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Item does not contain fulltext, PURPOSE: To develop prognostic models and equations for predicting participation at six months after stroke. METHODS: This European prospective cohort study recruited 532 consecutive patients from four rehabilitation centers. Participation was assessed at six months after stroke with the Sickness Impact Profile (SIP), which consists of a physical, psychosocial and independent dimension. Twenty-six independent variables on admission to the rehabilitation center and 13 additional variables measured at two months post stroke were included in the analysis. A multiple logistic regression analysis was conducted predicting good participation (SIP < 20%). Sensitivity, specificity, positive and negative predictive values were calculated. RESULTS: The prognostic models for the three dimensions provided independent predictors containing demographics, complications, diagnostic, and disability measures. Sensitivity ranged from 64-84%, specificity 66-85%, positive predictive value 70-78%, and negative predictive value 76-87%. Barthel Index on admission, Euroqol Health State at two months and Caregiver Strain Index at two months were retained in all prediction models. CONCLUSIONS: A combination of variables was found in the prognostic models of the three dimensions of the SIP at six months after stroke. Already from the early beginning of stroke rehabilitation it seems important to focus on personal activities of daily living as well as caregivers' strain. IMPLICATIONS FOR REHABILITATION: Prognostic factors predicting participation, measured by the three dimensions of the Sickness Impact Profile at six months post stroke include demographic variables, post-stroke complications, diagnostic parameters and disability measures. Significant prognostic variables for all three dimensions of the Sickness Impact Profile were a higher Barthel Index score on admission to the rehabilitation center, a higher Euroqol Health State score at two months post stroke and a lower Caregiver Strain Inde

Purpose: To determine the prognostic value of single items of the Barthel Index (BI) at discharge from rehabilitation, in predicting independence in personal activities of daily living (ADL) (BI score ≥95/100) at five years after stroke. Method: People with stroke were recruited consecutively from four European rehabilitation centres. BI was assessed on discharge and at five years after stroke. Stepwise multivariate logistic regression analysis was used to determine independent predictors of BI score ≥95/100 at five years after stroke. Thereupon, percentage chance of reaching BI ≥ 95/100 at five years after stroke was calculated. Results: Data were available for 153 patients. Independence in dressing (odds ratio (OR) = 5.22, 95% confidence interval (CI) = 1.85-14.76, p = 0.002) and bathing (OR = 8.10, 95% CI = 3.40-19.32, p < 0.0001) were independent predictors. Independence in both items resulted in 74.1% (57.6-85.8) chance of reaching BI ≥ 95/100 at five years after stroke. Dependence in both items resulted in 6.3% (5.1-7.9) chance. Independence in bathing, but dependence in dressing resulted in 35.4% (30.7-40.4) chance whereas the opposite resulted in 26.1% (20.7-32.3) chance. Conclusion: Simple assessment of dressing and bathing on discharge from rehabilitation enables therapeutic staff to predict prognosis for long-term independence in personal ADL. This method can be used for early identification of persons with stroke who need intensive follow-up. Implications for Rehabilitation (In)dependence for dressing and bathing at discharge from a rehabilitation centre are significant factors in the prediction of (in)dependence in personal ADL at five years after stroke. This predictive tool can be used for targeting inpatient stroke rehabilitation and early identification of those patients who need intensive follow-up.

Utilitarian cycling is recognized as an excellent way of being physically active on a regular basis and maintaining good health [1]. Unfortunately, some cyclists will be involved in an accident, will need medical care and may incur temporal or permanent physical injuries, which will induce costs to the cyclist and society. Aertsens [2] estimated, in Belgium, the average total cost of minor bicycle accidents at 841 euro (95% CI: 579‐1205) per accident or 0.125 euro per kilometre cycled. The aim of this study is to provide more insight into the resulting costs of major bicycle accidents in Flanders (Belgium). Data were collected in a retrospective study design. In 2008, 2364 bicycle accidents in Flanders were registered by the National Trust for Accidents (FAO). From those 2364 invited participants, 289 returned the questionnaire and 26 were classified as a major accident (hospitalised > 24 hours) and used for data analysis. Direct costs (e.g. material damage and medical costs), as well as indirect costs (e.g. productivity loss), intangible costs and Willingness To Pay (WTP) are calculated. For calculating of costs a differentiation was made between a recovery phase and a permanent disability phase. Costs were calculated over a period of 3 year after the accident. Nine respondents fully recovered and 17 had permanent damage. The average cost excluding WTP (€2011) per respondent (N=26) is €60,776±69,433, €35,190±39,317 for those who fully recovered and €74,322±78,718 for those who had permanent damage. When including WTP, the cost increases with +35% for the total group, +53% for those who fully recovered and +31% for those who had permanent damage. Total annual bicycle injury costs are huge, but these costs must be balanced against the benefits of bicycling, related to health and environment.

Background: Antenatal care can play an important role in the prevention of preterm birth. Evaluation of antenatal care is usually based on the number of visits rather than the content of care, using tools such as the Adequacy of Prenatal Care Use index. This article presents an analysis of the relation between specific elements of antenatal care and the risk of preterm birth compared with considering the number of visits only. Methods: A prospective cohort study was conducted in the Brussels Metropolitan Region. In all, 333 women were consecutively recruited at the beginning of their antenatal care trajectory and followed until birth. Information on timing and content for every visit was recorded by structured interview. A new tool was developed to measure the antenatal care trajectory, which included Content and Timing of care in Pregnancy (CTP). Odds ratios (OR) (adjusted and unadjusted) for preterm birth were calculated for the Adequacy of Prenatal Care Use and CTP model. Results: The number of visits alone was not associated with preterm birth. In contrast, a significant association was found between the content and timing of care and preterm birth. Compared with the CTP lowest ('inadequate') category, women in the CTP 'sufficient' (OR 0.30; 95% CI 0.09-0.94) and CTP 'appropriate' (OR 0.21; 95% CI 0.06-0.68) category had a lower risk. Conclusions: This study suggests that measurement of the content and timing of care of antenatal care using the new CTP tool is a better assessment of the risk of preterm birth than assessment of the number of antenatal visits alone.

Purpose: The aim was to document the prevalence and predictors of anxiety and depression 5 years after stroke, across four European centres. Method: A cohort of 220 stroke patients was assessed at 2, 4 and 6 months and 5 years after stroke. Patients were assessed on the Hospital Anxiety and Depression Scale and measures of motor function and independence in activities of daily living. Results: At 5 years, the prevalence of anxiety was 29% and depression 33%, with no significant differences between centres. The severity of anxiety and depression increased significantly between 6 months and 5 years. Higher anxiety at 6 months and centre were significantly associated with anxiety at 5 years, but not measures of functional recovery. Higher depression scores at 6 months, older age and centre, but not measures of functional recovery, were associated with depression at 5 years. Conclusions: Anxiety and depression were more frequent at 5 years after stroke than at 6 months. There were significant differences between four European centres in the severity of anxiety and depression. Although the main determinant of anxiety or depression scores at 5 years was the level of anxiety or depression at 6 months, this accounted for little of the variance. Centre was also a significant predictor of mood at 5 years. There needs to be greater recognition of the development of mood disorders late after stroke and evaluation of variation in management policies across centres. Implications for Rehabilitation Depression and anxiety persisted up to 5 years after stroke in about a third of patients. Variation in the rates of anxiety and depression between different European centres suggest management policies rather than stroke related factors may determine their persistence. The effect of variations in stroke management policies should be investigated. Patients' mood should be monitored over time in order to detect those with late onset mood disorders after stroke.

Objective: To determine 5-year mortality and its association with baseline characteristics and functional status 6 months post-stroke for patients who received inpatient rehabilitation. Design: A prospective rehabilitation-based cohort study. Subjects: A total of 532 consecutive strok

Objective: To determine 5-year mortality and its association with baseline characteristics and functional status 6 months post-stroke for patients who received inpatient rehabilitation. Design: A prospective rehabilitation-based cohort study. Subjects: A total of 532 consecutive stroke patients from 4 European rehabilitation centres. Methods: Predictors were recorded on admission. Barthel Index was assessed at 6 months (BI6mths) and patients were followed for 5 years post-stroke. Survival probability was computed using Kaplan-Meier analysis and compared across 3 BI6mths-classes (0-60, 65-90, 95-100) (log-rank test). Significant independent predictors were determined using multivariate Cox regression analysis (hazard ratio (HR)). Results: Five-year cumulative risk of death was 29.12% (95% confidence interval (CI): 22.86-35.38). Age (HR= 1.06, 95% CI: 1.04-1.09), cognitive impairment (HR= 1.77, 95% CI: 1.21-2.57), diabetes mellitus (HR= 1.68, 95% CI: 1.16-2.41) and atrial fibrillation (HR= 1.52, 95% CI: 1.08-2.14) were independent predictors of increased mortality. Hyperlipidaemia (HR=0.66, 95% CI: 0.46-0.94), and higher BI6mths (HR=0.98, 95% CI: 0.97-0.99) were independent predictors of decreased mortality. Five-year sur Conclusion: Nearly one-third of rehabilitation patients died during the first 5 years following stroke. Functional status at 6 months was a powerful predictor of long-term mortality. Maximum functional independence at 6 months post-stroke should be promoted through medical interventions and rehabilitation. Future studies are recommended to evaluate the direct effect of rehabilitation on long-term survival.