Exploring the impact of information and communication technologies on loneliness and social isolation in community-dwelling older adults: a scoping review of reviews.

BACKGROUND: Recognizing the escalating public health concerns of loneliness and social isolation in aging populations, this study seeks to comprehensively explore the potential of information and communication technology (ICT)-based interventions to address these issues among older adults. This scoping review of reviews aims to map and synthesize existing evidence on the effectiveness and scope of ICT interventions targeting loneliness and social isolation in community-dwelling older adults, elucidating types of technology, impacts, facilitators, barriers, and research gaps. METHODS: Following the Joanna Briggs Institute framework, we systematically searched eight diverse databases identifying relevant published reviews. We included English-written, peer-reviewed reviews of all types, with no limits regarding time of publication about ICTs targeting loneliness and/or social isolation for community-dwelling older adults. Eligible reviews were analysed and summarized, offering a holistic narrative of the reported types of ICTs and their impact, the identified facilitators and barriers influencing the implementation and adoption of ICT interventions, and the research gaps identified in the literature. RESULTS: The review included 39 publications published between 2012 and 2024, spanning systematic, scoping, and reviews of reviews. Various ICTs were reported, primarily social media virtual communities, followed by video-mediated friendly visits, conversational agents, social robots, exergames and online gameplay. Predominantly positive impacts on mitigating social isolation and loneliness were evident for these ICTs, although methodological diversity and contradictory findings complicated definite conclusions. Facilitators and barriers encompassed individual competencies, access and usage, and intervention design and implementation. Research gaps involved targeting specific subgroups, exploring innovative technologies, incorporating diverse study designs, improving research methodologies, and addressing usability and accessibility. Future research should focus on identifying elderly individuals who can benefit the most from ICT use, exploring novel technologies, using a wider range of study designs, and enhancing usability and accessibility considerations. CONCLUSIONS: This review sheds light on the diverse range of ICTs, their impact, and the facilitators and barriers associated with their use. Future investigations should prioritize refining outcome measures, addressing gender differences, and enhancing the usability and accessibility of interventions. The involvement of older adults in the design process and the exploration of technological training interventions hold promise in overcoming barriers.

Physical Performance and Cognition as Predictors of Instrumental Activities of Daily Living After Stroke: A Prospective Multicenter Cohort Study.

OBJECTIVE: To investigate whether cognition and physical performance, both separately and combined, 3 months post stroke predict change in instrumental activities of daily living (IADL) up to 18 months and whether different paths of IADL could be identified by different scenarios, defined by combinations of high and low scores on physical performance and cognition. DESIGN: The study is part of the Norwegian Cognitive Impairment After Stroke study, a prospective multicenter cohort study including patients with acute stroke. SETTING: Stroke outpatient clinics at 3 university hospitals and 2 local hospitals. PARTICIPANTS: Adult survivors of stroke (N=544) were followed up at 3 and 18 months after stroke. Participants' mean ± SD age was 72.6±11.8 years, and 235 (43.2 %) were female. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary outcome was IADL as measured by Nottingham Extended Activities of Daily Living. At 3 months, Short Physical Performance Battery (SPPB) and Montreal Cognitive Assessment (MoCA) were used to assess physical performance and cognition, respectively. RESULTS: Mixed-effects linear regression analyses showed that the regression coefficient (95% CI) for the interaction with time was significant for MoCA, 0.238 (CI, 0.030-0.445; P=.025) but not for SPPB. The model combining SPPB and MoCA was significantly better than separate models (likelihood ratio P<.001). Overall, there was no improvement in IADL over time. A combination of SPPB and MoCA score in the upper quartile at 3 months was associated with improved IADL of 1.396 (CI, 0.252-2.540; P=.017) over time. CONCLUSIONS: Combining measures of cognition and physical performance gave the best prediction of change in IADL. Function at 3 months seems to be predictive for long-term IADL status, which highlights the importance of targeted rehabilitation in the early and subacute phases after stroke.

Patient characteristics and outcome in three different working models of home-based rehabilitation: a longitudinal observational study in primary health care in Norway.

BACKGROUND: The organisation of health care services for older adults varies within and between countries. In Norway, primary care physiotherapy services offer home-based rehabilitation to older adults. The aim of this study was to compare patients' characteristics and treatment outcomes in three working models of home-based rehabilitation. METHODS: Patients referred to home-based rehabilitation in a large municipality in Norway were invited to participate in this prospective observational study. The three working models, early intervention, reablement and regular physiotherapy, were organised according to the patients' function and degree of independence. The older adults (≥ 65 years) were allocated to the different models by either a multidisciplinary group of health care personnel or by direct referral. Patients' demographic and clinical characteristics, including physical function (Patient-specific functional scale, PSFS), physical performance (Short Physical Performance Battery, SPPB) and health-related quality of life (EQ-5D) were registered at baseline and follow-up (maximum 6 months after baseline). One-way ANOVA was used to analyse group differences in clinical characteristics and paired t-tests to analyse changes from baseline to follow-up. RESULTS: In total, 603 and 402 patients (median (interquartile range) age: 84 (77-88) years) completed baseline and follow-up assessments, respectively. Patients in all three working models had an increased risk for functional decline. Patients receiving early intervention (n = 62) had significantly (p < 0.001) better physical performance and health-related quality of life (SPPB mean 7.9, SD 2.7; EQ-5D:mean 0.59, SD 0.19), than patients receiving reablement (n = 132) (SPPB: mean 5.5, SD 2.6; EQ-5D: mean 0.50, SD 0.15) and regular physiotherapy (n = 409) (SPPB: mean 5.6, SD 2.8; EQ-5D: mean 0.41, SD 0.22). At follow-up, the three working models showed significantly improvements in physical function (PSFS: mean change (95 % CI): 2.5 (1.9 to 3.2); 1.8 (0.5 to 3.1); 1.7 (0.8 to 2.6), for regular physiotherapy, reablement, and early intervention, respectively). Patients receiving regular physiotherapy and reablement also significantly improved physical performance and health-related quality of life. CONCLUSIONS: While older adults receiving reablement and regular physiotherapy showed similar patient characteristics and treatment outcomes, early intervention identified older patients at risk of functional decline at an earlier stage. These results are relevant for policy makers when designing and improving prevention and rehabilitation strategies in primary health care.

Factors contributing to post-stroke health care utilization and costs, secondary results from the life after stroke (LAST) study.

BACKGROUND: The result from the Life After Stroke (LAST) study showed that an 18-month follow up program as part of the primary health care, did not improve maintenance of motor function for stroke survivors. In this study we evaluated whether the follow-up program could lead to a reduction in the use of health care compared to standard care. Furthermore, we analyse to what extent differences in health care costs for stroke patients could be explained by individual need factors (such as physical disability, cognitive impairment, age, gender and marital status), and we tested whether a generic health related quality of life (HRQoL) is able to predict the utilisation of health care services for patients post-stroke as well as more disease specific indexes. METHODS: The Last study was a multicentre, pragmatic, single-blinded, randomized controlled trial. Adults (age ≥ 18 years) with first-ever or recurrent stroke, community dwelling, with modified Rankin Scale < 5. The study included 380 persons recruited 10 to 16 weeks post-stroke, randomly assigned to individualized coaching for 18 months (n = 186) or standard care (n = 194). Individual need was measured by the Motor assessment scale (MAS), Barthel Index, Hospital Anxiety and Depression Scale (HADS), modified Rankin Scale (mRS) and Gait speed. HRQoL was measured by EQ-5D-5 L. Health care costs were estimated for each person based on individual information of health care use. Multivariate regression analysis was used to analyse cost differences between the groups and the relationship between individual costs and determinants of health care utilisation. RESULTS: There were higher total costs in the intervention group. MAS, Gait speed, HADS and mRS were significant identifiers of costs post-stroke, as was EQ-5D-5 L. CONCLUSION: Long term, regular individualized coaching did not reduce health care costs compared to standard care. We found that MAS, Gait speed, HADS and mRS were significant predictors for future health care use. The generic EQ-5D-5 L performed equally well as the more detailed battery of outcome measures, suggesting that HRQoL measures may be a simple and efficient way of identifying patients in need of health care after stroke and targeting groups for interventions. TRIAL REGISTRATION: https://www.clinicaltrials.govNCT01467206. The trial was retrospectively registered after the first 6 participants were included.

Associations Between Adherence to the Physical Activity and Exercise Program Applied in the LAST Study and Functional Recovery After Stroke.

OBJECTIVE: To investigate the associations between participants' adherence to a physical activity and exercise program after stroke and functional recovery 18 months after inclusion. DESIGN: Secondary analyses of the intervention arm in the multisite randomized controlled trial Life After Stroke (LAST). SETTING: Primary health care services in 3 Norwegian municipalities. PARTICIPANTS: Of the participants enrolled (N=380), 186 (48.9%) were randomized to the intervention. The study sample comprised community dwelling individuals included 3 months after stroke, with mean age of 71.7 ± 11.9 years and 82 (44.1%) women. According to the National Institutes of Health Stroke Scale, 97.3% were diagnosed as having mild (National Institutes of Health Stroke Scale<8) and 2.7% with moderate (8-16 on the National Institutes of Health Stroke Scale) stroke. INTERVENTION: Monthly coaching by physiotherapists encouraging participants to adhere to 30 minutes of daily physical activity and 45-60 minutes of weekly exercise. MAIN OUTCOME MEASURES: The primary outcome was Motor Assessment Scale (MAS). Secondary outcome measures were 6-minute walk test, Timed Up and Go (TUG), Berg Balance Scale (BBS), and the physical domains of the Stroke Impact Scale (SIS). Adherence was assessed by combining participants' training diaries and physiotherapists' reports. RESULTS: The relationship between adherence and functional recovery was analyzed with simple and multiple linear regression models. Adjusted for age, sex, dependency, and cognition, results showed statistically significant associations between adherence and functional outcomes after 18 months, as measured by MAS, TUG, BBS, and SIS (P≤.026). CONCLUSIONS: Increased adherence to physical activity and exercise was associated with improved functional recovery after mild to moderate stroke. This emphasizes the importance of developing adherence-enhancing interventions. Dose-response studies are recommended for future research.

A physical activity program is no more effective than standard care at maintaining upper limb activity in community-dwelling people with stroke: secondary outcomes from a randomized trial.

OBJECTIVE: To evaluate whether an 18-month, physical activity coaching program is more effective than standard care in terms of upper-limb activity. DESIGN: A prospective, randomized controlled trial. SETTING: Three municipalities in Norway. POPULATION: A total of 380 persons with stroke. INTERVENTION: The intervention group received follow-up visits and coaching on physical activity and exercise each month for 18 months after inclusion, by a physiotherapist. The control group received standard care. MAIN MEASURES: The primary outcome, in this secondary analysis, was Motor Assessment Scale items 6, 7, and 8. Secondary outcomes were National Institute of Health Stroke Scale item 5, the Stroke Impact Scale domain 7, and the Modified Ashworth Scale in flexion/extension of the elbow. RESULTS: In total, 380 persons with stroke were recruited, with mean (SD) age 72 (11) years, and baseline scores total National Institute of Health Stroke Scale was 1.4 (2.2)/1.6 (2.4) and Motor Assessment Scale items 6, 7 and 8 in the intervention/control group was 5.5 (1.2)/5.5 (1.2), 5.4 (1.4)/5.4 (1.3), and 3.6 (2)/3.5 (2), respectively. There was no significant difference between groups in terms of upper limb function in any of the Motor Assessment Scale items. In this population with minor stroke, upper-limb activity was good at three months post-stroke (74% of the maximum) and remained good 18 months later (77% of maximum). CONCLUSION: After intervention, there was no difference between the groups in terms of upper-limb activity.

Efficacy and Safety of Individualized Coaching After Stroke: the LAST Study (Life After Stroke): A Pragmatic Randomized Controlled Trial.

BACKGROUND AND PURPOSE: The evidence for interventions to prevent functional decline in the long term after stroke is lacking. The aim of this trial was to evaluate the efficacy and safety of an 18-month follow-up program of individualized regular coaching on physical activity and exercise. METHODS: This was a multicentre, pragmatic, single-blinded, randomized controlled trial. Adults (age ≥18 years) with first-ever or recurrent stroke, community dwelling, with modified Rankin Scale <5, and no serious comorbidities were included 10 to 16 weeks poststroke. The intervention group received individualized regular coaching on physical activity and exercise every month for 18 consecutive months. The control group received standard care. Primary outcome was the Motor Assessment Scale at end of intervention (18-month follow-up). Secondary measures were Barthel index, modified Rankin Scale, item 14 from Berg Balance Scale, Timed Up and Go test, gait speed, 6-minute walk test, and Stroke Impact Scale. Other outcomes were adverse events and compliance to the intervention assessed by training diaries and the International Physical Activity Questionnaire. RESULTS: Three hundred and eighty consenting participants were randomly assigned to individualized coaching (n=186) or standard care (n=194). The mean estimated difference on Motor Assessment Scale in favor of control group was -0.70 points (95% confidence interval, -2.80, 1.39), P=0.512. There were no differences between the groups on Barthel index, modified Rankin Scale, or Berg Balance Scale. The frequency of adverse events was low in both groups. Results from International Physical Activity Questionnaire and training diaries showed increased activity levels but low intensity of the exercise in the intervention group. CONCLUSIONS: The regular individualized coaching did not improve maintenance of motor function or the secondary outcomes compared with standard care. The intervention should be regarded as safe. Despite the neutral results, the health costs related to the intervention should be investigated. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01467206.

Characteristics and Range of Reviews About Technologies for Aging in Place: Scoping Review of Reviews.

BACKGROUND: It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place. OBJECTIVE: This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest. METHODS: The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms "older people" and "technology for ageing in place," with alternate terms using Boolean operators and truncation, adapted to the rules for each database. RESULTS: A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps. CONCLUSIONS: Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low- and middle-income countries, especially in Africa.

Physical Activity Behavior and Its Association With Global Cognitive Function Three Months After Stroke: The Nor-COAST Study†.

OBJECTIVE: The purposes of this study were to determine the association between physical activity (PA) behavior and global cognitive function 3 months after stroke and to explore the role of physical capacity as a mediating factor. METHODS: Participants with stroke were successively recruited at 5 different hospitals in Norway. PA was measured using accelerometers, with a follow-up period of 7 consecutive days, and global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). The general pattern of PA and the percentage of participants adhering to World Health Organization PA recommendations (at least 150 minutes of moderate-intensity aerobic PA per week) were investigated using descriptive statistics. Multiple regression and mediator analyses were used to examine the relationship between PA behavior and MoCA scores; physical capacity, measured with the Short Physical Performance Battery, served as the mediating variable. RESULTS: A total of 193 women (42.6%) and 260 men (57.4%) with a median age of 73.7 years (25th and 75th percentiles = 65.8 and 80.4, respectively) and a median MoCA score of 25 points (25th and 75th percentiles = 22 and 27, respectively) were included. Mean total time spent walking at moderate intensity was 251.7 (SD = 164.6) min/wk (mean bout length = 20.9 [SD = 7.3] seconds), which indicated 69.3% adherence to World Health Organization guidelines. With each point decrease in the MoCA score, there was an expected 8.6% increase in the odds of nonadherence to PA recommendations. Physical capacity was identified as an important mediating factor, explaining the strength of the association between cognition and PA behavior. CONCLUSIONS: In contrast to previous research, in the present study, most participants adhered to the updated global PA guidelines. However, people who had survived stroke and had reduced cognitive function were at higher risk of inactivity, an association mediated by physical capacity. IMPACT: A better understanding of the association between cognition and PA behavior after stroke might help for developing more targeted early-onset interventions.

Can functional walk tests add value to the prediction of cardiorespiratory fitness after stroke? A prospective cohort study.

BACKGROUND: Cardiorespiratory fitness is often impaired following stroke, and peak oxygen consumption (VO2peak) is an important prognostic value of all-cause mortality. The primary objective was to investigate whether functional walk tests assessed in the subacute phase after stroke added value in predicting VO2peak in chronic stroke, in addition to age, sex and functional dependency. Secondary objectives were to investigate associations between daily physical activity and functional walk tests, and with VO2peak in chronic stroke. METHODS: This prospective cohort study included eligible participants originally included in the randomized controlled trial Life After Stroke. Functional walk tests, i.e., six-minute walk test (6MWT) and maximal gait speed, were assessed at inclusion and 18 months later. VO2peak [ml/kg/min] was assessed by a cardiopulmonary exercise test on a treadmill 20 months after inclusion. Daily physical activity was measured by a uniaxial accelerometer (activPAL) at 18-month follow-up. RESULTS: Ninety-two community-dwelling individuals, with a mean (SD) age of 69.2 (10.6) years and 33 (35.9%) women, were included 3 months after stroke onset. Eighty-three (90.2%) participants had a modified Rankin Scale (mRS) score of 1 or 2, indicating functional independence. An overall assessment of four prediction models indicated the combination of age, sex, mRS and 6MWT as predictors to be the best fitted model in predicting VO2peak (adjusted R2 = 0.612). Secondary results showed statistically significant, but not clinically significant, associations between daily physical activity and functional walk tests, and with VO2peak. CONCLUSIONS: 6MWT add significant value to the prediction of mean VO2peak in the chronic phase in mild strokes, in combination with age, sex and functional dependency. This prediction model may facilitate clinical decisions and rehabilitation strategies for mildly affected stroke survivors in risk of low levels of VO2peak. Future studies should validate the model in various stages after stroke and in patients moderately and severely affected.

Fatigue and activity after stroke. Secondary results from the Life After Stroke study.

OBJECTIVES: The aim of this study was to describe how the prevalence of fatigue changed from the subacute phase to the chronic phase after stroke, and to investigate how activity was associated with fatigue among participants included in the randomized controlled multicentre-study Life After STroke (LAST). METHODS: The present study represents secondary analysis based on data from the LAST study. One-hundred-and-forty-five patients with mild and moderate stroke (mean (SD) age: 71.5 (10.5) years, 57.2% males) recruited from St. Olav's University Hospital were included. Fatigue was assessed by the Fatigue Severity Scale (FSS-7) at inclusion, 3 months after stroke, and at follow-up 18 months later. activPAL was used to measure activity at follow-up. RESULTS: A total of 46 (31.7%) participants reported fatigue at inclusion and 43 (29.7%) at follow-up (p = .736). In the univariable regression analysis, sedentary behaviour, walking and sedentary bouts were significantly associated with fatigue (p ≤ .015), whereas only time spent walking was significantly associated with fatigue in the multivariable regression analysis (p = .017). CONCLUSIONS: The present study showed that fatigue is a common symptom after stroke and that the prevalence of fatigue remained unchanged from the subacute to the chronic phase. The study also showed that increased time spent walking was strongly related to lower fatigue, while no such associations were found between the other activity categories and fatigue.

A physical activity intervention to prevent cognitive decline after stroke: Secondary results from the Life After STroke study, an 18-month randomized controlled trial.

OBJECTIVE: To examine the effects of individualized regular coaching and exercise on post-stroke cognitive and emotional function. METHODS: The Life After STroke (LAST) study investigated the differences between intervention and care-as-usual between 3 and 21 months post-stroke. Outcome measures were the Trail Making Test (TMT) A and B, Mini Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), and adherence to the intervention. RESULTS: Of the 362 patients included in the study, 177 were assigned to the intervention. The mean age was 71.7 (SD 11.3) years and 39.5% were female. The adjusted mean difference between groups for TMT A was 8.54 (CI 0.7 to 16.3), p = 0.032, for TMT B 8.6 (CI -16.5 to 33.6), p = 0.50, for MMSE -0.1 (CI -0.8 to 0. 6), p = 0.77, for HADS A -0.2 (CI -0.9 to 0.5), p = 0.56 and for HADS D -0.1 (CI -0.7 to 0.5), p = 0.76). A higher level of adherence to the intervention was significantly associated with increased MMSE (B = 0.030 (CI 0.005-0.055), p = 0.020) Conclusion: No clinically relevant effects on cognitive or emotional function were found of individualized regular coaching for physical activity and exercise. However, increased adherence to the intervention was associated with improved cognitive function.

Adherence to a Long-Term Physical Activity and Exercise Program After Stroke Applied in a Randomized Controlled Trial.

Background: Persistent physical activity is important to maintain motor function across all stages after stroke. Objective: The objective of this study was to investigate adherence to an 18-month physical activity and exercise program. Design: The design was a prospective, longitudinal study including participants who had had a stroke randomly allocated to the intervention arm of a randomized controlled trial. Methods: The intervention consisted of individualized monthly coaching by a physical therapist who motivated participants to adhere to 30 minutes of daily physical activity and 45 minutes of weekly exercise over an 18-month period. The primary outcome was the combination of participants' self-reported training diaries and adherence, as reported by the physical therapists. Mixed-effect models were used to analyze change in adherence over time. Intensity levels, measured by the Borg scale, were a secondary outcome. Results: In total, 186 informed, consenting participants who had had mild-to-moderate stroke were included 3 months after stroke onset. Mean age was 71.7 years (SD = 11.9). Thirty-four (18.3%) participants withdrew and 9 (4.8%) died during follow-up. Adherence to physical activity and exercise each month ranged from 51.2% to 73.1%, and from 63.5% to 79.7%, respectively. Adherence to physical activity increased by 2.6% per month (odds ratio = 1.026, 95% CI = 1.014-1.037). Most of the exercise was performed at moderate-to-high intensity levels, ranging from scores of 12 to 16 on the Borg scale, with an increase of 0.018 points each month (95% CI = 0.011-0.024). Limitations: Limitations included missing information about adherence for participants with missing data and reasons for dropout. Conclusions: Participants with mild and moderate impairments after stroke who received individualized regular coaching established and maintained moderate-to-good adherence to daily physical activity and weekly exercise over time.

Responsiveness of the Berg Balance Scale in patients early after stroke.

The Berg Balance Scale (BBS) has previously shown good measurement properties. However, its ability to detect important change in patients early after stroke is still unknown. The purpose of the present study was to determine the minimal important change (MIC) and its relation to the minimal detectable change (MDC) for BBS in patients early after stroke. This prospective follow-up study included patients within the first 2 weeks after onset of stroke. The BBS, Barthel Index, and Scandinavian Stroke Scale were obtained at inclusion and 1 month later. At the follow-up assessment, the Patient Global Impression of Change was obtained. A receiver operating characteristic (ROC) curve was used to calculate the cut-off value for the MIC. Fifty-two patients (mean age of 78.7, SD 8.5 years) were included. All measures showed a significant improvement from baseline to follow-up. The ROC analysis identified a MIC of ≥6 BBS points, while the MDC was 5.97 BBS points at the 80% confidence level. This study shows that a change of 6 BBS point or more can be considered an important change for patients in the sub-acute phase after stroke, which also represents an 80% probability of exceeding the measurement error. A total of 80% of unchanged patients would display random fluctuations within the bounds of MDC80, while 20% of unchanged patients would exceed MDC80.

Upright activity within the first week after stroke is associated with better functional outcome and health-related quality of life: A Norwegian multi-site study.

OBJECTIVE: To assess the amount of early upright activity of patients managed in Norwegian stroke units and its association with functional outcome and health-related quality of life 3 months later. DESIGN: A prospective observational multi-centre study. SUBJECTS: A total of 390 acute stroke patients, mean age 76.8 years, 48.1% men, less than 14 days post-stroke, recruited from 11 Norwegian stroke units. METHODS: Time spent in different activity categories (in bed, sitting out of bed, upright) was observed with a standard method. Outcome was assessed by modified Rankin Scale (mRS), and health-related quality of life by EuroQol-5 Dimension 5 level (EQ-5D-5L) 3 months later. Ordinal logistic and linear regression analyses were used to examine the association between activity categories and mRS and EQ-5D-5L, respectively. Age, National Institute of Health Stroke Scale (NIHSS) score, premorbid mRS, sex, and hospital-site were added as covariates. RESULTS: The odds ratio (OR) (95% confidence interval (CI)) for poorer functional outcome (higher mRS) decreased as time spent in upright activities increased (OR 0.97 (95% CI 0.94-1.00)). There was also a significant positive association between time in upright activity and higher EQ-5D-5L, Beta 0.184 (95% CI 0.001- 0.008) 3 months later. CONCLUSION: This study confirms the beneficial effect of upright activity applied during hospital stay in Norwegian stroke units.