 years; p < 0.001), more often lived alone, were more dependent in daily living, had less physical activity, poorer general health status, more often needed mobility aids, were more often unable to move alone outside, and had poorer health-related quality of life in all items in EQ-5D-3L except pain/discomfort. CONCLUSIONS: Falls had occurred in approximately one third of the participants ten years after the stroke, and were strongly associated with several measures of frailty. Our results indicate that fall prevention should in particular focus on those at high risk of falls.

Need for structured healthcare organization and support for return to work after stroke in Sweden: Experiences of stroke survivors.

OBJECTIVE: To explore stroke survivors' experiences of healthcare-related facilitators and barriers concerning return to work after stroke. DESIGN: A qualitative study. SETTING: Outpatient stroke rehabilitation unit at a University Hospital in southern Sweden. PARTICIPANTS: A convenient sample of 20 persons admitted to Skåne University Hospital for acute stroke care (median age 52 years), in employment of at least 10 h per week at stroke onset and having been referred to stroke rehabilitation within 180 days. METHODS: The interviews were performed by focus groups, and the data were analysed by content analysis. RESULTS: Facilitating factors were a tailored rehabilitation content with relevant treatments, adequate timing and a structured stepwise return-to-work process. A lack of sufficient early healthcare information, rehabilitation planning and coordination were perceived as barriers. An early rehabilitation plan, a contact person, and improved communication between rehabilitation actors were requested, as well as help with work transport, home care, children and psychosocial support for families. CONCLUSION: Tailored rehabilitation content and a structured stepwise return-to-work process facilitated return to work. Insufficient structure within the healthcare system and lack of support in daily life were perceived barriers to return to work, and need to be improved. These aspects should be considered in the return-to-work process after stroke.

Pain management strategies among persons with long-term shoulder pain after stroke - a qualitative study.

OBJECTIVE:: To explore strategies that persons with persistent shoulder pain after stroke use to manage their pain in daily life. DESIGN:: A qualitative study using semi-structured face-to-face interviews, analysed by content analysis. SETTING:: A university hospital. SUBJECTS:: Thirteen community-dwelling persons (six women; median age: 65 years; range 57-77) with shoulder pain after stroke were interviewed median two years after the pain onset. RESULTS:: An overall theme 'Managing shoulder pain by adopting various practical and cognitive strategies' emerged from the analysis. Three categories were identified: (1) practical modifications to solve daily life problems; (2) changed movement patterns and specific actions to mitigate the pain, by non-painful movements, avoidance of pain-provoking activities and various pain distracting activities and (3) learned how to deal with the pain mentally. Several strategies were used simultaneously and they were experienced successful to various degrees. CONCLUSION:: The findings in the present study indicate that persons with persistent shoulder pain after stroke use both practical and cognitive strategies to manage their pain.

Shoulder pain after stroke - experiences, consequences in daily life and effects of interventions: a qualitative study.

PURPOSE: To describe experiences of shoulder pain after stroke, how pain affects daily life and perceived effects of interventions. METHOD: A qualitative interview study including 13 community-dwelling persons (six women; median age 65 years) with persistent shoulder pain after stroke. RESULTS: Three categories emerged from the content analysis. In "Multiple pain characteristics" an insidious pain onset was reported. The pain existed both day and night and could be located around the shoulder girdle but also have radiation to the arm and hand. An explanation of the pain was seldom given. In "Limitations caused by the pain" it was described how the pain negatively influenced personal care, household activities and leisure, but also could lead to emotional reactions. In "Multiple pain interventions with various effects" a variety of interventions were described. Self-management interventions with gentle movements were perceived most effective. A restraint attitude to pain medication due to side effects was reported. CONCLUSIONS: Shoulder pain after stroke can lead to a variety of pain characteristics. As the pain is complex and may affect many important areas in a person's life, multidisciplinary rehabilitation interventions are important. Implications for rehabilitation Shoulder pain after stroke can lead to a variety of pain characteristics with radiation to the arm and hand Shoulder pain often influence personal care, household activities and leisure negatively, which may lead to emotional reactions Self-management interventions with gentle movements are perceived most effective As the shoulder pain after stroke is complex, interventions by a multidisciplinary team may be needed.

Measurement variability of quantitative sensory testing in persons with post-stroke shoulder pain.

OBJECTIVE: To evaluate the measurement variability of quantitative sensory testing (QST) in persons with post-stroke shoulder pain. DESIGN: A test-retest design. PARTICIPANTS: Twenty-three persons with post-stroke shoulder pain (median age 65 years). METHODS: Thermal detection thresholds (cold and warm), pain thresholds (cold and heat) and mechanical pain thresholds (pressure and pin prick) were assessed twice in both arms, 2-3 weeks apart. Measurement variability was analysed with the intraclass correlation coefficient (ICC2.1), the change in mean (d) with 95% confidence interval (logarithmic scales), and the relative standard error of measurement (SEM%; re-transformed scales). RESULTS: The ICCs for thermal thresholds ranged from 0.48 to 0.89 in the affected (painful) arm and from 0.50 to 0.63 in the unaffected arm, and for mechanical pain thresholds from 0.66 to 0.90 in both arms. No systematic changes in the mean (d) were found. The SEM% ranged from 4% to 10% for thermal detection and heat pain thresholds, and from 17% to 42% for cold pain and mechanical pain thresholds in both arms. CONCLUSION: QST measurements, especially cold pain thresholds and mechanical pain thresholds, vary in persons with post-stroke shoulder pain. Before QST can be used routinely to evaluate post-stroke shoulder pain, a test protocol with decreased variability needs to be developed.

Poststroke shoulder pain and its association with upper extremity sensorimotor function, daily hand activities, perceived participation, and life satisfaction.

OBJECTIVE: To assess the differences in upper extremity sensorimotor function, daily hand activities, and perceived participation and life satisfaction between individuals with and without poststroke shoulder pain (PSSP), and to determine how PSSP is associated with these variables. DESIGN: A cross-sectional study of a convenience sample. PARTICIPANTS: Forty-nine community-dwelling individuals (mean ± standard deviation [SD] age, 64 ± 9 years), 24 with PSSP and 25 without (non-PSSP) were assessed, in mean ± SD 15 ± 8 months after stroke. METHODS: Upper extremity sensorimotor function was assessed, and daily hand activities, perceived participation, and life satisfaction were reported. Demographics were described, and shoulder pain characteristics were recorded in the PSSP group. Between-group differences and regression analyses were conducted. RESULTS: The PSSP group had significantly decreased passive shoulder abduction (P = .001) and upper extremity motor function (P = .03) in comparison with the non-PSSP group, but there were no significant differences between the groups in daily hand activities, perceived participation, or life satisfaction. In the multivariate analyses, PSSP (odds ratio [OR] 4.42 [95% confidence interval (CI), 1.21-16.24]; P = .03) and proprioception (OR 10.28 [95% CI, 1.1-96.01]; P = .04) were associated with upper extremity motor function, whereas perceived participation was associated with life satisfaction (OR 1.08 [95% CI, 1.03-1.13]; P = .002). Passive shoulder abduction, resistance to passive movements, and proprioception explained 45% of variance of daily hand activities, whereas daily hand activities, vocational situation, and gender explained 40% of variance of perceived participation. CONCLUSIONS: This cross-sectional study indicated that there is an association between PSSP and upper extremity motor function, whereas the association between PSSP, daily hand activities, perceived participation, and life satisfaction is less clear. PSSP is commonly described as a severely disabling condition, but our results imply that, in individuals with mild-to-moderate upper extremity paresis, it may not have a great impact on their life situation.

Somatosensory impairments are common after stroke but have only a small impact on post-stroke shoulder pain.

OBJECTIVE: To investigate whether somatosensory impairments are more common in individuals with post-stroke shoulder pain than in those without post-stroke shoulder pain and healthy controls. DESIGN: Descriptive analysis of a convenience sample. PARTICIPANTS: Forty-nine individuals with stroke, 24 with and 25 without post-stroke shoulder pain (median age 65 years), and 11 age- and sex-matched healthy controls. METHODS: Perception and pain thresholds for cold, warm and heat (thermal thresholds), and pain thresholds for pressure and pin prick (mechanical thresholds) were assessed using quantitative sensory testing (QST). Passive range of motion, motor function, resistance to passive movements, light touch and proprioception were assessed in the upper extremities. Shoulder pain characteristics were recorded in the post-stroke shoulder pain group. RESULTS: There were no significant differences between the group with post-stroke shoulder pain and the group without post-stroke shoulder pain in any of the QST assessments, but more participants in the post-stroke shoulder pain group reported abnormal cold sensation in the affected side. Both stroke groups had generally higher thermal thresholds and more extreme low or high mechanical thresholds than the healthy controls. CONCLUSION: Somatosensory impairments are common among individuals with stroke compared with healthy controls. The non-significant differences in QST thresholds between the group with post-stroke shoulder pain and the group without post-stroke shoulder pain indicate that somatosensory impairments have only a small impact on post-stroke shoulder pain.

Test-retest reliability of the ABILHAND questionnaire in persons with chronic stroke.

BACKGROUND: Reliable and valid outcome measures are needed to be able to evaluate recovery, effects of rehabilitation interventions, and changes over time. The ABILHAND Questionnaire is a measure of a patient's self-reported ability to perform complex daily activities involving use of the hand. This instrument is commonly used in stroke rehabilitation settings, but data about the measurement variability are missing. OBJECTIVE: To assess the test-retest reliability of the ABILHAND Questionnaire in persons with chronic stroke and to define limits for the smallest change that indicates a real change, both for a group of individuals and for a single individual. DESIGN: A test-retest reliability study. SETTINGS: University hospital. PARTICIPANTS: A convenience sample of 43 persons (11 women and 32 men; mean age 64 years) with mild to moderate impairments of hand function 6-48 months after sustaining a stroke. INTERVENTION: Not applicable. MAIN OUTCOME MEASUREMENTS: The ABILHAND Questionnaire is Rasch analyzed, enabling ordinal data to be converted into an interval scale (logits) and the use of parametric statistical analyses. The participants responded to 23 items in the ABILHAND Questionnaire on 2 occasions, 2 weeks apart. Reliability was assessed with the intraclass correlation coefficient (ICC22.1), the mean difference between the test sessions (d) together with the 95% confidence intervals for d, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%), and a Bland and Altman graph. RESULTS: Four outliers with high mean logit scores (>4.0) were identified in the sample. The results therefore are presented both for the entire sample (n = 43) and without the 4 outliers (n = 39). The test-retest agreement was high: ICC2,1 = 0.85 (n = 43) and 0.91 (n = 39). The SEM%, which represents the smallest change that indicates a real improvement for a group of individuals, was 21% (n = 43) and 15% (n = 39). The SRD%, which represents the smallest change that indicates a real clinical improvement for a single individual, was 59% (n = 43) and 42% (n = 39), respectively. CONCLUSION: The ABILHAND Questionnaire is reliable in persons with chronic stroke and can be recommended to evaluate recovery, rehabilitation interventions, and changes over time in a group of individuals but is less suitable for a single individual.

Left-sided hemiparesis, pain frequency, and decreased passive shoulder range of abduction are predictors of long-lasting poststroke shoulder pain.

OBJECTIVE: To determine the proportion of persons with poststroke shoulder pain 4 months after onset of the stroke in whom long-lasting shoulder pain develops and to assess the extent to which age, side of paresis at stroke onset, pain frequency and pain intensity, passive shoulder range of motion, resistance to passive movements, motor function, and subluxation at 4 months after stroke predict shoulder pain 1 year later. DESIGN: A prospective study. SETTING: A university hospital outpatient clinical setting. PARTICIPANTS: Fifty-eight men and women with their first-ever stroke (mean age, 71 years) and affected sensory-motor function in the upper extremity at stroke onset who all reported shoulder pain in the affected side 4 months after onset of the stroke. METHODS: At 4 and 16 months after having a stroke, the participants rated their self-perceived shoulder pain (frequency and intensity). Passive range of shoulder abduction and external rotation, resistance to passive movements in the elbow, and motor function in the shoulder were assessed by a physical therapist. MAIN OUTCOME MEASUREMENTS: A question about pain frequency (constant, often, or occasional), the Visual Analogue Scale for Pain for self-perceived shoulder pain intensity, a goniometer for range of motion, the Modified Ashworth Scale for resistance to passive movements, and the Motor Assessment Scale for motor function. RESULTS: Of the 58 participants who had shoulder pain 4 months after having a stroke, 42 (72%) still had pain at 16 months. The logistic regression indicated an association between shoulder pain at 16 months and left-sided hemiparesis at stroke onset (P = .01; odds ratio [OR] 10.47; 95% confidence interval [CI] 1.92-57.05), pain frequency (P = .02; OR 6.85; 95% CI 1.46-32.14), decreased passive abduction at 4 months (P = .05; OR 4.46; 95% CI 0.99-20.10), and age (P = .07; OR 1.05; 95% CI 1.0-1.12). CONCLUSIONS: A high proportion of persons with shoulder pain 4 months after having a stroke are at risk of having persistent shoulder pain 1 year later. Left-sided hemiparesis, pain reported frequently, and decreased passive shoulder range of abduction at 4 months are predictors of long-lasting poststroke shoulder pain and require increased attention in the rehabilitation setting.

Weight loss after stroke: a population-based study from the Lund Stroke Register.

BACKGROUND AND PURPOSE: Data on the prevalence and indicators of weight loss in population-based groups of stroke survivors are scarce. We aimed to find the predictors and indicators of weight loss >3 kg as a possible marker of malnutrition after stroke. METHODS: We registered weight at baseline, after 4 months, and 1 year later in 305 survivors from a population-based cohort of first-ever stroke patients. Characteristics of the patients were registered at baseline and follow-ups, including glycosylated hemoglobin at baseline and follow-up II, eating difficulties at both follow-ups, and screening for depression at follow-up II. We used univariate and multivariate analyses to find baseline predictors and follow-up indicators related to weight loss >3 kg from baseline. RESULTS: Among the 305 patients, 60% were male, the mean age was 72.5 years, and mean body mass index was 25.8 kg/m(2). The main stroke types were cerebral infarction (89%), intracerebral hemorrhage (7%), and subarachnoid hemorrhage (4%). Weight loss >3 kg was found in 74 (24%) patients (mean, -6.6 kg) after 4 months and in 79 patients (26%; mean, -8.3 kg) 1 year later. Severe stroke and elevated glycosylated hemoglobin levels were baseline predictors of weight loss >3 kg. Indicators associated with short-term weight loss (at follow-up I) were eating difficulties, low prealbumin value, and dependence (Barthel Index), whereas indicators associated with long-term weight loss (follow-up II) were eating difficulties, hemorrhagic stroke, and low prealbumin value. CONCLUSIONS: Weight loss >3 kg after stroke indicates the need for closer observation regarding nutritional status. Monitoring of body weight may be useful, particularly among patients with severe stroke, eating difficulties, low prealbumin values, and impaired glucose metabolism.

Shoulder pain after stroke: a prospective population-based study.

BACKGROUND AND PURPOSE: Shoulder pain is a well-known complication after stroke, but data on prevalence, predictors, and outcome in unselected stroke populations are limited. METHODS: During a 1-year period, 416 first-ever stroke patients were included in the population-based Lund Stroke Register. After 4 months, 327 patients were followed up and 1 year later, the surviving 305 patients were followed up again. General status (National Institutes of Health Stroke Scale score) was registered at stroke onset. Shoulder pain intensity (visual analog scale, score 0 to 30=no-mild and 40 to 100=moderate-severe pain); arm motor function; restricted dressing and/or ambulating; and functional status (Barthel Index) were registered at both follow ups. RESULTS: Shoulder pain onset within 4 months after stroke was reported by 71 patients (22%). Among the 61 patients able to score the visual analog scale, 79% had moderate-severe pain. One year later, 8 of these 71 patients had died, 17 had no remaining pain, and 28 additional patients had developed shoulder pain since the first follow up. Lost or impaired arm motor function and high National Institutes of Health Stroke Scale score were predictors of shoulder pain. Shoulder pain restricted daily life often or constantly when dressing for 51%/31% and when ambulating for 29%/13% of the patients at 4 and 16 months, respectively. CONCLUSIONS: Almost one third of the 327 patients developed shoulder pain after stroke onset, a majority with moderate- severe pain. Shoulder pain restricts patients' daily life after stroke. The increased risk of shoulder pain for patients with impaired arm motor function and/or low general status needs close attention in poststroke care.

Outpatient vs. comprehensive first-episode psychosis services, a 5-year follow-up of Soteria Nacka.

Three years experience of an outpatient unit for first-episode psychosis showed that most of the patients at some point became hospitalized in a psychiatric ward with discontinuity in care as a consequence. Adding "need-adapted" inpatient care in the form of a small and calm crisis home guaranteed continuity in approach and treatment, as the same caregivers staffed the inpatient and outpatient parts of Soteria. Information on early signs of psychosis was given to other units of the psychiatric clinic and to general practitioners. As the organization was considerably changed from that point of time, the patients could be divided into two separate groups. The aim of the present study was to follow the patients in the two groups for 5 years, comparing the outcome. The results showed that easily accessible need-adapted treatment with integrated overnight care might be advantageous for first-episode psychotic patients. The duration of untreated psychosis was shorter and the outcome better.