| dc.description.abstract | Komplikasjoner, smerte og følelsesmessige plager etter hjerneslag
Hvert år forekommer det omtrent 11000 hjerneslag i Norge. Dette kan være alt fra små drypp til alvorlige slag, og mange av de affiserte lever et liv med funksjonsnedsettelse og kognitive vansker. Hos noen oppstår plager relatert til slaget, som fall og infeksjoner. Depresjon, angst og smerte er også vanlig etter hjerneslag. Dette kan redusere både livskvaliteten og utsiktene for bedring betraktelig.
Hovedmålet med denne avhandlingen var kartlegge komplikasjoner og emosjonelle plager som oppstår tidlig etter hjerneslag. Avhandlingen et basert på prospektive observasjonsdata. I artikkel 1 ble to grupper pasienter med hjerneslag som var innlagt på sykehus med 10 års mellomrom undersøkt for å se om det var noen forskjell i forekomsten av komplikasjoner mellom de to. Resultatene viser at komplikasjoner var mindre vanlig i 2013 enn i 2003; dette gjaldt særlig for pasienter med moderate slag.
I artikkel 2 og 3 ble en gruppe pasienter fra ulike sykehus i Norge fulgt opp tre måneder etter slaget for å undersøke forekomsten av smerte og symptomer på angst og depresjon, og hvilke faktorer som hang sammen med disse plagene. Nyoppståtte smerter var tilstede hos én av ti like etter slaget, og tallet økte til én av fem tre måneder senere. Nye smerter 3 måneder etter slaget var mer vanlig hos de som også hadde symptomer på angst. Fysisk aktivitet virket ikke å ha noen sammenheng med symptomer på angst etter slaget, men de med et høyere aktivitetsnivå hadde mindre symptomer på depresjon.
Selv kom komplikasjoner etter hjerneslag virker å være sjeldnere enn før, er det fortsatt et behov for å finne fram til tiltak som kan forebygge og redusere komplikasjoner, særlig hos de med alvorlige slag, hvor forekomsten ikke har sunket. Smerter er ikke nødvendigvis så vanlig tidlig etter hjerneslag, men forekomsten øker mot 3 måneder etter slaget, og har stor innvirkning på livet til de affiserte. Forholdet mellom smerter, angstsymptomer og symptomer på depresjon er sammensatt, men kanskje kan en felles tilnærming til pasienter med slike plager være nyttig. Fysisk aktivitet kan være ett av tiltakene det er verdt å fokusere på. | nb_NO |
| dc.description.abstract | Summary
Stroke is a common disease, with approximately 11000 patients diagnosed with stroke as their primary diagnosis in Norway every year. A large proportion of stroke survivors face the challenges of functional decline and cognitive complaints. Some experience challenges related to the stroke such as falls, infections and pain. Anxiety and depression also seem to be common after stroke. Complications and emotional distress may reduce quality of life and have been associated with poor outcome after stroke. Modern stroke treatment seems to reduce the occurrence of certain complications after stroke.
The overall aim was to investigate the occurrence and risk factors of early complications, pain and emotional distress after stroke.
This thesis was based on prospective, observational data. In paper 1, data from patients treated in the stroke unit in Trondheim in 2003 and in 2013 were compared to investigate if there were any differences in the prevalence of complications occurring during the first week after stroke. Papers 2 and 3 were based on a sample of stroke patients from 11 different hospitals in Norway, assessed from 2012 to 2013. These patients were followed up at three months after the stroke. In the papers, the prevalence of pain and symptoms of anxiety and depression was investigated, and different factors associated with these variables were examined, including self-reported physical activity.
Results from paper 1 showed that complications after stroke were less common in 2013 than in 2003. Sub-group analyses showed that the reduction in complications was significant only in patients with moderate strokes. The frequency of progressing stroke and heart attack was significantly lower in 2013 compared to 2003.
In paper 2, one in ten patients reported new-onset pain early after the stroke, and the number increased towards one in five at three months after stroke. In particular, pain related to the limbs seemed to develop over time. New-onset pain three months after stroke was associated with symptoms of anxiety and depression. No association was seen between pain and depression after adjusting for symptoms of anxiety. Half of patients with new-onset pain said that the pain had a moderate to severe impact on daily activities and quality of life.
In paper 3, 17% of patients scored above cut-off for depression, and 11% scored above cut-off for anxiety three months after stroke. Physical activity, especially after stroke, was inversely associated with symptoms of depression, but not anxiety. Forty percent of patients reported having the same level of physical activity before and after stroke. One in three reported lower levels of activity after stroke, while one in four reported a higher level of activity after stroke.
Summarized, this thesis found that complications occurred less frequently in 2013 than ten years earlier, and the frequency was reduced especially among patients with moderate strokes. Furthermore, it found that new-onset pain became more frequent over time, and it seems that symptoms of anxiety were more strongly associated with pain than symptoms of depression were. A final finding was that higher activity levels, especially after the stroke, were associated with fewer symptoms of depression.
Even though complications seem to be less common than before, there is still a need to improve prevention and reduce their occurrence, especially among those with severe strokes, where the frequency of complications has not declined. The relationship between pain and symptoms of anxiety should be further investigated, as they seemed to be more strongly related than pain and symptoms of depression. Future research should also aim to further investigate the association between physical activity, both before and after stroke, and depressive symptoms after stroke. | nb_NO |
