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The overall aim of this thesis was to investigate postural balance, anxiety and motor function the first year after stroke and whether postural balance, anxiety and motor function was different at the intervention of Very Early Supported Discharge (VESD) com-pared to routine discharge during the first year post stroke. Methods. In paper I a systematic review and a meta-analysis was performed in order to study presence of anxiety after stroke. Papers II and IV included material from the GOTVED-study (Gothenburg Very Early Supported Discharge study), a random-ised controlled study where 140 patients with stroke admitted to a stroke unit at Sahlgrenska University Hospital were consecutively included. Paper II investigated whether VESD affects the anxiety assessed with the Hospital Anxiety and Depression Scale (HADS) and the overall disability measured with the modified ranking scale (mRS) for the stroke patient compared with ordinary discharge routines. In paper III data from two different data sources was merged to investigate if there was any association between function in the affected arm and postural balance. The dependent variables were Berg Balance Scale (BBS) and Timed Up and Go (TUG). As in-dependent variable was Fugl-Meyer assessment-Upper extremity (FMA-UE) scale was used. In Paper IV the correlation between self-confidence in postural balance, observer assessed postural balance and anxiety during the first year after stroke was investi-gated. The impact of the intervention on the correlation was also examined. The self-confidence in postural balance was measured using the Fall Efficacy Scale (FES(S)). Postural balance was as-sessed with Berg Balance Scale (BBS) and Time Up and Go (TUG). Anxiety was assessed with HADS. Assessments were made 5 days after stroke onset, 1 day and 1 month after discharge, 3- and 12 months post stroke. Main results. The systematic review showed that the overall pooled prevalence of anxiety after stroke was 29.3 %. There was no difference in anxiety if you received VESD or ordinary rehabili-tation, but the VESD led to a faster improvement of overall disa-bility compared to ordinary rehabilitation. The motor function in the affected arm significantly correlated with the postural balance the first year post-stroke. There was a significant correlation be-tween self-confidence in postural balance and observer assessed postural balance. Between anxiety and self-confidence in postural balance, there was only a small correlation. Conclusions and clinical implications. Anxiety is common af-ter stroke with about a third of patients experiencing it in the first year. Since anxiety influence quality of life and is a predictor of depression, routine screening would be worth considering in the stroke care. VESD did not show any harm or unintendent effects, but on the contrary led to a faster improvement in overall disabil-ity. We therefore suggest that coordinated VESD for patients with mild to moderate stroke should be considered as part of the ser-vice from a stroke unit. The result that motor function in the af-fected arm associated with the postural balance in a late stage after stroke can be of clinical importance to be aware of in assessment and planning the rehabilitation of postural balance. Patients with mild stroke seemed able to assess their confidence in postural bal-ance, involved in daily activity performance, in line with observer assessed postural balance. Assessment of self-confidence can pro-vide important information useful in rehabilitation planning and support patients regarding physically active after discharge.

Introduction: After a stroke, cognitive impairment is commonly associated with poor functional outcomes. The primary aim of this study was to investigate if cognitive function, assessed with the Montreal Cognitive Assessment (MoCA) 36–48 h after stroke, could predict functional dependence 3 months later. The secondary aim was to identify an optimal threshold for the MoCA score that could predict functional dependence. Materials and Methods: This was a longitudinal cohort study. The research database from a stroke unit at the Sahlgrenska University Hospital was linked with the Swedish Stroke Register—Riksstroke. Cognitive function and activities of daily living (ADL) were assessed with the MoCA and the Barthel Index (BI), respectively, 36–48 h after stroke. Functional outcome 3 months after stroke was studied with the modified Rankin Scale. The predictive characteristics of the MoCA were investigated using logistic regression analyses. Receiver operating characteristic curves (AUC) were used for identifying the optimal cutoff score on the MoCA for predicting functional dependence. The MoCA score that had equal sensitivity and specificity was chosen as the optimal score for predicting functional dependence. Results: A total of 305 participants were included in the study (mean age: 68.8 years, n = 179 men). The MoCA quartiles were a significant predictor of functional dependence 3 months after stroke as an individual variable (p < 0.001, AUC = 0.72) and when adjusted for covariates such as age at stroke onset, living arrangement prior to stroke, and ADL measured with BI within 36–48 h after stroke (p = 0.01, AUC = 0.84). The MoCA score of ≤23 for impaired cognition had equal sensitivity and specificity for predicting functional dependence 3 months after stroke. Discussion and Conclusion: Cognitive function assessed with the MoCA within 36–48 h after stroke could predict functional dependence 3 months later. The participants with MoCA scores ≤23 for impaired cognition were more likely to be functionally dependent.

Background: Impaired postural balance is a common symptom after stroke and a common cause of falling. Most common daily tasks use arm and hand movements. Impairment in an upper extremity is a common stroke symptom, affecting 50–80% in the acute phase after stroke, and 40–50% in the sub-acute phase. The impact of leg function on postural balance has been investigated in several studies, but few have stressed the importance of arm function on postural balance. Objective: To explore whether there is any association between arm function and postural balance after stroke. Method: A cross sectional study where 121 adults (mean age: 70 ± 12.3 years, 72 men) from two different data sources, Gothenburg Very Early Supported Discharge (GOTVED), and a study by Carvalho et al. were merged. Time for assessments ranged from 1 to 13 years when the patients were in the chronic phase. The dependent variables were Berg Balance scale (BBS) and Time Up and Go (TUG) both dichotomized to “impaired postural balance” and “not impaired postural balance.” As independent variables, the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scale was used. The FMA-UE was presented with the total score. Results: The motor function in the arm affected after stroke onset correlated with postural balance both measured with the BBS (0.321, p < 0.001) and the TUG (−0.315, p = 0.001). Having impaired motor function in the arm was significantly associated with impaired postural balance assessed with the BBS with OR = 0.879 (CI 0.826–0.934, p < 0.001). Regression analysis with the TUG showed the same result, OR = 0.868 (CI 0.813–0.927, p < 0.001) for FM-UE. Conclusion: The motor function of the affected arm was significantly associated with impaired postural balance post stroke, as assessed by BBS or TUG. It could be of clinical importance to be aware of the fact that not only lower extremity impairment, but also arm function can have an impact on postural balance in a late stage after stroke. Trial Registration: VGFOUGSB-669501.