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Wan M, Zhang Y, Wu Y, Ma X. Cognitive behavioural therapy for depression, quality of life, and cognitive function in the post-stroke period: systematic review and meta-analysis. Psychogeriatrics 2024; 24:983-992. [PMID: 38631702 DOI: 10.1111/psyg.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/12/2024] [Accepted: 04/01/2024] [Indexed: 04/19/2024]
Abstract
The post-stroke period is associated with a lot of sequelae, including depression, decreased quality of life, and decline of cognitive function. Apart from the pharmacotherapy, it is also important to find a non-pharmacological treatment to relieve the sequelae. Cognitive behavioural therapy (CBT) might be a potential candidate, which can be clarified by a systematic review and meta-analysis. The eligible criteria of enrolled studies in the systematic review and meta-analysis were the randomised clinical trials (RCTs) using CBT to treat post-stroke depression, or with the focus on quality of life or cognitive function in the post-stroke period. The endpoint scores of depression, quality of life, and cognitive function scales were the targeted outcome for the final meta-analysis in the random effects model. Ten RCTs with 432 post-stroke patients receiving CBT and 385 controls were included. The meta-analysis results showed significant improvements in depression severity and quality of life. However, no significant difference between CBT and control groups was found in cognitive function. In addition, significant heterogeneity was derived from the meta-analysis. According to the meta-analysis results, CBT might be beneficial for relieving depression severity and improving quality of life. However, cognitive function might not be influenced by CBT. Further studies with a more consistent CBT design with greater sample sizes should be warranted to clarify and confirm the treatment effects of CBT for post-stroke depression and quality of life.
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Affiliation(s)
- Mingye Wan
- Department of Neurology, General Hospital of the Yangtze River Shipping (Wuhan Brain Hospital), Wuhan, China
| | - Ying Zhang
- Department of Critical Care Medicine, Ezhou Central Hospital, Ezhou, China
| | - Youping Wu
- Department of Neurological ICU, The 904 Hospital of PLA Joint Logistic Support Force (Wuxi Taihu Hospital), Wuxi, China
| | - Xia Ma
- Department of Outpatient, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
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Ren XQ, Zhao GM, Fang SW, Xu LF, Wang LD, Zhao LH, Lu MM. Mediating roles of activities of daily living and depression on the relationship between sleep quality and health-related quality of life. Sci Rep 2024; 14:14057. [PMID: 38890451 PMCID: PMC11189409 DOI: 10.1038/s41598-024-65095-0] [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: 09/16/2023] [Accepted: 06/17/2024] [Indexed: 06/20/2024] Open
Abstract
This study aimed to explore the mediating effects of ADL and depression on the relationship between sleep quality and HRQOL among older people in rural China, while also exploring the moderating impact of loneliness. The study gathered data from a household survey conducted among 1587 Chinese rural older adults (mean age = 73.63 years). The collected data was analyzed using SPSS version 23.0 software (IBM, New York, USA) and the PROCESS macro version 4.0 program. The findings indicated a significant correlation between sleep quality, ADL, depression, loneliness and HRQOL. ADL and depression exhibited a chain mediation effect on the relationship between sleep quality and HRQOL. Notably, the association between sleep quality and HRQOL was entirely mediated by ADL and depression. Additionally, loneliness acted as a moderator in the relationship between ADL and HRQOL. The findings of this study suggest that interventions focusing on sleep quality should prioritize strategies for enhancing older adults' ADL and depression as integral components of promoting older adults' HRQOL.
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Affiliation(s)
- Xiao-Qing Ren
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
| | - Gong-Ming Zhao
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Shuo-Wen Fang
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
| | - Ling-Feng Xu
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
| | - Li-Dan Wang
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- Health Policy Research Center, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Lin-Hai Zhao
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- Health Policy Research Center, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Man-Man Lu
- School of Health Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China.
- Health Policy Research Center, Anhui Medical University, Hefei, 230032, Anhui, China.
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Le HT, Honma K, Annaka H, Sun S, Nomura T. Effectiveness of Problem-Solving Therapy in Improving Patient Mental Health, Function, Quality of Life, and Mortality Post-Stroke: A Systematic Review. Behav Sci (Basel) 2024; 14:446. [PMID: 38920778 PMCID: PMC11201169 DOI: 10.3390/bs14060446] [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: 04/12/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Problem-solving therapy (PST) is a potential psychological intervention aimed at preventing and treating psychological issues in stroke patients, although its efficacy is not clearly established. This systematic review assessed the effectiveness of PST in improving mental health, functioning, quality of life, and mortality in this population. Six databases were searched for literature indexed through March 2024, including the Cochrane Library, PubMed, Scopus, CINAHL, NeuroBITE, and OTseeker. This review (CRD42023483757) followed the PRISMA guidelines and the Cochrane Library Handbook, utilizing the RoB 2 tool and GRADE system to assess the quality of the evidence. It included eight randomized controlled trials (RCTs) involving 1249 patients with stroke. Among them, five RCTs showed that PST might improve depression. Additionally, individual RCTs demonstrated the efficacy of PST in addressing patient anxiety, apathy, and coping. With respect to mental health, PST might affect patient quality of life and mortality. However, the results of four RCTs demonstrated no effect of PST on patient functioning. The quality of evidence for the outcomes ranged from very low to high. PST may improve mental health, quality of life, and mortality in patients with stroke.
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Affiliation(s)
- Ha Thi Le
- Graduate School, Niigata University of Health and Welfare, Niigata 950-3198, Japan;
- Rehabilitation Department, Haiduong Medical Technical University, Haiduong 03117, Vietnam
| | - Kenta Honma
- Department of Occupational Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata 950-3198, Japan; (K.H.); (H.A.); (T.N.)
| | - Hiroki Annaka
- Department of Occupational Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata 950-3198, Japan; (K.H.); (H.A.); (T.N.)
| | - Shunxiang Sun
- Graduate School, Niigata University of Health and Welfare, Niigata 950-3198, Japan;
| | - Tomonori Nomura
- Department of Occupational Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata 950-3198, Japan; (K.H.); (H.A.); (T.N.)
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Raggi A, Serretti A, Ferri R. A comprehensive overview of post-stroke depression treatment options. Int Clin Psychopharmacol 2024; 39:127-138. [PMID: 38170802 DOI: 10.1097/yic.0000000000000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Nearly one-third of all stroke patients develop depression at any time after a stroke, and its presence is associated with unfavorable outcomes. This narrative review aims to provide a synopsis of possible pharmacological and non-pharmacological treatment modalities for post-stroke depression (PSD). Several studies have demonstrated the efficacy and safety of selective serotonin reuptake inhibitors in treating the symptoms of this clinical condition. The treatment of PSD has been recently enhanced by innovative approaches, such as cognitive-behavioral therapy, virtual reality, telehealth, repetitive transcranial magnetic stimulation, and non-conventional therapies, which might improve depression treatment in stroke survivors. Future high-quality randomized controlled trials are necessary to confirm this hypothesis.
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Affiliation(s)
- Alberto Raggi
- Unit of Neurology, G.B. Morgagni - L. Pierantoni Civic Hospital, Forlì
| | | | - Raffaele Ferri
- Department of Neurology, Oasi Research Institute - IRCCS, Troina, Italy
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Guo M, Xu S, He X, He J, Yang H, Zhang L. Decoding emotional resilience in aging: unveiling the interplay between daily functioning and emotional health. Front Public Health 2024; 12:1391033. [PMID: 38694972 PMCID: PMC11061423 DOI: 10.3389/fpubh.2024.1391033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/04/2024] [Indexed: 05/04/2024] Open
Abstract
Background EPs pose significant challenges to individual health and quality of life, attracting attention in public health as a risk factor for diminished quality of life and healthy life expectancy in middle-aged and older adult populations. Therefore, in the context of global aging, meticulous exploration of the factors behind emotional issues becomes paramount. Whether ADL can serve as a potential marker for EPs remains unclear. This study aims to provide new evidence for ADL as an early predictor of EPs through statistical analysis and validation using machine learning algorithms. Methods Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) national baseline survey, comprising 9,766 samples aged 45 and above, were utilized. ADL was assessed using the BI, while the presence of EPs was evaluated based on the record of "Diagnosed with Emotional Problems by a Doctor" in CHARLS data. Statistical analyses including independent samples t-test, chi-square test, Pearson correlation analysis, and multiple linear regression were conducted using SPSS 25.0. Machine learning algorithms, including Support Vector Machine (SVM), Decision Tree (DT), and Logistic Regression (LR), were implemented using Python 3.10.2. Results Population demographic analysis revealed a significantly lower average BI score of 65.044 in the "Diagnosed with Emotional Problems by a Doctor" group compared to 85.128 in the "Not diagnosed with Emotional Problems by a Doctor" group. Pearson correlation analysis indicated a significant negative correlation between ADL and EPs (r = -0.165, p < 0.001). Iterative analysis using stratified multiple linear regression across three different models demonstrated the persistent statistical significance of the negative correlation between ADL and EPs (B = -0.002, β = -0.186, t = -16.476, 95% CI = -0.002, -0.001, p = 0.000), confirming its stability. Machine learning algorithms validated our findings from statistical analysis, confirming the predictive accuracy of ADL for EPs. The area under the curve (AUC) for the three models were SVM-AUC = 0.700, DT-AUC = 0.742, and LR-AUC = 0.711. In experiments using other covariates and other covariates + BI, the overall prediction level of machine learning algorithms improved after adding BI, emphasizing the positive effect of ADL on EPs prediction. Conclusion This study, employing various statistical methods, identified a negative correlation between ADL and EPs, with machine learning algorithms confirming this finding. Impaired ADL increases susceptibility to EPs.
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Affiliation(s)
- Minhua Guo
- School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Songyang Xu
- School of Mechatronics and Energy Engineering, NingboTech University, Ningbo, China
| | - Xiaofang He
- Nursing Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Jiawei He
- School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Hui Yang
- Department of Neurology, The Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, Guizhou, China
| | - Lin Zhang
- Department of Neurology, The Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, Guizhou, China
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Nam S, Reistetter TA, Hong I. Longitudinal Association of Health Satisfaction With Functional Status and Income Satisfaction in Stroke Survivors. Am J Occup Ther 2024; 78:7802180170. [PMID: 38393990 DOI: 10.5014/ajot.2024.050410] [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: 02/25/2024] Open
Abstract
IMPORTANCE Although cross-sectional studies have reported the relationships among performance of activities of daily living (ADLs), income satisfaction, and health satisfaction, longitudinal associations in stroke survivors remain unclear. OBJECTIVE To examine the effects of ADL function and income satisfaction on health satisfaction over time in stroke survivors. DESIGN Retrospective longitudinal study designs with latent growth curve models (LGMs) to control for time-varying and time-invariant covariates. SETTING Community. PARTICIPANTS A total of 198 stroke survivors. OUTCOMES AND MEASURES Self-reported ADL performance, income satisfaction, and health satisfaction. RESULTS The average age of participants was 70.68 yr (SD = 8.09; 107 men, 91 women). Each LGM showed that an increase in ADL score (standardized β = 0.116∼0.296, all ps < .05) and income satisfaction (standardized β = 0.513∼0.726, all ps < .001) positively predicted health satisfaction over time, even after controlling for time-varying annual income, demographics, and behavioral characteristics. The fit results of all LGMs were within the acceptable range: χ2(47) = 66.378, p = .0327; χ2(47) = 57.742, p = .1355; root-mean-square error of approximation, <0.08; comparative fit index and Tucker-Lewis index, >0.90; standardized root-mean-square residual, <0.05. CONCLUSIONS AND RELEVANCE Because ADLs are significant modifiable health satisfaction factors, occupational therapy practitioners would need to focus more closely on ADL training in clinical settings. Furthermore, referring those clients to appropriate vocational rehabilitation to improve their income satisfaction would be necessary. Plain-Language Summary: This study recognizes the unique challenges and opportunities that arise when stroke survivors are preparing to return to their communities by emphasizing the significance of ADL training and income satisfaction during this stage of recovery. The study suggests that the therapeutic use of ADL training and income satisfaction could increase health satisfaction for stroke survivors. Therefore, comprehensive ADL training, as an occupational therapy intervention, could be crucial for stroke survivors who are preparing to return to their community from a clinical setting. Furthermore, connecting with vocational rehabilitation could also be important for improving income satisfaction for stroke survivors who are preparing to return to a community.
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Affiliation(s)
- Sanghun Nam
- Sanghun Nam, MS, OT, is Doctoral Student, Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Gangwon-do, Republic of Korea
| | - Timothy A Reistetter
- Timothy A. Reistetter, PhD, OTR, FAOTA, is Professor and Associate Dean for Research, Department of Occupational Therapy, University of Texas Health Science Center San Antonio
| | - Ickpyo Hong
- Ickpyo Hong, PhD, OTR, is Associate Professor, Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Gangwon-do, Republic of Korea;
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Chou CH, Lee YY, Chen PC, Leong CP, Huang YC. Effects of Kinesiotaping on upper limb function and daily activities in subacute or chronic stroke survivors: A randomized control study. NeuroRehabilitation 2024; 54:629-637. [PMID: 38905061 DOI: 10.3233/nre-240047] [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] [Indexed: 06/23/2024]
Abstract
BACKGROUND Impaired upper limb function in stroke survivors is characterized by muscle weakness, increased muscle tone, contracture, or impaired motor control. OBJECTIVE We aimed to evaluate the effectiveness of Kinesio-taping application for functional recovery on the affected arm and forearm during rehabilitation. METHODS Forty-one patients eligible for this study were randomly assigned to either the Kinesio-taping group (n = 21), receiving Kinesio-taping intervention and conventional therapy, or control group (n = 20), receiving sham Kinesio-taping intervention and conventional therapy. The whole intervention lasted for 3 weeks. Fugl-Meyer assessment of the upper extremity, Barthel Index, the Stroke Impact Scale, and modified Ashworth scale were measured at 3 time points: baseline, post-treatment (3rd week), and follow-up (6th week). RESULTS In the Kinesio-taping group, there were significant differences in the upper extremity (p = 0.003), wrist (p = 0.000) and hand (p = 0.000) parts of the Fugl-Meyer assessment of the upper extremity between the three assessment times. On the other hand, the Barthel Index showed significant differences in both groups after therapy. CONCLUSION Combining conventional rehabilitation with Kinesio-taping intervention may improve functional motor performance of both the proximal and distal parts of the affected upper extremity in stroke survivors, with potential benefits for activity of daily living.
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Affiliation(s)
- Chia-Hsin Chou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yan-Yuh Lee
- People First Bo'Ai Rehabilitation Clinic, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Lo SHS, Chau JPC, Lau AYL, Choi KC, Shum EWC, Lee VWY, Hung SS, Mok VCT, Siow EKC, Ching JYL, Mirchandani K, Lam SKY. Virtual Multidisciplinary Stroke Care Clinic for Community-Dwelling Stroke Survivors: A Randomized Controlled Trial. Stroke 2023; 54:2482-2490. [PMID: 37551588 PMCID: PMC10519295 DOI: 10.1161/strokeaha.123.043605] [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: 04/18/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Stroke survivors constantly feel helpless and unprepared after discharge from hospitals. More flexible and pragmatic support are needed for their optimized recovery. We examined the effects of a virtual multidisciplinary stroke care clinic on survivors' health and self-management outcomes. METHODS A randomized controlled trial was conducted. Survivors were recruited from 10 hospitals and randomized at 1:1 ratio into the intervention or the control groups. Intervention group participants received the Virtual Multidisciplinary Stroke Care Clinic service (monthly online consultations with a nurse, follow-up phone calls, and access to an online platform). Control group participants received the usual care. Outcomes of self-efficacy (stroke self-efficacy questionnaire; primary), self-management behaviors (Stroke Self-Management Behaviors Performance Scale), social participation (reintegration to normal living index), and depression (Geriatric Depression Scale; secondary) were measured at baseline, and 3 and 6 months after commencing the intervention (post-randomization). A generalized estimating equations model was used to compare the differential changes in outcomes at 3 and 6 months with respect to baseline between 2 groups. RESULTS Between July 2019 and June 2022, 335 eligible participants were enrolled in the study. Participants (intervention group; n=166) showed significantly greater improvements in outcomes of self-efficacy (group-by-time interaction regression coefficient, B=4.60 [95% CI, 0.16 to 9.05]), social participation (B=5.07 [95% CI, 0.61 to 9.53]), and depression (B=-2.33 [95% CI, -4.06 to -0.61]), and no significant improvement in performance of self-management behaviors (B=3.45, [95% CI, -0.87 to 7.77]), compared with the control group (n=169) right after the intervention (6 months after its commencement). Hedges' g effect sizes of the intervention on outcomes: 0.19 to 0.36. CONCLUSIONS The results provide some positive evidence on the usefulness of the Virtual Multidisciplinary Stroke Care Clinic service. The effect sizes are regarded as small to medium, which may not be of clinical relevance. The baseline levels in outcomes were in favor of the control group, the intervention effects might be overestimated. The service must be tested further to determine its effectiveness. REGISTRATION URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1800016101.
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Affiliation(s)
- Suzanne Hoi Shan Lo
- The Nethersole School of Nursing (S.H.S.L., J.P.C.C., K.C.C., K.M., S.K.Y.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing (S.H.S.L., J.P.C.C., K.C.C., K.M., S.K.Y.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Alexander Yuk Lun Lau
- Department of Medicine and Therapeutics (A.Y.L.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Kai Chow Choi
- The Nethersole School of Nursing (S.H.S.L., J.P.C.C., K.C.C., K.M., S.K.Y.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Vivian Wing Yan Lee
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong, Hong Kong SAR (V.W.Y.L.)
| | - Sheung Sheung Hung
- Hong Kong Institute of Integrative Medicine (S.S.H.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Vincent Chung Tong Mok
- Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Jessica Yuet Ling Ching
- Department of Medicine and Therapeutics (J.Y.L.C.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Kashika Mirchandani
- The Nethersole School of Nursing (S.H.S.L., J.P.C.C., K.C.C., K.M., S.K.Y.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Simon Kwun Yu Lam
- The Nethersole School of Nursing (S.H.S.L., J.P.C.C., K.C.C., K.M., S.K.Y.L.), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
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