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  • 1.
    Löfgren, Britta
    et al.
    Umeå University, Department of Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Department of Geriatric Medicine.
    Nyberg, Lars
    Psychological well-being 3 years after severe stroke1999In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 30, no 3, p. 567-72Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Stroke often has a very negative influence on the victims' perception of their life situation. The aim of this study was therefore to assess the subjects' long-term psychological well-being and to explore associations between subject characteristics, impairments, disabilities, and psychological well-being. METHODS: Of 100 subjects rehabilitated at a specialized geriatric stroke ward after the acute phase, 47 survivors were assessed in their homes 3 years after discharge and interviewed regarding their psychological well-being with the Philadelphia Geriatric Center Morale Scale (PGCMS). RESULTS: Sixty-four percent of the subjects were classified as having high scores for psychological well-being or fell within the middle range. In a cluster analysis, depression was shown to have the strongest association with the subjects' PGCMS scores. Variables including the subjects' social situation and functions as well as age, gender, ability to communicate, and need for help showed a much weaker association with the PGCMS. CONCLUSIONS: More than half of the stroke subjects were classified as having levels of psychological well-being that were good or fairly good. The strong association between PGCMS scores and depression indicates the importance of detecting and treating depression and of following up initiated therapy after stroke.

  • 2. Nyberg, Lars
    et al.
    Gustafson, Yngve
    Umeå University, Department of Geriatric Medicine.
    Fall prediction index for patients in stroke1997In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 28, no 4, p. 716-21Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: The identification of stroke patients who are prone to falls is essential to the development of prevention strategies. This study aimed at developing an easily administered fall risk index for patients in stroke rehabilitation. METHODS: A consecutive series of 135 patients in geriatric stroke rehabilitation was studied. Patient characteristics viewed as potential fall predictor variables were assessed at admission. Univariate and multiple Cox regression analyses of these variables were used in the development of a fall prediction index. RESULTS: The final index included the following items: male sex, poor performance of activities of daily living, urinary incontinence, impaired postural stability, bilateral motor impairment, presence of bilateral cortical or white matter lesions, visuospatial hemineglect, and use of diuretics, antidepressants, or sedatives. The index score correlated significantly with the fall risk (odds ratio, 1.46; 95% confidence interval, 1.26 to 1.69). The score was also used to classify individuals into low-, intermediate-, and high-risk groups, among which the fall rates differed significantly (log rank statistics, 29.86; P < .001). CONCLUSIONS: An easily administered fall risk index is suggested, which might serve as a basis for prevention strategies among patients in stroke rehabilitation.

  • 3. Nyberg, Lars
    et al.
    Gustafson, Yngve
    Umeå University, Department of Geriatric Medicine.
    Patient falls in stroke rehabilitation: A challenge to rehabilitation strategies1995In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 26, no 5, p. 838-42Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: The risk of falls is very high among stroke patients, and falling is a major complication in stroke rehabilitation. This study aimed to investigate the incidence, characteristics, and consequences of falls in an inpatient stroke rehabilitation setting. METHODS: One hundred sixty-one patients consecutively admitted to a geriatric stroke rehabilitation unit were studied. Falls that occurred during their rehabilitation stay were prospectively registered and analyzed. RESULTS: Sixty-two of the patients (39%) suffered falls. The total number of falls was 153, which corresponds to an incidence rate of 159 falls per 10,000 patient-days. Most falls occurred during transfers or from sitting in a wheelchair or on some other kind of furniture. Seventeen falls (11%) were classified as the result of extrinsic mechanisms, 49 (32%) were intrinsic falls, 39 (25%) occurred in a nonbipedal position (while sitting or lying), and 48 falls (31%) remained unclassified. No injury was observed in 109 of 153 incidents (71%), whereas 6 falls (4%) involved fractures or other serious injury. CONCLUSIONS: Since falls are so frequent, they must be considered a significant problem in stroke rehabilitation. Fall prevention strategies should therefore be developed and included in rehabilitation programs.

  • 4. Nyberg, Lars
    et al.
    Gustafson, Yngve
    Umeå University, Department of Geriatric Medicine.
    Using the Downton index to predict those prone to falls in stroke rehabilitation1996In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 17, no 10, p. 1821-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Falls are a major complication in inpatient stroke rehabilitation. An important issue in preventive strategies is the early identification of those at risk. This study aimed at assessing the fall-prediction accuracy of an easily administered fall risk index in stroke rehabilitation. METHODS: A consecutive series of 135 patients admitted to a geriatric stroke rehabilitation unit was studied. A score on the Downton fall risk index was obtained from the admission assessment data and used as a predictive indicator of the risk of falls. The patients' falls were prospectively recorded during their rehabilitation stay. The correlation between falls and the predicted risk was assessed by means of survival analysis and a multiple regression analysis, adjusting for the time of observation. RESULTS: The risk of falls as a function of the time observed was significantly greater among those predicted to be at high risk (index score > or = 3) than among the others (P = .009, log-rank test; odds ratio, 2.9). Furthermore, the number of falls during rehabilitation stay was moderately correlated (R = .57) with the fall risk index sum when adjusted as for the time of observation. The sensitivity of the fall prediction as to outcome was 91%, whereas the specificity was limited to 27%. CONCLUSIONS: A moderately high correlation was found between the predicted and the observed risk of falls in stroke rehabilitation when the Downton fall risk index was used. However, a low specificity rate limits the accuracy of the prediction

  • 5.
    Ramnemark, Anna
    et al.
    Umeå University, Department of Geriatric Medicine.
    Nyberg, Lars
    Lortentzon, Ronny
    Umeå University, Department of Orthopedics, Sports Medicine Unit.
    Olsson, T.
    Umeå University, Department of Medicine.
    Gustafson, Yngve
    Umeå University, Department of Geriatric Medicine.
    Hemiosteoporosis after severe stroke, independent of changes in body composition and weight1999In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 30, no 4, p. 755-60Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Fractures are a serious complication after stroke, and the risk of hip fractures among stroke patients is increased 2 to 4 times versus a reference population. Fractures after stroke are probably caused by the development of hemiosteoporosis and the high incidence of accidental falls. The aim of this study was to investigate the development of hemiosteoporosis in relation to other changes in body composition during the first year after severe stroke. METHODS: The study included 24 patients with extensive paresis after stroke. Bone mineral content (BMC) and fat and lean mass were assessed 1, 4, 7, and 12 months after stroke onset by a dual-energy x-ray absorptiometer. RESULTS: The loss of total body BMC was significant during the first year after stroke (-1.6%; P<0.05), but there were no significant changes in total lean or fat mass. At inclusion, there were no significant differences between sides in lean or fat mass or BMC, but during follow-up, BMC of the affected side decreased significantly compared with the same side at inclusion (-7.5%; P<0.01). Side differences in fat mass became significant between legs (9.3%; P<0.001) and whole sides (4. 8%; P<0.01). There were only minor side changes in lean mass. Loss of BMC was independent of weight changes. CONCLUSIONS: During the first year after severe stroke, patients developed pronounced hemiosteoporosis. This was not associated with general changes in lean or fat mass. The development of hemiosteoporosis was independent of weight changes after stroke.

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