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Biomedical subjects

J Schuling

Publications and source records attributed to J Schuling.

26 records · Page 2Linked to original sources
PubMed1993

[Home treatment of patients with cerebrovascular accidents].

OBJECTIVE: In the Netherlands one-third of stroke patients are managed at home. This study describes the characteristics of these patients and the management by the GP from stroke onset till six months afterwards. METHOD: A community based cohort of 185 stroke patients were examined at fixed intervals during 6 months poststroke; mortality and functional status of patients managed at home (n = 73) were compared with those of patients admitted to hospital (n = 109); 3 patients were directly admitted to a nursing home; characteristics of the GPs' management were registered. RESULTS: Patients managed at home were somewhat older (p < 0.05), lived more often in a residential home for the elderly (p < 0.05) and were more frequently known with comorbidity such as diabetes mellitus and Alzheimer (p < 0.05). Their poststroke disabilities were less grave; mortality rate was much lower than in the hospitalised group (p < 0.05). Recovery showed the same pattern in both groups. In the acute phase the GP made frequent housecalls; after a few days there was a decline in contact frequency. The mean 'treatment duration' was 12 weeks. The amount of care provided by the GP did not correlate with stroke severity. CONCLUSION: In the acute phase, when the patients' clinical condition was still unstable and the patients' families needed support, the GPs made frequent house-calls. During the stroke episode the number of contacts and the length of the treatment duration were defined more by comorbidity and social factors than by the severity of stroke. Regarding the pattern of stroke recovery the mean treatment duration of 12 weeks appears rather short for optimal support and rehabilitation.

Adult↗
PubMed1993

[Clinimetric evaluation of the Barthel Index, a measure of limitations in dailly activities].

OBJECTIVE: Evaluation of the clinimetric properties of the Barthel Index. DESIGN: To measure disabilities in activities of daily living (ADL) and mobility by independent observers. SETTING: Clinical and outpatient departments of Neurology of the University Medical Centre, Amsterdam. PATIENTS AND METHOD: In 35 patients of the clinical and 25 patients of the outpatient department the stroke disabilities were assessed independently by three observers. The Barthel Index was evaluated in terms of score agreements, homogeneity, and construct validity. RESULTS: There was an excellent concordance of total scores (mean kappa = 0.88; range 0.85-0.90) and single item scores (range mean values of kappa = 0.82-1.00). Repeated analyses, after exclusion of patients with maximum total scores, did not result in a significant reduction of these kappa values. The Barthel Index was a highly homogeneous scale (Cronbach's alpha = 0.96). All items contributed to this reliability in a balanced way. Factor analysis showed that the items on the scale described one common underlying trait. This factor explained 81% of the score variance. CONCLUSION: The Barthel Index is a sound instrument to measure disabilities in ADL and mobility. The scale is suitable for use in both patient care and research.

Activities of Daily Living↗
PubMed1993

The Frenchay Activities Index. Assessment of functional status in stroke patients.

BACKGROUND AND PURPOSE: Assessment of functional status in stroke patients is of major importance in both clinical practice and outcome studies. The Frenchay Activities Index has been developed specifically for measuring disability and handicap in stroke patients. The purpose of the study was to evaluate the metric properties of this instrument and to obtain normal values in a group of unselected elderly subjects. METHODS: The Frenchay Activities Index was tested in a group of stroke patients and a group of unselected subjects aged 65 or older. The functional status of the stroke patients was measured 26 weeks after stroke. Their prestroke status was registered retrospectively. Reliability and validity of the instrument were assessed. RESULTS: The mean scores in the prestroke, poststroke, and control group demonstrated differences in functional status. The reliability of unweighted scores (range of Cronbach's alpha-coefficients, 0.78 to 0.87) was sufficient. The construct validity was supported by meaningful correlations between the Frenchay Activities Index and scores on the Barthel Index and Sickness Impact Profile. Principal-components analysis indicated that the Frenchay Activities Index showed two traits: instrumental disability and some aspects of handicap. The reliability of the instrument could be improved by deleting two items and by creating two subscale scores: domestic and outdoors activities. CONCLUSIONS: The Frenchay Activities Index is a useful stroke-specific instrument to assess functional status. Completion of the questionnaire is easy and takes only a few minutes. Currently, the instrument is suitable for use in patient care and cross-sectional, descriptive studies.

Activities of Daily Living↗
PubMed1992

[The acute stage of the cerebrovascular accident; characteristics and management].

PURPOSE: Description of stroke patient characteristics, outcome in the acute phase (the first 3 weeks post-stroke) and management by the general practitioner (GP). DESIGN: Community based prospective study. METHODS: During the research period GPs reported all stroke patients (first event as well as recurring); these patients were followed at fixed intervals post-stroke regardless of treatment. RESULTS: The 98 GPs reported 185 patients. Stroke patients are predominantly old to very old people with a lot of comorbidity and an impaired pre-stroke functional status. The GP treated one third of the patients himself; half of the patients were instantly referred to a hospital. Younger patients are referred for further examination, probably because of possible therapeutic consequences. The very old are referred if their impairment makes home care impossible. Mortality, especially in the hospital group is high; 10% died within 24 hours, while after 1 week this figure was 17% and after 3 weeks 23%. In 21% of the referred patients no CT scan was made; the motive for referral was to provide sufficient care for the patient. In nine referred patients (8%) the diagnosis was changed. CONCLUSION: In choosing a strategy the GP considers several factors, of which impairment and the possibilities of home care are the most important. Diagnostic uncertainty played a minor role.

Activities of Daily Living↗
PubMedDate not supplied

Measuring functional status of stroke patients with the Sickness Impact Profile.

Measuring outcome of stroke treatment has focused mostly on Activities of Daily Living. In our study we investigated the impact of stroke on the patient's daily life and the course of functional status over time. A community-based cohort of stroke patients was examined with the Barthel ADL Index and the Sickness Impact Profile at fixed intervals post-stroke. Data were compared with those of an elderly control group in the community. The scores of the stroke group on all the subscales of the SIP were much worse than in the control group. The differences were greatest for house management, recreation/pastime and mobility. While there was significant improvement of the mean Barthel score between 8 and 26 weeks post-stroke, the mean SIP scores at these intervals did not change, with the exception of the subscale house management, which showed some improvement. It would appear that the impact of stroke on daily life is greatest in the fields of house management, recreation/pastime and mobility.

Activities of Daily Living↗