Stroke is one of the most common causes of long-term disability that leads to substantial economic and social burden for individuals, families, communities and nations. Rehabilitation aims to improve person’s functioning and decrease adverse consequences of stroke in all levels. Therefore, defining an optimal model of stroke care is in the interests of patients, health professionals, researchers and policymakers. One of the ways towards it is by investigating and comparing the outcomes of the stroke care systems currently in use. The aim of this thesis was to explore the determinants of rehabilitation outcomes for persons after stroke and to compare them between those living in Latvia or in Sweden, using the bio-psycho-social model suggested by World Health Organization (WHO). This project was organized in four parts. Part 1 focused on comparison between two in-patient rehabilitation systems and the differences in level of independence at discharge from rehabilitation between two cohorts were compared in 1055 and 1748 persons after stroke, living in Latvia and Sweden, respectively. For all following parts of this research work, cross-sectional study design was used. In Part 2, the influence of dependence level at discharge from rehabilitation on self-perceived disability in chronic phase of stroke was investigated in 255 persons from Latvia. Part 3 explored personal factors’ (age, gender, place of residence and time since onset of stroke) role in perception of functional limitations, barriers and facilitators in 243 persons living in Sweden. The relevance of the same factors in persons after stroke living in Latvia was evaluated in Part 4. Functional Independence Measure, International Classification of Functioning, Disability and Health Core Set for stroke and World Health Organization Disability Assessment Schedule 2.0 were used for outcome assessment. Socio-demographic and medical data, as well as information on organisational aspects of rehabilitation were also used as variables. Both theoretical as well as statistical analyses were used to compare rehabilitation systems in Latvia and Sweden. Appropriate regression analyses were used in all parts of this work. It seems that the components of stroke care are similar in rehabilitation systems in Latvia and Sweden. However, both populations vary in their basic medical and sociodemographic characteristics, as well as in the level of independence at admittance and discharge. There are also potential differences in the content and organizational aspects of rehabilitation. The levels of independence in daily activities at discharge from rehabilitation are significant factors that influenced perception of disability in the chronic phase of stroke. Personal factors such as age, gender, place of residence and time since onset of stroke can influence self-perceived functioning and environmental factors, as defined in the framework of the ICF, in persons living in Sweden. Same factors were also significant in the model that evaluated problems in ‘Activities and Participation’ persons living in Latvia. However, the role of those factors where rather small in both populations. Thus, the results of this thesis shows that different aspects of WHO’s suggested biopsycho- social model influence rehabilitation outcomes for persons after stroke and results depends on the country of residence (Latvia or Sweden). Functional, organizational, social and personal factors are of importance. Some of the factors are modifiable by the healthcare system, but some are the responsibility of society as a whole.
- Subsection – Physical and Rehabilitation Medicine
- Doctoral Thesis
Field of Science*
- 3.2 Clinical medicine
- 4. Doctoral Thesis