Læknablaðið : fylgirit - 01.05.2002, Blaðsíða 23

ABSTRACTS / 3 3RD SNC & 2ND SCNN
rethinking with our minds, and reaffirming our spirit for living. Our
teaching team includes all kinds of therapists, nurses, and doctors.
Their are also family and friends who learn along with us. Later, we
are sent out into the “real world” to practice what we have learned.
Hopefully we find new teachers and fellow classmates who rein-
force our efforts and value us for who we are.
This presentation will describe the learning process of surviving
to thriving based on my perspective as a stroke survivor. My jour-
ney of recovery has been paved with years of therapy, retraining,
and conquering what seem to be continuous small challenges. On
my life’s journey I am seeing new vistas, making new friends, and
realizing many new opportunities that are enriching me.
L15 - Evidence Based Nursing: Setting out to measure the
effects of NDT-nursing in stroke patients
Hafsteinsdóttir Þ, Kappelle LJ, Algra A, Grypdonck M
Division of Nursing Science, University Medical Centrum, Utrecht, The
Netherlands
Objective: Neurodevelopmental Treatment (NDT) based on the
Bobath principles has widely been implemented into nursing in the
western world, while no conclusive s-cientific evidence exists on its
effects on the stroke patient. Three outcome studies have been
conducted on the subject, showing contradictory findings. NDT-
nursing was also implemented on the neurological ward on the
University Medical Centrum of Utrecht, thereby confronting the
nurses with the question if NDT would lead to improved rehabili-
tation results for stroke patients. Therefore, in this study we address
the question: Does NDT-nursing lead to better functional status
and quality of life as compared to non NDT-nursing of hemiplegic
stroke patients?
In the design of the study we paid special attention to issues
which were covered unsatisfactorily in previous studies, in parti-
cular comparability of the two treatment groups and whether NDT-
nursing was performed according to generally accepted standards.
Method: In the study a prospective, non-randomised, longitudinal
design was used, comparing two groups of patients from 12 hospi-
tals, i.e. six neurological wards using NDT-nursing and six neuro-
logical wards not using NDT.
Outcome measures and instruments measured were: Functional
status measured with the Modified Barthel Index and the Rankin
Scale; Quality of life measured with the MOS SF-36, the SA-SIP
and the GSW; depression measured with the CES-D and shoulder-
pain measured with a VAS. Measures were taken at admission,
discharge, 6 and 12 months after the stroke.
The primary aim of the data analysis is to compare the percen-
tage of patients with poor outcome (Modified Barthel Index<12) at
12 months between the two study groups. The results will be ex-
pressed as cumulative incidence ratios with corresponding 95%
confidence intervals. Logistic regression will be employed to calcu-
late odds ratios adjusted for incomparability of multiple baseline
characteristics simultaneously.
In this study some of the limitations of previous studies were
overcome by conducting an intervention check within nursing,
measuring the nurses’ competency in performing NDT-nursing, and
within physiotherapy to find out if and to what extent physiothera-
pists use NDT in the treatment of stroke patients. Also, the general
level of quality of nursing care was measured on the 12 participating
wards, to determine if the general quality of nursing care, not
related to NDT, would vary between the two groups of wards and if
the two groups were comparable.
Results: A total of 326 patients was included in the study.
The intervention check, measuring the nurses’ competency in
performing NDT-nursing was conducted on the six NDT-wards,
with 144 nurses participating, showed that the nurses have the
adequate competency to conduct NDT-nursing according to the
preset standards. The findings showed the mean score for the six
neurological wards to be 195 (70%), varying from 206 (74%) to the
lowest score of 181 (65%) of the 280 (100%) possible.
Also, an intervention check was conducted within physiotherapy
in the 12 hospitals, consisting of a questionnaire and a case vignette.
All physiotherapists (N=38) involved in the treatment of stroke
patients took part in this part of the study. The findings showed that,
the 79% of the physiotherapists working in the NDT-wards have
followed adequate NDT-postgraduate education as opposed to the
21% of the physiotherapists working in non NDT-hospitals.
Measurement of quality of nursing care was conducted in the 12
wards through interviews of both nurses (N=125) and patients
(N=71). Analysis of the data showed no differences between the
two groups of wards in relation to the general level of quality of
nursing care not related to the NDT.
Not all data from the main study have been received. Analysis of
baseline data show that for most variables the two groups are com-
parable, but for a few variables, there are some differences between
the groups, which will be adjusted for. The available findings of the
analysis for the whole group will be presented.
Condusion: We will describe the setting up of a study to find an
evidence base for NDT-nursing and discuss the challenges of over-
coming the limitations of previous studies and of not being able to
randomise patients between the study groups. Data collection was
not yet complete, hence treatment specific results are not yet
available. The findings of the analysis of the available data for the
whole group of patients will be presented.
L16 - Health care utilization and medication overuse in migraine
Zwart JA
St. Olav Hospital, Trondheim, Norway
Abstract not received.
L17 - Mechanisms of Migraine
Olesen J
Professor of Neurology, University of Copenhagen, Glostrup Hospital, Dept. of
Neurology N01
The etiology of migraine is partly genetic, partly environmental.
The genetics of migraine are being dealt with in another contri-
bution at this symposium. Environmental factors can be divided
into: a) those that cause the expression of a genetic disposition. b)
Those that make migraine worse over a prolonged period of time
also called exacerbating factors. c) Factors that precipitate an
individual attack.
Recent years have brought at wealth of information about the
pathophysiological mechanisms and about the pain sensing appa-
Læknablaðið/Fylgirit 43 2002/88 23