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Objective: To explore how people with stroke, discharged to skilled nursing facilities before returning home, experience the chain of care and rehabilitation. Design: Qualitative, semi-structured interview design. Methods: Thirteen stroke survivors discharged from a stroke unit to a skilled nursing facility before returning to independent living participated. Semi-structured telephone interviews were conducted 2-5 months after stroke and analysed with content analysis. Results: The analysis resulted in three categories, Organizational processes, critical and complex, Rehabilitation, the right support at the right time and Adaptation to the changed situation, with a total of 9 subcategories. The informants perceived low participation in planning and goalsetting and limited information. Support from the healthcare services was important to proceed with improvements although the amount of supported training varied. Factors hindering and facilitating managing everyday life were described, as well as lingering uncertainty of what the future would be like. Conclusion: Support and rehabilitation as well as individuals' needs varied, throughout the chain of care. To enable participation in the rehabilitation, assistance in setting goals and repeated information is warranted. Tailored care and rehabilitation throughout the chain of care should be provided, followed up at home, and coordinated for smooth transitions between organizations.

Objective: To investigate (i) to what extent physiotherapists (PTs) working in stroke rehabilitation in various parts of the stroke care chain have implemented interventions according to the national guidelines for stroke (NGS), (ii) facilita-ting and hindering factors for the implementation, and (iii) differences between various care settings. Design: A cross-sectional study. Subjects: 148 PTs working in stroke rehabilitation in various parts of the care chain in Sweden. Methods: Data were collected by a web-based survey. Results: Task-specific training for walking (80–98%), impaired motor function (64–100%) and fall prevention (73–92%) were most implemented. Factors that facilitated implementation were: important to comply with the NGS, that PTs had confidence to per-form the interventions, and that interventions were clearly described. Limited time, lack of resources, no clear goals or routines at the workplace hindered the implementation. Significant differences (p < 0.05) between the settings existed. Municipal and primary care reported most challenges in implementing the NGS and providing evidence-based interventions. Conclusion: Most interventions, with high priority according to NGS, are provided by PTs working in stroke rehabilitation, although differences in various parts of the care chain exist. Knowledge, time, education and supportive management are important factors when implementing evidence-based interventions.

Rehabilitation is a key aspect of the treatment of stroke patients, both acute and in later phases. The patients' needs varies between individuals and over time. Several skills and methods and different professionals working together in teams, as well as coordination along the entire chain of care, are required in order to meet those different needs. Early supported discharge, ESD, is recommended for patients with mild to moderate stroke. Stroke is a chronic disease requiring lifelong structured follow-up focusing not only on medical treatment but also on lifestyle, mental and physical well-being and activity and participation., Ingår i: Tema: stroke. Publicerad på lakartidningen.se 2023-09-05.

Rehabilitation is a key aspect of the treatment of stroke patients, both acute and in later phases. The patients' needs varies between individuals and over time. Several skills and methods and different professionals working together in teams, as well as coordination along the entire chain of care, are required in order to meet those different needs. Early supported discharge, ESD, is recommended for patients with mild to moderate stroke. Stroke is a chronic disease requiring lifelong structured follow-up focusing not only on medical treatment but also on lifestyle, mental and physical well-being and activity and participation.

An intelligent rollator (IRO) was developed that aims at obstacle detection and guidance to avoid collisions and accidental falls. The IRO is a retrofit four-wheeled rollator with an embedded computer, two solenoid brakes, rotation sensors on the wheels and IR-distance sensors. The value reported by each distance sensor was compared in the computer to a nominal distance. Deviations indicated a present obstacle and caused activation of one of the brakes in order to influence the direction of motion to avoid the obstacle. The IRO was tested by seven healthy subjects with simulated restricted and blurred sight and five stroke subjects on a standardised indoor track with obstacles. All tested subjects walked faster with intelligence deactivated. Three out of five stroke patients experienced more detected obstacles with intelligence activated. This suggests enhanced safety during walking with IRO. Further studies are required to explore the full value of the IRO.

Background Stroke is a major cause of disability worldwide. After treatment in a specialized stroke unit, early supported discharge (ESD) followed by home rehabilitation has shown to be an effective way to improve patient outcome and quality of care for persons with mild to moderate stroke. ESD service is recommended in the national and international guidelines for stroke care, but has only partially been implemented in Sweden. Following stroke, fatigue is a common consequence that often becomes more evident when the patient comes home. Currently, there is insufficient evidence about how to measure, treat and handle post-stroke fatigue. The overall aim of this thesis was to evaluate and implement early supported discharge (ESD) based on stroke patients experience after discharge from the stroke unit and local conditions. The aim was also to evaluate post-stroke fatigue with a potentially valid and reliable scale and finally to prepare for a study to evaluate cardiorespiratory training as a part of ESD service for patients with post-stroke fatigue. Methods In paper I, nine strategically chosen patients were interviewed of their experience of falling ill, the hospital stay, discharge, contact with health care after discharge and their request of support. Papers II-III describe and evaluate the development, content, implementation and effects of a locally adopted method for early supported discharge (Umeå Stroke Center ESD) in modern stroke care. Paper II included 153 consecutive patients and paper III, 30 232 patients with first-ever stroke registered in the Riksstroke registry in Sweden. Paper II evaluated number of patients/year, clinical and functional health status, satisfaction in relation to needs, accidental falls/other injuries and resources with the result summarized in a value compass. The implementation process was evaluated retrospectively by means of Consolidated Framework for Implementation (CFIR). Paper III evaluated patient reported outcome measurement

Background: Randomized controlled trials on early supported discharge (ESD) service in stroke have demonstrated favorable results. However, there are difficulties in transferring research results regarding ESD to the clinic. The aim of this study is to describe the method, content, implementation and outcome of ESD in its natural habit for stroke patients. Methods: A prospective observational implementation study of 153 consecutive stroke patients with mild to moderate severity with ESD and rehabilitation by a specially trained interdisciplinary team in the patient’s home, directly after discharge from the stroke unit. The interdisciplinary team in the ESD team is similar to the work at the stroke unit. Number of patients/year, clinical and functional health status, patient satisfaction, accidental falls/other injuries and resources were evaluated. Results: The number of patients/year in the ESD service has gradually increased from 2005 to 2009.The stroke patients subjected to Umea ESD service in January 2008 until May 2009 had a mean of 8.6 days of in-hospital care. The ESD service included 11 visits and 18 h per patient during 23 days (mean values). Compared with time of enrollment, patients exhibited reduced functional dependency (ADL- stairs 3 (1 - 5) vs. 1 (0–3), median, Q1–Q3, p <0.001, two-sided Wilcoxon Signed Ranks test) and increased mobility (Rivermead Mobility Index, (RMI) 11 (9–13) vs. 13 (12–15), p <0.001) at the time of discharge from the ESD service. Patient satisfaction regarding ESD was high. The long-term risk of accidental falls and other injuries appeared not to be increased. Conclusions: It is possible to locally develop and implement ESD care for stroke patients based on evidencebased principles. Our locally adapted ESD care, a stroke unit in the patients’ home, appears to be an appropriate alternative to conventional rehabilitation for patients with mild to moderate stroke.