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T B Wyller

Publications and source records attributed to T B Wyller.

34 records · Page 2Linked to original sources
PubMed1997

Subjective well-being one year after stroke.

OBJECTIVE: To compare the subjective well-being of stroke patients with that of a reference group, and to study its relationship to patient characteristics. DESIGN: Cross-sectional study. SETTING: Interviews performed in the respondents' homes, tests performed at the outpatient clinic. SUBJECTS: Sixty patients one year after stroke (median age 74 years, interquartile range (IQR) 68-80), and 419 reference individuals (median age 75 years, IQR 71-80). MEASURES: Subjective well-being assessed with the General Health Questionnaire (GHQ-20). Explanatory variables were demographic and medical characteristics of the individuals and scores on validated tests: Barthel Index, Frenchay Activities Index (FAI), Sødring Motor Evaluation of Stroke Patients, Assessment of Cerebral Stroke and other Brain Damage, and Mini-Mental State Examination (MMSE). RESULTS: A significantly higher proportion of the stroke patients than of the controls rated their subjective well-being as low, also after adjustment for age and gender (adjusted odds ratio 20.1, 95% confidence interval 9.6-42.0 by logistic regression). In bivariate analyses, leg and arm motor impairment, visuospatial impairment, apraxia, aphasia, low Barthel score, low FAI score, low MMSE score, and institutionalization were highly significant predictors of low subjective well-being (p-values < 0.01). In multiple linear regression, a model with gender (p = 0.3) and upper extremity motor score (p < 0.01) fitted the data well, and explained 48% of the variance in GHQ. CONCLUSION: Subjective well-being is decreased one year after stroke, and this is mainly attributed to arm motor impairments.

Activities of Daily Living↗
PubMed1997

Are there gender differences in functional outcome after stroke?

PURPOSE: To study gender differences in functional outcome unexpectedly observed in a follow-up study of stroke patients. DESIGN: Prospective study of hospitalized stroke patients, with evaluations in the subacute phase and after one year. SETTING: Geriatric and general medical wards, and geriatric outpatient clinic of a university hospital serving as general hospital for a defined population. SUBJECTS: All stroke patients admitted during a six-month period (n = 165) were considered for inclusion, of whom 87 could be assessed in the subacute phase and 65 after one year. MAIN OUTCOME MEASURES: Motor function assessed by the Sødring Motor Evaluation of Stroke Patients; cognitive function by the Assessment of Stroke and other Brain Damage; and activities of daily living (ADL) function by the Barthel Index. Nursing-home residency registered after one year. RESULTS: Men achieved a significantly better score than women on most of the scales used. The age-adjusted odds for a man to have a higher Barthel score than a woman was 3.1 (95% confidence interval (CI) 1.3-7.0) in the subacute phase and 3.3 (95% CI 1.2-9.0) after one year. Differences of the same magnitude were seen on the subscales of the motor and cognitive tests. The same trend was observed on all items of the Barthel Index. The males had a lower likelihood to be permanent nursing-home residents after one year, the age-adjusted odds ratio for nursing-home residency for females versus males being 6.3 (95% CI 1.2-65.3). CONCLUSION: Women seem to be functionally more impaired by stroke than men.

Activities of Daily Living↗
PubMed1997

Disability models in geriatrics: comprehensive rather than competing models should be promoted.

The usefulness of different models of disability is discussed. There is no clear-cut demarcation between ability and disability, and a person's functional abilities are highly dependent on societal as well as individual factors. One should not, however, promote models of disability that cover only the social aspects, but rather try to build comprehensive models including medical, psychological and social aspects of disability. The World Health Organization's International Classification of Impairments, Disabilities and Handicaps (ICIDH) provides a useful basis for such model building. The main weakness of the ICIDH is that it fails to take the subjective perceptions of the individual fully into account. Accordingly, it should be supplemented by some model of subjective well-being. Possible relationships between subjective well-being and the ICIDH concepts are discussed.

Aged↗
PubMed1996

[Treatment of hyperactivity and attention deficit with amphetamine. Experience with five adult prisoners].

Attention deficit hyperactivity disorder (ADHD) is a fairly common syndrome within child psychiatry. Stimulant medication is an important part of the treatment of the disorder. According to the literature, 30-50% of children with ADHD will still suffer from symptoms when they reach adulthood. The syndrome is a risk factor for various psychiatric disorders, drug and alcohol abuse, and criminality. There is some evidence that even adult patients may benefit from stimulant medication. ADHD was diagnosed and stimulant medication was started in five adult men who had been imprisoned for serious crimes of violence. The response to treatment was good in all of them. After 4-6 years two had been successfully rehabilitated.

Adult↗
PubMed1996

The Frenchay Activities Index in stroke patients: agreement between scores by patients and by relatives.

The aim of the study was to compare stroke patients' own scorings of the Frenchay Activities Index with scorings based on interviews with their nearest relatives. Fifty-two patients and relatives were interviewed separately 1 year after the stroke. The mean sumscore based upon information from the patients was 29.0, and that based upon the relatives' replies was 27.7 (mean difference 1.4, 95% confidence interval (CI) -0.1 to 2.8). The Kendall tau B correlation between the two sumscores was 0.72 (95% CI 0.63 to 0.81). In half of the patients the two sumscores differed by four points or more, and in every fourth the two sumscores differed by six points or more. The weighted kappa for the single items varied between 0.36 and 0.89. No characteristics of patients or relatives were identified that were related to disagreement between the two scores.

Activities of Daily Living↗
PubMed1996

Predictive validity of the Sødring Motor Evaluation of Stroke Patients (SMES).

The Sødring Motor Evaluation of Stroke Patients (SMES) has been developed as an instrument for the evaluation by physiotherapists of motor function and activities in stroke patients. The predictive validity of the instrument was studied in a consecutive sample of 93 acute stroke patients, assessed in the acute phase and after one year. The outcome measures were: survival, residence at home or in institution, the Barthel ADL index (dichotomized at 19/20), and the Frenchay Activities Index (FAI) (dichotomized at 9/10). The SMES, scored in the acute phase, demonstrated a marginally significant predictive power regarding survival, but was a highly significant predictor regarding the other outcomes. The adjusted odds ratio for a good versus a poor outcome for patients in the upper versus the lower tertile of the SMES arm subscore was 5.4 (95% confidence interval 0.9-59) for survival, 11.5 (2.1-88) for living at home, 86.3 (11-infinity) for a high Barthel score, and 31.4 (5.2-288) for a high FAI score. We conclude that SMES has high predictive validity.

Activities of Daily Living↗
PubMed1995

[Rehabilitation of stroke patients--does it have an effect?].

A search of the literature was carried out in order to identify controlled trials to study the effect of rehabilitation after a stroke. A limited number of studies have been published, and many are of poor quality. Making the organization of rehabilitation more efficient, emphasizing early start of rehabilitation, and close cooperation between the involved health professionals and an improvement of their competence have the best documented effect on mortality and on the percentage of patients who return home. There is also evidence that retraining of motor function and of language skills is effective. Rehabilitation seems to lead to more rapid recovery and a better result overtime. However, the achieved functional level may decline when the rehabilitational efforts are scaled down. The effect of rehabilitation on sensory and cognitive functioning is poorly documented.

Activities of Daily Living↗
PubMed1995

The Barthel ADL index: factor structure depends upon the category of patient.

The validity and reliability of the Barthel index were studied in 60 geriatric patients, 87 stroke patients, and 102 patients with hip fracture, using a factor analysis methodology which explicitly accounts for the ordinal nature of the scoring on each item. The findings substantiate that the Barthel index is unidimensional among stroke patients, but not among geriatric patients or patients with hip fracture. In the latter two groups, one factor related to mobility, the other to bodily functions. A sum-score to characterize geriatric and hip fracture patients does not take into account the complex structure of the Barthel index.

Activities of Daily Living↗
PubMed1995

The Barthel ADL index one year after stroke: comparison between relatives' and occupational therapist's scores.

The activities of daily living of 54 patients 1 year after stroke were rated with the Barthel Index by an occupational therapist (OT). A physician independently rated the same patients from interviews with their nearest relative. The mean sum-score obtained by the doctor was 16.7, while the mean sum-score obtained by the OT was 17.1. In more than 80% of the patients, the difference in sum-score was two points or less, which was considered to reflect acceptable agreement. Weighted kappa values of each item varied between 0.42 and 0.92, indicating moderate agreement for the items 'grooming' and 'bladder' and good or very good agreement for the other items. There was a statistically significant bias in the bladder item; the doctor's score being lower than that of the OT. The other items showed no significant bias. The probability of disagreement between the two raters increased with the patient's age; no other factors were found to be related to disagreement.

Activities of Daily Living↗
PubMed1995

Description and validation of a test of motor function and activities in stroke patients. The Sødring Motor Evaluation of Stroke Patients.

A new method (The Sødring Motor Evaluation of Stroke Patients) has been developed for physiotherapists to evaluate motor function and activities in stroke patients. Its main characteristics are the assessment of motor activity without assisting the patient, and the use of a rating which reflects quantity as well as quality in motor performance. A hospitalised group of stroke patients (n = 93) was assessed three times after the acute event, by means of SMES. The data were analysed regarding construct validity as well as concurrent validity against another assessment method. Factor analyses showed a reasonably stable three-factor pattern ("arm", "gross motor function", and "leg") which explained 84, 89 and 90%, respectively, of the variance at the three study points, with Factor 1 ("arm") as the dominant factor. The ordinality of the rating scale was assessed by means of linear regression analysis and found to be acceptable. The correlation coefficients were high between comparable parts of the new and the reference methods.

Aged↗
PubMed1992

Lifestyle factors and risk of cerebral infarction.

BACKGROUND AND PURPOSE: We evaluated the impact of lifestyle factors on the risk of ischemic stroke. METHODS: We used a nested case-control design. The cases comprised 163 persons (median age 69 years) admitted to a stroke unit and diagnosed with acute cerebral infarction. All cases had earlier participated in the North Trøndelag Health Survey. The controls comprised 567 participants from the North Trøndelag Health Survey, matched by sex and year of birth. RESULTS: Raised systolic (p less than 0.001) and diastolic (p = 0.02) blood pressure, antihypertensive treatment (p less than 0.001), previous myocardial infarction (p less than 0.001), prior stroke (p = 0.002), diabetes (p less than 0.001), and former daily smoking (p = 0.02) were identified as significant risk factors by univariate conditional logistic regression. No difference in risk was detected at different levels of alcohol consumption, salt intake, physical activity, or body mass index. Current smokers had virtually the same risk as nonsmokers. No association was found between stroke and the number of cigarettes smoked per day or the number of years of smoking. Multivariate conditional logistic regression identified diabetes (p = 0.002), raised systolic blood pressure (p less than 0.001), and former daily smoking (p = 0.01) as significant and independent risk factors. Previous myocardial infarction (p = 0.07), previous stroke (p = 0.1), and current daily smoking (p = 0.1) were of marginal significance. CONCLUSIONS: The established medical risk factors for stroke are confirmed. With the possible exception of smoking, we have not identified any lifestyle factor with a significant impact on the risk of ischemic stroke.

Case-Control Studies↗
PubMed1991

[Dependence on carisoprodol (Somadril)? A prospective withdrawal study among prisoners].

Carisoprodol (Somadril) was gradually withdrawn for a fortnight in nine male prisoners who had been taking daily doses of from 700 to 2,100 mg for at least nine months. The patients were assessed clinically during the withdrawal period, with special attention to the occurrence of abstinence symptoms. Most of the patients reported mental distress, such as anxiety, insomnia and irritability. Cranial and muscular pain and vegetative symptoms were also frequently reported. Most of these symptoms were transient, and no seizures or psychotic reactions occurred. Our information from drug addicts indicates that carisoprodol can be misused as a narcotic. The occurrence of abstinence symptoms during withdrawal supports this supposition. We propose a more gradual reduction of the doses when terminating medication with carisoprodol in general practice.

Adult↗
PubMedDate not supplied

Stroke and gender.

The literature regarding gender-specific aspects of cerebrovascular diseases is quite sparse. It is well-documented that the incidence of stroke is higher in men than in women in all age classes, and women are, on average, several years older than men when they suffer their first stroke. The prevalence of stroke is higher among men up to the age of approximately 80 years, after which it becomes higher in women. A majority of studies indicate that the case-fatality rate is higher in female than in male stroke patients; there is also some evidence, albeit relatively weak, indicating a better functional outcome in men. Gender differences in risk factor profile and treatment response appear to be weak. The burden of providing informal care to stroke patients seems to constitute a threat to the mental health of the caregivers, who are predominantly women.

Caregivers↗