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Chen J, Liu J, Zeng Y, Li R, Wang Y, Ding W, Guo J, Lin H, Li J. Development and initial validation of a clinical measure to assess symptoms of post-stroke depression in stroke patients at the rehabilitation stage. Front Psychol 2022; 13:928257. [PMID: 35967723 PMCID: PMC9369669 DOI: 10.3389/fpsyg.2022.928257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background The high incidence of post-stroke depression (PSD) during rehabilitation exerts a negative effect on the treatment and functional recovery of patients with stroke and increases the risk of mortality. It is necessary to screen PSD in the rehabilitation stage and thus provide effective intervention strategies. However, existing measurements used to assess PSD in the rehabilitation stage in patients with stroke lack specificity. This study aimed to develop a clinical measure to assess symptoms of PSD in the rehabilitation stage. Methods The research team created the initial items through a literature review and semi-structured interviews of patients with stroke. Then, the symptom-related items were estimated by three panels: healthcare professionals (N = 41), Delphi experts (N = 15), and patients with stroke in the rehabilitation stage (N = 30). Results The literature review and semi-structured interview produced 51 symptom-related items including six domains, and the items were reduced to 47 by the healthcare professionals. The symptom-related items were further reduced to 33 items by a two-round Delphi consultation. The initiative coefficients of the two Delphi rounds were 71.4 and 100%, the expert authority coefficients were both 0.85, Kendall’s W were 0.152 and 0.408 (p < 0.01), and the coefficient of variation (CV) were 0.05–0.32 and 0.00–0.18, respectively. The item-level content validity index (I-CVI) was 0.53–1.00, the scale-level CVI/universal agreement (S-CVI/UA) was 0.26, and the S-CVI/average (S -CVI/Ave) was 0.85 for the first found Delphi consultation; the I-CVI was 0.67–1.00, the S-CVI/UA was 0.61, and the S-CVI/Ave was 0.97 for the second round Delphi consultation. All content validity indicators have been significantly improved compared with the first round. Using mean ≥ 4 and full score ≥ 0.5, combined with CV ≤ 0.16 as the item criteria, a clinical measure of PSD with 33 items and 6 dimensions (cognition, sleep, behavior, emotion, body, and guilt) was finally formed after two rounds. The patients with stroke made no further revisions after evaluation. Conclusion The research team developed a specific tool with good content validity to assess the symptoms of PSD in the rehabilitation stage.
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Affiliation(s)
- Junya Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Jing Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yawei Zeng
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Ruonan Li
- Division of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yucui Wang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiwei Ding
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Junyi Guo
- Department of Rehabilitation, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Junyi Guo,
| | - Haiyun Lin
- Department of Rehabilitation, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Haiyun Lin,
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, China
- Jufang Li,
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Hum S, Fellows LK, Lourenco C, Mayo NE. Are the Items of the Starkstein Apathy Scale Fit for the Purpose of Measuring Apathy Post-stroke? Front Psychol 2021; 12:754103. [PMID: 34950086 PMCID: PMC8688540 DOI: 10.3389/fpsyg.2021.754103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Importance: Given the importance of apathy for stroke, we felt it was time to scrutinize the psychometric properties of the commonly used Starkstein Apathy Scale (SAS) for this purpose. Objectives: The objectives were to: (i) estimate the extent to which the SAS items fit a hierarchical continuum of the Rasch Model; and (ii) estimate the strength of the relationships between the Rasch analyzed SAS and converging constructs related to stroke outcomes. Methods: Data was from a clinical trial of a community-based intervention targeting participation. A total of 857 SAS questionnaires were completed by 238 people with stroke from up to 5 time points. SAS has 14 items, rated on a 4-point scale with higher values indicating more apathy. Psychometric properties were tested using Rasch partial-credit model, correlation, and regression. Items were rescored so higher scores are interpreted as lower apathy levels. Results: Rasch analysis indicated that the response options were disordered for 8/14 items, pointing to unreliability in the interpretation of the response options; they were consequently reduced from 4 to 3. Only 9/14 items fit the Rasch model and therefore suitable for creating a total score. The new rSAS was deemed unidimensional (residual correlations: < 0.3), reasonably reliable (person separation index: 0.74), with item-locations uniform across time, age, sex, and education. However, 30% of scores were > 2 SD above the standardized mean but only 2/9 items covered this range (construct mistargeting). Apathy (rSAS/SAS) was correlated weakly with anxiety/depression and uncorrelated with physical capacity. Regression showed that the effect of apathy on participation and health perception was similar for rSAS/SAS versions: R2 participation measures ranged from 0.11 to 0.29; R2 for health perception was ∼0.25. When placed on the same scale (0–42), rSAS value was 6.5 units lower than SAS value with minimal floor/ceiling effects. Estimated change over time was identical (0.12 units/month) which was not substantial (1.44 units/year) but greater than expected assuming no change (t: 3.6 and 2.4). Conclusion: The retained items of the rSAS targeted domains of behaviors more than beliefs and results support the rSAS as a robust measure of apathy in people with chronic stroke.
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Affiliation(s)
- Stanley Hum
- McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, Montreal, QC, Canada
| | - Lesley K Fellows
- McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, Montreal, QC, Canada
| | - Christiane Lourenco
- Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, Brazil
| | - Nancy E Mayo
- McGill University, Montreal, QC, Canada.,McGill University Health Centre (MUHC), Montreal, QC, Canada.,McGill University Health Centre-Research Institute (MUHC-RI), Montreal, QC, Canada
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French MA, Miller A, Pohlig RT, Reisman DS. Depressive Symptoms Moderate the Relationship Among Physical Capacity, Balance Self-Efficacy, and Participation in People After Stroke. Phys Ther 2021; 101:6380792. [PMID: 34636909 PMCID: PMC8697846 DOI: 10.1093/ptj/pzab224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/02/2021] [Accepted: 08/27/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE It was previously found that balance self-efficacy mediated the relationship between physical capacity and participation after stroke. The effect of other factors that influence participation, such as depression, on this relationship has not been explored. This study examined the effect of symptoms of depression on the mediated relationship between physical capacity and participation by balance self-efficacy in individuals after stroke. METHODS In this cross-sectional study, 282 persons with chronic stroke (>6 months) were classified as having either low or high Geriatric Depression Scale scores. This study used a multiple group structural equation model to test moderated mediation by comparing a constrained model (indicating no effect of depression on the mediation) and an unconstrained model (indicating an effect of depression on the mediation). The models were compared using a chi-squared difference test. RESULTS The chi-squared difference test suggested that the unconstrained model was a better fit, indicating that depressive symptoms moderated the mediated relationship between physical capacity and participation (χ2(3, N = 282) = 9.0). In the Low Depression group, a significant indirect effect indicated that balance self-efficacy did mediate the relationship between physical capacity and participation. There was no significant indirect effect in the High Depression group. CONCLUSION The results suggest the relationship between physical capacity and participation appears to be mediated by balance self-efficacy in individuals after stroke with low reports of depressive symptoms, but in those with high reports of depressive symptoms, physical capacity and balance self-efficacy are unrelated to participation. IMPACT Targeting balance self-efficacy to improve post-stroke participation may be beneficial only for individuals with low reports of depression. In individuals after stroke with high reports of depression, treatment should include and emphasize the treatment of those depressive symptoms. Additional work further examining these complex relationships is warranted.
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Affiliation(s)
- Margaret A French
- Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Allison Miller
- Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Ryan T Pohlig
- Department of Biostatistics Core Facility, University of Delaware, Newark, Delaware, USA
| | - Darcy S Reisman
- Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA,Address all correspondence to Dr Reisman at:
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Pollock A, Hazelton C, Rowe FJ, Jonuscheit S, Kernohan A, Angilley J, Henderson CA, Langhorne P, Campbell P. Interventions for visual field defects in people with stroke. Cochrane Database Syst Rev 2019; 5:CD008388. [PMID: 31120142 PMCID: PMC6532331 DOI: 10.1002/14651858.cd008388.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Visual field defects are estimated to affect 20% to 57% of people who have had a stroke. Visual field defects can affect functional ability in activities of daily living (commonly affecting mobility, reading and driving), quality of life, ability to participate in rehabilitation, and depression and anxiety following stroke. There are many interventions for visual field defects, which are proposed to work by restoring the visual field (restitution); compensating for the visual field defect by changing behaviour or activity (compensation); substituting for the visual field defect by using a device or extraneous modification (substitution); or ensuring appropriate diagnosis, referral and treatment prescription through standardised assessment or screening, or both. OBJECTIVES To determine the effects of interventions for people with visual field defects after stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, the Cochrane Eyes and Vision Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, AMED, PsycINFO, and PDQT Databse, and clinical trials databases, including ClinicalTrials.gov and WHO Clinical Trials Registry, to May 2018. We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts. SELECTION CRITERIA Randomised trials in adults after stroke, where the intervention was specifically targeted at improving the visual field defect or improving the ability of the participant to cope with the visual field loss. The primary outcome was functional ability in activities of daily living and secondary outcomes included functional ability in extended activities of daily living, reading ability, visual field measures, balance, falls, depression and anxiety, discharge destination or residence after stroke, quality of life and social isolation, visual scanning, adverse events, and death. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, extracted data and appraised trials. We undertook an assessment of methodological quality for allocation concealment, blinding of outcome assessors, method of dealing with missing data, and other potential sources of bias. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS Twenty studies (732 randomised participants, with data for 547 participants with stroke) met the inclusion criteria for this review. However, only 10 of these studies compared the effect of an intervention with a placebo, control, or no treatment group, and eight had data which could be included in meta-analyses. Only two of these eight studies presented data relating to our primary outcome of functional abilities in activities of daily living. One study reported evidence relating to adverse events.Three studies (88 participants) compared a restitutive intervention with a control, but data were only available for one study (19 participants). There was very low-quality evidence that visual restitution therapy had no effect on visual field outcomes, and a statistically significant effect on quality of life, but limitations with these data mean that there is insufficient evidence to draw any conclusions about the effectiveness of restitutive interventions as compared to control.Four studies (193 participants) compared the effect of scanning (compensatory) training with a control or placebo intervention. There was low-quality evidence that scanning training was more beneficial than control or placebo on quality of life, measured using the Visual Function Questionnaire (VFQ-25) (two studies, 96 participants, mean difference (MD) 9.36, 95% confidence interval (CI) 3.10 to 15.62). However, there was low or very-low quality evidence of no effect on measures of visual field, extended activities of daily living, reading, and scanning ability. There was low-quality evidence of no significant increase in adverse events in people doing scanning training, as compared to no treatment.Three studies (166 participants) compared a substitutive intervention (a type of prism) with a control. There was low or very-low quality evidence that prisms did not have an effect on measures of activities of daily living, extended activities of daily living, reading, falls, or quality of life, and very low-quality evidence that they may have an effect on scanning ability (one study, 39 participants, MD 9.80, 95% CI 1.91 to 17.69). There was low-quality evidence of an increased odds of an adverse event (primarily headache) in people wearing prisms, as compared to no treatment.One study (39 participants) compared the effect of assessment by an orthoptist to standard care (no assessment) and found very low-quality evidence that there was no effect on measures of activities of daily living.Due to the quality and quantity of evidence, we remain uncertain about the benefits of assessment interventions. AUTHORS' CONCLUSIONS There is a lack of evidence relating to the effect of interventions on our primary outcome of functional ability in activities of daily living. There is limited low-quality evidence that compensatory scanning training may be more beneficial than placebo or control at improving quality of life, but not other outcomes. There is insufficient evidence to reach any generalised conclusions about the effect of restitutive interventions or substitutive interventions (prisms) as compared to placebo, control, or no treatment. There is low-quality evidence that prisms may cause minor adverse events.
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Affiliation(s)
- Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, 6th Floor, Govan Mbeki Building, Cowcaddens Road, Glasgow, UK, G4 0BA
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Rasch Analysis of the 9-Item Shared Decision Making Questionnaire in Women With Breast Cancer. Cancer Nurs 2019; 42:E34-E42. [DOI: 10.1097/ncc.0000000000000607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Massai P, Colalelli F, Sansoni J, Valente D, Tofani M, Fabbrini G, Fabbrini A, Scuccimarri M, Galeoto G. Reliability and Validity of the Geriatric Depression Scale in Italian Subjects with Parkinson's Disease. PARKINSON'S DISEASE 2018; 2018:7347859. [PMID: 30155239 PMCID: PMC6093010 DOI: 10.1155/2018/7347859] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/27/2018] [Accepted: 07/11/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The Geriatric Depression Scale (GDS) is commonly used to assess depressive symptoms, but its psychometric properties have never been examined in Italian people with Parkinson's disease (PD). The aim of this study was to study the reliability and validity of the Italian version of the GDS in a sample of PD patients. METHODS The GDS was administered to 74 patients with PD in order to study its internal consistency, test-retest reliability, construct, and discriminant validity. RESULTS The internal consistency of GDS was excellent (α = 0.903), as well as the test-retest reliability (ICC = 0.941 [95% CI: 0.886-0.970]). GDS showed a strong correlation with instruments related to the depression (ρ = 0.880) in PD (ρ = 0.712) and a weak correlation with generic measurement instruments (-0.320 < ρ <-0.217). An area under the curve of 0.892 (95% CI 0.809-0.975) indicated a moderate capability to discriminate depressed patients to nondepressed patient, with a cutoff value between 15 and 16 points that predicts depression (sensitivity = 87%; specificity = 82%). CONCLUSION The GDS is a reliable and valid tool in a sample of Italian PD subjects; this scale can be used in clinical and research contexts.
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Affiliation(s)
| | | | - Julita Sansoni
- Department of Public Health and Infection Disease, Sapienza University of Rome, Rome, Italy
| | - Donatella Valente
- Department Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Fabbrini
- Department Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCSS Neuromed Institute, Pozzilli, IS, Italy
| | - Andrea Fabbrini
- Department Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Galeoto
- Department of Public Health and Infection Disease, Sapienza University of Rome, Rome, Italy
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Best Practices for The Interdisciplinary Rehabilitation Team: A Review of Mental Health Issues in Mild Stroke Survivors. Stroke Res Treat 2018; 2018:6187328. [PMID: 29973980 PMCID: PMC6008610 DOI: 10.1155/2018/6187328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/22/2018] [Accepted: 03/12/2018] [Indexed: 01/02/2023] Open
Abstract
Individuals with mild strokes are generally considered fully functional and do not traditionally receive rehabilitation services. Because patients with mild stroke are assumed to have a good recovery, they may have deficits in other areas, including mental health, that are not addressed. As a result, patients with mild stroke are unable to meet quality of life standards. In addition, healthcare professionals are likely unaware of the potential mental health issues that may arise in mild stroke. To address this gap in knowledge, we review the evidence supporting mental health evaluation and intervention in mild stroke. Specifically, we review comorbid diagnoses including depression, anxiety, fatigue, and sleep disturbances and their potential effects on health and function. Finally, we conclude with general recommendations describing best practice derived from current evidence.
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8
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Wu TY, Yu WH, Huang CY, Hou WH, Hsieh CL. Rasch Analysis of the General Self-Efficacy Scale in Workers with Traumatic Limb Injuries. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:332-339. [PMID: 26614307 DOI: 10.1007/s10926-015-9617-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Purpose The purpose of this study was to apply Rasch analysis to examine the unidimensionality and reliability of the General Self-Efficacy Scale (GSE) in workers with traumatic limb injuries. Furthermore, if the items of the GSE fitted the Rasch model's assumptions, we transformed the raw sum ordinal scores of the GSE into Rasch interval scores. Methods A total of 1076 participants completed the GSE at 1 month post injury. Rasch analysis was used to examine the unidimensionality and person reliability of the GSE. The unidimensionality of the GSE was verified by determining whether the items fit the Rasch model's assumptions: (1) item fit indices: infit and outfit mean square (MNSQ) ranged from 0.6 to 1.4; and (2) the eigenvalue of the first factor extracted from principal component analysis (PCA) for residuals was <2. Person reliability was calculated. Results The unidimensionality of the 10-item GSE was supported in terms of good item fit statistics (infit and outfit MNSQ ranging from 0.92 to 1.32) and acceptable eigenvalues (1.6) of the first factor of the PCA, with person reliability = 0.89. Consequently, the raw sum scores of the GSE were transformed into Rasch scores. Conclusions The results indicated that the items of GSE are unidimensional and have acceptable person reliability in workers with traumatic limb injuries. Additionally, the raw sum scores of the GSE can be transformed into Rasch interval scores for prospective users to quantify workers' levels of self-efficacy and to conduct further statistical analyses.
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Affiliation(s)
- Tzu-Yi Wu
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan
| | - Wan-Hui Yu
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan
| | - Chien-Yu Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
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Mayo NE, Anderson S, Barclay R, Cameron JI, Desrosiers J, Eng JJ, Huijbregts M, Kagan A, MacKay-Lyons M, Moriello C, Richards CL, Salbach NM, Scott SC, Teasell R, Bayley M. Getting on with the rest of your life following stroke: a randomized trial of a complex intervention aimed at enhancing life participation post stroke. Clin Rehabil 2015; 29:1198-211. [DOI: 10.1177/0269215514565396] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 12/01/2014] [Indexed: 11/15/2022]
Abstract
Objective: To enhance participation post stroke through a structured, community-based program. Design: A controlled trial with random allocation to immediate or four-month delayed entry. Setting: Eleven community sites in seven Canadian cities. Subjects: Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently. Interventions: Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups. Main measures: Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months. Results: A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combined and a within-person analysis was carried out at three time points. There were statistically significant increases in all study outcomes on average over all persons. Over 45% of people met or exceeded the pre-specified target of a three hour per week increase in meaningful activity and this most often took a full year of intervention to achieve. Greatest gains were in satisfaction with community integration (mean 4.78; 95% CI: 2.01 to 7.55) and stroke-specific health-related quality of life (mean 4.14; 95% CI: 2.31 to 5.97). Conclusions: Community-based programs targeting participation are feasible and effective, but stroke survivors require time to achieve meaningful gains.
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Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
| | - Sharon Anderson
- Department of Human Ecology, University of Alberta, Alberta, Canada
| | - Ruth Barclay
- Department of Physical Therapy, University of Manitoba, Manitoba, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Johanne Desrosiers
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Maria Huijbregts
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Aura Kagan
- Education and Applied Research, Aphasia Institute – The Pat Arato Aphasia Centre, Toronto, ON, Canada
| | | | - Carolina Moriello
- McGill University Health Center (MUHC), MUHC Research Institute, Montreal, QC, Canada
| | - Carol L Richards
- Department of Rehabilitation and Center for Interdisciplinary Research in Rehabilitation and Social Integration, Laval University, Quebec, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Susan C Scott
- Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
| | - Robert Teasell
- Department of Physical Medicine and Rehabilitation, Western University, London, UK
| | - Mark Bayley
- Brain and Spinal Cord Rehab Program, UHN-Toronto Rehabilitation Institute, Toronto, ON, Canada
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Liu-Ambrose T, Eng JJ. Exercise training and recreational activities to promote executive functions in chronic stroke: a proof-of-concept study. J Stroke Cerebrovasc Dis 2015; 24:130-7. [PMID: 25440324 PMCID: PMC4486380 DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/25/2014] [Accepted: 08/01/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Stroke survivors represent a target population in need of intervention strategies to promote cognitive function and prevent dementia. Both exercise and recreational activities are promising strategies. We assessed the effect of a 6-month exercise and recreation program on executive functions in adults with chronic stroke. METHODS A 6-month ancillary study within a multicentre randomized trial. Twenty-eight chronic stroke survivors (ie, ≥ 12 months since an index stroke) were randomized to 1 of 2 experimental groups: intervention (INT; n = 12) or delayed intervention (D-INT; n = 16). Participants of the INT group received a 6-month community-based structured program that included 2 sessions of exercise training and 1 session of recreation and leisure activities per week. Participants of the D-INT group received usual care. The primary outcome measure was the Stroop Test, a cognitive test of selective attention and conflict resolution. Secondary cognitive measures included set shifting and working memory. Mood, functional capacity, and general balance and mobility were additional secondary outcome measures. RESULTS Compared with the D-INT group, the INT group significantly improved selective attention and conflict resolution (P = .02), working memory (P = .04), and functional capacity (P = .02) at the end of the 6-month intervention period. Improved selective attention and conflict resolution was significantly associated with functional capacity at 6 months (r = .39; P = .04). CONCLUSIONS This is the first randomized study to demonstrate that an exercise and recreation program can significantly benefit executive functions in community-dwelling chronic stroke survivors who are mildly cognitively impaired-a population at high-risk for dementia and functional decline. Thus, clinicians should consider prescribing exercise and recreational activities in the cognitive rehabilitation of chronic stroke survivors.
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Affiliation(s)
- Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, University of British Columbia, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Brain Research Centre, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Rehab Research Laboratory, GF Strong Rehab Centre, Vancouver, British Columbia, Canada
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Barclay R, Ripat J, Mayo N. Factors describing community ambulation after stroke: a mixed-methods study. Clin Rehabil 2014; 29:509-21. [DOI: 10.1177/0269215514546769] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 07/06/2014] [Indexed: 11/16/2022]
Abstract
Objective: To develop a model of community ambulation after stroke based on: Canadian data from community-dwelling individuals post-stroke; the experiences and opportunities for community ambulation expressed by individuals with stroke; and current literature. The model presents a visual depiction of the relationships between the different factors of community ambulation after stroke. Design: A quantitative/qualitative explanatory sequential mixed-methods design was utilized. Secondary data analysis with structural equation modeling resulted in a community ambulation model. Two focus groups of individuals with stroke were conducted to verify and explain the model. Setting: Community. Subjects: Quantitative data from 227 participants: 142 (63%) male; 63.4 (12.0) years of age and 2.6 (2.5) years post stroke. Eleven individuals participated in the focus groups: 6 (55%) male; 61.4 (6.9) years of age and 5.8 (3.3) years since stroke. Main measures: Model variables: items from the EuroQol, Preference Based Stroke Index, gait speed, Reintegration to Normal Living Index, the Community Health Activities Model Program for Seniors, and the Geriatric Depression Scale. Results: The model had reasonable fit with three latent variables: ambulation, gait speed, and health perceptions (normed χ2 = 1.8, root mean square error of approximation = 0.060 (0.043; 0.075)). Depression was also a component of community ambulation. Participants verified the model and added endurance and the environment as additional components. Participants used self-awareness and knowledge of the environment to engage in cognitive strategies related to community ambulation. Conclusions A model of community ambulation after stroke was developed and verified. Recognizing important components of community ambulation may assist physiotherapists in determining community ambulation goals, needs, and opportunities in partnership with clients.
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Affiliation(s)
- Ruth Barclay
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacquie Ripat
- Department of Occupational Therapy, University of Winnipeg, Manitoba, Manitoba, Canada
| | - Nancy Mayo
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
- Research Scientist, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
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Messinger-Rapport BJ, Gammack JK, Thomas DR, Morley JE. Clinical update on nursing home medicine: 2013. J Am Med Dir Assoc 2014; 14:860-76. [PMID: 24286710 DOI: 10.1016/j.jamda.2013.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/18/2013] [Indexed: 12/18/2022]
Abstract
This is the seventh article in the series of Clinical Updates on Nursing Home Care. The topics covered are antiresorptive drugs, hip fracture, hypertension, orthostatic hypotension, depression, undernutrition, anorexia, cachexia, sarcopenia, exercise, pain, and behavioral and psychological symptoms of dementia.
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da Rocha NS, Chachamovich E, de Almeida Fleck MP, Tennant A. An introduction to Rasch analysis for Psychiatric practice and research. J Psychiatr Res 2013; 47:141-8. [PMID: 23069651 DOI: 10.1016/j.jpsychires.2012.09.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 08/17/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
Abstract
This article aims to present the main characteristics of Rasch analysis in the context of patient reported outcomes in Psychiatry. We present an overview of the main features of the Rasch analysis, using as an example the latent variable of depressive symptoms, with illustrations using the Beck Depression Inventory. We will show that with fitting data to the Rasch model, we can confirm the structural validity of the scale, including key attributes such as invariance, local dependency and unidimensionality. We also illustrate how the approach can inform on the meaning of the numbers attributed to scales, the amount of the latent traits that such numbers represent, and the consequent adequacy of statistical operations used to analyse them. We would argue that fitting data to the Rasch model has become the measurement standard for patient reported outcomes in general and, as a consequence will facilitate a quality improvement of outcome instruments in psychiatry. Recent advances in measurement technologies built upon the calibration of items derived from Rasch analysis in the form of computerized adaptive tests (CAT) open up further opportunities for reducing the burden of testing, and/or expanding the range of information that can be collected during a single session.
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Affiliation(s)
- Neusa Sica da Rocha
- Hospital de Clinicas de Porto Alegre, Programa de Pós Graduação em Ciências Médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil.
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Development of a method for quantifying cognitive ability in the elderly through adaptive test administration. Int Psychogeriatr 2011; 23:1116-23. [PMID: 21457610 DOI: 10.1017/s1041610211000615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The field of geriatric medicine has identified a need for an evaluative tool that can rapidly quantify global cognitive ability and accurately monitor change over time in patients with a wide range of impairments. We hypothesized that the development of an adaptive test approach to cognitive measurement would help to meet that need. This study aimed to provide evidence for the interpretability of scores obtained from a novel, adaptive approach to cognitive assessment, called the Geriatric Rapid Adaptive Cognitive Estimate (GRACE) method. METHODS An adaptive method for cognitive assessment was developed using data from 185 patients referred for geriatric cognitive assessment, and pilot tested in an additional 137 patients. Correlations between test scores and between rank orders of patients were computed to examine the reliability and validity of cognitive ability scores obtained by (1) administering test questions out of their usual order, (2) administering only a subset of questions, and (3) administering questions adaptively using simplified selection rules based on the most difficult question passed. RESULTS Cognitive ability scores obtained with the GRACE method correlated highly with the Montreal Cognitive Assessment (MoCA) scores (r = 0.93) and ranked patients similarly in order of ability (r > 0.87). A simplified adaptive testing algorithm for pencil-and-paper assessment demonstrated moderately high correlations with scores obtained from administering the full set of MMSE and MoCA items as well as the MoCA items alone. CONCLUSIONS Scores from the GRACE method can be obtained easily in 5-10 minutes, reducing test burden. The resulting numeric score quantifies cognitive ability, allowing clinicians to compare patients and monitor change in global cognition over time. The adaptive nature of this method allows for evaluation of persons across a broader range of cognitive ability levels than currently available tests.
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