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Duevel JA, Baumgartner A, Grosser J, Kreimeier S, Elkenkamp S, Greiner W. A Case Management Approach in Stroke Care: A Mixed-Methods Acceptance Analysis From the Perspective of the Medical Profession. Prof Case Manag 2024; 29:158-170. [PMID: 38015804 DOI: 10.1097/ncm.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
PURPOSE OF STUDY In terms of continuous and coordinated health care, cross-sectoral care structures are crucial. However, the German health care system is characterized by fragmentation of medical services and responsibilities. This fragmentation leads to multiple interfaces frequently causing loss of information, effectiveness, and quality. The concept of case management has the potential to improve cooperation between sectors and health care providers. Hence, a case management intervention for patients with stroke was evaluated with an acceptance analysis on the physicians' willingness to cooperate with stroke managers and their assessment of the potential of case management for the health care of patients with stroke. PRIMARY PRACTICE SETTINGS Primary practice settings included physicians working in the hospital, rehabilitation, and outpatient sectors who had actual or potential contact with a stroke case manager within the project region of East Westphalia-Lippe. METHODOLOGY AND SAMPLE The analysis was conducted using a mixed-methods approach. Expert interviews were conducted in 2020. Afterward a questionnaire was developed, which was then distributed to physicians in 2021. Both the interviews and the questionnaire included questions on conceptual knowledge and concrete expectations prior of the project, on experiences during the project and on recommendations and physicians' assessment of future organization in health care to classify and describe the acceptance. RESULTS Nine interviews were conducted and 23 questionnaires were completed. Only slightly more than 50% of the physicians had prior knowledge of the case management approach. Overall, ambiguous results concerning the acceptance of case managers were revealed. Additional personal assistance for patients with stroke was seen as beneficial at the same time critical perspectives regarding further fragmentation of health care and overlapping of competences with existing professional groups or forms of health care were collected. General practitioners in particular were critical of the case management approach. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE From the physicians' point of view, at least two changes are necessary for the project approach to be integrated into standard care. First, the target group should be adapted according to the case management approach. Second, the delegation of tasks and responsibilities to case managers should be revised. The sectoral difference in the acceptance of case managers by physicians indicates that active cooperation and communication in everyday work has direct impact on the acceptance of a new occupational profession. Physician acceptance has a significant impact on the implementation of new treatment modalities and thus influences the overall quality of health care.
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Affiliation(s)
- Juliane Andrea Duevel
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Alina Baumgartner
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - John Grosser
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Simone Kreimeier
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Svenja Elkenkamp
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Wolfgang Greiner
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
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Yang J, Wu C, Jin Y, Hu M, Lin Y, Yao Q, Zhu C. Long-term outcomes among ischemic stroke TOAST subtypes: A 12-year Cohort study in China. J Stroke Cerebrovasc Dis 2024; 33:107783. [PMID: 38896973 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Disparities in short-term ischemic stroke (IS) prognosis among Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes were observed. Notably, little is known about the long-term prognosis of different subtypes in China. We aim to investigate the long-term outcome in IS patients and try to explore the potential interactive effects between IS subtypes and antithrombotic therapy. METHODS This is a prospective cohort of stroke survivors. Patients diagnosed with first-ever IS at the Department of Neurology, West China Hospital, Sichuan University from January 2010 to December 2019 were recruited. They were followed until September 2022 to assess recurrence, mortality, and functional recovery. The multivariate Fine-Gray model assessed stroke recurrence, while Cox regression estimated hazard ratios. Modified Rankin Scale scores(mRS) were analyzed using the generalized linear mixed effects model. RESULTS At baseline, 589 of 950 participants (62.00 %) were male. The longest follow-up was 150 months, the shortest was 1.5 months, and the median follow-up was 81.0 months. Cardio-embolism (CE) bore the highest mortality risk compared to large artery atherosclerosis (LAA) (HR=4.43,95 %CI 1.61-12.23). Among survivors on anticoagulant therapy, CE exhibited a reduced risk of mortality (HR = 0.18, 95 % CI 0.04-0.80). In function recovery, small artery occlusion (SAO) demonstrated more favorable prognostic outcomes (β=-2.08, P<0.01, OR=0.13,95 %CI 0.03-0.47). Among survivors taking antiplatelet drugs, SAO demonstrated a slower pace of functional recovery compared to LAA (β=1.39, P=0.05, OR=3.99,95 %CI 1.01-15.74). CONCLUSIONS Long-term outcomes post-first IS vary among TOAST subtypes. Anticoagulant therapy offers long-term benefits among patients of the CE. However, prolonged administration of antiplatelet drugs among SAO patients may be limited in improving function recovery. Physicians should carefully consider treatment options for different IS subtypes to optimize patient outcomes and stroke care effectiveness.
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Affiliation(s)
- Jing Yang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Chenyao Wu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China; Public Health Center, Tianfu New Area Disease Prevention and Control Center, Sichuan, PR China
| | - Yu Jin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Meijing Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Yidie Lin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Qiang Yao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China.
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Zhu L, Shen X, Shi X, Ouyang X. Factors associated with intrinsic capacity impairment in hospitalized older adults: a latent class analysis. BMC Geriatr 2024; 24:494. [PMID: 38840051 PMCID: PMC11151595 DOI: 10.1186/s12877-024-05093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Intrinsic capacity (IC) is proposed by the World Health Organization (WHO) to promote healthy aging. Although some studies have examined the factors influencing IC, few studies have comprehensively confirmed lifestyle factors on IC, especially IC impairment patterns. The present study aimed to identify the patterns of IC impairment and explore the lifestyle and other factors associated with different patterns of IC impairment. METHODS This cross-sectional study was conducted in a Chinese geriatric hospital. IC was evaluated in five domains according to the recommendations of WHO: cognition, locomotion, vitality, sensory and psychological domains. The sociodemographic and health-related characteristics of participants were assessed.The health promoting lifestyle was evaluated using the Health-Promoting Lifestyle Profile-II scale, including nutrition, health responsibility, interpersonal relationships, physical activity, spiritual growth and stress management. We applied latent class analysis to identify IC impairment patterns and compared basic activities of daily living, instrumental activities of daily living, frailty, quality of life and falls among different IC impairment patterns. Multinomial logistic regression analysis was conducted to identify factors influencing the IC impairment patterns. RESULTS Among 237 participants included, the latent class analysis identified three patterns of IC impairment: 44.7% high IC (Class 1), 31.2% intermediate IC mainly locomotor impairment (Class 2) and 24.1% low IC mainly cognitive impairment (Class 3). Older adults in class 1 had the best function ability and quality of life, while class 3 had the highest levels of disability and frailty, the poorest quality of life and a higher prevalence of falls. Compared with class 1, older adults with advanced age (OR = 22.046, 95%CI:1.735-280.149), osteoporosis (OR = 3.377, 95%CI:1.161-9.825), and lower scores in physical activity (OR = 0.842, 95%CI:0.749-0.945), stress management (OR = 0.762, 95%CI:0.585-0.993) and social support (OR = 0.897, 95%CI:0.833-0.965) were more likely to belong to the class 2. Simultaneously, compared with class 1, older adults with advanced age (OR = 104.435, 95%CI:6.038-1806.410), stroke (OR = 3.877, 95%CI:1.172-12.823) and lower scores in physical activity (OR = 0.784, 95%CI:0.667-0.922) and social support (OR = 0.909, 95%CI:0.828-0.998) were more likely to be class 3. In addition, compared with class 2, older adults with a lower score in nutrition (OR = 0.764, 95%CI:0.615-0.950) were more likely to belong to the class 3. CONCLUSIONS This study provides evidence that there are heterogeneous IC impairment patterns in older adults and identifies various associated factors in each pattern, including age, stroke, osteoporosis, social support and lifestyle behaviors such as nutrition, physical activity and stress management. It informs stakeholders on which modifiable factors should be targeted through public health policy or early intervention to promote IC and healthy aging in older adults.
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Affiliation(s)
- Lingzhi Zhu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xiaoxing Shen
- Department of Geriatrics, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaolan Shi
- Department of Geriatrics, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaojun Ouyang
- Department of Geriatrics, Geriatric Hospital of Nanjing Medical University, Nanjing, China.
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An Z, Li K, Yang X, Ke J, Xu Y, Zhang X, Meng X, Luo X, Yu L. Community-based rehabilitation services implemented by multidisciplinary teams among adults with stroke: a scoping review with a focus on Chinese experience. BMC Public Health 2024; 24:740. [PMID: 38454384 PMCID: PMC10921794 DOI: 10.1186/s12889-024-18218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Despite the growing interest in hospital rehabilitation services for communities, studies on existing community-based rehabilitation (CBR) services remain scarce owing to limitations in the development of community health services and regional cultural diversity. As a guaranteed measure for ensuring the quality of rehabilitation services and achieving the desired service outcomes, clear roles and responsibilities in multidisciplinary teams and effective service delivery are particularly important. OBJECTIVE This scoping review aimed to determine the scope of community stroke rehabilitation programs involving existing multidisciplinary teams and to analyze the implementation content and implementers' functional roles to provide guidance for future CBR programs. METHODS The scoping review design followed the methodology of the Joanna Briggs Institute and was based on the normative scoping review framework proposed by Arksey and O'Malley. The comprehensive CBR framework was proposed by World Health Organization-guided data charting and analysis. RESULTS Of the 22,849 identified citations, 74 studies were included, consisting of 6,809 patients with stroke and 49 primary caregivers, most of whom were from China. The most common working mode in CBR programs was a dual approach involving both healthcare professionals in medical institutions and community healthcare professionals. The number of programs in each discipline was in the following descending order: nursing, medical care, rehabilitation, psychology, nutrition, and public health. Among these, multidisciplinary teams comprising medical, nursing, and rehabilitation disciplines were the most common, with a total of 29 programs. Disciplinary members were mainly responsible for implementing their respective disciplinary content, with physicians providing guidance for the programs. More than 82.4% of the studies reported 2-4 intervention strategies. The intervention forms of rehabilitation content were the most diverse, whereas preventive interventions were more homogeneous than others. Physical function and socio-psychological measurements were the most commonly reported outcomes. CONCLUSION CBR services implemented by multidisciplinary teams can effectively achieve functional and emotional improvement in patients with stroke, and nurses are the most involved in implementation, especially in community settings. The results further emphasize the importance of strengthening the exploration of nurses' maximum potential to implement CBR plans in future practice. TRIAL REGISTRATION The registration information for this scoping review can be found at osf.io/pv7tg.
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Affiliation(s)
- Zifen An
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Ke Li
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Xinyi Yang
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Jie Ke
- Department of General Practice, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Yuying Xu
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Xi Zhang
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China
| | - Xianmei Meng
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China.
- Department of General Practice, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, 430071, Wuhan, Hubei Province, China.
| | - Xianwu Luo
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China.
| | - Liping Yu
- School of Nursing, Wuhan University, No. 115 Donghu Road, 430071, Wuhan, Hubei Province, China.
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Guo L, Wei M, Namassevayam G, Zhang M, Xie Y, Meng R, Guo Y, Liu Y. Is sleep quality a moderated mediator between perceived stress and depression among stroke patients? Front Public Health 2024; 11:1284197. [PMID: 38249388 PMCID: PMC10796719 DOI: 10.3389/fpubh.2023.1284197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Background Sleep quality can offer new insights into addressing depression among stroke patients. However, the current understanding of the mechanism by which sleep quality reduces depression is not clear in existing research. Objectives This study aimed to identify the relationships and mechanisms among perceived stress, sleep quality, social support, and depression in stroke patients. Methods A multicenter cross-sectional study was conducted from January to May 2023. Cluster random sampling was used to recruit 500 stroke patients from five hospitals in Henan Province, China. The Chinese Perceived Stress Scale (CPSS), Pittsburgh Sleep Quality Index (PSQI), Social Support Rating Scale (SSRS), and Hamilton Depression Scale (HAMD-24) were employed to assess perceived stress, sleep quality, social support, and depression, respectively. Data were analyzed using descriptive analysis, Pearson's correlation analysis, and moderated mediation analysis. The study adhered to the STROBE checklist for reporting. Results Out of 500 participants, 471 completed the survey (94.2%). After controlling for sex and age, mediation analysis revealed that poor sleep quality partially mediated the relationship between perceived stress and depression (β = 0.184, 95% CI: 0.110, 0.359). Additionally, social support played a moderating role in the mediation model. Conclusion This study explained the moderated mediation of sleep quality and social support between perceived stress and depression. It provided a theoretical basis for the development of a sleep quality intervention program for reducing depression among stroke patients.
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Affiliation(s)
- Lina Guo
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Miao Wei
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Genoosha Namassevayam
- Department of Supplementary Health Sciences, Faculty of Health-Care Sciences, Eastern University, Chenkalady, Sri Lanka
| | - Mengyv Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yvying Xie
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Runtang Meng
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yuanli Guo
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanjin Liu
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Llamas-Ramos R, Llamas-Ramos I, Pérez-Robledo F, Sánchez-González JL, Bermejo-Gil BM, Frutos-Bernal E, Martín-Nogueras AM. Validity of the telematic Fugl Meyer assessment scale - upper extremity (TFMA-UE) Spanish version. Front Neurol 2023; 14:1226192. [PMID: 37638200 PMCID: PMC10449578 DOI: 10.3389/fneur.2023.1226192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Background Telematic assistance has become indispensable in recent years. The increased prevalence of Acquired brain injury and the sequels it causes, requires long-lasting multidisciplinary treatments. Validated tools to assess the evolution of the disabilities and limitations of this pathology are essential to individualize and prescribe adapted treatments. The aim has been to create the telematic version of the Fugl Meyer Assessment-Upper Extremity Motor Function (TFMA-UE) Spanish scale and its adaptation to the remote assessment of neurologic patients. Methods An adapted scale was designed based on the Fugl Meyer Assessment scale-telematic version (FMA-TV): TFMA-UE. This scale is composed by 21 items which evaluate the upper extremity motor function. Physiotherapists trained in this tool, evaluate the results obtained from applying the two versions (on-site and telematic) to compare the results. Results TFMA-UE was administered to 30 patients with acquired brain injury. It was applied on site and through the web platform selected by the patients in two different days. Patients completed all the scale in an easily way without help. The exploratory and confirmatory factor analysis confirmed a factorial structure with a factor (76.08% of the variance). The Cronbach's internal consistency index obtained was 0.98 and the weight kappa index used to measure agreement between the two versions was 0.78 which represents substantial agreement. Conclusion The Telematic Fugl Meyer Assessment-Upper Extremity Motor Function (TFMA-UE) scale is a viable, useful and easy to apply tool that allows the upper extremity motor function assessment of Acquired Brain Injury patients.
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Affiliation(s)
- Rocío Llamas-Ramos
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| | - Inés Llamas-Ramos
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
- University Hospital of Salamanca, Salamanca, Spain
| | - Fátima Pérez-Robledo
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| | - Juan Luis Sánchez-González
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| | - Beatriz María Bermejo-Gil
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| | - Elisa Frutos-Bernal
- Department of Statistics, Facultad de Medicina, Universidad de Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - Ana María Martín-Nogueras
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
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Fan W, Ma KK, Yang CX, Guo YL. The mediating effect of stigma between self-perceived burden and loneliness in stroke patients. Front Psychiatry 2023; 14:1219805. [PMID: 37575575 PMCID: PMC10412817 DOI: 10.3389/fpsyt.2023.1219805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Stroke patients may experience reduced socialization and feelings of isolation due to post-stroke sequelae such as impaired motor function and cognitive deficits. Factors associated with loneliness need to be explored to develop targeted interventions. However, little is known about the impact of self-perceived burden and illness stigma on loneliness in this population.The aim of this study was to explore the mediating effect of stigma on self-perceived burden and loneliness in stroke patients. Methods The cluster random sampling method was adopted to select 1028 stroke patients from the neurology department of third-grade A hospitals and second-grade A hospitals in 5 cities of Henan Province from May 2022 to August 2022. A general data questionnaire, self-perceived burden scale, stroke stigma scale, and loneliness scale were used to investigate. The structural equation model was used to analyze the mediating effect of stigma between self-perceived burden and stigma. Results The loneliness of stroke patients was positively correlated with self-perceived burden and stigma. The results of the mediation analysis showed that stigma played a complete mediating role between self-perceived burden and loneliness. Discussion The results of the study revealed the relationship between self-perceived burden, stigma, and loneliness in stroke patients. Stigma mediated the relationship between self-perceived burden and loneliness in this population.Stigma should be emphasized as an important modifiable psychological factor that affects loneliness of stroke patients.
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Affiliation(s)
- Wenfeng Fan
- Nursing and Health School, Zhengzhou University, Zhengzhou, China
| | - Ke ke Ma
- Neurology of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cai xia Yang
- Neurology of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan li Guo
- Neurology of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Li ZD, Qiu HJ, Wang XQ, Zhang CC, Zhang YJ. Transcutaneous auricular vagus nerve stimulation in poststroke cognitive impairment: protocol for a randomised controlled trial. BMJ Open 2022; 12:e063803. [PMID: 36198457 PMCID: PMC9535199 DOI: 10.1136/bmjopen-2022-063803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND As one of the most common stroke sequelae, poststroke cognitive impairment significantly impacts 17.6%-83% of survivors, affecting their rehabilitation, daily living and quality of life. Improving cognitive abilities among patients in stroke recovery is therefore critical and urgent. Transcutaneous auricular vagus nerve stimulation (TAVNS) is a non-invasive, safe, cost-effective treatment with great potential for improving the cognitive function of poststroke patients. This clinical research will evaluate the effectiveness, and help elucidate the possible underlying mechanisms, of TAVNS for improving poststroke cognitive function. METHODS AND ANALYSIS A single-centre, parallel-group, allocation concealment, assessor-blinded randomised controlled clinical trial. We will allocate 88 recruited participants to the TAVNS or sham group for an intervention that will run for 8 weeks, 5 days per week with twice daily sessions lasting 30 min each. Blood tests will be performed and questionnaires issued at baseline and 8-week and 12 week follow-ups. Primary outcomes will be changes in cognitive function scores. Secondary outcomes will be changes in activities of daily living, quality of life and serum oxidative stress indicators. ETHICS AND DISSEMINATION The Ethics Committee of the First Affiliated Hospital of Hunan University of Chinese Medicine has approved the protocol (No. HN-LL-YJSLW-2022200). Findings will be published in peer-reviewed academic journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER ChiCTR2200057808.
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Affiliation(s)
- Zhen-Dong Li
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Hang-Jian Qiu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Xiao-Qian Wang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Cheng-Cheng Zhang
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yue-Juan Zhang
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
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Li Z, Yang L, Qiu H, Wang X, Zhang C, Zhang Y. Comparative efficacy of 5 non-pharmacological therapies for adults with post-stroke cognitive impairment: A Bayesian network analysis based on 55 randomized controlled trials. Front Neurol 2022; 13:977518. [PMID: 36247793 PMCID: PMC9554560 DOI: 10.3389/fneur.2022.977518] [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: 06/24/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAs a common sequela after stroke, cognitive impairment negatively impacts patients' activities of daily living and overall rehabilitation. Non-pharmacological therapies have recently drawn widespread attention for their potential in improving cognitive function. However, the optimal choice of non-pharmacological therapies for post-stroke cognitive impairment (PSCI) is still unclear. Hence, in this study, we compared and ranked 5 non-pharmacological therapies for PSCI with a Bayesian Network Meta-analysis (NMA), to offer a foundation for clinical treatment decision-making.MethodsPubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Chinese Biomedical Medicine, China National Knowledge Infrastructure, Wangfang Database, and China Science and Technology Journal Database were searched from database inception to December 31, 2021, to collect Randomized Controlled Trials for PSCI. All of the studies were assessed (according to Cochrane Handbook for Systematic Reviews) and then data were extracted by two researchers separately. Pairwise meta-analysis for direct comparisons was performed using Revman. NMA of Bayesian hierarchical model was performed by WinBUGS and ADDIS. STATA was used to construct network evidence plots and funnel plots.ResultsA total of 55 trials (53 Two-arm trials and 2 Three-arm trials) with 3,092 individuals were included in this study. In the pair-wise meta-analysis, Transcranial Magnetic Stimulation (TMS), Virtual Reality Exposure Therapy (VR), Computer-assisted cognitive rehabilitation (CA), Transcranial Direct Current Stimulation (tDCS), and Acupuncture were superior to normal cognition training in terms of MoCA, MMSE, and BI outcomes. Bayesian NMA showed that the MoCA outcome ranked Acupuncture (84.7%) as the best therapy and TMS (79.7%) as the second. The MMSE outcome ranked TMS (76.1%) as the best therapy and Acupuncture as the second (72.1%). For BI outcome, TMS (89.1%) ranked the best.ConclusionsTMS and Acupuncture had a better effect on improving cognitive function in post-stroke patients according to our Bayesian NMA. However, this conclusion still needs to be confirmed with large sample size and high-quality randomized controlled trials.Registrationhttps://inplasy.com (No. INPLASY202260036).
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Affiliation(s)
- Zhendong Li
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Lei Yang
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Hangjian Qiu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaoqian Wang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Chengcheng Zhang
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Yuejuan Zhang
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Yuejuan Zhang
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