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      The Importance of the Built Environment in Person-Centred Rehabilitation at Home: Study Protocol

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          Abstract

          Health services will change dramatically as the prevalence of home healthcare increases. Only technologically advanced acute care will be performed in hospitals. This—along with the increased healthcare needs of people with long-term conditions such as stroke and the rising demand for services to be more person-centred—will place pressure on healthcare to consider quality across the continuum of care. Research indicates that planned discharge tailored to individual needs can reduce adverse events and promote competence in self-management. However, the environmental factors that may play a role in a patient’s recovery process remain unexplored. This paper presents a protocol with the purpose to explore factors in the built environment that can facilitate/hinder a person-centred rehabilitation process in the home. The project uses a convergent parallel mixed-methods design, with ICF (International Classification of Functioning, Disability and Health) and person–environment theories as conceptual frameworks. Data will be collected during home visits 3 months after stroke onset. Medical records, questionnaires, interviews and observations will be used. Workshops will be held to identify what experts and users (patients, significant others, staff) consider important in the built environment. Data will be used to synthesise the contexts, mechanisms and outcomes that are important to support the rehabilitation process at home.

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          Global stroke statistics.

          Background Up to date data on incidence, mortality, and case-fatality for stroke are important for setting the agenda for prevention and healthcare. Aims and/or hypothesis We aim to update the most current incidence and mortality data on stroke available by country, and to expand the scope to case-fatality and explore how registry data might be complementary. Methods Data were compiled using two approaches: (1) an updated literature review building from our previous review and (2) direct acquisition and analysis of stroke events in the World Health Organization (WHO) mortality database for each country providing these data. To assess new and/or updated data on incidence, we searched multiple databases to identify new original papers and review articles that met ideal criteria for stroke incidence studies and were published between 15 May 2013 and 31 May 2016. For data on case-fatality, we searched between 1980 and 31 May 2016. We further screened reference lists and citation history of papers to identify other studies not obtained from these sources. Mortality codes for ICD-8, ICD-9, and ICD-10 were extracted. Using population denominators provided for each country, we calculated both the crude mortality from stroke and mortality adjusted to the WHO world population. We used only the most recent year reported to the WHO for which both population and mortality data were available. Results Fifty-one countries had data on stroke incidence, some with data over many time periods, and some with data in more than one region. Since our last review, there were new incidence studies from 12 countries, with four meeting pre-determined quality criteria. In these four studies, the incidence of stroke, adjusted to the WHO World standard population, ranged from 76 per 100,000 population per year in Australia (2009-10) up to 119 per 100,000 population per year in New Zealand (2011-12), with the latter being in those aged at least 15 years. Only in Martinique (2011-12) was the incidence of stroke greater in women than men. In countries either lacking or with old data on stroke incidence, eight had national clinical registries of hospital based data. Of the 128 countries reporting mortality data to the WHO, crude mortality was greatest in Kazhakstan (in 2003), Bulgaria, and Greece. Crude mortality and crude incidence of stroke were both positively correlated with the proportion of the population aged ≥ 65 years, but not with time. Data on case-fatality were available in 42 studies in 22 countries, with large variations between regions. Conclusions In this updated review, we describe the current data on stroke incidence, case-fatality and mortality in different countries, and highlight the growing trend for national clinical registries to provide estimates in lieu of community-based incidence studies.
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            Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review

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              Validity of EQ-5D-5L in stroke

              Purpose To assess EQ-5D-5L (5L) validity in patients with acute stroke, in comparison with EQ-5D-3L (3L). Methods Cross-sectional study of 408 patients during index hospitalization. We compared 5L and 3L in terms of feasibility, frequency of unique health states, ceiling effect and discriminatory power (informativity). We assessed construct validity in terms of known-groups validity and convergent validity of 5L dimensions with other stroke outcome measures. Results The overall proportion of patients with acute stroke reporting ‘no problems’ with 3L—6.1 % was further reduced to 5.6 % with 5L (relative reduction of 8.2 %). The highest improvement in relative discriminatory power, when moving from 3L to 5L, was noticed in pain/discomfort and anxiety/depression dimensions (Shannon Evenness Index 0.91 for both 5L dimensions; relative increase 34.4 and 29.1 %, respectively). Known-groups validity tests confirmed prior hypotheses: Health state utilities were lower in following subpopulations—females, patients with high modified Rankin Scale (mRS) score, low Barthel Index (BI) or VAS score, patients with subarachnoid hemorrhage or intracerebral hemorrhage, and when proxy respondent was used. Convergence of EQ-5D-5L dimensions with mRS, BI and EQ VAS was improved or at least the same as for 3L dimensions. Conclusions Results support the validity of the EQ-5D-5L descriptive system as a generic health outcome measure in patients with acute stroke, demonstrating some psychometric advantages in comparison with EQ-5D-3L.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                06 July 2019
                July 2019
                : 16
                : 13
                : 2409
                Affiliations
                [1 ]School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden
                [2 ]Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, SE-141 83 Huddinge, Sweden
                [3 ]Karolinska University Hospital, SE-141 86 Stockholm, Sweden
                [4 ]Skåne University Hospital, Department of Neurology and Rehabilitation Medicine, 221 85 Lund, Sweden
                [5 ]Lund University, Department of Clinical Sciences Lund, Neurology, 221 84 Lund, Sweden
                [6 ]Arkitektur och samhällsbyggnadsteknik, Byggnadsdesign, ACE, Chalmers University, SE-412 96 Gothenburg, Sweden
                [7 ]KU Leuven, Department of Architecture, Research[x]Design, 3001 Leuven, Belgium
                Author notes
                [* ]Correspondence: mky@ 123456du.se ; Tel.: +46-(0)708446397
                Author information
                https://orcid.org/0000-0003-2887-3674
                https://orcid.org/0000-0002-8560-3016
                https://orcid.org/0000-0002-0163-4748
                https://orcid.org/0000-0003-3704-8887
                https://orcid.org/0000-0001-6811-3464
                https://orcid.org/0000-0001-7044-8896
                Article
                ijerph-16-02409
                10.3390/ijerph16132409
                6651011
                31284620
                85913e18-cb5d-4d95-be06-d7c27b37eb55
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 22 May 2019
                : 04 July 2019
                Categories
                Protocol

                Public health
                rehabilitation,person-centred care,person–environment fit,mixed-methods design,housing

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