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Freeman-Hildreth Y, Aron D, Cola PA, Jr RB, Wang Y. Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making. PATIENT EDUCATION AND COUNSELING 2024; 127:108348. [PMID: 38870706 DOI: 10.1016/j.pec.2024.108348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 05/18/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes. METHODS We sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8. RESULTS Patient-provider collaboration through autonomy support improved treatment satisfaction (β = .16, ρ < .05) and self-management adherence (β = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (β = .25, ρ < .01), it worsened SM adherence (β = -.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided. CONCLUSIONS Autonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider. PRACTICAL IMPLICATIONS For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.
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Affiliation(s)
| | - David Aron
- Department of Medicine, Case Western Reserve University, Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - Philip A Cola
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Richard Boland Jr
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Yunmei Wang
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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van der Veen S, Evans N, Widdershoven G, Huisman M. The BigMove Intervention for People With Physical and Mental Health Conditions: A First Evaluation of Self-Perceived Health, Quality of Life, Coping and Mental and Social Functioning. Int J Integr Care 2024; 24:12. [PMID: 39131909 PMCID: PMC11312720 DOI: 10.5334/ijic.8317] [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: 12/04/2023] [Accepted: 07/25/2024] [Indexed: 08/13/2024] Open
Abstract
Background The BigMove intervention aims to improve the functioning and quality of life of people with physical and mental health conditions via an integrated care approach. This pilot study evaluates the impact of the intervention on self-perceived health (SPH), quality of life (QoL), active coping behaviour, and mental and social functioning. Methods Data were analysed from N = 457 participants who had been referred to the intervention by their general practitioner (mean age 48.98 years; 76% female). Three patient-reported and one clinician-rated measures were used: SPH, QoL (MANSA), active coping behaviour (UPCC-ACT), mental and social functioning (HoNOS). Pre- and post-intervention measurements (from 2011 to 2018) were compared using paired-samples t-tests. Due to missing data, analyses were conducted with 205-257 participants per completed outcome. Associations with age and sex were assessed using repeated-measures ANOVA. Clinically relevant change was evaluated with the Edwards-Nunnally index and standard error of measurement (SEM) scores. Results Post-intervention, there were statistically significant improvements for all outcomes (p < 0.0001) with moderate to large effect sizes (d = 0.41 to 1.02). The observed changes in outcomes can be considered as clinically relevant improvements. Conclusion This pilot study provides preliminary evidence that the intervention has positive effects on SPH, QoL, active coping behaviour, and mental and social functioning.
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Affiliation(s)
- Sabina van der Veen
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, Netherlands
- Faculty of Social Sciences, Institute of Psychology, Health, Medical and Neuropsychology unit, Leiden University, Leiden, Netherlands
| | - Natalie Evans
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, Netherlands
| | - Guy Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Faculty of Social Sciences, Department of Sociology, VU University, Amsterdam, Netherlands
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Cox VC, Welten JJ, Schepers VP, Ketelaar M, Kruithof WJ, van Heugten CM, Visser-Meily JM. Burden, anxiety and depressive symptoms in partners – course and predictors during the first two years after stroke. Top Stroke Rehabil 2022:1-10. [DOI: 10.1080/10749357.2022.2098898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Vincent C.M. Cox
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Jennifer J.E. Welten
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Vera P.M. Schepers
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Willeke J. Kruithof
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
| | - Caroline M. van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
- Limburg Center for Brain Injury, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Johanna M.A. Visser-Meily
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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Welten JJE, Cox VCM, Kruithof WJ, Visser-Meily JMA, Post MWM, van Heugten CM, Schepers VPM. Intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression and life satisfaction in patient-partner couples after stroke. Neuropsychol Rehabil 2022; 33:849-870. [PMID: 35297736 DOI: 10.1080/09602011.2022.2051564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many stroke patients and partners suffer from anxiety, depression, and low life satisfaction. Psychological factors such as coping style and self-efficacy can be protective factors within individuals. The close relationship between stroke patients and partners suggests that there may be interdependence in psychological functioning. The aim of this study was to examine intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression, and life satisfaction in patient-partners couples. In this prospective cohort study, pro-active coping (UPCC), general self-efficacy (GSES), anxiety (HADS-A), depression (HADS-D), and life satisfaction (1-6 scale) were assessed in 215 couples at 2 and 12 months post-stroke. Effects within couples were assessed using structural equation modelling. Several intra- and interpersonal effects of coping style and self-efficacy at 2 months post-stroke were related to emotional health at 12 months post-stroke. Most effects were intrapersonal effects. The interpersonal effects were small but showed that pro-active coping by the patient was associated with lower anxiety of the partner. Higher self-efficacy of the partner was associated with lower depression scores and higher life satisfaction of the patient. This study underscores the importance of a dyadic approach to post-stroke functioning. It supports a family-based approach for treating post-stroke emotional problems.
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Affiliation(s)
- J J E Welten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - V C M Cox
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - W J Kruithof
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - V P M Schepers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Scholten EW, Ketelaar M, Visser-Meily JM, Roels EH, Kouwenhoven M, Post MW. Prediction of Psychological Distress Among Persons With Spinal Cord Injury or Acquired Brain Injury and Their Significant Others. Arch Phys Med Rehabil 2020; 101:2093-2102. [DOI: 10.1016/j.apmr.2020.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/12/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
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van Mastrigt GAPG, van Eeden M, van Heugten CM, Tielemans N, Schepers VPM, Evers SMAA. A trial-based economic evaluation of the Restore4Stroke self-management intervention compared to an education-based intervention for stroke patients and their partners. BMC Health Serv Res 2020; 20:294. [PMID: 32268896 PMCID: PMC7140323 DOI: 10.1186/s12913-020-05103-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Since stroke survivors are increasingly responsible for managing stroke-related changes in their own health and lifestyle, self-management skills are required. In a recent randomised controlled trial a self-management intervention based on proactive coping action planning (SMI) in comparison with an education-based intervention (EDU) in stroke patients was investigated. However, no relevant treatment effects on the Utrecht Proactive Coping Competence scale (UPCC) and the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-Participation) were found. The current study is a trial-based economic evaluation from a societal perspective comparing the same interventions (SMI versus EDU). METHODS UPCC, USER-Participation and EuroQol (EQ-5D-3 L) and costs were measured at baseline, three, six and twelve months after treatment. For the cost-effectiveness analyses, incremental cost effectiveness ratios (ICERs) were calculated for UPCC and USER-Participation. For the cost-utility analyses the incremental cost utility ratio (ICUR) was expressed in cost per Quality Adjusted Life Years (QALYs). Outcomes were tested by means of AN(C)OVA analyses and costs differences by means of bootstrapping. Bootstrapping, sensitivity analyses and a subgroup analysis were performed to test the robustness of the findings. RESULTS One hundred thirteen stroke patients were included in this study. The mean differences in USER-Participation scores (95%CI:-13.08,-1.61, p-value = .013) were significant different between the two groups, this does not account for UPCC scores (95%CI:-.267, .113, p-value = not significant) and QALYs (p-value = not significant) at 12 months. The average total societal costs were not significantly different (95%CI:€-3380,€7099) for SMI (€17,333) in comparison with EDU (€15,520). Cost-effectiveness analyses showed a mean ICER of 26,514 for the UPCC and 346 for the USER-Participation. Cost-utility analysis resulted in an ICUR of €44,688 per QALY. Assuming a willingness to pay (WTP) threshold of €50,000 per QALY, the probability that SMI will be cost-effective is 52%. Sensitivity analyses and subgroup analysis showed the robustness of the results. CONCLUSIONS SMI is probably not a cost-effective alternative in comparison with EDU. Based on the current results, the value of implementing SMI for a stroke population is debatable. We recommend further exploration of the potential cost-effectiveness of stroke-specific self-management interventions focusing on different underlying mechanisms and using different control treatments.
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Affiliation(s)
- Ghislaine A. P. G. van Mastrigt
- CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Mitchel van Eeden
- CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- MHeNS, School for Mental Health and Neuroscience; Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Caroline M. van Heugten
- MHeNS, School for Mental Health and Neuroscience; Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Nienke Tielemans
- MHeNS, School for Mental Health and Neuroscience; Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Vera P. M. Schepers
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Silvia M. A. A. Evers
- CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- Department of Public Mental Healthcare, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Postbus 725, 3500 AS Utrecht, The Netherlands
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Radder DLM, Lennaerts HH, Vermeulen H, van Asseldonk T, Delnooz CCS, Hagen RH, Munneke M, Bloem BR, de Vries NM. The cost-effectiveness of specialized nursing interventions for people with Parkinson's disease: the NICE-PD study protocol for a randomized controlled clinical trial. Trials 2020; 21:88. [PMID: 31941538 PMCID: PMC6961317 DOI: 10.1186/s13063-019-3926-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 11/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background Current guidelines recommend that every person with Parkinson’s disease (PD) should have access to Parkinson’s disease nurse specialist (PDNS) care. However, there is little scientific evidence of the cost-effectiveness of PDNS care. This hampers wider implementation, creates unequal access to care, and possibly leads to avoidable disability and costs. Therefore, we aim to study the (cost-)effectiveness of specialized nursing care provided by a PDNS compared with usual care (without PDNS) for people with PD in all disease stages. To gain more insight into the deployed interventions and their effects, a preplanned subgroup analysis will be performed on the basis of disease duration (diagnosis < 5, 5–10, or > 10 years ago). Methods We will perform an 18-month, single-blind, randomized controlled clinical trial in eight community hospitals in the Netherlands. A total of 240 people with PD who have not been treated by a PDNS over the past 2 years will be included, independent of disease severity or duration. In each hospital, 30 patients will randomly be allocated in a 1:1 ratio to receive either care by a PDNS (who works according to a recent guideline on PDNS care) or usual care. We will use two co-primary outcomes: quality of life (measured with the Parkinson’s Disease Questionnaire-39) and motor symptoms (measured with the Movement Disorders Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale part III). Secondary outcomes include nonmotor symptoms, health-related quality of life, experienced quality of care, self-management, medication adherence, caregiver burden, and coping skills. Data will be collected after 12 months and 18 months by a blinded researcher. A healthcare utilization and productivity loss questionnaire will be completed every 3 months. Discussion The results of this trial will have an immediate impact on the current care of people with PD. We hypothesize that by offering more patients access to PDNS care, quality of life will increase. We also expect healthcare costs to remain equal because increases in direct medical costs (funding additional nurses) will be offset by a reduced number of consultations with the general practitioner and neurologist. If these outcomes are reached, wide implementation of PDNS care will be warranted. Trial registration ClinicalTrials.gov, NCT03830190. Registered February 5, 2019 (retrospectively registered).
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Affiliation(s)
- Danique L M Radder
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, PO Box 9101 (947), 6500, HB, Nijmegen, The Netherlands.
| | - Herma H Lennaerts
- Department of Neurology, Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thies van Asseldonk
- Department of Neurology, Elisabeth-TweeSteden Center, Tilburg, The Netherlands
| | | | - Rob H Hagen
- Patient Expert at the Dutch Parkinson Association, Bunnik, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, PO Box 9101 (947), 6500, HB, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, PO Box 9101 (947), 6500, HB, Nijmegen, The Netherlands
| | - Nienke M de Vries
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, PO Box 9101 (947), 6500, HB, Nijmegen, The Netherlands
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Freeman-Hildreth Y, Aron D, Cola PA, Wang Y. Coping with diabetes: Provider attributes that influence type 2 diabetes adherence. PLoS One 2019; 14:e0214713. [PMID: 30939144 PMCID: PMC6445439 DOI: 10.1371/journal.pone.0214713] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 03/19/2019] [Indexed: 12/30/2022] Open
Abstract
Diabetes, a chronic disease affecting over 29 million people in the United States, requires the integration of complex medical tasks into a person's daily life. Patient-centered care and compassion are recognized as essential dimensions of the quality care experience. This research examined provider attributes that influence adherence to type 2 diabetes mellitus (T2DM) regimens and sought to understand the phenomena of provider attributes, treatment adherence, and their relationship to coping ability and treatment outcomes. This quantitative study sampled 474 people with T2DM using a 62-item online survey administered to three different groups. The sample population included people over age 18 diagnosed with T2DM. The first group included 91 persons with T2DM identified through a Facebook group and personal social media connections, the second group included 120 Amazon Mechanical Turk participants with T2DM, and the third group included 263 respondents from a Qualtrics panel who had T2DM. Results indicated that perceived provider compassion (β = .41, ρ < .001) and optimism (β = .48, ρ < .001) positively affected coping ability. Additionally, full mediation effects for self-management were revealed, with coping ability positively mediating the effect of compassion on self-management and the effects of optimism on self-management. Furthermore, full mediation effects were found for treatment satisfaction, with coping ability positively mediating the effect of compassion on treatment satisfaction and the effects of optimism on treatment satisfaction. This research has implications for patients, healthcare professionals, and leaders suggesting that providers who communicate with optimism and compassion positively affect coping ability. As a result, healthcare providers and professionals have an opportunity to enhance self-management adherence by helping their patients cope with the burdens of diabetes. In addition, this study has implications for developing provider communication tools aimed at assessing patients' coping capacity and increasing compassionate communication.
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Affiliation(s)
| | - David Aron
- Department of Medicine, Case Western Reserve University, Louis Stokes VA Medical Center, Cleveland, Ohio, United States
| | - Philip A. Cola
- Department of Design and Innovation, Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, United States
| | - Yunmei Wang
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
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Fisher DW, Han Y, Lyman KA, Heuermann RJ, Bean LA, Ybarra N, Foote KM, Dong H, Nicholson DA, Chetkovich DM. HCN channels in the hippocampus regulate active coping behavior. J Neurochem 2018; 146:753-766. [PMID: 29953635 PMCID: PMC6158061 DOI: 10.1111/jnc.14539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022]
Abstract
Active coping is an adaptive stress response that improves outcomes in medical and neuropsychiatric diseases. To date, most research into coping style has focused on neurotransmitter activity and little is known about the intrinsic excitability of neurons in the associated brain regions that facilitate coping. Previous studies have shown that HCN channels regulate neuronal excitability in pyramidal cells and that HCN channel current (Ih ) in the CA1 area increases with chronic mild stress. Reduction of Ih in the CA1 area leads to antidepressant-like behavior, and this region has been implicated in the regulation of coping style. We hypothesized that the antidepressant-like behavior achieved with CA1 knockdown of Ih is accompanied by increases in active coping. In this report, we found that global loss of TRIP8b, a necessary subunit for proper HCN channel localization in pyramidal cells, led to active coping behavior in numerous assays specific to coping style. We next employed a viral strategy using a dominant negative TRIP8b isoform to alter coping behavior by reducing HCN channel expression. This approach led to a robust reduction in Ih in CA1 pyramidal neurons and an increase in active coping. Together, these results establish that changes in HCN channel function in CA1 influences coping style.
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Affiliation(s)
- Daniel W Fisher
- Davee Department of Neurology and Clinical Neurosciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ye Han
- Davee Department of Neurology and Clinical Neurosciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kyle A Lyman
- Davee Department of Neurology and Clinical Neurosciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert J Heuermann
- Davee Department of Neurology and Clinical Neurosciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Linda A Bean
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Natividad Ybarra
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Kendall M Foote
- Davee Department of Neurology and Clinical Neurosciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hongxin Dong
- Department of Psychiatry & Behavioral Sciences, Northwestern University, Feinberg School of medicine, Chicago, Illinois, USA
| | - Daniel A Nicholson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Dane M Chetkovich
- Davee Department of Neurology and Clinical Neurosciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Kooijmans H, Post MWM, Stam HJ, van der Woude LHV, Spijkerman DCM, Snoek GJ, Bongers-Janssen HMH, van Koppenhagen CF, Twisk JW, Bussmann JBJ. Effectiveness of a Self-Management Intervention to Promote an Active Lifestyle in Persons With Long-Term Spinal Cord Injury: The HABITS Randomized Clinical Trial. Neurorehabil Neural Repair 2018; 31:991-1004. [PMID: 29256337 DOI: 10.1177/1545968317736819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most people with long-term spinal cord injury (SCI) have a very inactive lifestyle. Higher activity levels have been associated with health benefits and enhanced quality of life. Consequently, encouraging an active lifestyle is important and behavioral interventions are needed to establish durable lifestyle changes. OBJECTIVE The Healthy Active Behavioral Intervention in SCI (HABITS) study was aimed to evaluate the effectiveness of a structured self-management intervention to promote an active lifestyle in inactive persons with long-term SCI. METHODS This assessor-blinded randomized controlled trial was conducted at 4 specialized SCI units in the Netherlands. Sixty-four individuals with long-term SCI (>10 years), wheelchair-user and physically inactive, were included. Participants were randomized to either a 16-week self-management intervention consisting of group meetings and individual counseling and a book, or to a control group that only received information about active lifestyle by one group meeting and a book. Measurements were performed at baseline, 16 weeks, and 42 weeks. Primary outcome measures were self-reported physical activity and minutes per day spent in wheelchair driving. Secondary outcomes included perceived behavioral control (exercise self-efficacy, proactive coping), stages of change concerning exercise, and attitude toward exercise. RESULTS Mixed models analyses adjusted for age, sex, level of SCI, time since injury, baseline body mass index, and location did not show significant differences between the intervention and control groups on the primary and secondary outcomes ( P ≥ .05). CONCLUSIONS A structured 16-week self-management intervention was not effective to change behavior toward a more active lifestyle and to improve perceived behavioral control, stages of change, and attitude.
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Affiliation(s)
- Hedwig Kooijmans
- 1 Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marcel W M Post
- 2 University Medical Center Utrecht and De Hoogstraat, Utrecht, Netherlands.,3 University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Henk J Stam
- 1 Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | | | - Govert J Snoek
- 5 Roessingh Rehabilitation Center, Enschede, Netherlands
| | | | | | - Jos W Twisk
- 8 VU University Medical Center, Amsterdam, Netherlands
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11
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van Diemen T, Scholten EW, van Nes IJ, Geertzen JH, Post MW. Self-Management and Self-Efficacy in Patients With Acute Spinal Cord Injuries: Protocol for a Longitudinal Cohort Study. JMIR Res Protoc 2018; 7:e68. [PMID: 29483066 PMCID: PMC5847820 DOI: 10.2196/resprot.8054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/18/2017] [Accepted: 09/25/2017] [Indexed: 01/03/2023] Open
Abstract
Background People with recently acquired spinal cord injury (SCI) experience changes in physical, social and psychological aspects of their lives. In the last decades, attention has grown for aspects of self-management and self-efficacy in SCI research. However, we still do not know what the self-management and self-efficacy outcomes of first rehabilitation are and whether utilizing these skills may prevent secondary health conditions (SHCs) and increase participation and psychological adjustment early after SCI. Objective To describe the course and determinants of self-management and self-efficacy during and after first SCI rehabilitation; and to determine theory-based associations between self-management and self-efficacy with SHCs, participation and psychological adjustment. Methods Multicenter prospective longitudinal cohort study. All people with a newly acquired SCI admitted to one of the 8 specialized SCI rehabilitation centers in the Netherlands will be considered for inclusion in this study. Main assessments will take place during the first and last week of admission and 3, 6 and 12 months after discharge. The target sample is 250 participants. The primary outcomes are self-management (knowledge and execution of self-care) and self-efficacy (confidence in the ability to manage the consequences of SCI and of self-care). Secondary outcome measures are SHCs, participation and psychological adjustment to SCI. Results The first results with the complete set of data are expected in June 2019. Conclusions This protocol describes the SELF-SCI cohort study investigating self-management and self-efficacy of initial inpatient SCI rehabilitation. Second, associations will be investigated with SHCs, participation and psychological adjustment early after onset of SCI, until 1 year after discharge. The results will be used to test theories about motivation to perform health-promoting behaviors and adjustment to SCI.
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Affiliation(s)
- Tijn van Diemen
- Sint Maartenskliniek, Department of Rehabilitation, Nijmegen, Netherlands.,Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, Groningen, Netherlands
| | - Eline Wm Scholten
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Ilse Jw van Nes
- Sint Maartenskliniek, Department of Rehabilitation, Nijmegen, Netherlands
| | | | - Jan Hb Geertzen
- University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, Groningen, Netherlands
| | - Marcel Wm Post
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, Groningen, Netherlands
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Karube N, Sasaki A, Hondoh F, Odagiri C, Hagii J, Seino S, Yasujima M, Osanai T. Quality of Life in Physical and Psychological Health and Social Environment at Posthospitalization Period in Patients with Stroke. J Stroke Cerebrovasc Dis 2016; 25:2482-7. [PMID: 27363621 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/06/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Interaction of quality of life (QOL) in physical and psychological health and social environment has not been tested in stroke during a posthospitalization period, and a better understanding of the components of QOL would lead to a more integrated and person-centered approach to health management and outcome optimization. We investigated how QOL emerges from the sequelae of stroke and interacts with each other during the posthospitalization period. METHODS We performed a cross-sectional study in 53 outpatients of stroke survivors (39 men and 14 women with a mean age of 66 years, 46 infarctions, and 7 hemorrhages). RESULTS Eight QOL domains of psychological health were scored by interview, and 2 of them ("desire to distend what they can do" or "desire to do rehabilitation") were associated with the improvement of physical health during the posthospitalization period (P < .05 and P = .08, respectively). These patients were characterized by the items like "I need to succeed for health improvement, to go home, to go back to work, and to see grandchildren" as goals to achieve their desire (P < .05). In interaction of QOL in psychological health and social environment, another psychological domain "to gain satisfaction from the experience" was closely related to the presence of hobby or work before stroke attack (P < .05). CONCLUSION During the posthospitalization period, QOL of psychological health may support that of physical health, being associated with the presence of hobby or work before stroke attack.
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Affiliation(s)
- Narumi Karube
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Aya Sasaki
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Fumika Hondoh
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Chiyo Odagiri
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Satoshi Seino
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | | | - Tomohiro Osanai
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan.
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13
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Jesus TS, Silva IL. Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes. Clin Rehabil 2015; 30:315-28. [DOI: 10.1177/0269215515585133] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 04/12/2015] [Indexed: 12/20/2022]
Abstract
Background: There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) ‘how’ rehabilitation outcomes can be improved by communication; and (b) through ‘which’ elements in particular. This article elaborates on the conceptual developments toward informing further practice and research. Methods: Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review. Results: After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the ‘4 Rehab Communication Elements’ deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing. Discussion: This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the ‘4 Rehab Communication Elements’. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes.
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Affiliation(s)
- Tiago Silva Jesus
- Health Psychology Department, Medical School, Universidad Miguel Hernández, Elche, Spain
- Universidade Fernando Pessoa, Oporto, Portugal
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14
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Associations of proactive coping and self-efficacy with psychosocial outcomes in individuals after stroke. Arch Phys Med Rehabil 2015; 96:1484-91. [PMID: 25921978 DOI: 10.1016/j.apmr.2015.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/29/2015] [Accepted: 04/09/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the associations of proactive coping and self-efficacy with psychosocial outcomes in individuals after stroke. DESIGN Cross-sectional study. Regression analyses were performed. SETTING Outpatient settings of hospitals and rehabilitation centers. PARTICIPANTS Individuals after stroke (N=112; mean age ± SD, 57.1±8.9y; mean time ± SD since stroke, 18.9±28.5mo). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Proactive coping was measured using the Utrecht Proactive Coping Competence scale (UPCC), and self-efficacy was measured using the General Self-Efficacy Scale (GSES). Psychosocial outcomes were measured as (1) participation with the use of the restriction and satisfaction subscales of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation); (2) emotional problems with the use of the Hospital Anxiety and Depression Scale (HADS); (3) life satisfaction with the use of 2 questions (2LS); and (4) health-related quality of life (HRQOL) with the use of the Short Stroke-Specific Quality of Life scale (SS-QOL-12). RESULTS Higher UPCC scores were associated with lower HADS scores (β=-.55, P<.001) and with higher USER-Participation satisfaction (β=.31, P=.001), 2LS (β=.34, P<.001), and SS-QOL-12 scores (β=.44, P<.001). The influence of UPCC scores on HRQOL was indirect through self-efficacy. Higher GSES scores were associated with higher UPCC scores (β=.65, P<.001), which in turn were associated with lower HADS scores (β=-.51, P<.001). GSES scores were directly associated with higher SS-QOL-12 scores (β=.32, P=.002). GSES scores did not influence the association between UPCC scores and any of the psychosocial outcomes (all P>.0025). CONCLUSIONS Proactive coping and self-efficacy have different associations with each of the psychosocial outcomes. Therefore, outcome-specific models appear to be necessary to describe these associations.
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van Mierlo ML, van Heugten CM, Post MW, de Kort PL, Visser-Meily JM. Psychological factors determine depressive symptomatology after stroke. Arch Phys Med Rehabil 2015; 96:1064-70. [PMID: 25681672 DOI: 10.1016/j.apmr.2015.01.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify psychological factors related to poststroke depressive symptoms. DESIGN Cross-sectional study, with patients assessed at 2 months poststroke. SETTING Patients with stroke from 6 general hospitals. PARTICIPANTS Stroke patients (N=344; mean age ± SD, 66.9±12.3y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The presence of clinical depressive symptoms was determined with the depression subscale of the Hospital Anxiety and Depression Scale 2 months poststroke. Psychological factors assessed were extraversion, neuroticism, optimism, pessimism, self-efficacy, helplessness, acceptance, perceiving benefits, proactive coping, and passive coping. RESULTS Bivariate correlations and multivariate backward logistic regression were used to analyze associations between psychological factors and poststroke depressive symptoms, accounting for demographic and stroke-related factors. More neuroticism, pessimism, passive coping, and helplessness, and less extraversion, optimism, self-efficacy, acceptance, perceived benefits, and proactive coping were bivariately associated with the presence of depressive symptoms. Multivariate logistic regression analysis showed that more helplessness (odds ratio [OR]=1.17) and passive coping (OR=1.19) and less acceptance (OR=.89) and perceived benefits (OR=.89) were independently significantly associated with the presence of poststroke depressive symptoms (Nagelkerke R(2)=.49). CONCLUSIONS We found a relationship between psychological variables and the presence of depressive symptoms 2 months poststroke. It is important to take these factors into account during poststroke rehabilitation.
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Affiliation(s)
- Maria L van Mierlo
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Marcel W Post
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul L de Kort
- Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Johanna M Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
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16
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Leenen LA, Wijnen BF, de Kinderen RJ, Majoie MH, van Heugten CM, Evers SM. (Cost)-effectiveness of a multi-component intervention for adults with epilepsy: study protocol of a Dutch randomized controlled trial (ZMILE study). BMC Neurol 2014; 14:255. [PMID: 25540089 PMCID: PMC4301056 DOI: 10.1186/s12883-014-0255-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/17/2014] [Indexed: 11/23/2022] Open
Abstract
Background In patients with epilepsy, poor adherence to anti-epileptic drugs has been shown to be the most important cause of poorly controlled epilepsy. Furthermore, it has been noted that the quality of life among patients with epilepsy can be improved by counseling and treatments aimed at increasing their self-efficacy and concordance, thus stimulating self-management skills. However, there is a need for evidence on the effectiveness of such programs, especially within epilepsy care. Therefore, we have developed a multi-component intervention (MCI) which combines a self-management/education program with e-Health interventions. Accordingly, the overall objective of this study is to assess the (cost)-effectiveness and feasibility of the MCI, aiming to improve self-efficacy and concordance in patients with epilepsy. Methods A RCT in two parallel groups will be conducted to compare the MCI with a control condition in epilepsy patients. One hundred eligible epilepsy patients will be recruited and allocated to either the intervention or control group. The intervention group will receive the MCI consisting of a self-management/education program of six meetings, including e-Health interventions, and will be followed for 12 months. The control group will receive care as usual and will be followed for 6 months, after which patients will be offered the possibility of participating in the MCI. The study will consist of three parts: 1) a clinical effectiveness study, 2) a cost-effectiveness study, and 3) process evaluation. The primary outcome will be self-efficacy. Secondary outcomes include adherence, side effects, change in seizure severity & frequency, improved quality of life, proactive coping, and societal costs. Outcome assessments will be done using questionnaires at baseline and after 3, 6, 9, and 12 months (last two applicable only for intervention group). Discussion In times of budget constraints, MCI could be a valuable addition to the current healthcare provision for epilepsy, as it is expected that higher concordance and self-efficacy will result in reduced use of healthcare resources and an increased QOL. Accordingly, this study is aimed helping patients to be their own provider of health care, shifting epilepsy management from professionals to self-care by patients equipped with appropriate skills and tools. Trial registration number NTR4484.
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Affiliation(s)
- Loes Am Leenen
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands.
| | - Ben Fm Wijnen
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands.
| | - Reina Ja de Kinderen
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands.
| | - Marian Hjm Majoie
- Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands. .,Department of Neurology, Academic Centre for Epileptology, Epilepsy Centre Kempenhaeghe & Maastricht University Medical Centre, Maastricht, The Netherlands. .,MHENS, School for Mental Health and Neuroscience, department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Caroline M van Heugten
- MHENS, School for Mental Health and Neuroscience, department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands. .,Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands.
| | - Silvia Maa Evers
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
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