Page 586

Karger_ESC London_2013

22. European Stroke Conference 586 © 2013 S. Karger AG, Basel Scientific Programme 28 Rehabilitation and reorganisation after stroke Objective and subjective participation problems of chronic stroke patients in the Netherlands measured with the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Partic-ipation) M.W.M. Post1, C.H. van der Zee2, L.J. Kappelle3, J.M.A. Visser-Meily4 De Hoogstraat Rehabilitation, Utrecht, THE NETHERLANDS1, De Hoogstraat Rehabilitation, Utrecht, THE NETHERLANDS2, University Medical Center Utrecht, Utrecht, THE NETHER-LANDS3, University Medical Center Utrecht, Utrecht, THE NETHERLANDS4 Background: Social participation consists of an objective and a subjective dimension, indicating what patients do and how they feel about what they do or cannot do, respectively. However, few stroke studies used such a multidimensional perspective on participation. Objective: (1) To describe objective and subjective participation in community-dwelling stroke sur-vivors in The Netherlands. (2) To examine physical and cognitive independence and subjective com-plaints (pain, fatigue, and mood) as determinants of participation. Methods: Cross-sectional study. The USER-Participation measures 3 dimensions of participation: frequency, experienced restrictions, and satisfaction. Spearman correlations and regression analyses were used to analyze associations between the 3 USER-Participation scores and determinants of par-ticipation. Results: A total of 111 participants were included, mean age 57.4 (SD 10.7) years, 80.7% infarction, 47.7% right-hemisphere lesion, mean time of 1 year post-stroke. Participants showed few physical or cognitive disabilities. Fatigue was the most common subjective complaint. However only 48.5% of all patients returned to work, mostly for only 1 to 16 hours/week, and few performed outdoor activities. Participation restrictions were most prevalent in physical exercise, chores in/around the house, housekeeping, and outdoor activities. Most participants were satisfied with their participa-tion, but dissatisfaction occurred in activities outdoors and work/housekeeping. Regression analysis revealed that objective participation was determined by physical and cognitive independence, age, and education, whereas subjective participation was determined by physical and cognitive indepen-dence, fatigue, and mood. Conclusion: Most participants experienced participation problems, despite relatively good physical recovery. In addition to physical and cognitive factors, subjective complaints of persons with stroke should be addressed in the rehabilitation program. 27 Rehabilitation and reorganisation after stroke Cluster randomised trial evaluation of a patient and carer centred system of longer-term stroke care (the LoTS care trial) A. Forster1, J. Young2, A. Patel3, J. Nixon4, K. Chapman5, M. Knapp6, K. Mellish7, I. Holloway8, A. Farrin9 Bradford Institute for Health Research and University of Leeds, Bradford, UNITED KING-DOM1, Bradford Institute for Health Research and University of Leeds, Bradford, UNITED KING-DOM2, Institute of Psychiatry, King’s College London, London, UNITED KINGDOM3, Clinical Trials Research Unit, University of Leeds, Leeds, UNITED KINGDOM4, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UNITED KINGDOM5, London School of Economics and Political Science, London, UNITED KINGDOM6, Bradford Institute for Health Re-search, Bradford Royal Infirmary, Bradford, UNITED KINGDOM7, Clinical Trials Research Unit, University of Leeds, Leeds, UNITED KINGDOM8, Clinical Trials Research Unit, University of Leeds, Leeds, UNITED KINGDOM9 Background Longer-term recovery is poor for many stroke patients and services may not be appropriately config-ured to address their needs. We developed a new post-discharge ‘system of care’ comprising a struc-tured assessment covering the range of longer-term problems experienced by stroke patients and carers linked to evidence-based treatment algorithms and reference guides contained in a manual. Methods We evaluated by pragmatic cluster randomised controlled trial the clinical and cost effectiveness of this system of care as delivered by UK stroke care coordinator (SCC) services. Services randomised to the intervention were trained in using the system of care; control services continued with usual practice. Patients and carers (if available) were recruited on referral to the service and patient out-comes assessed using self-reported postal questionnaires at 6 and 12 months post-registration. The primary outcome was patient psychological health (General Health Questionnaire 12) at 6 months. Secondary outcomes included patient functional health and cost-effectiveness. Results 32 services were randomised and 800 stroke patients (401 intervention, 399 control) and 208 carers (108 intervention, 100 control) were recruited. Randomised groups were well matched in demo-graphic and clinical characteristics. There was no evidence of statistically significant differences between control and intervention in primary or secondary outcomes in intention to treat analysis. Adjusted between-group mean difference (GHQ12) was -0.6 points (95% confidence interval -1.8 to 0.7, p=0.39). Per protocol analysis indicated no evidence of statistically significant difference in out-comes. Further analyses are ongoing to explore patient and service sub-groups. Conclusions Addressing the needs of a heterogenous post-stroke population remains problematic. It might be that SCC service should be more targeted towards patients (and carers) with specific needs, leading to a more specialised bespoke service.


Karger_ESC London_2013
To see the actual publication please follow the link above