The report is available in English with a French summary - KCE

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 183
Health Care District of North-East Skane, Sweden for about 190 patients. Prostheses
were delivered to 43% of all patients with primary amputations. These patients spent a
median of 13 days at the orthopaedic clinic. 55 days at the rehabilitation unit.
A retrospective study 194 analysed medical and nursing records of 45 patients who had
undergone LEA at Uddevalla General Hospital. Hospitalization, rehabilitation and
nursing-related data related to subjects alive after 6 months were compared with data
concerning those deceased during hospital stay and within 6 months after amputation.
The aetiology of the diagnosis leading to the LEA was cardiovascular disease in the
majority of cases. The most common amputation level was below the knee. The
patients surviving after 6 months had permanent problems in the area of nutrition,
elimination, skin ulceration, sleep, pain and pain alleviation. The patients who died
during the hospital stay had problems in all these areas.
8.6.5 Example: stroke pp
Although the organisation models can differ per county, rehabilitation of stroke patients
is organised according to an overall general approach in Sweden The general approach
follows the process outlined in the Evidence based national guidelines for stroke care,
issued by the Swedish Board of Health and Welfare. The board monitors the quality of
care and whether the correct measures are taken to implement the guidelines.
A vast majority of the stroke patients are discharged home. Depending on their needs
the rehabilitation process is continued in ambulatory form at hospitals in case of
comprehensive needs. If the patient is referred to a nursing home, the rehabilitation is
continued at a low level by the paramedical staff attached to that facility. For those
patients directly returning home from a stroke unit, and needing further rehabilitation,
the health services of the municipalities are taking charge of the rehabilitation.
A smaller group (around 9% of the total) of stroke patients is referred to post-acute
inpatient rehabilitation units within the hospitals. That can be general mixed
neurological rehabilitation units (serving both TBI (about 25%) and stroke (about 60%))
or general geriatric rehabilitation units.
The quality approach in stroke rehabilitation is supported by a tradition of stroke
registration qq .The steering committee for “Riks-Stroke”, frames and outlines quality
indicators reflecting structure, process and outcome. All hospitals in Sweden admitting
patients with acute stroke (85) participate since 1998. Annually, each hospital receives a
written report in which the local results are compared with the national data and with
comments and suggestions on improvements for the care. Data collection includes
information on the patient's gender, age, history of previous stroke, life situation prior
to the current stroke and level of mobility and need of assistance in three ADL
functions, namely dressing, bathing, and going to the toilet. Items related to acute care
include, the time from the onset of symptoms to admission to hospital, type of
department to which the patient is admitted (medical, neurological or geriatric),
whether or not the unit has organized stroke care (stroke unit), the patient's level of
consciousness on admission, whether or not a CT-scan was done, and, in patients who
died, whether or not an autopsy was done. In addition, drug treatment during the acute
phase has been added since 1998. Items registered at discharge included: the duration of
the acute admission to hospital; diagnosis of the stroke subtype, the patient's status at
discharge (alive or dead), details of further management (at home or in an institution)
and whether or not they required further care in an institution. A 3-month follow-up of
the patients is included 195 .
Results from Riks-Stroke show that women, in comparison with men, are more often
living in institutions three months after stroke. Women also less often receive
196 , 197
secondary stroke prevention.
pp the information is based on a personal communication of Prof. Katharina Stibrant Sunnerhagen, Insitute of
Neuroscience and Physiology - Rehabilitation Medicine The Sahlgrenska Academy Göteborg University,
SWEDEN
qq www.riks-stroke.org