Hospital Differences in Motor Activity Early after Stroke: A Comparison of 11 Norwegian Stroke Units

Hokstad, Anne; Indredavik, Bent; Bernhardt, Julie; Ihle‐Hansen, Hege; Salvesen, Øyvind; Seljeseth, Yngve Müller; Schüler, Stephan; Engstad, Torgeir; Askim, Torunn

doi:10.1016/j.jstrokecerebrovasdis.2015.02.009

Cited by 46 publications

(57 citation statements)

References 23 publications

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“…Observations of patients’ activities and interactions in stroke units have revealed that patients are often alone and inactive during the acute phase [6–9]. Similar inactivity patterns were found in a recent study of eleven Norwegian stroke units, but an increase in upright patient activity was observed in hospitals where meals were served in a communal area [10]. This emphasizes the need to further elucidate whether and how the physical environment can be a barrier to or a facilitator of patients’ activities and interactions in stroke units.…”

Section: Introductionmentioning

confidence: 67%

“…Had the patient lounge been placed more centrally in the ward, it might have increased access and the time patients spent in the communal areas. Access to meeting places, such as patient lounges, and opportunities for cognitive and social activities, e.g., access to computers, books, newspapers, games and personal hobbies, have been reported to promote activity and well-being among people with stroke [10, 20, 39]. We argue that a clearly visible and inviting communal area and a simple and understandable corridor plan offering views from windows to support orientation could facilitate and encourage patients to be more physically active and engage in more extensive interactions with other people.…”

Section: Discussionmentioning

confidence: 99%

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A comparative study of patients’ activities and interactions in a stroke unit before and after reconstruction—The significance of the built environment

et al. 2017

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Early mobilization and rehabilitation, multidisciplinary stroke expertise and comprehensive therapies are fundamental in a stroke unit. To achieve effective and safe stroke care, the physical environment in modern stroke units should facilitate the delivery of evidence-based care. Therefore, the purpose of this study was to explore patients’ activities and interactions in a stroke unit before the reconstruction of the physical environment, while in a temporary location and after reconstruction. This case study examined a stroke unit as an integrated whole. The data were collected using a behavioral mapping technique at three different time points: in the original unit, in the temporary unit and in the new unit. A total of 59 patients were included. The analysis included field notes from observations of the physical environment and examples from planning and design documents. The findings indicated that in the new unit, the patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than the patients in the original unit. The reconstruction involved a change from a primarily multi-bed room design to single-room accommodations. In the new unit, the patients’ lounge was located in a far corner of the unit with a smaller entrance than the patients’ lounge in the old unit, which was located at the end of a corridor with a noticeable entrance. Changes in the design of the stroke unit may have influenced the patients’ activities and interactions. This study raises the question of how the physical environment should be designed in the future to facilitate the delivery of health care and improve outcomes for stroke patients. This research is based on a case study, and although the results should be interpreted with caution, we strongly recommend that environmental considerations be included in future stroke guidelines.

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Section: Introductionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

A comparative study of patients’ activities and interactions in a stroke unit before and after reconstruction—The significance of the built environment

et al. 2017

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“…In the last decade, increased responsiveness in terms of onset‐to‐treatment times and improved availability of thrombectomy and thrombolysis in combination with enhanced rehabilitation strategies have improved the overall survival rate of stroke patients by 20% (Askim, Bernhardt, Salvesen, & Indredavik, ; Askim et al., , ; Cavanaugh, Barbot, Carrasco, & Huxlin, ; Cavanaugh & Huxlin, ; Hokstad et al., ). Despite this progress, stroke remains the leading cause of adult disability, with 50% of survivors suffering from severe sensorimotor and cognitive impairments (Modo, Ambrosio, Friedlander, Badylak, & Wechsler, ).…”

Section: Introductionmentioning

confidence: 99%

Neuroplasticity in stroke recovery. The role of microglia in engaging and modifying synapses and networks

Sandvig

Augestad

Håberg

et al. 2018

Eur J of Neuroscience

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Neuroplasticity after ischaemic injury involves both spontaneous rewiring of neural networks and circuits as well as functional responses in neurogenic niches. These events involve complex interactions with activated microglia, which evolve in a dynamic manner over time. Although the exact mechanisms underlying these interactions remain poorly understood, increasing experimental evidence suggests a determining role of pro- and anti-inflammatory microglial activation profiles in shaping both synaptogenesis and neurogenesis. While the inflammatory response of microglia was thought to be detrimental, a more complex profile of the role of microglia in tissue remodelling is emerging. Experimental evidence suggests that microglia in response to injury can rapidly modify neuronal activity and modulate synaptic function, as well as be beneficial for the proliferation and integration of neural progenitor cells (NPCs) from endogenous neurogenic niches into functional networks thereby supporting stroke recovery. The manner in which microglia contribute towards sculpting neural synapses and networks, both in terms of activity-dependent and homeostatic plasticity, suggests that microglia-mediated pro- and/or anti-inflammatory activity may significantly contribute towards spontaneous neuronal plasticity after ischaemic lesions. In this review, we first introduce some of the key cellular and molecular mechanisms underlying neuroplasticity in stroke and then proceed to discuss the crosstalk between microglia and endogenous neuroplasticity in response to brain ischaemia with special focus on the engagement of synapses and neural networks and their implications for grey matter integrity and function in stroke repair.

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“…Registers are increasingly used to monitor and benchmark between-hospital or between-country stroke care performance [1][2][3][4][5][6][7][8][9] . However, the quality of data included in the registers is often insufficiently assessed.…”

Section: Introductionmentioning

confidence: 99%

Validation of Hospital Performance Measures of Acute Stroke Care Quality. Riksstroke, the Swedish Stroke Register

Söderholm¹,

Stegmayr²,

Glader³

et al. 2016

Neuroepidemiology

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Background: Registers are increasingly used to monitor stroke care performance. Fair benchmarking requires sufficient data quality. We have validated acute care data in Riksstroke, the Swedish Stroke Register. Methods: Completeness was assessed by comparisons with diagnoses at hospital discharge recorded in the compulsory National Patient Register and content validity by comparisons with (a) key variables identified by European stroke experts, and (b) items recorded in other European stroke care performance registers. Five test cases recorded by 67 hospitals were used to estimate inter-hospital reliability. Results: All 72 Swedish hospitals admitting acute stroke patients participated in Riksstroke. The register was estimated to cover at least 90% of acute stroke patients. It includes 18 of 22 quality indicators identified by international stroke experts and 14 of 15 indicators used by at least 2 stroke performance registers in other European countries. Inter-hospital reliability was high (≥85%) in 77 of 81 Riksstroke items. Conclusions: A nationwide stroke care register can be maintained with sufficient data quality to permit between-hospital performance benchmarking. Our experiences may serve as a model for other stroke registers while evaluating data quality.

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Hospital Differences in Motor Activity Early after Stroke: A Comparison of 11 Norwegian Stroke Units

Abstract: Despite variation between the hospitals, patients admitted to Norwegian stroke units spend most of the day out of bed. Time spent with a physical therapist and hospitals having a policy of serving meals in communal areas explained most of the variation in activity between hospitals.

Cited by 46 publications

References 23 publications

A comparative study of patients’ activities and interactions in a stroke unit before and after reconstruction—The significance of the built environment

A comparative study of patients’ activities and interactions in a stroke unit before and after reconstruction—The significance of the built environment

Neuroplasticity in stroke recovery. The role of microglia in engaging and modifying synapses and networks

Validation of Hospital Performance Measures of Acute Stroke Care Quality. Riksstroke, the Swedish Stroke Register

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