Accelerometer-measured physical activity at 3 months as a predictor of symptoms of depression and anxiety 1 year after stroke: a multicentre prospective cohort study in central Norway.

OBJECTIVES: To study sedentary behaviour and physical activity at 3 months as predictors for symptoms of depression and anxiety at 1-year post-stroke. DESIGN: A prospective cohort study. PATIENTS: Patients with first-ever ischaemic stroke. METHODS: Mood was assessed 3- and 12-months post-stroke using the Hospital Anxiety and Depression Scale. Sedentary behaviour and physical activity were measured using accelerometry 3 months post-stroke. RESULTS: A total of 292 participants (116 (39.7%) females; mean age 71.7 (standard deviation 11.3) years) were included. At 12 months, 16.7% experienced depression and 19.5% anxiety, respectively. Adjusting for age and sex, regression analysis showed that comorbidity burden (ß 0.26; 95% confidence interval (95% CI) 0.02, 0.51; p = 0.038), stroke severity (ß 0.22; 95% CI 0.10, 0.35; p = 0.001), functional disability (ß 0.89, 95% CI 0.49, 1.30; p = 0.000), and global cognition (ß-0.15; 95% CI -0.25, -0.05; p = 0.004) predicted depression. Multi-adjusted analysis showed sedentary behaviour and physical activity did not significantly predict depression or anxiety (p > 0.05). CONCLUSION: Sedentary behaviour and physical activity did not significantly predict mood after stroke. Comorbidity burden, stroke severity, functional disability, and global cognition were identified as possible predictors of depression. More research is needed to determine the impact of physical activity on depression and anxiety symptoms.

Factors contributing to post-stroke health care utilization and costs, secondary results from the life after stroke (LAST) study.

BACKGROUND: The result from the Life After Stroke (LAST) study showed that an 18-month follow up program as part of the primary health care, did not improve maintenance of motor function for stroke survivors. In this study we evaluated whether the follow-up program could lead to a reduction in the use of health care compared to standard care. Furthermore, we analyse to what extent differences in health care costs for stroke patients could be explained by individual need factors (such as physical disability, cognitive impairment, age, gender and marital status), and we tested whether a generic health related quality of life (HRQoL) is able to predict the utilisation of health care services for patients post-stroke as well as more disease specific indexes. METHODS: The Last study was a multicentre, pragmatic, single-blinded, randomized controlled trial. Adults (age ≥ 18 years) with first-ever or recurrent stroke, community dwelling, with modified Rankin Scale < 5. The study included 380 persons recruited 10 to 16 weeks post-stroke, randomly assigned to individualized coaching for 18 months (n = 186) or standard care (n = 194). Individual need was measured by the Motor assessment scale (MAS), Barthel Index, Hospital Anxiety and Depression Scale (HADS), modified Rankin Scale (mRS) and Gait speed. HRQoL was measured by EQ-5D-5 L. Health care costs were estimated for each person based on individual information of health care use. Multivariate regression analysis was used to analyse cost differences between the groups and the relationship between individual costs and determinants of health care utilisation. RESULTS: There were higher total costs in the intervention group. MAS, Gait speed, HADS and mRS were significant identifiers of costs post-stroke, as was EQ-5D-5 L. CONCLUSION: Long term, regular individualized coaching did not reduce health care costs compared to standard care. We found that MAS, Gait speed, HADS and mRS were significant predictors for future health care use. The generic EQ-5D-5 L performed equally well as the more detailed battery of outcome measures, suggesting that HRQoL measures may be a simple and efficient way of identifying patients in need of health care after stroke and targeting groups for interventions. TRIAL REGISTRATION: https://www.clinicaltrials.govNCT01467206. The trial was retrospectively registered after the first 6 participants were included.

Stroke in Norway 2015­16 ­ treatment and outcomes. / Hjerneslag i Norge 2015­16 ­ behandling og resultater.

BACKGROUND: Treatment of stroke in Norway is decentralised; patients with stroke are treated at 50 different hospitals. We have surveyed the treatment of stroke in these hospitals and collated this with data from the Norwegian Stroke Registry. We wished to investigate whether there was any variation in treatment interventions and treatment outcomes between university hospitals and local hospitals. MATERIAL AND METHOD: A questionnaire survey among all Norwegian hospitals examined treatment interventions and resource availability. Data from the Norwegian Stroke Registry in 2015-2016 (n = 17 183) were used to compare patient characteristics and treatment outcomes for patients in university hospitals (n = 5 312) and local hospitals (n = 11 871). Treatment quality was measured using the quality indicators in the Norwegian Stroke Registry. RESULTS: The median age in the university hospitals was 75 years (interquartile range 65-83), and 44.1% of the patients were women. The median age in the local hospitals was 76 years (interquartile range 67-85); 46.7% women. Goal achievement on five out of ten quality indicators was high; for example, more than 90% of the patients were treated in a stroke unit, irrespective of the type of hospital. At the university hospitals, 1 038 (19.0%) of patients received thrombolytic therapy, compared to 1 612 (17.2%) in the local hospitals. Adjusted for age and level of consciousness, the probability of being self-reliant three months after the stroke was higher in local hospitals (OR 1.15, CI 1.04-1.27). INTERPRETATION: The decentralised stroke treatment in Norway accomplishes high and moderate goal achievement on the Norwegian Stroke Registry's quality indicators. The quality of treatment in local hospitals appears to be equally good or better than that provided in university hospitals.