Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Sep 2011
Reliability and validity of COOP/WONCA functional health status charts for stroke patients in primary care.
Dartmouth Coop Functional Health Assessment/World Organization of National Colleges, Academies and Academic Association of General Practitioners (COOP/WONCA) functional health assessment charts depict levels of function/well being along 5-point ordinal scales in 6 domains. Responses, illustrated by drawings, make these charts a suitable tool for the stroke population, given the high prevalence (20%) of language impairment in this population. This study examined the validity and reliability of COOP/WONCA charts for community-dwelling stroke survivors. ⋯ Discriminative ability for independent ambulation and clinical depression was demonstrated (U = 103.5, P < .001; U = 156, P = .015). Test-retest reliability in each domain except Changes in Health was significant at P < .05 (Kendall's τ-b, 0.344-0.653). Our data indicate that the COOP/WONCA Functional Health charts demonstrate good validity and overall reliability for use with stroke patients in primary care.
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J Stroke Cerebrovasc Dis · Sep 2011
Multicenter StudyFactors influencing cooperation among healthcare providers in a community-based stroke care system in Japan.
Community-based stroke care in Japan is currently provided in acute hospitals, convalescent rehabilitation units, general practices, sanatorium-type wards, nursing care facilities, and in-home/commuting care services. We conducted a nationwide survey to identify factors influencing cooperation among the various providers of community-based stroke care. We sent questionnaires to 11,178 facilities and assessed the independent variables of excellent and fair cooperation among the care providers. ⋯ The following independent variables were inversely associated with excellent or fair cooperation in the community: area with the higher population density among 3 groups divided by tertile threshold (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.41-0.69), facilities covered by long-term care insurance (OR, 0.27; 95% CI, 0.22-0.34), and insufficient communication with local government (OR, 0.19; 95% CI, 0.14-0.24). Positive independent variables of excellent or fair cooperation were the sharing of patient information in the community (OR, 2.53; 95% CI, 1.78-3.66), use of a scale for assessing activities of daily living (OR, 1.93; 95% CI, 1.42-2.63), appropriate utilization of care support managers (OR, 1.91; 95% CI, 1.43-2.55), and adequate comprehension of the long-term care insurance system (OR, 1.54; 95% CI, 1.24-1.92). Our findings suggest that improved communication between healthcare providers and local government, along with appropriate attention to the problems facing providers covered by long-term care insurance, may improve community-based stroke care in Japan.
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J Stroke Cerebrovasc Dis · Sep 2011
Multicenter StudyIs cognitive functioning 1 year poststroke related to quality of life domain?
Previous studies on the association between poststroke cognitive impairment and quality of life (QoL) have shown divergent results. In this study, we investigated the relationships between cognitive functioning and various QoL domains at 1 year poststroke. This was a cross-sectional study, examining 92 patients at 1 year poststroke. ⋯ Controlling for demographic factors and motor impairments resulted in negligible percentages of variance additionally explained by cognitive functioning. The percentages of explained variance were somewhat lower in the analyses with the separate cognitive domains and not significant for depression. Poor cognitive functioning was associated with reduced functional independence, social participation, depressive mood, and life satisfaction 1 year post; however, motor impairment was a stronger determinant of long-term QoL than cognitive functioning.