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BACKGROUND: To help enhance the quality of integrated stroke care delivery, regional stroke services networks in the Netherlands participated in a self-assessment study in 2012, 2015 and 2019. METHODS: Coordinators of the regional stroke services networks filled out an online self-assessment questionnaire in 2012, 2015 and 2019. The questionnaire, which was based on the Development Model for Integrated Care, consisted of 97 questions in nine clusters (themes). Cluster scores were calculated as proportions of the activities implemented. Associations between clusters and features of stroke services were assessed by regression analysis. RESULTS: The response rate varied from 93.1% (2012) to 85.5% (2019). Over the years, the regional stroke services networks increased in 'size': the median number of organisations involved and the volume of patients per network increased (7 and 499 in 2019, compared to 5 and 364 in 2012). At the same time, fewer coordinators were appointed for more than 1 day a week in 2019 (35.1%) compared to 2012 (45.9%). Between 2012 and 2019, there were statistically significantly more elements implemented in four out of nine clusters: 'Transparent entrepreneurship' (MD = 18.0% F(1) = 10.693, p = 0.001), 'Roles and tasks' (MD = 14.0% F(1) = 9.255, p = 0.003), 'Patient-centeredness' (MD = 12.9% F(1) = 9.255, p = 0.003), and 'Commitment' (MD = 11.2%, F(1) = 4.982, p = 0.028). A statistically significant positive correlation was found for all clusters between implementation of activities and age of the network. In addition, the number of involved organisations is associated with better execution of implemented activities for 'Transparent entrepreneurship', 'Result-focused learning' and 'Quality of care'. Conversely, there are small but negative associations between the volume of patients and implementation rates for 'Interprofessional teamwork' and 'Patient-centredness'. CONCLUSION: This long-term analyses of stroke service development in the Netherlands, showed that between 2012 and 2019, integrated care activities within the regional stroke networks increased. Experience in collaboration between organisations within a network benefits the uptake of integrated care activities.
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OBJECTIVE: To assess the reproducibility of 3 participation measures. DESIGN: Repeated administration of a postal questionnaire with a 2-week interval. PARTICIPANTS: Outpatients (n = 47) from 2 rehabilitation centres and a university hospital in The Netherlands. METHODS: Measures were the ICF Measure of Participation and Activities Screener (IMPACT-S), the Participation Scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). Test-retest reliability was analysed using Cohen's weighted kappa and the intraclass correlation coefficient (ICC). Agreement was expressed as the standard error of measurement and the smallest detectable change (SDC), substantiated as the ratio between the SDC and the standard deviation (SDC/SD). RESULTS: ICC values of the IMPACT-S were 0.54-0.90 for the scale scores, 0.92 and 0.74 for sub-total scores Activities and Participation, and 0.88 for the total score. The ICC of the Participation Scale was 0.82. The ICC of the USER-P was 0.65 for the Frequency scale, 0.85 for the Restrictions scale, and 0.84 for the Satisfaction scale. The SDC/SD ratios for all measures were small (0.11-0.28) at the group level, but large (0.78-1.91) at the individual level. Most participants found all measures relevant and easy to complete. CONCLUSION: All 3 measures showed generally satisfying reproducibility and were acceptable to the participants.