Patients' experiences with self-referral to in-patient rehabilitation: A qualitative interview study

Purpose. To describe objectives, experiences and satisfaction among subjects referring themselves to in-patient rehabilitation.

Method. Persons suffering from stroke or multiple sclerosis were invited to refer themselves to a specialised rehabilitation department. Ten patients referred themselves within the study period, of whom two were excluded. The remaining eight underwent qualitative semi-structured in-depth interviews, focusing on the decision of self-referral, the personal goals for the rehabilitation, and the satisfaction with the stay. The interviews were tape-recorded and subjected to content analysis. As an underlying theoretical framework, we applied Antonovsky's Sense of Coherence model.

Results. Half of the patients had not written the application themselves and did not know which grounds had been put forward in the application. Nevertheless, all the patients were able to formulate their personal goals for the rehabilitation stay. These were distributed in three main categories: those who recently had got a progressive disability wanted education and improved knowledge on their disease; those who had had an acute, traumatic change of health status wanted training in order to improve muscular strength or everyday skills; and those who had been disabled for several years wanted inspiration for further life.

Conclusions. Patients may put forward other reasons to apply for rehabilitation than health personnel. Does the Sense of Coherence Model seems applicable to describe these reasons.     

Lifestyle factors and risk of cerebral infarction.

BACKGROUND AND PURPOSE: We evaluated the impact of lifestyle factors on the risk of ischemic stroke. METHODS: We used a nested case-control design. The cases comprised 163 persons (median age 69 years) admitted to a stroke unit and diagnosed with acute cerebral infarction. All cases had earlier participated in the North Tr?ndelag Health Survey. The controls comprised 567 participants from the North Tr?ndelag Health Survey, matched by sex and year of birth. RESULTS: Raised systolic (p less than 0.001) and diastolic (p = 0.02) blood pressure, antihypertensive treatment (p less than 0.001), previous myocardial infarction (p less than 0.001), prior stroke (p = 0.002), diabetes (p less than 0.001), and former daily smoking (p = 0.02) were identified as significant risk factors by univariate conditional logistic regression. No difference in risk was detected at different levels of alcohol consumption, salt intake, physical activity, or body mass index. Current smokers had virtually the same risk as nonsmokers. No association was found between stroke and the number of cigarettes smoked per day or the number of years of smoking. Multivariate conditional logistic regression identified diabetes (p = 0.002), raised systolic blood pressure (p less than 0.001), and former daily smoking (p = 0.01) as significant and independent risk factors. Previous myocardial infarction (p = 0.07), previous stroke (p = 0.1), and current daily smoking (p = 0.1) were of marginal significance. CONCLUSIONS: The established medical risk factors for stroke are confirmed. With the possible exception of smoking, we have not identified any lifestyle factor with a significant impact on the risk of ischemic stroke.     

Well-being and instrumental activities of daily living after stroke

OBJECTIVE: To explore the relationship between subjective well-being and competence in instrumental activities of daily living after stroke. DESIGN: Cross-sectional with evaluation at six months post stroke. SUBJECTS: Eighty-two patients admitted to an acute stroke unit, of whom 64 were seen at six months. The mean age was 77.5 years, 55% were females and 55% were living alone. MAIN OUTCOME MEASURES: The General Health Questionnaire (GHQ-20 version), a well-being scale, was factor analysed and yielded three dimensions, named 'coping', 'anxiety' and 'satisfaction' that served as main outcomes. RESULTS: Explanatory variables were the four subscales of the Nottingham IADL scale, the Ullevaal Aphasia Screening test, urinary continence and demographics. Structural equation modelling showed that the GHQ dimension 'satisfaction' related significantly to the Nottingham subscale 'leisure activities' (beta = -0.38, p = 0.01), whereas 'coping' was indirectly associated with 'leisure activities' by its correlation with 'satisfaction' (R = 0.26, p = 0.01). None of the outcomes were statistically associated with aphasia, continence or the background variables. CONCLUSION: 'Leisure activities' demonstrated the strongest association to subjective well-being as expressed by the 'satisfaction' dimension. In stroke rehabilitation leisure activities should be addressed when assessing function and planning intervention.     

TOAST criteria applied in acute ischemic stroke

BACKGROUND: Etiological subclassification of ischemic stroke has become increasingly important, as new therapeutic agents have been introduced. The aim of this study was to assess the inter-rater reliability of the TOAST classification applied in the acute setting, and further to evaluate the criterion validity of the TOAST classification in discriminating between small vessel disease and other etiologies. METHODS: From June to December 2001, 38 patients with acute ischemic stroke were included in the present study. All were classified according to the TOAST criteria by two junior registrars shortly after admission. Later, a consensus classification was made based on a comprehensive investigation programme. RESULTS: The inter-rater reliability between the two junior registrars was very good (kappa 0.88). The overall agreement between initial and consensus classifications was fair (kappa 0.30). The TOAST classification discriminated between small vessel disease and other subgroups in most patients (sensitivity 0.93, specificity 0.83). CONCLUSION: Etiological subclassification of ischemic stroke requires extensive cerebrovascular investigation. Normally, such resources are not available at admission. Nevertheless, the TOAST classification should be used in this setting to help physicians differentiate between small vessel disease and other etiologies of acute stroke, particularly when therapies with possible harmful side effects are considered an option.