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Objective: To analyze definitions and related requirements, processes, and operationalization of person-centered goal-setting in the physiotherapy research literature; to discuss those findings in relation to underlying principles of person-centeredness; and to provide an initial framework for how person-centered goal-setting could be conceptualized and operationalized in physiotherapy. Methods: A literature search was conducted in the databases: CINAHL, PubMed, PEDro, PsycINFO, REHABdata and Scopus. A content analysis was performed on how person-centered goal-setting was described. Results: A total of 21 articles were included in the content analysis. Five categories were identified: 1) Understanding goals that are meaningful to the patients; 2) Setting goals in collaboration; 3) Facing challenges with person-centered goal-setting; 4) Developing skills by experiences and education; and 5) Changing interaction and reflective practice. These categories were abstracted into two higher-ordered interlaced themes: 1) To seek mutual understanding of what is meaningful to the patient; and 2) To refine physiotherapy interaction skills, which we suggest would be useful for further conceptualization. Conclusion: In this analysis, we interpreted person-centered goal-setting in physiotherapy as a process of interaction toward a mutual understanding of what is meaningful to the patient. Future research may explore how to integrate mindful listening, embodied interaction and continuous ethical reflection with different assessments and treatment methods. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONEarly supported discharge (ESD) aims to enable the transition of care from specialised stroke units to patients’ homes. Even though ESD is well-researched, little is known about the experiences faced by persons with stroke in very early supported discharge (VESD). The aim of this study was to understand these experiences when participating in a VESD rehabilitation program.Qualitative individual and semi-structured interviews were held (at 3 months post-discharge) with stroke survivors discharged home at a very early stage and participating in a VESD programme. A thematic analysis process was applied.Nine participants living in Sweden and following a mild or moderate stroke expressed their narratives through the following themes: “The importance of the VESD team intervention during the initial home rehabilitation”; “Everyday life was perceived as a struggle depending on close relatives”; “Experiencing problems with fatigue and low energy” and “Feeling angrier or more worried in everyday life”Home-based VESD rehabilitation was important for increasing patients’ sense of independence and control in daily life, while at the same time making them feel secure in the support from the rehabilitation team. Future research may investigate how VESD functions in other countries and healthcare systems.People following a stroke seem positive to rehabilitate in their familiar home environment when working towards personalised goals with the support of a rehabilitation team.Through Very Early Supported Discharge people with stroke may experience engagement and motivation in their own rehabilitation process from the onset.Very Early Supported Discharge tends to encourage family members to be supportive and involved in the rehabilitation early after a stroke.Early rehabilitation in a home environment may enhance the individuals’ feelings of self-reliance and independence. [ABSTRACT FROM AUTHOR]

Objective Locked-in syndrome (LiS) is a rare condition, characterised by a complete paresis except for vertical eye movements and blinking with cognitive functions intact, commonly caused by ischaemia in the ventral pons. Previous studies have indicated that persons with LiS can live on for many years and have a good quality of life (QoL). To our knowledge, LiS has never been studied in Sweden. The aim was to explore LiS in Sweden; describing population characteristics, living situation, mortality/cause of death and health-related QoL/impact on participation. Design Explorative, nationwide study with two parts (quantitative and qualitative). Persons registered in the national quality register WebRehab during 2007-2014 were eligible. Participants Ten persons were identified in part 1, four participated in part 2. During part 1, data were collected from WebRehab, medical charts and registers, while questionnaires and interviews were used during part 2. Results Seven out of 10 were men, median age at onset was 49 years and the cause of LiS was in all cases stroke, 70% of which ischaemic. Three were deceased with a median time of survival of 1.9 years. Seven were still alive, with a median time elapsed since onset of 5.8 years. Three participants experienced good QoL. Information, respect from professionals and more specialised technical devices were three areas containing unfulfilled needs. Conclusion This was the first study conducted in Sweden and the characteristics of this population were like those studied abroad. In this study, the persons with LiS who were interviewed expressed the need for proper care, appropriate technical aids and a supportive environment in order to have QoL. However, there is still much room for improvements. [ABSTRACT FROM AUTHOR]

Background: Fatigue is the most frequent symptom reported by patients with chronic illnesses. As a subjective experience, fatigue is commonly assessed with patient-reported outcome measures (PROMs). Currently, there are more than 40 generic and disease-specific PROMs for assessing fatigue in use today. The interpretation of changes in PROM scores may be enhanced by estimates of the so-called minimal important difference (MID). MIDs are not fixed attributes of PROMs but rather vary in relation to estimation method, clinical and demographic characteristics of the study group, etc. The purpose of this paper is to compile published MIDs for fatigue PROMs, spanning diagnostic/patient groups and estimation methods, and to provide information relevant for appraising their appropriateness for use in specific clinical trials and in monitoring fatigue in defined patient groups in routine clinical practice. Methods: A systematic search of three databases (Scopus, CINAHL and Cochrane) for studies published between January 2000 to April 2015 using fatigue and variations of the term MID, e.g. MCID, MIC, etc. Two authors screened search hits and extracted data independently. Data regarding MIDs, anchors used and study designs were compiled in tables. Results: Included studies (n= 41) reported 60 studies or substudies estimating MID for 28 fatigue scales, subscales or single item measures in a variety of diagnostic groups and study designs. All studies used anchor-based methods, 21/60 measures also included distribution-based methods and 17/60 used triangulation of methods. Both similarities and dissimilarities were seen within the MIDs. Conclusions: Magnitudes of published MIDs for fatigue PROMs vary considerably. Information about the derivation of fatigue MIDs is needed to evaluate their applicability and suitability for use in clinical practice and research. [ABSTRACT FROM AUTHOR]

Background: An Early Supported Discharge (ESD) and rehabilitation from a coordinated team in the home environment is recommended in several high-income countries for patients with mild to moderate symptoms after stroke. Returning home from the hospital takes place very early in Sweden today (12 days post stroke), thus the term Very Early Supported Discharge (VESD) is used in the current study. The aim of this study was to describe patients' expectations of coming home very early after stroke with support and rehabilitations at home. Method: This is an interview study nested within a randomized controlled trial; Gothenburg Very Early Supported Discharge (GOTVED), comparing VESD containing a home rehabilitation intervention from a coordinated team to conventional care after stroke. Ten participants (median age 69) with mild to moderate stroke symptoms (NHISS 0 to 8 points) were recruited from the intervention group in GOTVED. Interviews were conducted 0-5 days before discharge and the material was analyzed with qualitative content analysis. Results: Four main categories containing 11 subcategories were found. The VESD team was expected to provide "Support towards independency", by helping the participants to manage and feel safe at home as well as to regain earlier abilities. The very early discharge gave rise to expectations of coming home to "A new and unknown situation", causing worries not to manage at home and to leave the safe environment at the ward. A fear to suffer a recurrent stroke when being out of reach of immediate professional help was also pronounced. In contrast to these feelings of insecurity and fear, "Returning to one's own setting" described the participants longing home, where they would become autonomous and capable people again. They expected this to facilitate recovery and rehabilitation. "A new everyday life" waited for the participants at home and this was expected to be challenging. Different strategies to deal with these challenges were described. Conclusions: The participants described mixed expectations such as insecurity and fear, and on the other hand, longing to come home. Moreover, they had a high degree of confidence in the expected support of the VESD team. The health professionals at the hospital may build on this trust to reduce the patients' insecurity for coming home. In addition, it may be beneficial to explore the patients' expectations thoroughly in front of discharge, as certain feelings and thoughts could complicate or support the home coming process. Thus, a greater attention on such expectations may facilitate the patient's transition from hospital to home after stroke. [ABSTRACT FROM AUTHOR]

Background: Stroke is the disease with the highest costs for hospital care and also after discharge. Early supported discharge (ESD) has shown to be efficient and safe and the best results with well-organised discharge teams and patients with less severe strokes. The aim is to investigate if very early supported discharge (VESD) for stroke patients in need for on-going individualised rehabilitation at home is useful for the patient and cost effective. Methods/design: A randomized controlled trial comparing VESD with ordinary discharge. Inclusion criteria: confirmed stroke, >18 years of age, living within 30 min from the stroke unit, on day 2 0-16 points on the National institute of health stroke scale (NIHSS) and 50-100 points on the Barthel Index (BI), with BI 100 then the patient can be included if the Montreal Cognitive Assessment is < 26. Exclusion criteria are: NIHSS >16, BI < 50, life expectancy < 1 year, inability to speak or to communicate in Swedish. The inclusion occurs on day 4 and in block randomization of 20 and with blinded assessor. Primary outcome: levels of anxiety and depression. Secondary outcomes: independence, security, level of function, quality of health, needs of support in activities of daily living and caregiver burden. Power calculation is based on the level of anxiety and with a power of 80%, p-value 0.05 (2 sided test) 44 persons per group are needed. Data is gathered on co-morbidity, re-entry to hospital, mortality and a health economic analysis. Interviews will be accomplished with a strategic sample of 15 patients in the intervention group before discharge, within two weeks after homecoming and 3 months later. Interviews are also planned with 15 relatives in the intervention group 3 months after discharge. Discussion: The ESD studies in the Cochrane review present hospital stays of a length that no longer exist in Sweden. There is not yet, to our knowledge, any study of early supported discharge with present length of hospital stay. Thus it is not clear if home rehabilitation nowadays without risks, is cost effective, or with the same patient usefulness as earlier studies. [ABSTRACT FROM AUTHOR]

Roots of wheat seedlings (Triticum aestivum L. cv. Weibulls Starke) were cooled (+ 1 °C) for 24 h while the shoots were kept at 25°C. The treatment induced an increased water deficit in the leaves. Fresh weight, dry weight, and the uptake and distribution of potassium and calcium were measured before and after cooling. Growth, measured both as fresh weight and dry weight increase, was reduced during the cold treatment. Afterwards (at 20° C), growth recovered to nearly pre-stress rates. Analysis of the potassium fluxes in and out of the roots by "Rb- techniques showed that influx, and to a lesser extent efflux, were inhibited at low temperature. The result was a net potassium uptake raw of one-third that of unstressed plants. After the cooling period the potassium influx increased to the rate of control plants. The potassium efflux increased to one and one-half times the rate of unstressed wheat so that net uptake was negative. The increase in potassium efflux was explained by a higher permeability of the root cell membranes after cooling. The net uptake of calcium was reduced to one-third by root cooling. Contrary to potassium up- take, calcium uptake increased under post-stress conditions, partly due to a low efflux rate. During root cooling there was a redistribution of dry matter from the leaves down towards the lower part of the shoot. Afterwards the original distribution of dry matter was reestablished. The net flow of potassium and calcium followed a similar pattern as dry matter, suggesting a growth-regulated flow. [ABSTRACT FROM AUTHOR]

The transpiration response to recurrent light periods was studied in water-stressed wheat seedlings. Seedlings were stressed by three methods: addition of mannitol to the root medium, root cooling and drying of the roots in air. All three methods induced almost equal effects on transpiration regulation during alternating dark and light intervals. Exogenous abscisic acid supplied to the shoots of excised plants had qualitatively the same effect as water stress. Water stress and ABA increased the time lapse between light-on and the onset of transpiration increase and lowered the amplitude of transpiration increase and lowered the amplitude of transpiration increase in light. Weak light introduced before strong light shortened the delay times. [ABSTRACT FROM AUTHOR]

Transpiration and water uptake were measured simultaneously using a micro-wave hygrometer and a recording potometer. Wheat seedlings (Triticum aestivum L. cv. Weibulls Starke) were kept with the roots at +1°C in nutrient solution and with the shoots in air at 20°C for 24 h, a treatment which induced a decrease of about 2% in relative water content of the leaves. The induced deficit rapidly disappeared after returning to normal root temperatures (20°C.). The treatment produced after-effects on steady rates of water absorption and transpiration in light, whereas the times taken for transient changes in transpiration brought about by changes in light conditions were not affected. The after-effects were not completely eliminated 24 h after removal of stress. The magnitude of the after-effects varied with the leaf water content, though some contribution of root cooling to the after-effects cannot be excluded. The decreased water flow through the plant after removal of stress can be attributed mainly to increased stomatal resistance and not to effects on root conductivity. The increased stomatal resistance appears linked to increased membrane permeability rather than to a decrease in the active mechanism for ion uptake. [ABSTRACT FROM AUTHOR]