Abstract:is paper describes the ndings of a study aiming to achieve deeper insight into reasons people with cognitive functional limitations cease to use public transport. Semi-structured interviews in combination with a qualitative content analysis were performed with nine participants. e results showed that reasons not to use public transport were to some degree a usability problem-both real and imagined. Other reasons were that participants had changed from buses or trains to other modes of transport or had psychologically adapted themselves to a new situation which meant that they did not miss using public transport.

This study was part of a Swedish interdisciplinary research project targeting accessibility problems in public transport for people with cognitive functional limitations (CFLs). The objective was to describe and compare different assessment perspectives of long-term CFLs among community citizens having had CFLs in the acute stroke phase but with moderate physical limitations. Eighty-four participants in ordinary housing 18-36 months post stroke, initially sampled from a national quality stroke register, received data collection home-visits. The Cognistat screening instrument was used for an objective assessment, and a study-specific questionnaire for self-evaluations of CFLs. A revised form of the latter questionnaire was used for reports from spouses of a subset of 30 participants. The agreement between self-evaluated CFLs and spouse reports was analysed by percentage agreement and Cohen's kappa, whereas differences in ratings were tested by McNemar's test, as were differences between objective and self-evaluated/spouse-reported occurrence of CFLs. Regardless of the different perspectives applied, CFLs were frequent. In absence of significant difference in ratings, the percentage agreement between self-evaluations and spouse reports was good or very good, whereas kappa values were less encouraging. Overall, participants and spouses expressed more CFLs, as compared with the screening. Most consistency was demonstrated for the area of calculation. When researchers and clinicians solely rely on cognitive screenings in their investigations, there is a considerable risk for underestimations of CFLs.

The use of ESD was feasible in the routine setting of an urban stroke unit. The input of the ESD services per patient decreased over time, perhaps indicating an improvement in use of healthcare resources.

The results indicate considerably affected use of modes of transport after stroke, and higher frequencies of PFLs and symptoms of depression among those with decreased/ceased public transport use.