Frenchay Activities Index Research Articles

Activity among long-term stroke survivors. A study based on an ICF-oriented analysis of two established ADL and social activity instruments

Purpose: To describe activity in different aspects of daily life among long-term stroke survivors, and conceptualise the content of the Barthel Index (BI) and the Swedish extended and modified Frenchay Activities Index (mFAI) using the ICF framework.Method: Assessments were performed by means of the BI and the mFAI at a 10-year follow-up of 145 consecutive stroke survivors from Lund Stroke Register, Sweden. After linking the two instruments to the ICF core set for stroke, data were analysed and presented in terms of activity-specific domain-scores for the total sample and sub-groups according to gender and age.Results: Together the two instruments covered 69% of the Activities and participation component of the ICF core set for stroke. Two activity-specific domains were identified within the BI and six within the mFAI. Most participants reported a high overall activity level. Inactivity was most common among those ≥80 years. Men and women participated in different types of activities and used different modes of transport.Conclusions: Long-term stroke survivors have a high activity level in daily life, though individual variation is considerable. The structure provided by linking instruments to the ICF core set for stroke can be used for more fine-tuned descriptions of activity.Implications for RehabilitationSince most long-term stroke survivors are independent in ADL but may have limitations in other activity domains such as social and leisure activities, these aspects should be considered in the rehabilitation process.Older stroke survivors deserve special attention due to their higher risk of long-term inactivity.The Barthel Index and the Swedish extended and modified Frenchay Activities Index are complementary for assessments of ADL and social activity after stroke and cover over two thirds of the Activities and participation component in the ICF core set for stroke.

The effects a respiration rehabilitation program on IADL, satisfaction with leisure, and quality of sleep of patients with chronic obstructive pulmonary disease.

[Purpose] This study was designed to determine the effect of a respiration rehabilitation program on daily activities, satisfaction with leisure, and quality of sleep of patients with chronic obstructive pulmonary disease. [Subjects and Methods] The program was conducted three times a week for 12 weeks (a total of 36 times) with 20 patients aged between 50 and 70 years old. The Frenchay Activity Index was used to determine the instrumental activities of daily living before and after the intervention. The Korean scale of satisfaction with leisure was employed to determine the satisfaction with leisure, and the Korean version of the Pittsburgh Sleep Quality Index was used to measure the quality of sleep. [Results] The total score of all three instruments (instrumental activities of daily living (IADL), satisfaction with leisure, and quality of sleep) improved significantly after the intervention. [Conclusion] In conclusion, the scores of all three instruments (IADL, satisfaction with leisure, and quality of sleep) improved significantly after the intervention, indicating that the respiration rehabilitation program was effective at improving the overall quality of life for patients with chronic obstructive pulmonary disease.

Measuring outcome after cardiac arrest: construct validity of Cerebral Performance Category

IntroductionApproximately half of the survivors of cardiac arrest have cognitive impairments due to hypoxic brain injury. To describe the outcome after a cardiac arrest, the Cerebral Performance Category (CPC) is frequently used. Although widely used, its validity is still debatable. ObjectiveTo investigate the construct validity of the Cerebral Performance Category in survivors of a cardiac arrest.Participants were 18 years and older that survived a cardiac arrest more than six months. MethodsCross-sectional design. A method to administer the CPC in a structured and reproducible manner was developed. This ‘Structured CPC’ was administered by a structured interview. Construct variables were Cognitive Failure Questionnaire (CFQ), Barthel Index (BI), Frenchay Activity Index (FAI), Community Integration Questionnaire (CIQ) and Quality of Life after Brain Injury (Qolibri). Associations were tested based on Spearman correlation coefficients. ResultsA total of 62 participants responded. In 58 (94%) patients the CPC was determined, resulting in CPC 1 (48%), CPC 2 (23%) and CPC 3 (23%). The CPC-scoring correlated significantly with the CFQ (r=−0.40); BI (r=−0.57); FAI (r=−0.65), CIQ (r=−0.53) and Qolibri (r=−0.67). Discussion and conclusionsIn this study we developed the ‘Structured CPC’ to improve the transparency and reproducibility of the original CPC. A moderate correlation between the ‘Structured CPC’ and the constructs ‘activities’, ‘participation’ and ‘quality of life’ confirmed the validity of the ‘Structured CPC’. Clinical messageThe ‘Structured CPC’ can be used as an instrument to measure the level of functioning after cardiac arrest.

Participation in Complex and Social Everyday Activities Six Years after Stroke: Predictors for Return to Pre-Stroke Level.

BackgroundLong-term disability following stroke can lead to participation restrictions in complex and social everyday activities, yet information is lacking on to what extent stroke survivors return to their pre-stroke levels of participation.ObjectivesThe objectives of this study were to investigate the level of participation in complex and social everyday activities 6 years after stroke, to compare this with pre-stroke participation and to identify predictors of returning to pre-stroke levels of participation.MethodAll patients admitted to Karolinska University Hospital's stroke units during a 1-year period were eligible to participate and 349 patients were recruited. Assessments were made at base-line, 3 months and 6 years using self-reported outcome measures. Participation was assessed using the Frenchay Activities Index (FAI). The 6-year score for each participant was compared to the pre-stroke score, both for the total score and for each domain (domestic chores, leisure/work and outdoor activities). Predictors of having the same or better level of participation at 6 years were identified using logistic regression.ResultsAt 6 years, 121 participants were followed up, 166 were deceased, 44 declined to take part and 18 could not be traced. At 6 years 84% could be described as active (FAI≥15). The same level of participation or better than pre-stroke was found in 35% of participants, in 65% the level was lower. Similar predictors were identified for achieving the same or better level of participation at 6 years for FAI total and the three domains; ability to walk without aids and a lower age at stroke onset, and perceived mobility, participation and recovery at 3 months.ConclusionSix years after stroke, 35% of participants had the same or better level of participation as pre-stroke. Rehabilitation after stroke to improve walking ability and participation might improve long-term participation in complex and social everyday activities.

Longitudinal follow-up study on fear of falling during and after rehabilitation in skilled nursing facilities.

BackgroundFear of falling (FoF) is regarded as a major constraint for successful rehabilitation in older people. However, few studies have investigated FoF in vulnerable older people who rehabilitate in a skilled nursing facility (SNF). Therefore, this study measures the prevalence of FoF during and after rehabilitation and assesses differences between those with and without FoF. The relation between FoF and instrumental activities of daily living (IADL) after discharge was also assessed.MethodsIn this longitudinal follow-up study, patients who rehabilitated in a SNF were assessed at admission and at 4 weeks after discharge. A one-item instrument was used to measure FoF at admission; based on their answer, the patients were divided into groups with no FoF and with FoF. To study FoF after discharge, the one-item instrument and the short Falls Efficacy Scale-International (FES-I) were used. IADL after discharge was assessed with the Frenchay Activities Index (FAI).ResultsOf all participants, 62.5 % had FoF at admission. The participants with FoF were older, more often female, and had a higher average number of falls per week, more depressive symptoms and a lower level of self-efficacy. Four weeks after discharge, 82.1 % of the participants had FoF. IADL after discharge was considerably lower in patients with FoF (FAI of 27.3 vs. 34.8; p = 0.001).ConclusionsFoF is common among older persons who rehabilitate in SNF. FoF seems to be persistent and may even increase after rehabilitation, thereby hampering IADL after discharge. Interventions are needed to reduce FoF to ensure better outcomes in older patients rehabilitating in a SNF.

Impact of a Dance Programme on Health and Well-Being for Community Dwelling Adults Aged 50 Years and Over

ABSTRACTAims: The study examined the impact of a 6-week dance programme on frequency of activity participation, falls efficacy, and quality of life for community dwelling adults aged 50 years and over. It also explored participants’ perceptions of the programme impact and delivery. Methods: The programme was delivered by two dance instructors and targeted community dwelling adults aged 50 years and over, who were independently mobile. Sixty-two participants were recruited and provided baseline data. Thirty-five participants provided immediate follow-up data. Outcome measures were conducted at baseline and immediately post-intervention. Measures included frequency of participation in activities (The Frenchay Activities Index); falls efficacy (Falls Efficacy Scale- International); and quality of life (EQ-5D-3L). Focus groups explored participants’ perceptions of the programme. Results: Significant differences were found post-programme in frequency of activity participation (p = 0.036), including domestic activity (p = 0.048). No significant differences were found in falls efficacy or quality of life. Focus group data indicated participants enjoyed the programme and perceived enhanced physical abilities, emotional and psychological well-being and increased activity participation as a result of programme participation. Conclusion: Findings suggest that a dance programme may increase activity participation in social and community-based activities, however given the study limitations, further research is required to corroborate this.

Longitudinal functional changes, depression, and health-related quality of life among stroke survivors living at home after inpatient rehabilitation.

This study investigated changes in functional status in home-dwelling stroke survivors 1-3 years after inpatient rehabilitation. It also examined the factors associated with longitudinal functional changes and health-related quality of life. Survey evaluations were conducted at the homes of 27 stroke survivors. The Functional Independence Measure (FIM), Short Form 36, Frenchay Activities Index, and Hamilton Depression Rating Scale were used to assess functional status, quality of life, social activity, and depression symptoms, respectively. From the time of discharge to follow-up (mean: 2.1 ± 0.6 years), total FIM and motor FIM scores were mildly improved, and cognitive FIM score was significantly improved. On the Short Form 36, physical functioning, general health, and vitality scores were lower than norm-based scores. Multiple regression analyses showed a positive association between change in motor FIM score and Frenchay Activities Index score and a negative association between change in cognitive FIM score and elapsed time after discharge. With regard to health-related quality of life, motor FIM score was associated with the physical component summary, whereas age and Hamilton Depression Rating Scale score were associated with the mental component summary. Social participation was associated with long-term improvement in activities of daily living, indicating that interventions targeting social function are important for maintaining and further improving activities of daily living in stroke survivors. Health-related quality of life was correlated with activities of daily living and depression; therefore, interventions targeting these parameters are important in improving the quality of life of stroke survivors.

OPTIMAL, an occupational therapy led self-management support programme for people with multimorbidity in primary care: a randomized controlled trial.

BackgroundWe investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting.MethodsPragmatic feasibility randomised controlled trial including fifty participants with multimorbidity recruited from family practice and primary care settings. OPTIMAL is a six-week community-based programme, led by occupational therapy facilitators and focuses on problems associated with managing multimorbidity. The primary outcome was frequency of activity participation. Secondary outcomes included self-perception of, satisfaction with and ability to perform daily activities, independence in activities of daily living, anxiety and depression, self-efficacy, health-related quality of life, self-management support, healthcare utilisation and individualised goal attainment. Outcomes were collected within two weeks of intervention completion.ResultsThere was a significant improvement in frequency of activity participation, measured using the Frenchay Activities Index, for the intervention group compared to the control group (Adjusted Mean Difference at follow up 4.22. 95% Confidence Interval 1.59-6.85). There were also significant improvements in perceptions of activity performance and satisfaction, self-efficacy, independence in daily activities and quality of life. Additionally, the intervention group demonstrated significantly higher levels of goal achievement, following the intervention. No significant differences were found between the two groups in anxiety, depression, self-management scores or healthcare utilisation.ConclusionsOPTIMAL significantly improved frequency of activity participation, self-efficacy and quality of life for patients with multimorbidity. Further work is required to test the sustainability of these effects over time but this study indicates that it is a promising intervention that can be delivered in primary care and community settings.Trial registrationTrial Number: ISRCTN67235963

Abstract T P124: Psychometric Properties of the Chinese Version of the Stroke Specific Quality of Life Scale in Community-Dwelling Stroke Survivors

Introduction: Health-related quality of life is a significant outcome of stroke survivors’ recovery. The 49-item English version of the Stroke Specific Quality of Life Scale (SSQOL) (Williams et al., 2009) is a stroke-specific assessment of stroke survivors’ health-related quality of life in 12 domains. However there has been no Chinese version of the scale for Chinese stroke survivors in Hong Kong. Aim: To examine the reliability and validity of the Chinese version of Stroke Specific Quality of Life Scale (SSQOL-C) in stroke survivors. Methods: SSQOL was translated into Chinese and blind back-translated by independent bilingual baccalaureate nursing students. Content validity was reviewed by an expert panel which consisted of one nurse academic, one nurse manager, three advanced practice nurses, and two registered nurses. A cross-sectional study was conducted to validate the translated version. A convenience sample of 135 adult stroke survivors were recruited from three community centres and a stroke support group in Hong Kong. Internal consistency analysis was performed. Pearson’s correlation coefficients were calculated between SSQOL-C, SF-36, and Frenchay Activities Index (FAI) to determine the convergent validity. Results: Content validity index of SSQOL-C was 0.99. SSQOL-C had high internal consistency with Cronbach’s alpha of 0.94 for the total scale, and between 0.65 and 0.90 for the 12 domains. The total SSQOL-C scores showed significant positive correlations with SF-36 physical health (r=0.58, p<0.01) and mental health (r=0.54, p<0.01) component scores, and FAI score (r=0.59, p<0.01). SSQOL-C physical subtotal scores showed significant positive correlations with SF-36 physical health (r=0.55, p<0.01) and mental health (r=0.43, p<0.01) component scores, and FAI score (r=0.54, p<0.01). SSQOL-C psychosocial subtotal scores showed significant positive correlations with SF-36 physical health (r=0.52, p<0.01) and mental health (r=0.56, p<0.01) component scores, and FAI score (r=0.56, p<0.01). Conclusion: The results showed SSQOL-C had good content and convergent validity, and reliability in Chinese stroke survivors. Further evaluation of factor structure of SSQOL-C will be conducted to determine its validity.

Wii Fit balance training or progressive balance training in patients with chronic stroke: a randomised controlled trial.

[Purpose] The aim of this study was to compare the effects of Wii Fit balance training (WBT) and progressive balance training (PBT) approaches on balance functions, balance confidence, and activities of daily living in chronic stroke patients. [Subjects] A total of 30 patients were randomized into the WBT (n=15) and PBT (n=15) groups. [Methods] All of the subjects received exercise training based on a neurodevelopemental approach in addition to either Wii Fit or progressive balance training for total of 1 hour a day, 3 days per week for 4 weeks. Primary measurements were static balance function measured with a Wii Balance Board and dynamic balance function assessed with the Berg Balance Scale, Timed Up and Go test, Dynamic Gait Index, and Functional Reach Test. Secondary measures were balance confidence assessed with the Activities-specific Balance Confidence scale and activities of daily living evaluated with the Frenchay Activity Index. [Results] There was not remarkable difference between the two treatments in dynamic balance functions, balance confidence, and activities of daily living. [Conclusion] Although both of the approaches were found to be effective in improving the balance functions, balance confidence, and activities of daily living, neither of them were more preferable than the other for the treatment of balance in patients with chronic stroke.

The REFORM study protocol: a cohort randomised controlled trial of a multifaceted podiatry intervention for the prevention of falls in older people

IntroductionFalls and fall-related injuries are a serious cause of morbidity and cost to society. Foot problems and inappropriate footwear may increase the risk of falls; therefore podiatric interventions may play...

2014 Canadian Stroke Congress Abstracts

d’Esterre, CD1, 3 Qazi, E1, 3 Patil, S1, 3 Almekhlafi, M3, 1 Lee, T2, 3 Demchuk, A1, 3 Goyal, M1, 3 Menon, B1, 3; 1. University of Calgary, Calgary, AB; 2. University of Western Ontario, London, ON; 3. Calgary Stroke Program, Calgary, AB Background : For ischemic stroke, CT Perfusion (CTP) may change thrombolytic/endovascular treatment decisions when compared to NCCT/CTA alone. Two distinct thresholds may be useful in this regard: separation of 1) non-salvageable tissue (infarct core) from salvageable electrically silent tissue (penumbra), and 2) penumbra from benign oligemia (hypoperfused, but will survive if clot persists). Methods : CTP (120s,8cm) was performed on 180 patients within 12hrs of ischemic stroke. Two patient cohorts were analyzed: (1) recanalization (TICI 2b,3) 6s. For group (2) CBF, CBV, and Tmax values were obtained from within the final infarct region, and total ipsilateral hemisphere, excluding infarction. CBF, CBV and Tmax were used in univariate regression models. Results : For group (1)[n=11], mean time from CTP to recanalization was 60±19min. CBF parameter (thresholds for gray and white matter 7.2 and 5.2 ml•min-1•(100g)-1) had the highest sensitivity (90.9%) and specificity (81.8%) for infarction. For group (2)[n=15], the Tmax parameter (thresholds for gray and white matter 11.3s and 11.8s) had the highest sensitivity (86.6%) and specificity (80.0%) for penumbra. Conclusion : Knowing the status of recanalization within 90mins of CTP allows for accurate delineation of infarct core, as …

Engagement in Instrumental Activities of Daily Living, Social Activities, and Use of Everyday Technology in Older Adults with and without Cognitive Impairment

Introduction: Little is known about how subtle activity limitations may be manifested and clinically detected in people with mild cognitive impairment, but these people have been found to experience greater challenges with everyday technology use. The aim of this study was to investigate levels and profiles of engagement in activities, and their associations with perceived difficulty in technology use, for people with mild cognitive impairment, and to compare this group to people with Alzheimer's disease and to controls. Method: Samples with mild cognitive impairment (n = 37), Alzheimer's disease (n = 37), and controls (n = 44) were included. Based on raw data from the Frenchay Activity Index, a Rasch model was used to generate linear measures. Analysis of variance and differential item functioning were used. Results: The analysis yielded a profile of decreased engagement in specific activities even in mild cognitive impairment. The association between activity engagement and difficulty with everyday technology use was stronger in people with mild cognitive impairment and Alzheimer's disease than in controls. Conclusion: Taken together, engagement in outdoor activities showed the greatest decrease of all activity types for the group with mild cognitive impairment, suggesting that participation in life outside the home is threatened. The results also suggest that challenges in managing technology are restricting people with cognitive impairment more than they restrict controls.

The effects of reciprocal inhibition on motor function and brain functional network connectivity of stroke patients

Objective To investigate the effects of reciprocal inhibition on motor function connectivity in the brains of stroke patients.Methods Thirty patients with stroke were randomly divided into a treatment group (n =15) and a control group (n =15).The control group underwent normal limb positioning,medium frequency electrotherapy,circulated compression of the limbs,etc.The treatment group received conventional rehabilitation treatment plus reciprocal inhibition treatment for 30 min daily,6 times a week for 4 weeks.All of the patients were assessed before and after treatment using the Canadian neurological scale (CNS),the Frenchay activities index (FAI),the motricity index (MI) and functional magnetic resonance imaging of the motor cortex in a resting state (rs-fMRI).Results In both groups the average CNS,FAI and MI scores improved significantly.Compared with the control group,the changes in FAI and MI scores in the treatment group improved significantly more.The coefficient of functional connectivity of the bilateral motor cortex decreased significantly after treatment in both groups.In the treatment group the motor cortex functional connectivity correlated significantly with the improvements in MI scores.Conclusions Reciprocal inhibition can accelerate the improvement of extremity motor function and ability in the activities of daily living significantly after stroke.It reduces functional connectivity in the bilateral motor cortex in ways significantly correlated with improvements in motor function. Key words: Reciprocal inhibition; Resting-state functional magnetic resonance imaging; Stroke

Effectiveness of a novel community exercise transition program for people with moderate to severe neurological disabilities.

To determine the effectiveness of a community re-integration exercise initiative on function, mood, participation, and exercise adherence for persons with moderate to severe neurological conditions (stroke, multiple sclerosis, etc.). We recruited 29 adults (able to walk at least 3 m with assistance) discharged from an outpatient rehabilitation program for the 10 week intervention which was comprised of two components: circuit training and guided transition to a standard gym setting. We evaluated participants before and after the intervention and at four month follow up, including functional balance and mobility using the Timed Up and Go Test, walking endurance using the 6 Minute Walk Test, health related quality of life (HR QoL) using a visual analogue scale, activity and participation using the Frenchay Activities Index and mood using the Hospital Anxiety and Depression Scale. Twenty-seven participants completed the intervention. The only significant improvement was in HR QoL. Forty-four percent of participants continued to exercise after cessation of the program. Those who continued to exercise (Exercisers n = 12) experienced more improvement in HR QoL than Non-Exercisers (n = 15). This re-integration initiative for people with neurological impairments improved HR QoL and facilitated independent exercise for 44% of participants. The novel component of the program, which facilitated transition to standard gym equipment, likely contributed to improved exercise adherence in the longer term.

Clinical predictors of functional recovery at six month post-stroke

Aim: To investigate predictors of functional recovery at six-month among Nigerians with first-ever stroke. Methods: Participants with first ever stroke were recruited at stroke?onset from the University College Hospital, Ibadan, Nigeria. Stroke severity was measured using the National Institute of Health Stroke-Scale. Stroke was classified using the results of the CT scan of the brain. The weighted-standard values of Barthel Index and Frenchay Activities Index were combined to indicate Comprehensive Activities of Daily Living (CADL). The presence of depressive features and Trunk-Control (TC) were measured using the Centre for Epidemiological Scale-Depression and the Postural Assessment-Scale for Stroke?Patients respectively. Measurements were taken every month for six months. Data were analyzed using multivariate regression and survival analyses at p=0.05. Results: Sixty?five participants were recruited. Ten died within a week of stroke onset. Fifty-five (mean age = 57.4±14.8 years, 28 males) participants completed the study; Twenty-six (47.3%) had ischaemic stroke and 29 (52.7%) had haemorrhagic stroke. Forty of the 55 participants were married and of the 40, 31 reported spousal support. Type of stroke (β=7.5) and age (β=–0.4) significantly predicted functional recovery after controlling for co-morbidity (β=–2.1), brainstem lesion (β= –0.2), stroke severity (β= –0.6) and TC (β= 0.7) and the scores on depressive symptoms ratings (β= –0.1). Conclusion: Functional recovery at six?month is better in individuals who had haemorrhagic stroke. However, functional recovery decreases as age increases. The combination of haemorrhagic stroke with the presence of co-morbidity predicted death after stroke. DOI: http://dx.doi.org/10.3126/ajms.v6i1.5911 Asian Journal of Medical Sciences Vol.6(1) 2015 49-54

Influence of Self-Efficacy and Coping on Quality of Life and Social Participation After Acquired Brain Injury: A 1-Year Follow-Up Study

ObjectivesTo investigate the relations linking self-efficacy and coping to quality of life (QOL) and social participation and what effect self-efficacy, changes in self-efficacy, and coping style have on long-term QOL and social participation. DesignProspective clinical cohort study. SettingGeneral hospitals, rehabilitation centers. ParticipantsPatients with newly acquired brain injury (ABI) (N=148) were assessed at baseline (start outpatient rehabilitation or discharge hospital/inpatient rehabilitation; mean time since injury, 15wk) and 1 year later (mean time since injury, 67wk). InterventionsNot applicable. Main Outcome MeasuresQOL was measured with the EuroQuol 5D (the EQ-5D index and the EQ-5D visual analog scale [EQ VAS]) and the 9-item Life Satisfaction Questionnaire (LiSat-9), social participation with the modified Frenchay Activities Index, coping with the Coping Inventory for Stressful Situations, and self-efficacy with the Traumatic Brain Injury Self-efficacy Questionnaire. ResultsAt baseline, self-efficacy moderated the effect of emotion-oriented coping on the EQ-5D index and of avoidance coping on the EQ VAS. Self-efficacy mediated the relation between emotion-oriented coping and LiSat-9. An increase in self-efficacy over time predicted better scores on the EQ-5D index (β=.30), the EQ VAS (β=.49), and LiSat-9 (β=.44) at follow-up. In addition, higher initial self-efficacy (β=.40) predicted higher LiSat-9 scores at follow-up; higher initial emotion-oriented coping (β=−.23) predicted lower EQ VAS scores at follow-up. Higher modified Frenchay Activities Index scores at follow-up were predicted by higher self-efficacy (β=.19) and higher task-oriented coping (β=.14) at baseline (combined R2=5.1%). ConclusionsSelf-efficacy and coping predict long-term QOL but seem less important in long-term social participation. High self-efficacy protects against the negative effect of emotion-oriented coping. Enhancing self-efficacy in the early stage after ABI may have beneficial long-term effects.

Mixture modelling analysis of one-month disability after stroke: stroke outcomes study (SOS1).

Understanding the heterogeneity in disability after stroke is important to guide treatment and rehabilitation planning. We explored mixture modelling analysis to identify subgroups of stroke disability and factors associated with disability subgroups. Analyses were performed using secondary data from a cohort of 448 stroke patients who participated in a 2-year study of stroke outcomes. Mixture modelling approach was used to determine subgroups of early disability following stroke based on the Barthel Index, General Health Questionnaire (GHQ-28), Frenchay Activities Index and the Nottingham Extended Activities of Daily Living Scale. Five distinct disability groups were identified. Nineteen (4.2%) patients were classified as having very severe disability, 58 (12.9%) severe disability, 133 (29.7%) moderate disability, 198 (44.2%) mild disability and 40 (8.9%) a mood disorder. Compared to the mild group, patients in the "very severe" group were more likely to be elderly and to have had a previous stroke, and less likely to live alone and had a greater risk of mortality 2 years after stroke. Patients in the mood disorder group showed greater dependency in activities of daily living were younger compared to the other groups and had a greater risk of having mood symptoms 2 years after stroke. Mixture modelling of 1-month disability after stroke using a broad range of outcome measures has identified clinically meaningful groups relating to long-term outcomes.

Abstract T P118: Participation in Extended Activities of Daily Living is an Important Determinant of Long-Term Quality of Life in Stroke Patients after an Early Supported Discharge Program

Objective: We previously found stroke patients who underwent home therapy in our Early Supported Discharge (ESD) program had excellent improvement in basic activities of daily living (ADL). Their extended ADL remained impaired after ESD but showed significant improvement after 1 year. We hypothesize that improvement in extended ADL is an important determinant of long-term quality of life (QOL) in this group of stroke patients. Methods: Consecutive stroke patients enrolled in an ESD program in a tertiary hospital in Singapore from August 2007 to July 2012 were recruited. Basic and extended ADL functions were assessed using the Functional Independence Measure (FIM) and Frenchay Activities Index (FAI) respectively, pre- and post-ESD. FAI and SF-36 were administered via telephone interview 1 year after stroke onset. Multiple linear regression analyses with the 8 scales of SF-36 were carried out to determine their associations with variables including age, sex, FIM pre-ESD, FIM change (pre- to post-ESD), premorbid FAI, FAI post-ESD and FAI change (post-ESD to 1 year follow-up). Results: Data from 243 patients (60.9% male, mean age 64.7, SD11.8 years) were available for analysis. They received an average of 7.5 home therapy sessions. FIM improved from 100(17) pre-ESD to 115(15) post-ESD. FAI was 21.7(9.4) premorbid, 11.1(7.6) post-ESD and 17.9(10.3) at 1 year. Multiple regression analyses revealed 8 models which were statistically significant and explained 10-50% of the variance in SF-36 scales. In particular, 50% of the variance in Physical Functioning can be explained by the following factors: female gender (β=-.20, p<.001), FIM pre-ESD (β=.28, p<.001), FIM change (β=.15, p<.01), FAI post-ESD (β=.28, p<.001) and FAI change (β=.40, p<.001). Improvement in FAI scores from post-ESD to 1 year follow-up was positively associated with all 8 scales of SF-36 at 1 year. Conclusion: Compared to improvement in basic ADL after ESD, continued improvement in extended ADL including leisure, work and outdoor activities is a more important determinant of long-term QOL after stroke. Facilitating stroke patients in extended ADL participation and community reintegration after ESD is therefore a potentially important but currently neglected aspect in ESD for stroke patients.

To live with amyotrophic lateral sclerosis (ALS) - a longitudinal study of disability and health

Methods Repeated data collections during home-based visits every 6 months up to 3 years. Data on use and satisfaction with care, disability, personal and environmental factors are collected by structured interviews, standardized tests and questionnaires. Disease severity ALS functional rating scale (ALSFRS-R) score 0-48 Activity and Participation Katz Personal ADL index (Katz P-ADL) score 0-6 Katz Instrumental ADL index (Katz I-ADL) score 0-4 Frenchay activities index (FAI) score 0-45 Higher scores=better Health status Sickness Impact Scale (SIP), 0=best, 100=worst EQ VAS, 100=best, 0=worst Objectives To explore and describe disability and health in people with ALS, and the use and satisfaction with present care, to be able to improve, individualize and make the care more effective for these persons. Preliminary Results, baseline data Mean (sd) ALSFRS-R score: 28 (11), min-max: 0-45