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BACKGROUND: Knowledge on long-term participation is scarce for patients with paid employment at the time of stroke. OBJECTIVE: Describe the characteristics and the course of participation (paid employment and overall participation) in patients who did and did not remain in paid employment. METHODS: Patients with paid employment at the time of stroke completed questions on work up to 30 months after starting rehabilitation, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P, Frequency, Restrictions and Satisfaction scales) up to 24 months. Baseline characteristics of patients with and without paid employment at 30 months were compared using Fisher's Exact Tests and Mann-Whitney U Tests. USER-P scores over time were analysed using Linear Mixed Models. RESULTS: Of the 170 included patients (median age 54.2 interquartile range 11.2 years; 40% women) 50.6% reported paid employment at 30 months. Those returning to work reported at baseline more working hours, better quality of life and communication, were more often self-employed and in an office job. The USER-P scores did not change statistically significantly over time. CONCLUSION: About half of the stroke patients remained in paid employment. Optimizing interventions for returning to work and achieving meaningful participation outside of employment seem desirable. [ABSTRACT FROM AUTHOR] more...

Implementation of an eRehabilitation intervention named Fit After Stroke @Home (Fast@home) – including cognitive/physical exercise applications, activity-tracking, psycho-education – after stroke resulted in health-related improvements. This study investigated what worked and why in the implementation. Implementation activities (information provision, integration of Fast@home, instruction and motivation) were performed for 14 months and evaluated, using the Medical Research Council framework for process evaluations which consists of three evaluation domains (implementation, mechanisms of impact and contextual factors). Implementation activities were evaluated by field notes/surveys/user data, it's mechanisms of impact by surveys and contextual factors by field notes/interviews among 11 professionals. Surveys were conducted among 51 professionals and 73 patients. User data (n = 165 patients) were extracted from the eRehabilitation applications. Implementation activities were executed as planned. Of the professionals trained to deliver the intervention (33 of 51), 25 (75.8%) delivered it. Of the 165 patients, 82 (49.7%) were registered for Fast@home, with 54 patient (65.8%) using it. Mechanisms of impact showed that professionals and patients were equally satisfied with implementation activities (median score 7.0 [IQR 6.0–7.75] versus 7.0 [6.0–7.5]), but patients were more satisfied with the intervention (8.0 [IQR 7.0–8.0] versus 5.5 [4.0–7.0]). Guidance by professionals was seen as most impactful for implementation by patients and support of clinical champions and time given for training by professionals. Professionals rated the integration of Fast@home as insufficient. Contextual factors (financial cutbacks and technical setbacks) hampered the implementation. Main improvements of the implementation of eRehabilitation are related to professionals' perceptions of the intervention, integration of eRehabilitation and contextual factors. To increase the use of eRehabilitation by patients, patients should be supported by their healthcare professional in their first time use and during the rehabilitation process. To increase the use of eRehabilitation by healthcare professionals, healthcare professionals should be (1) supported by a clinical champion and (2) provided with sufficient time for learning to work and getting familiar with the eRehabilitation program. Integration of eRehabilitation in conventional stroke rehabilitation (optimal blended care) is an important challenge and a prerequisite for the implementation of eRehabilitation in the clinical setting. [ABSTRACT FROM AUTHOR] more...

To describe the course of depressive symptoms during the first 12 months post-stroke and its association with unmet needs. A prospective cohort study among stroke patients admitted to inpatient rehabilitation. Depressive symptoms were assessed 3, 6, and 12 months post-stroke using the Hospital Anxiety and Depression Scale, and categorized into three trajectories: no (all times <8), non-consistent (one or two times ≥8), or persistent (all times ≥8) depressive symptoms. Unmet needs were assessed using the Longer-Term Unmet Needs questionnaire. Multivariable logistic regression analyses were used to investigate the association between depressive symptoms and unmet needs. One hundred and fifty-one patients were included, of whom 95 (62.9%), 38 (25.2%), and 18 (11.9%) had no, non-consistent, or persistent depressive symptoms, respectively. Depressive symptoms three months post-stroke persisted in 43.9% and recurred in 19.5% of patients during the first 12 months post-stroke. Depressive symptoms were significantly associated with the occurrence and number of unmet needs (odds ratio 6.49; p = 0.003 and odds ratio 1.28; p = 0.005, respectively). Depressive symptoms three months post-stroke were likely to persist or recur during the first 12 months post-stroke. Depressive symptoms are associated with unmet needs. These results suggest that routine monitoring of depressive symptoms and unmet needs should be considered post-stroke. Patients with depressive symptoms three months post-stroke have a high risk of developing persistent or recurrent depressive symptoms during the first 12 months post-stroke. Unmet needs are associated with both non-consistent and persistent depressive symptoms post-stroke. These results suggest that health professionals should routinely screen for depressive symptoms and health care needs around three months post-stroke. In patients with depressive symptoms at three months post-stroke early treatment of depressive symptoms and addressing unmet needs should be considered and depressive symptoms should be routinely monitored during the first 12 months post-stroke. [ABSTRACT FROM AUTHOR] more...

Background/objective: A systematic review was conducted on the association between ethnicity and health-related quality of life in post-stroke populations., Methods: In February 2024, a comprehensive search was conducted across several databases. Studies were included when they had at least 2 distinct ethnic post-stroke groups for comparison, along with the utilization of validated questionnaires to measure health-related quality of life. Two authors independently screened, selected, and evaluated studies, while 1 author extracted outcome data. When possible, effect sizes were calculated using raw data from included studies., Results: Eleven studies were included, comprising 12,430 patients. All but 1 study found ethnic disparities in post-stroke health-related quality of life. In 8 studies, patients from minority ethnic groups had lower health-related quality of life after stroke compared with the predominant ethnic group in a country. In 2 studies, the minority group (Asians and non-Hispanic blacks, respectively) showed better outcomes compared with the majority group. In 1 study no differences were observed. In 6 studies the effect size was calculable, and ranged from small to moderate., Conclusion: Included studies show a large heterogeneity regarding included populations and reported outcomes. Racial/ethnic disparities in stroke patients exist in most studies from different countries. Further studies are needed to investigate the background of these disparities. more...