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Bent Indredavik

Publications and source records attributed to Bent Indredavik.

10 recordsLinked to original sources
PubMed2006

Does an extended stroke unit service with early supported discharge have any effect on balance or walking speed?

OBJECTIVE: To evaluate the effect of an extended stroke unit service with early supported discharge on balance and walking speed, and to explore the association between initial leg paresis, initial movement ability and balance one year after stroke. DESIGN: A randomized controlled trial comparing early supported discharge with ordinary stroke unit service. PATIENTS: A total of 62 eligible patients after stroke. METHODS: The outcome measures were Berg Balance Scale and walking speed at 1, 6, 26 and 52 weeks after stroke. RESULTS: We found no significant differences between the 2 groups during follow-up. There was a significant improvement on Berg Balance Scale (p=0.013) and walking speed (p=0.022) in the early supported discharge group, but not in the ordinary service group, from 1 to 6 weeks' follow-up. All patients with initial severe leg paresis suffered from poor balance one year after the stroke. The odds ratio for poor balance was 42.1 (95% confidence interval; 3.5-513.9) among patients with no initial walking ability. CONCLUSION: These results do not conclusively indicate that early supported discharge has an effect on balance. A strong association was found between initial severe leg paresis, initial inability to walk and poor balance after one year.

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PubMed2005

Early supported discharge for stroke patients improves clinical outcome. Does it also reduce use of health services and costs? One-year follow-up of a randomized controlled trial.

BACKGROUND: An early supported discharge service (ESD) appears to be a promising alternative to conventional care. The aim of this trial was to compare the use of health services and costs with traditional stroke care during a one-year follow-up. METHODS: Three hundred and twenty patients were randomly allocated either to ordinary stroke unit care or stroke unit care combined with ESD which was coordinated by a mobile team. The use of all health services was recorded prospectively; its costs were measured as service costs and represent a combination of calculated average costs and tariffs. Hospital expenses were measured as costs per inpatient day and adjusted for the DRG. RESULTS: There was a reduction in average number of inpatient days at 52 weeks in favour of the ESD group (p = 0.012), and a non-significant reduction in total mean service costs in the ESD group (EUR 18,937/EUR 21,824). ESD service seems to be most cost-effective for patients with a moderate stroke. CONCLUSION: Acute stroke unit care combined with an ESD programme may reduce the length of institutional stay without increasing the costs of outpatient rehabilitation compared with traditional stroke care.

Age Factors↗
PubMed2004

Acute stroke unit care combined with early supported discharge. Long-term effects on quality of life. A randomized controlled trial.

OBJECTIVES: The aim of the present trial was to compare the effects of an extended stroke unit service (ESUS) with the effects of an ordinary stroke unit service (OSUS) on long-term quality of life (QoL). DESIGN: One year follow-up of a randomized controlled trial with 320 acute stroke patients allocated either to OSUS (160 patients) or ESUS (160 patients) with early supported discharge and follow-up by a mobile team. The intervention was a mobile team and close co-operation with the primary health care service. All assessments were blinded. MAIN OUTCOME MEASURE: Primary outcome of QoL in this paper was measured by the Nottingham Health Profile (NHP) at 52 weeks. Secondary outcomes measured at 52 weeks were differences between the groups measured by the Frenchay Activity Index, Montgomery-Asberg Depression Scale, Mini-Mental State Score and the Caregivers Strain Index. RESULTS: The ESUS group had a significantly better QoL (mean score 78.9) assessed by global NHP after one year than the OSUS group (mean score 75.2) (p =0.048). There were no significant differences between the groups in the secondary outcomes, but a trend in favour of ESUS. Caregivers Strain Index showed a mean score of 23.3 in the ESUS group and 22.6 in the OSUS group (p=0.089). CONCLUSION: It seems that stroke unit treatment combined with early supported discharge in addition to reducing the length of hospital stay can improve long-term QoL. However, similar trials are necessary to confirm the benefit of this type of service.

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PubMed2003

Stroke unit care combined with early supported discharge: long-term follow-up of a randomized controlled trial.

BACKGROUND AND PURPOSE: Early supported discharge from a stroke unit reduces the length of hospital stay. Evidence of a benefit for the patients is still unknown. The aim of this trial was to evaluate the long-term effects of an extended stroke unit service (ESUS), characterized by early supported discharge. The short-term effects were published previously. METHODS: We performed a randomized controlled trial in which 320 acute stroke patients were allocated to either ordinary stroke unit service (OSUS) (160 patients) or stroke unit care with early supported discharge (160 patients). The ESUS consists of a mobile team that coordinates early supported discharge and further rehabilitation. Primary outcome was the proportion of patients who were independent as assessed by modified Rankin Scale (RS) (RS < or =2=global independence). Secondary outcomes measured at 52 weeks were performance on the Barthel Index (BI) (BI > or =95=independent in activities of daily living), differences in final residence, and analyses to identify patients who benefited most from an early supported discharge service. All assessments were blinded. RESULTS: We found that 56.3% of the patients in the ESUS versus 45.0% in the OSUS were independent (RS < or =2) (P=0.045). The number needed to treat to achieve 1 independent patient in ESUS versus OSUS was 9. The odds ratio for independence was 1.56 (95% CI, 1.01 to 2.44). There were no significant differences in BI score and final residence. Patients with moderate to severe stroke benefited most from the ESUS. CONCLUSIONS: Stroke service based on treatment in a stroke unit combined with early supported discharge appears to improve the long-term clinical outcome compared with ordinary stroke unit care. Patients with moderate to severe stroke benefit most.

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PubMed2003

Stroke units - the Norwegian experience.

The main aims of acute stroke care should be to reduce death and disability. Treatment in stroke units is the only treatment option proven to reduce death in acute stroke patients. Stroke unit care is also the only treatment which has shown a marked reduction in disability for general stroke patients, and also the only treatment with beneficial long-term effects on survival, disability and quality of life. Most acute hospitals in Norway have established stroke units. The recommended stroke unit model is a non-intensive combined unit able to focus simultaneously both on acute care and rehabilitation. This model has been very well evaluated in randomised trials and has achieved some of the best results regarding acute stroke care. Hence one can probably conclude that stroke unit care in Norway is evidence based.

Electrocardiography↗
PubMedDate not supplied

Early supported discharge services for stroke patients: a meta-analysis of individual patients' data.

BACKGROUND: Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. METHODS: We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. FINDINGS: Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (p<0.0001). There were also significant improvements in scores on the extended activities of daily living scale and in the odds of living at home and reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patients with mild to moderate disability. INTERPRETATION: Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as shortening hospital stays.

Activities of Daily Living↗