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Eddy Dejaeger

Publications and source records attributed to Eddy Dejaeger.

12 recordsLinked to original sources
PubMed2007

Inpatient stroke rehabilitation: a comparative study of admission criteria to stroke rehabilitation units in four European centres.

OBJECTIVE: To explore the clinical and non-clinical factors involved in decision-making concerning admission to European stroke rehabilitation units. DESIGN: Observational study on case-mix at intake combined with questionnaires and semi-structured interviews with the medical consultants of each European stroke rehabilitation unit. PATIENTS AND SETTINGS: Clinical data on 532 first-ever patients after stroke. Medical consultants from 6 European stroke rehabilitation units in 4 European countries (UK, Belgium, Germany and Switzerland). METHODS: Standardized clinical assessments within 2 days after admission. Questionnaires to each medical consultants followed by a qualitative round of semi-structured interviews. RESULTS: Case-mix of patients after stroke was significantly different between European stroke rehabilitation units. Clinical criteria for admission were seldom explicit and were evaluated differently between the European stroke rehabilitation units. In the UK units, diagnosis of stroke was the only criterion for admission. In the Belgian, German and Swiss units, pre-morbid conditions were taken into account in admission decisions. The likelihood of discharge home was considered highly important in the Swiss units. CONCLUSION: Case-mix differences at intake could be linked to different appraisals of clinical and non-clinical factors of patients after stroke. The findings urge us to be more explicit about decision-making processes at admission in order to provide a more comprehensive insight into the interplay between context and process of care.

Belgium↗
PubMed2006

Effect of socioeconomic status on functional and motor recovery after stroke: a European multicentre study.

BACKGROUND: Previous studies have shown an inverse gradient in socioeconomic status for disability after stroke. However, no distinction has been made between the period in the stroke rehabilitation unit (SRU) and the period after discharge. The purpose of this study was to examine the impact of education and equivalent income on motor and functional recovery for both periods. METHODS: 419 consecutive patients were recruited from six SRUs across Europe. The Barthel Index (BI) and Rivermead Motor Assessment (RMA) were measured on admission, at discharge and 6 months after stroke. Ordinal logistic regression models were used, adjusting for case mix. Cumulative odds ratios (OR) were calculated to measure differences in recovery between educational levels and income groups with adjustments for case mix. RESULTS: Patients with a low educational level were less likely to improve on the BI (OR 0.53; 95% CI 0.32 to 0.87) and the RMA arm during inpatient stay (OR 0.54; 95% CI 0.31 to 0.94). For this period, no differences in recovery were found between income groups. After discharge, patients with a low equivalent income were less likely to improve on all three sections of the RMA: gross function (OR 0.20; 95% CI 0.06 to 0.66), leg and trunk (OR 0.22; 95% CI 0.09 to 0.55) and arm (OR 0.30; 95% CI 0.10 to 0.87). No differences were found for education. CONCLUSIONS: During inpatient rehabilitation, educational level was a determinant of recovery, while after discharge, equivalent income played an important role. This study suggests that it is important to develop a better understanding of how socioeconomic factors affect the recovery of stroke patients.

Aged↗
PubMed2006

Use of time by physiotherapists and occupational therapists in a stroke rehabilitation unit: a comparison between four European rehabilitation centres.

PURPOSE: The aim of this study was to compare the time allocated to therapeutic activities (TA) and non-therapeutic activities (NTA) of physiotherapists (PT) and occupational therapists (OT) in stroke rehabilitation units in four European countries. METHOD: Therapists documented their activities in 15-min periods for two weeks. They recorded: activity, number of patients, number of stroke patients, involvement of other people, location and frequency of each activity. Kruskal-Wallis tests and negative binomial regression models were used to compare activities between professional groups and between units. RESULTS: The average proportion of TA per day ranged between 32.9% and 66.1% and was higher for PT than for OT in each unit. For OT, significant differences emerged between the units in the proportion of time allocated to TA compared to NTA with British OTs spending significantly less time in TA. In the Belgian unit, three times less time was spent on patient-related co-ordination activities (e.g., administration, ward rounds) compared to the British and Swiss units. CONCLUSIONS: Time allocation differed between PT and OT and between units, affecting the time available for TA. Further investigation is necessary to study the effect of work organization in stroke rehabilitation units on the efficiency of rehabilitation regimes.

Appointments and Schedules↗
PubMed2006

Stroke rehabilitation in Europe: what do physiotherapists and occupational therapists actually do?

BACKGROUND AND PURPOSE: Physiotherapy (PT) and occupational therapy (OT) are key components of stroke rehabilitation. Little is known about their content. This study aimed to define and compare the content of PT and OT for stroke patients between 4 European rehabilitation centers. METHODS: In each center, 15 individual PT and 15 OT sessions of patients fitting predetermined criteria were videotaped. The content was recorded using a list comprising 12 therapeutic categories. A generalized estimating equation model was fitted to the relative frequency of each category resulting in odds ratios. RESULTS: Comparison of PT and OT between centers revealed significant differences for only 2 of the 12 categories: ambulatory exercises and selective movements. Comparison of the 2 therapeutic disciplines on the pooled data of the 4 centers revealed that ambulatory exercises, transfers, exercises, and balance in standing and lying occurred significantly more often in PT sessions. Activities of daily living, domestic activities, leisure activities, and sensory, perceptual training, and cognition occurred significantly more often in OT sessions. CONCLUSIONS: This study revealed that the content of each therapeutic discipline was consistent between the 4 centers. PT and OT proved to be distinct professions with clear demarcation of roles.

Aged↗
PubMed2006

Manofluorographic evaluation of swallowing in amyotrophic lateral sclerosis and its relationship with clinical evaluation of swallowing.

The aim of this cross-sectional study was, first, to identify swallowing dysfunctions in an ALS population of 40 consecutive patients through combined videofluoroscopy and manometry. Secondly, these objective swallowing data were correlated with the functional feeding status as reported by the patient or family member. Videofluoroscopic evaluation showed dysfunctions in the oral phase of swallowing, pharyngeal initiation and pharyngeal transport. In addition, manometric data revealed low tongue driving forces and pharyngeal contraction amplitudes but normal relaxation of the upper oesophageal sphincter (UES). Aspiration was noted in a not negligible number of 9/40 patients. These objective data were then correlated with the clinical swallowing and feeding status, assessed by means of the ALS Swallowing Severity Scale. Patients receiving scores of 6 or lower on the ALSSSS, report dietary consistency changes but are considered 'safe oral feeders'. Nevertheless, our data revealed that these patients showed significant aspiration during videofluoroscopy. Although not every patient with ALS should be referred routinely for radiographic evaluation of swallowing, our findings suggest referral for a radiological examination as soon as the ALSSSS drops to a score of 6 or lower, to evaluate the presence of (silent) aspiration.

Amyotrophic Lateral Sclerosis↗
PubMed2005

Use of time by stroke patients: a comparison of four European rehabilitation centers.

BACKGROUND AND PURPOSE: Differences exist between European countries in the proportion of patients who die or become dependent after stroke. The aim of the present study was to identify differences in the use of time by stroke patients in 4 rehabilitation centers in 4 European countries. METHODS: In each of the 4 centers, 60 randomly selected stroke patients were observed at 10-minute intervals using behavioral mapping. Observations took place on 30 weekdays selected at random, on equal numbers of morning, afternoon, and evening sessions. A logistic generalized estimating equation model with correction for differences in case mix and multiple testing was used for the analysis. RESULTS: Overall time available from different professions was the highest in the United Kingdom, but patients in the United Kingdom spent on average only 1 hour per day in therapy. This was significantly less than patients in Belgium and Germany, who spent approximately 2 hours, and patients in Switzerland who spent approximately 3 hours per day in therapy. In all centers, patients spent less than half their time in interactions and >72% of the time in nontherapeutic activities. CONCLUSIONS: Important differences in the use of time were established, which appeared dependent on management decisions rather than the number of staff available. Patients in the Swiss and German centers spent more time in therapy, possibly because of the structured organization of rehabilitation. Further studies will verify whether this has an effect on outcome.

Activities of Daily Living↗
PubMed2004

Early and repetitive stimulation of the arm can substantially improve the long-term outcome after stroke: a 5-year follow-up study of a randomized trial.

BACKGROUND AND PURPOSE: Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke, with follow-ups at a maximum of 12 months. The aim of this study was to examine the effect of repetitive sensorimotor training of the arm at 5 years after stroke. SUBJECTS AND METHODS: One hundred consecutive stroke patients were randomly allocated either to an experimental group that received daily additional sensorimotor stimulation of the arm or to a control group. The intervention period was 6 weeks. Assessments of the patients were made before, midway, and after intervention, and at 6 and 12 months after stroke. In this study, 62 patients were reassessed at 5 years after stroke. The Brunnström-Fugl-Meyer (BFM) test, Action Research Arm (ARA) test, and Barthel index (BI) were used as the primary outcome measures. RESULTS: At the 5-year follow-up, there was a statistically significant difference for both the BFM and ARA tests in favor of the experimental group. The mean differences in improvement between the groups from the initial evaluation to the 5-year assessment corresponded to 17 points on the BFM and 17.4 on the ARA. No effect was found for the BI. The treatment was most effective in patients with a severe initial motor deficit. CONCLUSIONS: Adding a specific intervention for the arm during the acute phase after a stroke resulted in a clinically meaningful and long-lasting effect on motor function. The effect can be attributed to early, repetitive, and targeted stimulation.

Adult↗
PubMed2004

[Falls among community-dwelling elderly: a pilot study of prevalence, circumstances and consequences in Flanders].

This pilot study was designed to examine prevalence, circumstances and consequences of falls among 131 community-dwelling elderly (mean age = 76.7 y.; SD = 5.4; response = 29.8%). Based on a retrospective analysis, 39.7% of our study population had experienced one (65.4%) or more (34.6%) falls in the preceding year. Falls appeared to occur predominantly while getting up from the bed, chair or bath (18%), cycling (14%), walking on an uneven surface (14%) and during household work (14%). Fall-related injuries were reported in 67.3% of the fallers, fractures in 17.4%. Additionally, a majority of fallers (63.5%) experienced a mild to serious form of anxiety, 48.1% consulted a general practitioner after the fall and 34.6% was hospitalised. In line with data reported in the literature, falls are a common problem in Flanders and are associated with a negative impact on the physical and psychosocial well being of the elderly population. We conclude that there is an urgent need to develop and implement preventive measures as well as multidisciplinary strategies to identify, assess and target high-risk persons for falling.

Accidental Falls↗
PubMed2004

[Is pulse oximetry a reliable tool for detection of aspiration?].

This study was designed to determine whether significant differences in saturation levels existed among patients with aspiration and patients without and wether pulse oximetry can reliably detect aspiration in patients with dysphagia. We also examined the effects of gender and disease (neurologic versus non neurologic) on saturation levels. We studied 38 patients. They all underwent a videofluoroscopic study of swallowing (VFSS). Twenty patients aspirated on videofluoroscopic study of swallowing: ten patients were solid aspirators, ten patients were liquid aspirators. In each group (liquid aspirators, solid aspirators or non aspirators) we found no significant difference in saturation levels. We found however a significant difference in saturation levels between each group before, during and after videofluoroscopic study of swallowing. Both gender and disease had an effect on saturation levels. We conclude that pulse oximetry can not serve as a screening tool for detection of aspiration as saturation levels are dependent on many factors. Therefore one can not reliably predict aspiration with a single saturation screening.

Aged↗
PubMed2003

Falls and fractures in postmenopausal women: a review.

Older people are a major risk group for falls. 35-40% of over-65s living at home fall at least once a year, and between a third and a half of these fall twice or more. The figure rises to 50% for the over-80s. Falls contribute to the occurrence of fractures. Of all the fractures linked to osteoporosis and falls, hip fractures are the most important in terms of early death, functional dependence, and costs of care. Many identifiable risk factors have been shown to contribute to hip fracture risk, including low bone density, previous fractures, clinical risk factors for falls, and low body weight. Interaction has been found between falls and osteoporosis in the occurrence of fractures. Prospective studies are needed to evaluate whether a combined bone- and fall-directed therapy can further decrease the risk for fractures in patients with low bone density and an increased fall risk.

Accidental Falls↗