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Francis T, Peiris RG, Stanimirovic A, Stogios N, Syed F, Rac VE, Nolan RP. The EvalUation of goal-diRected activities to prOmote well-beIng and heAlth (EUROIA) scale: Psychometric evaluation with Confirmatory Factor Analysis. PLoS One 2024; 19:e0299854. [PMID: 38484021 PMCID: PMC10939273 DOI: 10.1371/journal.pone.0299854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES While state-based models of health-related quality of life (HRQL) are well-established in providing clinically relevant descriptions of HRQL status, they do not provide information on how to maintain or improve HRQL. The EvalUation of goal-diRected activities to prOmote well-beIng and heAlth (EUROIA), rooted in a novel process-based model of HRQL, measures goal-directed activities that are self-reported to promote HRQL as part of an individual's process of adapting to dynamic changes in health status. Our objectives were to condense and summarize the psychometric properties of the EUROIA by (i) defining and confirming its factor structure, (ii) evaluating its construct validity, and (iii) examining its internal consistency. METHODS Principal component analysis was performed on the 18-item EUROIA to explore the underlying factor structure and condense the scale. Confirmatory factor analysis was conducted on the revised 14-item, 4-factor structure EUROIA instrument to evaluate the model fit. Data was obtained from adult participants with a diagnosis of chronic heart failure or advanced chronic kidney disease from 3 hospitals in Toronto, Canada. RESULTS The revised 14-item EUROIA demonstrated 4 dimensions-Social Affiliation, fulfillment of Social Roles and Responsibilities, Self-Affirmation, and Eudaimonic Well-being-with a Cronbach's alpha of 0.83, representing good internal consistency. Our confirmatory factor analysis final model achieved good overall model fit: (χ2 / df = 1.80; Tucker-Lewis index = 0.90; comparative fit index = 0.93; standardized root-mean-square residual = 0.06; root-mean-square error of approximation = 0.06). All items exhibited a factor loading greater than λ > 0.4 and p < 0.001. CONCLUSION The EUROIA holds clinical potential in its ability to provide informed feedback to patients on how they might maintain or modify their use of goal-directed activities to maintain and optimize perceived well-being.
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Affiliation(s)
- Troy Francis
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rachel G. Peiris
- Cardiac eHealth, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Aleksandra Stanimirovic
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nicolette Stogios
- Cardiac eHealth, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Fatima Syed
- Cardiac eHealth, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Valeria E. Rac
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robert P. Nolan
- Cardiac eHealth, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Nevarez-Flores AG, Chappell KJ, Morgan VA, Neil AL. Health-Related Quality of Life Scores and Values as Predictors of Mortality: A Scoping Review. J Gen Intern Med 2023; 38:3389-3405. [PMID: 37653208 PMCID: PMC10682357 DOI: 10.1007/s11606-023-08380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/15/2023] [Indexed: 09/02/2023]
Abstract
Health-related quality of life (HRQoL) can be assessed through measures that can be generic or disease specific, encompass several independent scales, or employ holistic assessment (i.e., the derivation of composite scores). HRQoL measures may identify patients with differential risk profiles. However, the usefulness of generic and holistic HRQoL measures in identifying patients at higher risk of death is unclear. The aim of the present study was to undertake a scoping review of generic, holistic assessments of HRQoL as predictors of mortality in general non-patient populations and clinical sub-populations with specified conditions or risk factors in persons 18 years or older. Five databases were searched from 18 June to 29 June 2020 to identify peer-reviewed published articles. The searches were updated in August 2022. Reference lists of included and cited articles were also searched. Of 2552 articles screened, 110 met criteria for inclusion. Over one-third of studies were from North America. Most studies pertained to sub-populations with specified conditions and/or risk factors, almost a quarter for people with cardiovascular diseases. There were no studies pertaining to people with mental health conditions. Nearly three-quarters of the studies used a RAND Corporation QoL instrument, predominantly the SF-36, and nearly a quarter, a utility instrument, predominantly the EQ-5D. HRQoL was associated with mortality in 67 of 72 univariate analyses (92%) and 100 of 109 multivariate analyses (92%). HRQoL was found to be associated with mortality in the general population and clinical sub-populations with physical health conditions. Whether this relationship holds in people with mental health conditions is not known. HRQoL assessment may be useful for screening and/or monitoring purposes to understand how people perceive their health and well-being and as an indicator of mortality risk, encouraging better-quality and timely patient care to support and maximize what may be a patient's only modifiable outcome.
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Affiliation(s)
| | - Katherine J Chappell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Vera A Morgan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
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The Associated Factors of Quality of Life among Stroke Survivors: A Study in Indonesia. NURSE MEDIA JOURNAL OF NURSING 2022. [DOI: 10.14710/nmjn.v12i3.45763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: The prevalence and burden of stroke are still high, especially in low and middle-income countries. Stroke affects the economy and physics related to the Quality of Life (QoL). Various QoL-associated factors, including sociodemographic, functional outcome, emotional, and cognitive function, were studied. However, there was very limited information about the QoL-associated factors among stroke survivors in Semarang, Indonesia.Purpose: This study aimed to identify the QoL-associated factors among stroke survivors in Semarang, Indonesia.Methods: This cross-sectional study was conducted in outpatient services and involved 57 ischemic stroke survivors using convenience sampling. Demographic and clinical information were obtained using medical records and questionnaires. The questionnaires were the Short Version of Specific Stroke Quality of Life (SS-QoL) to measure QoL, GRID-HAMD 17 to measure Post Stroke Depression (PSD), Mini-Mental Status Examination (MMSE) to measure cognitive impairment, Barthel–Index (BI) to measure functional outcome, Hamilton Anxiety Rating Scale (HAM-A) to measure anxiety, and Multidimensional Scale of Perceived Social Support (MSPSS) to measure social support. Linear regression was conducted in the model performance of QoL-associated factors.Results: The stroke duration was 155(18) days, and 50.9% of participants were males. The linear regression showed that age (-.164 95% CI -.412 - .084), marital status (3.937 95% CI 1.010 - 6.864), functional outcome (.127 95% CI .013 - .241), PSD (-1.090 95% CI -2.144 - -.036), cognitive function (.308 95% CI -.482 - 1.098) and anxiety (-.408 95% CI -1.125 - .268) were QoL-predictors (p<.001, adjusted R2=52.1). It is assumed that age, marital status, functional outcome, PSD, cognition, and anxiety significantly predict the QoL among ischemic stroke survivors.Conclusion: The QoL-associated factors were age, marital status, functional outcome, PSD, cognition, and anxiety. These associated factors of QoL should be considered as elements in formulating nursing interventions that aim to improve the good QoL among stroke survivors.
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Abstract
OBJECTIVE Research is limited regarding the predictive utility of the RAND-36 questionnaire and physical performance tests in relation to all-cause, cardiovascular disease (CVD), and total-cancer mortality in older women. METHODS Data on the RAND-36 questionnaire, gait speed, and chair stand performance were assessed in 5,534 women aged ≥ 65 years at baseline. A subset (n = 298) had physical function assessments additionally at follow-up (years 1, 3, or 6). Multivariable Cox proportional hazards regression models estimated associations (HR) for a 1-standard deviation (SD) difference in baseline RAND-36 scores and performance tests (alone and combined) with mortality outcomes in the overall cohort and in models stratified by enrollment age (<70 and ≥70 y). The relative prognostic value of each physical function exposure was assessed using the Uno concordance statistic. RESULTS A total of 1,186 deaths from any cause, 402 deaths from CVD, and 382 deaths from total-cancer were identified during a mean follow-up of 12.6 years. Overall, each 1-SD unit higher baseline RAND-36 score was associated with significantly lower all-cause mortality (HR =0.90) and discriminatory capacity (Uno=0.65) that was comparable to each performance exposure (HRs 0.88-0.91; Uno = 0.65). These findings were consistent in women aged <70 and ≥70 years. The associations of RAND-36 and performance measures with CVD mortality and total-cancer mortality were not significant in multivariable models nor in age-stratified models. CONCLUSIONS The RAND-36 questionnaire is a reasonable substitute for tracking physical functioning and estimating its association with all-cause mortality in older adults when clinical performance testing is not feasible.
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Ellepola S, Nadeesha N, Jayawickrama I, Wijesundara A, Karunathilaka N, Jayasekara P. Quality of life and physical activities of daily living among stroke survivors; cross-sectional study. Nurs Open 2022; 9:1635-1642. [PMID: 35261205 PMCID: PMC8994929 DOI: 10.1002/nop2.1188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/30/2022] [Indexed: 11/29/2022] Open
Abstract
Aim To examine the relationship between quality of life (QoL), level of physical activities of daily living (PADL) and associated factors among stroke survivors during the acute stage as there is little evidence in Sri Lanka. Design We conducted a descriptive cross‐sectional study among conveniently recruited stroke survivors in Sri Lanka (n = 134). Methods QoL was assessed by the Short Form‐36 (SF‐36), while the PADL was assessed by the Barthel Index (BI). The relationship between SF36 and BI was assessed by Pearson correlation, while Multiple Linear Regression (MLR) was performed to determine the factors associated with QoL and PADL. Results The majority of the SF36 domains were below the average level of 50, while BI indicated that most of them belonged to either the severely or totally dependent category. Aphasia, disability, dysarthria, type of stroke, dyslipidaemia, smoking, alcohol consumption, geographical area and income were the associated factors of QoL, while disability of the face and limbs, dysarthria and smoking were the associated factors of PADL (p < .05).
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Affiliation(s)
- Sachini Ellepola
- Department of Nursing & Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Nethuli Nadeesha
- Department of Nursing & Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Ishara Jayawickrama
- Department of Nursing & Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Anjali Wijesundara
- Department of Nursing & Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Nimantha Karunathilaka
- Department of Nursing & Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Priyamali Jayasekara
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
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Del Brutto VJ, Rundek T, Sacco RL. Prognosis After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Short- and Long-Term Effects of Rehabilitation after Perimesencephalic Subarachnoid Hemorrhage. Diseases 2021; 9:diseases9040069. [PMID: 34698166 PMCID: PMC8544554 DOI: 10.3390/diseases9040069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
In about 25% of patients with spontaneous subarachnoid hemorrhage (SAH), a bleeding source cannot be identified during radiological diagnostics. Generally, the outcome of perimesencephalic or prepontine (PM) SAH is known to be significantly better than after non-PM SAH. Data about long-term follow-up concerning physical and mental health are scarce, so this study is reports on long-term results. We measured the influence of PM SAH on a quality-of-life modified Rankin (mRs) scale after six months. For long-term follow-up, a SF-36 questionnaire was used. Questionnaires were sent out between 18 and 168 months after ictus. In 37 patients, a long-term follow-up was available (up to 14 years after SAH). Data detected with the SF-36 questionnaire are compared to reference applicability to the standard population. In total, 37 patients were included for further analysis and divided in 2 subgroups; 13 patients (35%) received subsequent rehabilitation after clinical stay and 24 (65%) did not. In the short-term outcome, a significant improvement from discharge until follow-up was identified in patients with subsequent rehabilitation, but not in the matched pair group without rehabilitation. When PM SAH was compared to the standard population, a reduction in quality of life was identified in physical items (role limitations because of physical health problems, physical functioning) as well as in psychological items (role limitations because of emotional problems). Subsequent rehabilitation on PM SAH patients probably leads to an increase in independence and better mRs. While better mRs was shown at discharge in patients without subsequent rehabilitation, the mRs of rehabilitants was nearly identical after rehabilitation. Patients with good mRs also reached high levels of health-related quality of life (HRQoL) without rehabilitation. Thus, subsequent rehabilitation needs to be encouraged on an individual basis. Indication criteria for subsequent rehabilitation should be defined in further studies to improve patient treatment and efficiency in health care.
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Health-related quality of life after first-ever acute ischemic stroke: associations with cardiovascular health metrics. Qual Life Res 2021; 30:2907-2917. [PMID: 33932220 DOI: 10.1007/s11136-021-02853-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the associations between cardiovascular health (CVH) metrics and health-related quality of life (HRQL) among patients with ischemic stroke in China, and further explore the role of physical and cognitive function in their associations. METHODS This hospital-based study included 1714 patients with first-ever acute ischemic stroke (age ≥ 40 years; 36.7% women) who were admitted to two university hospitals in Shandong, China. We collected information on seven CVH metrics (smoking, body mass index, diet, physical activity, blood pressure, total cholesterol, and fasting blood glucose) through interviews, clinical examinations, and laboratory tests. EQ-5D-3L was used to assess HRQL. Cognitive and physical functioning was assessed by the Montreal Cognitive Assessment test and Barthel index, respectively. Data were analyzed using the general linear regression models. RESULTS The average score (SD) was 0.746 (0.23) for HRQL index and 72.7 (15.8) for self-rated health. Optimal levels of four individual CVH metric components (diet, physical activity, blood pressure, and blood glucose) and a higher composite CVH score were significantly associated with a greater HRQL index and better self-rated health (p < 0.05 for all). Physical dependence and cognitive impairment were associated with a lower HRQL index and poorer self-rated health status (p < 0.001). Furthermore, the relationships between CVH metrics and HRQL index varied by functional status, such that their associations were statistically significant only among people who had physical dependence or cognitive impairment. CONCLUSION Achieving a better cardiovascular health profile is associated with better quality of life among ischemic stroke survivors, primarily in those with physical or cognitive impairment.
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Prost A, Kubitz K, Pelz J, Hobohm C, Hinz A, Michalski D. Acute and long-term impairments regarding emotional symptoms and quality of life in patients suffering from transient ischemic attack and stroke. Neurol Res 2021; 43:396-405. [PMID: 33478369 DOI: 10.1080/01616412.2020.1866370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Ischemic stroke (IS) is often associated with long-lasting physical deficits, linked to emotional symptoms (ES) and lowered quality of life (QoL). However, recent observations raised doubts regarding the traditional perspective of solely impairment-driven ES. In fact, anxiety and depression were also reported after transient ischemic attack (TIA) with a per definition absence of infarction and thus lacking physical deficits. This study follows the hypothesis that TIA patients might exhibit non-physical symptoms affecting individual QoL.Methods: In a prospective single-center observational study, IS patients (n = 73) were compared with TIA patients (n = 24) regarding their neurological deficit, ES and QoL, whereas the latter were evaluated by the Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 Heath Survey (SF-36). Assessments were conducted six times within a one-year follow-up period.Results: Overall, anxiety and depression decreased over time, while anxiety decreased more substantially. TIA patients showed similar levels of anxiety and depression when compared to IS patients. ES were detectable very early after the event and remained throughout the follow-up period in both groups. ES were associated with an impaired QoL including non-functional dimensions, while the strongest interrelations were observed for TIA patients, emphasizing interrelations between QoL and anxiety.Discussion: This study indicates that ES after TIA are comparable to the emotional burden after IS. ES after TIA were associated with QoL, pointing out their crucial role for individual well-being. Although confirmation in larger studies is necessary, these data underpin the need for early clinical awareness regarding non-physical symptoms in TIA patients.
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Affiliation(s)
- Alexander Prost
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Katharina Kubitz
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Johann Pelz
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Carsten Hobohm
- Department of Neurology, University of Leipzig, Leipzig, Germany.,Department of Neurology, Carl-von-Basedow-Klinikum Saalekreis, Merseburg, Germany
| | - Andreas Hinz
- Department of Medical Psychology, University of Leipzig, Leipzig, Germany
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Liang YY, Wang L, Yang Y, Chen Y, Mok VCT, Ungvari GS, Chu WCW, Kim JS, Tang WK. Association Between Behavioral Dysexecutive Syndrome and the Health-Related Quality of Life Among Stroke Survivors. Front Psychiatry 2020; 11:563930. [PMID: 33101083 PMCID: PMC7506061 DOI: 10.3389/fpsyt.2020.563930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
AIM Behavioral dysexecutive syndrome (BDES) is one common neuropsychiatric comorbidity after stroke. Despite evidences suggesting the adverse effect of BDES on the survivors' outcome, little is known about the association between BDES and the health-related quality of life (HRQoL) among stroke survivors and how BDES impacts the HRQoL. This study aimed to address these questions. METHODS This study included 219 patients with acute ischemic stroke consecutively admitted to a regional hospital in Hong Kong. BDES was defined as a Chinese version of the Dysexecutive Questionnaire (DEX) score of ≥20 assessed at three months after stroke. The HRQoL was assessed with the Chinese version of the Stroke-Specific Quality of Life (SSQoL) questionnaire encompassing 12 domains. Multivariate linear regression models were employed to examine the association between BDES symptoms and the SSQoL total and domain scores. Structural equation model (SEM) was further constructed to delineate the linking pathways linking BDES and the HRQoL. RESULTS The study sample compromised mainly older patients with mild to moderate ischemic stroke. Compared with patients without BDES, those with BDES exhibited poorer performances regarding with the summarized SSQoL (226.2 ± 18.8 vs. 200.3 ± 29.8, p < 0.001) and almost all domains. The BDES symptoms were independently contributed to the whole HRQoL (SSQoL total score) (β = -0.20, p = 0.002), specifically to the domains in personality (β = -0.34, p < 0.001), language (β = -0.22, p = 0.01), and work/productivity (β = -0.32, p < 0.001), after adjusting demographic and clinical characteristics in linear models. The impacts of the BDES symptoms on the HRQoL were mainly explained by the indirect path mediated by depression and anxiety (path coefficient = -0.27, p < 0.05) rather than physical disability, while the resting was elucidated by the path directly linking BDES to the HRQoL (path coefficient = -0.17, p < 0.05). CONCLUSION The present study preliminarily demonstrated a potential association between BDES and a lower level of the HRQoL, predominantly in domains of personality, language, and work/productivityafter acute ischemic stroke. This study also offered insights into the underlying mechanisms linking BDES and the HRQoL, implicating that integrative psychological therapies were urged to achieve better HRQoL after stroke.
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Affiliation(s)
- Yannis Yan Liang
- Stroke Center and Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Lisha Wang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ying Yang
- Stroke Center and Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yangkun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Gabor S Ungvari
- University of Notre Dame Australia/Graylands Hospital, Perth, WA, Australia
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Wai-Kwong Tang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Macdonald S, Jepsen P, Alrubaiy L, Watson H, Vilstrup H, Jalan R. Quality of life measures predict mortality in patients with cirrhosis and severe ascites. Aliment Pharmacol Ther 2019; 49:321-330. [PMID: 30585338 DOI: 10.1111/apt.15084] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/16/2018] [Accepted: 11/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Severe ascites is associated with both a poor health-related quality of life (HRQL) and a mortality in excess of that captured by current prognostic clinical scores. AIM To determine the association between HRQL and mortality in patients with severe ascites. METHODS The HRQL data from previously published randomised controlled trials examining the efficacy of satavaptan in ascites were retrospectively evaluated. RESULTS Of the 496 patients randomised who completed the SF-36, 405 patients had complete datasets and were included in the analysis (difficult-to-treat ascites, n = 164 or refractory ascites, n = 241). Overall, patients reported poor HRQL, in particular the physical component score (PCS) of SF-36. The physical component score (PCS) correlated with the mental component score (MCS) of SF-36 (Spearman rank correlation = 0.68) but not with markers of severity of liver disease. The PCS, but not the MCS, was significantly lower in patients who died (P = 0.01 and P = 0.84, respectively). After confounder-adjustment, the hazard ratio for a 10-point increase in the physical component score was 0.83 (95% CI; 0.72-0.97) for all-cause mortality and 0.84 (95% CI; 0.71-0.99) for cirrhosis-related deaths only, indicating that patients with better physical HRQL live longer on average. CONCLUSIONS Poor physical component score (PCS) of SF-36 is an independent predictor of 12-month mortality in patients with severe ascites independent of current prognostic clinical scores. It holds promise not only in prognostic modelling but also as an endpoint in the evaluation of therapies targeting ascites.
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Affiliation(s)
- Stewart Macdonald
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, UK
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hugh Watson
- Infectious Diseases Unit, Sanofi-Aventis R&D, Marcy l'Etoile, France
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, UK
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Miller KK, Lin SH, Neville M. From Hospital to Home to Participation: A Position Paper on Transition Planning Poststroke. Arch Phys Med Rehabil 2018; 100:1162-1175. [PMID: 30465739 DOI: 10.1016/j.apmr.2018.10.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 12/25/2022]
Abstract
Based on a review of the evidence, members of the American Congress of Rehabilitation Medicine Stroke Group's Movement Interventions Task Force offer these 5 recommendations to help improve transitions of care for patients and their caregivers: (1) improving communication processes; (2) using transition specialists; (3) implementing a patient-centered discharge checklist; (4) using standardized outcome measures; and (5) establishing partnerships with community wellness programs. Because of changes in health care policy, there are incentives to improve transitions during stroke rehabilitation. Although transition management programs often include multidisciplinary teams, medication management, caregiver education, and follow-up care management, there is a lack of a comprehensive and standardized approach to implement transition management protocols during poststroke rehabilitation. This article uses the Transitions of Care (TOC) model to conceptualize how to facilitate a comprehensive patient-centered hand off at discharge to maximize patient functioning and health. Specifically, this article reviews current guidelines and provides an evidence summary of several commonly cited approaches (Early Supported Discharge, planned predischarge home visits, discharge checklists) to manage TOC, followed by a description of documented barriers to effective transitions. Patient-centered and standardized transition management may improve community integration, activities of daily living performance, and quality of life for stroke survivors while also decreasing hospital readmission rates during the transition from hospital to home to community.
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Affiliation(s)
- Kristine K Miller
- Department of Physical Therapy, Indiana University, Indianapolis, IN.
| | - Susan H Lin
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Marsha Neville
- School of Occupational Therapy, Texas Woman's University, Dallas, TX
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Han L, Li Y, Yan W, Xie L, Wang S, Wu Q, Ji X, Zhu B, Ni C. Quality of life and influencing factors of coal miners in Xuzhou, China. J Thorac Dis 2018; 10:835-844. [PMID: 29607155 DOI: 10.21037/jtd.2018.01.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Coal industry is one of the national pillar industries in China. A large number of coal miners are exposed to various occupational hazards, which might cause occupational disease. The aim of the study was to assess the quality of life (QOL) of coal miners in Xuzhou, China and explore influencing factors to QOL of coal miners. Methods Six hundred and twelve underground miners and 354 ground workers in one of coal mines of Xuzhou were enrolled in our study. The 36-item Short-Form Health Survey (SF-36) questionnaires were applied to evaluate the QOL of coal miners. Multivariate stepwise regression analysis was used to assess the potential impact factors on QOL. Results The score of role limitations due to physical health problems (RP) dimension in underground miners was significantly lower than that of ground workers (P=0.005). Multivariate stepwise regression analysis showed that longer job tenure for dust exposure significantly lower coal miners' RP score. Comparing with normal populations, our subjects scored lower in both the physical health components (PHC) and the mental health components (MHC), and many factors accounted for it including job tenure for dust exposure, chronic disease, medical insurance, etc. Conclusions QOL of coal miners has been affected. Some measures might be taken by enterprise and coal miners themselves to protect the health of coal miners and improve their quality of life.
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Affiliation(s)
- Lei Han
- Institute of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210028, China
| | - Yan Li
- Department of Occupational Medicine and Environmental Health, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Weiwen Yan
- Department of Occupational Medicine and Environmental Health, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Lisheng Xie
- Department of Occupational Medicine and Environmental Health, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Shuping Wang
- Jiangsu Datun Coal and Electricity Company, Xuzhou 221611, China
| | - Qiuyun Wu
- Department of Occupational Medicine and Environmental Health, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xiaoming Ji
- Department of Occupational Medicine and Environmental Health, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Baoli Zhu
- Institute of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210028, China
| | - Chunhui Ni
- Department of Occupational Medicine and Environmental Health, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
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14
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Kim ES, Kim JW, Kang HJ, Bae KY, Kim SW, Kim JT, Park MS, Cho KH, Kim JM. Longitudinal Impact of Depression on Quality of Life in Stroke Patients. Psychiatry Investig 2018; 15:141-146. [PMID: 29475223 PMCID: PMC5900407 DOI: 10.30773/pi.2017.10.11] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/11/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Stroke is associated with significant long-term morbidity and poor quality of life (QOL). Depression is one of the most common complications after stroke and has been associated with QOL cross-sectionally. We investigated the longitudinal impact of depression in the acute phase of stroke on QOL 1 year after stroke. METHODS In total, 423 patients were evaluated 2 weeks after stroke, and 288 (68%) were followed 1 year later. QOL was assessed using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF) at baseline and follow-up. Depression was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria; demographic and clinical characteristics data, including stroke severity, were obtained at baseline. The longitudinal associations of post-stroke depression (PSD) at baseline with QOL across two evaluation points were assessed using a repeated-measures analysis of variance. RESULTS The WHOQOL-BREF scores were significantly and persistently lower 1 year after stroke in patients with PSD at baseline compared with those without PSD at baseline independent of demographic and clinical characteristics, including stroke severity. CONCLUSION PSD in the acute phase of stroke is an independent predictor of QOL in both the acute and chronic phases of stroke. Our findings underscore the importance of evaluating depression in the acute phase of stroke.
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Affiliation(s)
- Eun-Song Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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15
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The influence of computer-based cognitive flexibility training on subjective cognitive well-being after stroke: A multi-center randomized controlled trial. PLoS One 2017; 12:e0187582. [PMID: 29145410 PMCID: PMC5690615 DOI: 10.1371/journal.pone.0187582] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 10/21/2017] [Indexed: 12/20/2022] Open
Abstract
Background Stroke can result in cognitive complaints that can have a large impact on quality of life long after its occurrence. A number of computer-based training programs have been developed with the aim to improve cognitive functioning. Most studies investigating their efficacy used only objective outcome measures, whereas a reduction of subjective cognitive complaints may be equally important for improving quality of life. A few studies used subjective outcome measures but were inconclusive, partly due to methodological shortcomings such as lack of proper active and passive control groups. Objective The aim of the current study was to investigate whether computer-based cognitive flexibility training can improve subjective cognitive functioning and quality of life after stroke. Methods We performed a randomized controlled double blind trial (RCT). Adults (30–80 years old) who had a stroke 3 months to 5 years ago, were randomly assigned to either an intervention group (n = 38), an active control group (i.e., mock training; n = 35), or a waiting list control group (n = 24). The intervention and mock training consisted of 58 half-hour sessions within 12 weeks. The primary subjective outcome measures were cognitive functioning (Cognitive Failure Questionnaire), executive functioning (Dysexecutive Functioning Questionnaire), quality of life (Short Form Health Survey), instrumental activities of daily living (IADL; Lawton & Brody IADL scale), and participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation). Secondary subjective outcome measures were recovery after stroke, depressive symptoms (Hospital Anxiety Depression Scale—depression subscale), fatigue (Checklist Individual Strength—Fatigue subscale), and subjective cognitive improvement (exit list). Finally, a proxy of the participant rated the training effects in subjective cognitive functioning, subjective executive functioning, and IADL. Results and conclusions All groups improved on the two measures of subjective cognitive functioning and subjective executive functioning, but not on the other measures. These cognitive and executive improvements remained stable 4 weeks after training completion. However, the intervention group did not improve more than the two control groups. This suggests that improvement was due to training-unspecific effects. The proxies did not report any improvements. We, therefore, conclude that the computer-based cognitive flexibility training did not improve subjective cognitive functioning or quality of life after stroke.
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16
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Anxiety, depression and quality of life in patients with a treated or untreated unruptured intracranial aneurysm. J Clin Neurosci 2017; 45:223-226. [DOI: 10.1016/j.jocn.2017.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/03/2017] [Accepted: 07/11/2017] [Indexed: 11/21/2022]
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17
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Wang R, Langhammer B. Predictors of quality of life for chronic stroke survivors in relation to cultural differences: a literature review. Scand J Caring Sci 2017; 32:502-514. [DOI: 10.1111/scs.12533] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Rongrong Wang
- Department of Physiotherapy; Faculty of Health; Oslo and Akershus University College; Oslo Norway
- Neurorehabilitation Department; China Rehabilitation Research Center; Beijing China
| | - Birgitta Langhammer
- Department of Physiotherapy; Faculty of Health; Oslo and Akershus University College; Oslo Norway
- Sunnaas Rehabilitation Hospital; Oslo Norway
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18
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Kislitsyn YV, Konopatkina IY, Fishcheva IN. [The correlation analysis of parameters of neurological deficit and quality-of-life in the patients after atherotrombotic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:17-20. [PMID: 28252598 DOI: 10.17116/jnevro20171171117-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To establish correlations between parameters of the neurological status of patients in the acute period and quality-of-life in the late recovery period of atherotrombotic stroke in carotid and vertebrobasilar areas. MATERIAL AND METHODS One hundred and sixty-two patients, including 124 with carotid stroke and 28 with vertebrobasilar stroke, were examined. Quantitative parameters of the neurologic status were estimated during the hospitalization of patients. Quality-of-life assessed with the «SF-36 Health Status Survey» with the calculation of two parameters (mental (MH) and physical (PH) wellbeing) was evaluated 10-14 months after stroke. RESULTS AND CONCLUSION Parameters of the neurologic status had an effect only on the PH domain of quality-of-life while MH was independent of the indicators studied. The initial NIHSS index and Rivermead Mobility Index had the greatest impact on PH in patients with carotid stroke. In patients with vertebrobasilar stroke, the strong correlation of PH with the age of patients and an index of independence, measured with the Rankin scale on the 14th day of hospitalization, was found.
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Affiliation(s)
- Yu V Kislitsyn
- Kirov State Medical Academy Ministries of Health of Russia, Kirov, Russia
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19
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Li Y, Mei Z, Liu S, Wang T, Li H, Li XX, Han S, Yang Y, Li J, Xu ZQD. Galanin Protects from Caspase-8/12-initiated Neuronal Apoptosis in the Ischemic Mouse Brain via GalR1. Aging Dis 2017; 8:85-100. [PMID: 28203483 PMCID: PMC5287390 DOI: 10.14336/ad.2016.0806] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/06/2016] [Indexed: 11/29/2022] Open
Abstract
Galanin (GAL) plays key role in many pathophysiological processes, but its role in ischemic stroke remains unclear. Here, the models of 1 h middle cerebral artery occlusion (MCAO)/1-7 d reperfusion (R)-induced ischemic stroke and in vitro cell ischemia of 1 h oxygen-glucose deprivation (OGD)/24 h reoxygenation in primary cultured cortical neurons were used to explore GAL’s effects and its underlying mechanisms. The results showed significant increases of GAL protein levels in the peri-infarct region (P) and infarct core (I) within 48 h R of MCAO mice (p<0.001). The RT-qPCR results also demonstrated significant increases of GAL mRNA during 24-48 h R (p<0.001), and GAL receptors GalR1-2 (but not 3) mRNA levels in the P region at 24 h R of MCAO mice (p<0.001). Furthermore, the significant decrease of infarct volume (p<0.05) and improved neurological outcome (p<0.001-0.05) were observed in MCAO mice following 1 h pre- or 6 h post-treatment of GAL during 1-7 d reperfusion. GalR1 was confirmed as the receptor responsible for GAL-induced neuroprotection by using GalR2/3 agonist AR-M1896 and Lentivirus-based RNAi knockdown of GalR1. GAL treatment inhibited Caspase-3 activation through the upstream initiators Capsases-8/-12 (not Caspase-9) in both P region and OGD-treated cortical neurons. Meanwhile, GAL’s neuroprotective effect was not observed in cortical neurons from conventional protein kinase C (cPKC) γ knockout mice. These results suggested that exogenous GAL protects the brain from ischemic injury by inhibiting Capsase-8/12-initiated apoptosis, possibly mediated by GalR1 via the cPKCγ signaling pathway.
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Affiliation(s)
- Yun Li
- Department of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Zhu Mei
- Department of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Shuiqiao Liu
- Department of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Tong Wang
- Department of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Hui Li
- Department of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Xiao-Xiao Li
- Department of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Song Han
- Department of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Yutao Yang
- Department of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Junfa Li
- Department of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Zhi-Qing David Xu
- Department of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
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20
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Jiang C, Yang S, Tao J, Huang J, Li Y, Ye H, Chen S, Hong W, Chen L. Clinical Efficacy of Acupuncture Treatment in Combination With RehaCom Cognitive Training for Improving Cognitive Function in Stroke: A 2 × 2 Factorial Design Randomized Controlled Trial. J Am Med Dir Assoc 2016; 17:1114-1122. [DOI: 10.1016/j.jamda.2016.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/15/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
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21
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Konczalla J, Schmitz J, Kashefiolasl S, Senft C, Platz J, Seifert V. Non-aneurysmal non-perimesencephalic subarachnoid hemorrhage: effect of rehabilitation at short-term and in a prospective study of long-term follow-up. Top Stroke Rehabil 2016; 23:261-8. [PMID: 26916565 DOI: 10.1080/10749357.2016.1149982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A recently published prospective study identified an impaired outcome of patients with non-perimesencephalic (NPM) subarachnoid hemorrhage (SAH). Our objective was to analyze the long-term outcome of patients with subsequent rehabilitation after NPM SAH. METHODS A comparison of patients with NPM SAH receiving subsequent in-patient rehabilitation was done at discharge (using the modified Rankin scale (mRS)), short-term outcome after 6 months (mRS), and prospectively using a questionnaire (short-form health survey with 36 questions (SF-36)), which was sent to 66 patients. RESULTS Thirty-seven patients answered the SF-36, on average 6.3 years after ictus (range 1.5-14 years). After NPM SAH, the mRS is impaired. Patients with subsequent rehabilitation had a significant better improvement until short-term follow-up. Until long-term outcome, the psychological items were non-significantly reduced, whereas all physical items (physical functioning, role limitations because of physical health problems, bodily pain, and general health perceptions) were significantly decreased compared to the standard population. In patients with subsequent rehabilitation, all items were only non-significantly reduced. About 16% of the patients developed secondary neurological and/or psychiatric diseases. CONCLUSIONS The quality of life (QoL) is decreased after NPM SAH. In the long-term follow-up, a significant reduction in physical items was identified. Due to subsequent in-patient rehabilitation after NPM SAH, the impairment can be improved significantly until short-term follow-up. Whereas patients with NPM SAH had a significantly decreased QoL at long-term follow-up, for patients with rehabilitation, the QoL was only slightly (non-significantly) reduced. Therefore, patients should receive subsequent rehabilitation after NPM SAH to improve the functional short-term outcome (mRS) and long-term QoL. www.clinicaltrials.gov (Identifier No. NCT02334657).
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Affiliation(s)
- Juergen Konczalla
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
| | - Jens Schmitz
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
| | - Sepide Kashefiolasl
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
| | - Christian Senft
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
| | - Johannes Platz
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
| | - Volker Seifert
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
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