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Wang YL, Wu WX, Yang CC, Huang SM, Chang CC, Li CR, Chiang SL, Chen YJ. Heart rate variability biofeedback enhances cognitive, motor, psychological, and autonomic functions in post-stroke rehabilitation. Int J Psychophysiol 2024; 203:112411. [PMID: 39116804 DOI: 10.1016/j.ijpsycho.2024.112411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/02/2024] [Accepted: 08/03/2024] [Indexed: 08/10/2024]
Abstract
Post-stroke patients often experience psychological distress and autonomic nervous system (ANS) dysregulation, impacting their well-being. This study evaluated the effectiveness of heart rate variability (HRV) biofeedback on cognitive, motor, psychological, and ANS functions in sixty-two ischemic stroke patients (43 males, mean age = 60.1) at a Medical Center in southern Taiwan. To prevent interaction, we allocated patients to the HRV biofeedback or control (usual care) group based on their assigned rehabilitation days, with 31 patients in each group. Assessments conducted at baseline, three, and six months included the Montreal Cognitive Assessment (MoCA), Fugl-Meyer Assessment for Upper Extremities (FMA-UE), Perceived Stress Scale, Hospital Anxiety and Depression Scales (HADS), and HRV indices. Mixed-effect models were used to analyze Group by Time interactions. The results revealed significant interactions across all functions. At 3 months, significant improvements in the HRV biofeedback group were observed only in MoCA, FMA-UE, and HADS-depression scores compared to the control group. By 6 months, all measured outcomes demonstrated significant improvements in the biofeedback group relative to the control group. These results suggest that HRV biofeedback may be an effective complementary intervention in post-stroke rehabilitation, warranting further validation.
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Affiliation(s)
- Yu-Lin Wang
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Xuan Wu
- Department of Nursing, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Chia-Chen Yang
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Ming Huang
- Department and Graduate Institute of Biochemistry, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Rong Li
- Department of Teaching and Research, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ju Chen
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.
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Wang Y, Xie H, Sun H, Ren L, Jiang H, Chen M, Dong C. Influencing Factors of Psychological Resilience in Stroke Patients: A Systematic Review and Meta-Analysis. Arch Clin Neuropsychol 2024; 39:644-654. [PMID: 38324660 DOI: 10.1093/arclin/acad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To systematically review the current status and influencing factors of psychological resilience in stroke patients and to provide a theoretical basis for future personalized rehabilitation support and psychological interventions. METHOD This systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. A comprehensive search of databases including PubMed, Web of Science, Medline, PsycINFO, CINAHL, Cochrane Library, CNKI, VIP, CMB, and WANGFANG was conducted from inception until November 22, 2023, resulting in the retrieval of 2099 studies. Literature screening and data extraction were performed by two independent evaluators based on pre-defined inclusion and exclusion criteria, and meta-analysis was performed using Review Manager 5.4 software. RESULTS The final review included 23 studies. The results showed that self-efficacy, hope, confrontation coping, avoidance coping, functional independence, quality of life, and social support were positively associated with psychological resilience. Conversely, anxiety, depression, and resignation coping were negatively associated with psychological resilience. CONCLUSIONS Patients with stroke have a low level of psychological resilience, which was influenced by a variety of factors. However, longitudinal and large sample studies are needed to further confirm these findings. These results should be integrated into clinical practice for early assessment and targeted intervention in psychological resilience to assist patients in coping with the rehabilitation process and life changes after a stroke.
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Affiliation(s)
- Yuxin Wang
- School of Nursing, Wenzhou Medical University, Wenzhou 325035, China
| | - Hongxia Xie
- School of Computing, Hangzhou City University, Hangzhou 310015, China
| | - Hongyu Sun
- School of Nursing, Peking University, Beijing 100191, China
| | - Liya Ren
- School of Nursing, Wenzhou Medical University, Wenzhou 325035, China
| | - Hao Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou 325035, China
| | - Meijia Chen
- The Second School of Medicine, Wenzhou Medical University, Wenzhou 325035, China
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, Wenzhou 325035, China
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Smith MJ, Pellegrini M, Major B, Graco M, Porter S, Kramer S, Sewell K, Salberg S, Chen Z, Mychasiuk R, Lannin NA. Improving physical movement during stroke rehabilitation: investigating associations between sleep measured by wearable actigraphy technology, fatigue, and key biomarkers. J Neuroeng Rehabil 2024; 21:84. [PMID: 38802847 PMCID: PMC11131210 DOI: 10.1186/s12984-024-01380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Sleep disturbance and fatigue are common in individuals undergoing inpatient rehabilitation following stroke. Understanding the relationships between sleep, fatigue, motor performance, and key biomarkers of inflammation and neuroplasticity could provide valuable insight into stroke recovery, possibly leading to personalized rehabilitation strategies. This study aimed to investigate the influence of sleep quality on motor function following stroke utilizing wearable technology to obtain objective sleep measurements. Additionally, we aimed to determine if there were relationships between sleep, fatigue, and motor function. Lastly, the study aimed to determine if salivary biomarkers of stress, inflammation, and neuroplasticity were associated with motor function or fatigue post-stroke. METHODS Eighteen individuals who experienced a stroke and were undergoing inpatient rehabilitation participated in a cross-sectional observational study. Following consent, participants completed questionnaires to assess sleep patterns, fatigue, and quality of life. Objective sleep was measured throughout one night using the wearable Philips Actiwatch. Upper limb motor performance was assessed on the following day and saliva was collected for biomarker analysis. Correlation analyses were performed to assess the relationships between variables. RESULTS Participants reported poor sleep quality, frequent awakenings, and difficulties falling asleep following stroke. We identified a significant negative relationship between fatigue severity and both sleep quality (r=-0.539, p = 0.021) and participants experience of awakening from sleep (r=-0.656, p = 0.003). A significant positive relationship was found between grip strength on the non-hemiplegic limb and salivary gene expression of Brain-derived Neurotrophic Factor (r = 0.606, p = 0.028), as well as a significant negative relationship between grip strength on the hemiplegic side and salivary gene expression of C-reactive Protein (r=-0.556, p = 0.048). CONCLUSION The findings of this study emphasize the importance of considering sleep quality, fatigue, and biomarkers in stroke rehabilitation to optimize recovery and that interventions may need to be tailored to the individual. Future longitudinal studies are required to explore these relationships over time. Integrating wearable technology for sleep and biomarker analysis can enhance monitoring and prediction of outcomes following stroke, ultimately improving rehabilitation strategies and patient outcomes.
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Affiliation(s)
- Madeleine J Smith
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Michael Pellegrini
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Brendan Major
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Alfred Health, Melbourne, VIC, 3004, Australia
| | | | | | - Sharon Kramer
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Alfred Health, Melbourne, VIC, 3004, Australia
| | - Katherine Sewell
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Sabrina Salberg
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Zhibin Chen
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
- Alfred Health, Melbourne, VIC, 3004, Australia.
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Meshkat S, Tassone VK, Wu M, Duffy SF, Boparai JK, Jung H, Lou W, Vyas MV, Bhat V. Does Self-Reported BMI Modify the Association Between Stroke and Depressive Symptoms? Can J Neurol Sci 2024:1-7. [PMID: 38523509 DOI: 10.1017/cjn.2024.41] [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: 03/26/2024]
Abstract
BACKGROUND Depressive symptoms are common in stroke survivors. While obesity has been associated with stroke and depression, its influence on the association between stroke and depressive symptoms is unknown. METHODS Cross-sectional data from 2015 to 2016 Canadian Community Health Survey was used. History of stroke was self-reported and our outcome of interest was depressive symptoms in the prior 2 weeks, measured using the 9-item Patient Health Questionnaire. Self-reported body mass index (BMI) was modeled as cubic spline terms to allow for nonlinear associations. We used multivariable logistic regression to evaluate the association between stroke and depressive symptoms and added an interaction term to evaluate the modifying effect of BMI. RESULTS Of the 47,521 participants, 694 (1.0%) had a stroke and 3314 (6.5%) had depressive symptoms. Those with stroke had a higher odds of depressive symptoms than those without (aOR = 3.13, 95% CI 2.48, 3.93). BMI did not modify the stroke-depressive symptoms association (P interaction = 0.242) despite the observed variation in stroke-depressive symptoms association across BMI categories,: normal BMI [18.5-25 kg/m2] (aOR† = 3.91, 95% CI 2.45, 6.11), overweight [25-30 kg/m2] (aOR† = 2.63, 95% CI 1.58, 4.20), and obese [>30 kg/m2] (aOR† = 2.76, 95% CI 1.92, 3.94). Similar results were found when depressive symptoms were modeled as a continuous measure. CONCLUSION The association between stroke and depressive symptoms is not modified by BMI, needing additional work to understand the role of obesity on depression after stroke.
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Affiliation(s)
- Shakila Meshkat
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Vanessa K Tassone
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Michelle Wu
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Sophie F Duffy
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Josheil K Boparai
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Hyejung Jung
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Manav V Vyas
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- St. Michael's Research Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Mental Health and Addictions Services, St. Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Bai Y, Sui R, Zhang L, Bai B, Zhu Y, Jiang H. Resveratrol Improves Cognitive Function in Post-stroke Depression Rats by Repressing Inflammatory Reactions and Oxidative Stress via the Nrf2/HO-1 Pathway. Neuroscience 2024; 541:50-63. [PMID: 38278473 DOI: 10.1016/j.neuroscience.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 01/28/2024]
Abstract
Post-stroke depression (PSD) is a prevalent mental health issue, and resveratrol (RES) has been implicated in its management. This study aimed to elucidate the impact of RES on PSD. A PSD rat model was established through middle cerebral artery occlusion and chronic unpredictable mild stress. Rats received RES via gavage, and depressive behaviors were evaluated through various measures. Cerebral infarction areas and brain tissue pathology were assessed using TTC and H&E staining. Levels of inflammatory factors (TNF-α/IL-1β/IL-6/IL-10), neurotransmitters (ACH/DA/5-HT/BDNF), and oxidative stress-related indicators (SOD/GSH-Px/MDA), along with the total Nrf2/C-Nrf2/N-Nrf2/HO-1 proteins, were analyzed. The role of the Nrf2/HO-1 pathway was investigated by co-treating rats with RES and either an Nrf2 pathway specific inhibitor (ML385) or activator (dimethyl fumarate). PSD rats exhibited depressive behaviors, disrupted neurotransmitter levels, and oxidative stress markers. RES treatment effectively alleviated these symptoms and activated the Nrf2/HO-1 pathway in PSD rat brain tissues. Co-administration of ML385 attenuated the beneficial effects of RES in PSD rats. Altogether, RES mitigates depressive behaviors, improves cognitive dysfunction, and reduces oxidative stress and inflammatory response in PSD rats. These effects are mediated through the activation of the Nrf2/HO-1 pathway, suggesting RES as a potential therapeutic agent for PSD-related cognitive impairment.
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Affiliation(s)
- Yanjuan Bai
- Department of Neurology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, Liaoning, People's Republic of China
| | - Rubo Sui
- Department of Neurology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, Liaoning, People's Republic of China.
| | - Lei Zhang
- School of Nursing, Jinzhou Medical University, Jinzhou 121000, Liaoning, People's Republic of China
| | - Bing Bai
- Academic Affairs Office of Liaoning University of Technology, Jinzhou 121000, Liaoning, People's Republic of China
| | - Yue Zhu
- Department of Neurology, First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, Liaoning, People's Republic of China
| | - Hongxin Jiang
- Department of Radiology, Gucheng County Hospital of Hebei Province, Hengshui 253800, Hebei, People's Republic of China
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Randolph S, Lee Y, Nicholas ML, Connor LT. The mediating effect of anxiety on the association between residual neurological impairment and post-stroke participation among persons with and without post-stroke depression. Neuropsychol Rehabil 2024; 34:181-195. [PMID: 36630107 DOI: 10.1080/09602011.2023.2165115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/01/2023] [Indexed: 01/12/2023]
Abstract
Previous research has reported that residual neurological impairment and emotional factors play a role in regaining successful participation post-stroke. The objective of this study was to investigate the mediating impact of anxiety on the association between residual neurological impairment and participation in survivors with and without post-stroke depressive symptoms. Participants (N = 79) were classified into 2 categories, those with post-stroke depressive symptoms (N = 40) and those without post-stroke depressive symptoms (N = 39). Variables measured in this study: residual neurological impairment (NIH Stroke Scale Score), participation (Reintegration to Normal Living Index), depressive symptoms (Patient Health Questionnaire-9), and trait anxiety (State-Trait Anxiety Inventory). A regression-based mediation analysis was conducted for each group of participants. The majority of participants had some level of anxiety. Residual neurological impairment predicted participation in stroke survivors both with (β = -.45, p = .003) and without (β = -.45, p = .004) post-stroke depressive symptoms. Anxiety mediated this relationship in participants with depressive symptoms (β = -.19, 95% CI = -.361 ∼ -.049), but not in participants without depressive symptoms (β = -.18, 95% CI = -.014 ∼ .378). Depressive and anxious symptoms should both be addressed to best facilitate participation by stroke survivors.
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Affiliation(s)
- Samantha Randolph
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Yejin Lee
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Marjorie L Nicholas
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA
| | - Lisa Tabor Connor
- Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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Chen J, Wu Y, Li L, He F, Zou B, Zhuang Y, Tuersun Y, Yang J, Wu F, Kan Y, Lyu K, Lu Y, Ming WK, Sun X, Wang D. How is family health related to health-related quality of life among middle-aged and older adults in rural China? A cross-sectional study. Int J Older People Nurs 2024; 19:e12605. [PMID: 38374792 DOI: 10.1111/opn.12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is unequal between countries and regions, and the emphasis on HRQOL of populations of low-income countries and regions is unprecedented. OBJECTIVES To examine the association between family health and HRQOL among middle-aged and older adults in rural China, and determine whether this association differs by age, gender and chronic disease subgroup. METHODS Cross-sectional survey carried out from July to September 2021. The participants were 1059 people aged 46 and over living in rural China. We used the European Quality of Life Five Dimension Five Level (EQ-5D-5L) and Family Health Scale-Short Form (FHS-SF) to assess health-related quality of life (HRQOL) and family health, respectively. RESULTS The mean EQ-VAS was 75.66, the mean EQ index score was 0.92, and the mean FHS was 37.90 in rural middle-aged and older adults. After Bonferroni correction, generalised linear regression models showed that FHS was significantly associated with the EQ-VAS (β = 0.829; 95% confidence interval [CI]: 0.660 to 0.997; p < .001) and the EQ index score (β = 0.003; 95%CI: 0.001 to 0.004; p < .001). Binary logistic regression models showed that FHS was associated with three dimensions of HRQOL (mobility, self-care and usual activities) (p < .01). Based on subgroup analyses, the effect of FHS on EQ-VAS and the EQ index score was significant in three subgroups after Bonferroni correction (p < .01), but the association between FHS and the dimensions of HRQOL differed by age, gender and chronic disease group (p > .01). CONCLUSIONS This study is the first to explore that family health and its dimensions are significant positive predictors of HRQOL among middle-aged and older adults in rural China. Family-based measures may have more potential and value because better family health significantly improves HRQOL. IMPLICATIONS FOR PRACTICE In the health strategy, the government and primary health care workers should include family health as an indicator and assess it before and after the implementation of the strategy.
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Affiliation(s)
- Jiangyun Chen
- School of Health Management, Southern Medical University, Guangzhou, China
- Institute of Health Management, Southern Medical University, Guangzhou, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Lehuan Li
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Feiying He
- Southern Medical University, Guangzhou, China
| | - Biqing Zou
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Yishan Zhuang
- School of Public Health, Southern Medical University, Guangzhou, China
| | | | - Jiao Yang
- School of Public Health, Capital Medical University, Beijing, China
| | - Fangjing Wu
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Yifan Kan
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Ke Lyu
- School of Public Health, China Medical University, Shenyang, China
| | - Yefeng Lu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
- Institute of Health Management, Southern Medical University, Guangzhou, China
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Moreno-Morente G, Hurtado-Pomares M, Sánchez-Pérez A, Terol-Cantero MC. Translation, Cross-Cultural Adaptation, and Feasibility of the NHPT-E of Manual Dexterity for the Spanish Population. Healthcare (Basel) 2024; 12:550. [PMID: 38470661 PMCID: PMC10930797 DOI: 10.3390/healthcare12050550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The Nine-Hole Peg Test (NHPT) is considered a "gold standard" for the measurement of manual dexterity. The aim of this study was the translation and culturally adapting the original version of the NHPT. MATERIALS AND METHODS The adaptation was carried out following the standardized translation-retrotranslation guidelines and procedures referred to in the literature and in the International Test Commission (CIT). The final Spanish version of the NHPT (NHPT-E) was administered to 40 healthy adults. We evaluated its feasibility by means of a questionnaire elaborated according to Iraossi's checklist proposal for the pilot test process. RESULTS Modifications of expression in the grammatical mode of the verbs were performed, as well as the adaptation of some terms used in the three sections of the original version of the test (General Information, Installation, and Application Instructions). In the pilot study, for 95% of the participants, the NHPT-E is a comfortable test to take, and, for 100% of the evaluators, the test includes all the necessary information, with clear instructions and interpretation of the results. CONCLUSIONS The cross-cultural adaptation and pilot study enabled the development of a suitable and viable version of the NHPT-E for use in the Spanish population.
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Affiliation(s)
- Gema Moreno-Morente
- Department of Pathology and Surgery, Universidad Miguel Hernández de Elche, 03550 Alicante, Spain; (M.H.-P.); (A.S.-P.)
| | - Miriam Hurtado-Pomares
- Department of Pathology and Surgery, Universidad Miguel Hernández de Elche, 03550 Alicante, Spain; (M.H.-P.); (A.S.-P.)
- Grupo de Investigación en Terapia Ocupacional (InTeO), Universidad Miguel Hernández de Elche, 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03550 Alicante, Spain
| | - Alicia Sánchez-Pérez
- Department of Pathology and Surgery, Universidad Miguel Hernández de Elche, 03550 Alicante, Spain; (M.H.-P.); (A.S.-P.)
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03550 Alicante, Spain
- B + D + b Occupational Research Group, Miguel Hernández University of Elche, 03550 Alicante, Spain
| | - M. Carmen Terol-Cantero
- Department of Behavior and Health, Miguel Hernández University of Elche, 03550 Alicante, Spain;
- Research Group—Psychosocial Action in the Community Sphere, 03550 Alicante, Spain
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9
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Rintala A, Kossi O, Bonnechère B, Evers L, Printemps E, Feys P. Mobile health applications for improving physical function, physical activity, and quality of life in stroke survivors: a systematic review. Disabil Rehabil 2023; 45:4001-4015. [PMID: 36325613 DOI: 10.1080/09638288.2022.2140844] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the effectiveness of mobile health applications (mHealth apps) containing a physical training component on physical function and physical activity in stroke rehabilitation. MATERIALS AND METHODS A systematic literature search was conducted in three databases for studies published from inception to 12 July 2022. Clinical trials including mHealth apps with a physical training component were included using outcomes of physical function and physical activity. Quality of life was extracted as a secondary outcome. RESULTS Five RCTs, two non-RCTs, and four uncontrolled clinical trials were included with a total of 264 stroke survivors. Eleven apps were identified with a physical training component using features of gamification (six apps), exercise prescription (three apps), and physical activity (two apps). Six out of seven studies reported statistically significant improvements in physical function in favor of the experimental group, with the most robust findings for upper extremity function. For physical activity, statistically significant improvements were seen in the experimental groups. Only one study showed significant improvement in quality of life. Overall study quality was fair. CONCLUSIONS mHealth apps containing a physical training component are promising for physical function and physical activity in stroke rehabilitation. Further research is warranted to confirm these conclusions.Implications for rehabilitationDesign content of mobile apps with a physical training component were focused on gamification, exercise prescription, and physical activityUsing mobile app-delivered therapy seem promising for improving upper extremity function in stroke rehabilitationUsing mobile apps also supported an increase of physical activity in people with strokeStudies using mobile apps should report more specifically the dosage of physical training and adherenceUsing mobile apps seems promising as an additional tool for clinical work, however, more studies are required to understand their effectiveness in stroke rehabilitation.
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Affiliation(s)
- A Rintala
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Faculty of Social Services and Health Care, LAB University of Applied Sciences, Lahti, Finland
| | - O Kossi
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
| | - B Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - L Evers
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - E Printemps
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - P Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Liu W, Liu X, Wang J, Peng S, Li J, Pei M, Qiu Z, Zhang P. Predicting the relationship between anxiety and health-related quality of life in post-stroke patients: The role of sleep duration. J Stroke Cerebrovasc Dis 2023; 32:107368. [PMID: 37740992 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023] Open
Abstract
OBJECTIVES Sleep and psychological disorders are common complaints in stroke survivors. The effectiveness of sleep duration in post-stroke on mental well-being and health outcomes has been reported recently. This study aimed to investigate the mediating effect of sleep duration on the relationship between anxiety and health-related quality of life in Chinese post-stroke; MATERIALS AND METHODS: We conducted a quantitative, cross-sectional study with participants recruited through a multistage, stratified, probability proportional to size sampling method. Anxiety, health-related quality of life, and sleep duration were measured by Zung Self-rating Anxiety Scale, World Health Organization Quality of Life Questionnaire, and a self-administered, structured questionnaire. A multiple linear regression analysis was conducted to identify the association between anxiety, sleep duration, and quality of life. The direct and indirect effects of sleep duration on health-related quality of life was assessed using the bootstrap method via Model 4 (parallel mediation) of SPSS PROCESS macro; RESULTS: A total of 856 post-stroke patients participated in the study, and incidence of anxiety symptom amongst post-stroke was 33.53%. Sleep duration mainly plays partial mediating roles in the relationship between mild-to-moderate anxiety and quality of life in physical, psychological, and environment domains, with sleep duration of 7-8h playing a major role; CONCLUSIONS: A significant relationship among anxiety, sleep duration, and quality of life in post-stroke was found in this study. The sleep duration partially mediated the association between anxiety and quality of life. Suitable prevention methods and early interventions for sleep duration may improve the quality of life for post-stroke anxiety.
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Affiliation(s)
- Wei Liu
- General Medical Department, Lianyang Community Health Service Center, Shanghai, China
| | - Xingyue Liu
- School of Health and Social Care, Shanghai urban construction vocational college, Shanghai, China
| | - Jian Wang
- Research and Development Department, ANEXT Shanghai Biotechnology Co., Ltd., Shanghai, China
| | - Shuzhi Peng
- Graduate School, Shanghai University of Medicine & Health Sciences, Shanghai, China; Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Li
- School of Public Health, Anhui Medical University, Anhui, China
| | - Mengyun Pei
- Graduate School, Shanghai University of Medicine & Health Sciences, Shanghai, China; Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhichao Qiu
- School of Health and Social Care, Shanghai urban construction vocational college, Shanghai, China
| | - Peng Zhang
- School of Management, Hainan Medical University, Haikou, China; School of Clinical Medicine, Shanghai University of Medicine & Health Sciences, Shanghai, China.
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11
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Ma H, Chang Q, Jia J, Zhang Y, Wang G, Li Y. Linkage of blood cell division cycle 42 with T helper cells, and their correlation with anxiety, depression, and cognitive impairment in stroke patients. Braz J Med Biol Res 2023; 56:e12855. [PMID: 37703110 PMCID: PMC10496759 DOI: 10.1590/1414-431x2023e12855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023] Open
Abstract
Cell division cycle 42 (CDC42) regulates T helper (Th) cell differentiation and is related to psychological disorders. This study aimed to assess the correlation between blood CDC42 and Th cells, and their association with mental issues in stroke patients. Peripheral blood samples were obtained from 264 stroke patients and 50 controls. Then, serum CDC42 was measured by enzyme-linked immunosorbent assay, and Th1, Th2, and Th17 cells were detected by flow cytometry. Hospital Anxiety and Depression Scale (HADS) and Mini Mental State Examination (MMSE) were applied to patients. CDC42 was decreased (P<0.001), Th1 (P=0.013) and Th17 (P<0.001) cells were elevated, while Th2 cells (P=0.108) showed no difference in stroke patients compared to controls. In addition, CDC42 was negatively associated to Th1 (P=0.013) and Th17 (P<0.001) cells in stroke patients but were not associated with Th2 cells (P=0.223). Interestingly, CDC42 was negatively associated with HADS-anxiety (P<0.001) and HADS-depression scores (P=0.034) and positively associated with MMSE score (P<0.001) in stroke patients. Lower CDC42 was associated to lower occurrence of anxiety (P=0.002), depression (P=0.001), and cognitive impairment (P=0.036) in stroke patients. Furthermore, increased Th17 cells were positively correlated with HADS-anxiety and HADS-depression scores and inversely correlated with MMSE score, which were also associated with higher occurrence of anxiety, depression, and cognitive impairment in stroke patients (all P<0.05). Blood CDC42 and Th17 cells were correlated, and both of them were linked to the risk of anxiety, depression, and cognitive impairment. However, the findings need further large-scale validation, and the implicated mechanism needs more investigation.
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Affiliation(s)
- Haifeng Ma
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Qing Chang
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Jujuan Jia
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Yaoyuan Zhang
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Gang Wang
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Yuanyuan Li
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
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12
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Hwang HS, Kim H. Factors Affecting the Quality of Sleep and Social Participation of Stroke Patients. Brain Sci 2023; 13:1068. [PMID: 37509000 PMCID: PMC10377525 DOI: 10.3390/brainsci13071068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Stroke patients are exposed to various psychosocial factors, such as depression, anxiety, and stress, which can cause problems with respect to their quality of sleep and social participation. (2) Objectives: We analyzed the causal relationships between the factors affecting sleep quality and social participation in hospitalized and community-based stroke patients using a path analysis model. (3) Methods: A questionnaire survey was administered to stroke patients from June to November 2020 using the Pittsburgh Sleep Quality Index to assess sleep quality; the Beck Depression Inventory to assess depression; the Beck Anxiety Inventory to assess anxiety; the Stress Scale to assess stress; and the Reintegration to Normal Living Index to assess participation. The data thus obtained were subjected to descriptive statistics, frequency analysis, and Pearson correlation analysis. In addition, anxiety, stress, and spasticity were set as exogenous variables to perform path analysis of their causal effects on depression (parameter), sleep quality, and social participation (final endogenous variables). (4) Results: In total, 145 people participated in this study, and the data of 129 people, excluding 16 insincere respondents, were analyzed. The general characteristics of the subjects comprised 84 males (65.1%) and 45 females (34.9%). Poor sleep quality comprised 54.3%, and good sleep quality comprised 45.7%, where the average age was 58.29 ± 15.46 years and the duration from onset was 39.73 ± 51.49 months. This study confirmed correlations between social participation and sleep quality, spasticity, depression, anxiety, and stress. Path analysis also revealed that anxiety and stress led to depression and that depression is a risk factor for sleep quality and social participation. (5) Conclusions: Sleep quality and social participation in stroke patients play an important role in rehabilitation. By carrying out this study, direct and indirect factors that affect sleep quality and social participation were analyzed, and the quality level in rehabilitation treatment should be improved from a structural point of view when approaching psychosocial factors.
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Affiliation(s)
- Ho-Sung Hwang
- Department of Occupational Therapy, Konyang University of Occupational Therapy, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Republic of Korea
| | - Hee Kim
- Department of Occupational Therapy, Konyang University of Occupational Therapy, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Republic of Korea
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13
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Alnsasra H, Khalil F, Kanneganti Perue R, Azab AN. Depression among Patients with an Implanted Left Ventricular Assist Device: Uncovering Pathophysiological Mechanisms and Implications for Patient Care. Int J Mol Sci 2023; 24:11270. [PMID: 37511030 PMCID: PMC10379142 DOI: 10.3390/ijms241411270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Depression is a common and devastating mental illness associated with increased morbidity and mortality, partially due to elevated rates of suicidal attempts and death. Select patients with end-stage heart failure on a waiting-list for a donor heart undergo left ventricular assist device (LVAD) implantation. The LVAD provides a circulatory flow of oxygenated blood to the body, mimicking heart functionality by operating on a mechanical technique. LVAD improves functional capacity and survivability among patients with end-stage heart failure. However, accumulating data suggests that LVAD recipients suffer from an increased incidence of depression and suicide attempts. There is scarce knowledge regarding the pathological mechanism and appropriate treatment approach for depressed LVAD patients. This article summarizes the current evidence on the association between LVAD implantation and occurrence of depression, suggesting possible pathological mechanisms underlying the device-associated depression and reviewing the current treatment strategies. The summarized data underscores the need for a rigorous pre-(LVAD)-implantation psychiatric evaluation, continued post-implantation mental health assessment, and administration of antidepressant treatment as necessary.
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Affiliation(s)
- Hilmi Alnsasra
- Cardiology Division, Soroka University Medical Center, Beer-Sheva 8410501, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Fouad Khalil
- Department of Internal Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
| | - Radha Kanneganti Perue
- Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Abed N Azab
- Cardiology Division, Soroka University Medical Center, Beer-Sheva 8410501, Israel
- Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
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14
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Chen YM, Chen PC, Lin WC, Hung KC, Chen YCB, Hung CF, Wang LJ, Wu CN, Hsu CW, Kao HY. Predicting new-onset post-stroke depression from real-world data using machine learning algorithm. Front Psychiatry 2023; 14:1195586. [PMID: 37404713 PMCID: PMC10315461 DOI: 10.3389/fpsyt.2023.1195586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/29/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Post-stroke depression (PSD) is a serious mental disorder after ischemic stroke. Early detection is important for clinical practice. This research aims to develop machine learning models to predict new-onset PSD using real-world data. Methods We collected data for ischemic stroke patients from multiple medical institutions in Taiwan between 2001 and 2019. We developed models from 61,460 patients and used 15,366 independent patients to test the models' performance by evaluating their specificities and sensitivities. The predicted targets were whether PSD occurred at 30, 90, 180, and 365 days post-stroke. We ranked the important clinical features in these models. Results In the study's database sample, 1.3% of patients were diagnosed with PSD. The average specificity and sensitivity of these four models were 0.83-0.91 and 0.30-0.48, respectively. Ten features were listed as important features related to PSD at different time points, namely old age, high height, low weight post-stroke, higher diastolic blood pressure after stroke, no pre-stroke hypertension but post-stroke hypertension (new-onset hypertension), post-stroke sleep-wake disorders, post-stroke anxiety disorders, post-stroke hemiplegia, and lower blood urea nitrogen during stroke. Discussion Machine learning models can provide as potential predictive tools for PSD and important factors are identified to alert clinicians for early detection of depression in high-risk stroke patients.
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Affiliation(s)
- Yu-Ming Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Yang-Chieh Brian Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- College of Humanities and Social Sciences, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Hung-Yu Kao
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan City, Taiwan
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15
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Rahmatian A, Karbasfrushan A, Modara F. Relationship Between Pain and Disability Among Stroke Patients. Anesth Pain Med 2023; 13:e136330. [PMID: 38021327 PMCID: PMC10664167 DOI: 10.5812/aapm-136330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background Stroke is prevalent in Iran, and its complications can decline patients' quality of life and psychological state. Objectives This study aimed to investigate the relationship between pain following stroke (PFS) and disability in stroke patients. Methods The current case-control study was conducted on 184 stroke patients (92 cases and 92 controls). Data collection tools included a demographic questionnaire, the Visual Analog Scale (VAS), and the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. Based on the medical files of all patients with stroke, eligible ones were invited to participate in the study via phone calls. The collected data were then analyzed. Results The disability rate was higher in the case group of patients with a history of hemorrhagic stroke, smoking, stroke, and diabetes (P < 0.05). The mean ± SD age was 72.45 (11.54). Also, the level of disability in patients increased with age (P = 0.000). The mean ± SD disability score was 78.63 (6.92) in patients with PFS and 54.9 (10.87) in patients without PFS. Also, R = 0.795 and R2= 0.631 indicated the significance of disability severity in patients with PFS. Conclusions The prevalence of disability was higher in patients with higher PFS levels. Hence, drug interventions or rehabilitation programs can be used to reduce the disability of stroke patients.
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Affiliation(s)
- Aryoobarzan Rahmatian
- School of Medicine, Shahid Mostafa Khomaeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Karbasfrushan
- Department of Anesthesiology, School of Medicine, Imam Khomeini Hospital, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farhad Modara
- School of Medicine, Shahid Mostafa Khomaeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
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16
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Chan MWM, Lo SHS, Sit JWH, Choi KC, Tao AA. Effects of visual arts-based interventions on physical and psychosocial outcomes of people with stroke: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023. [DOI: 10.1016/j.ijnsa.2023.100126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
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17
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Gao Y, Zhu Y, Lu X, Wang N, Zhu S, Gong J, Wang T, Tang SW. Vagus nerve stimulation paired with rehabilitation for motor function, mental health and activities of daily living after stroke: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2023; 94:257-266. [PMID: 36600569 DOI: 10.1136/jnnp-2022-329275] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Vagus nerve stimulation (VNS) plus rehabilitation (Rehab) has shown a potential effect on recovery with a stroke. We systematically synthesised studies examining VNS+Rehab for improving motor function, mental health and activities of daily living (ADL) postintervention and at the end of follow-up in patients with a stroke. METHODS The search was performed in electronic databases EMBASE, Medline, EBSCO, Cochrane Library, PubMed, PsycINFO, CINAHL, CNKI, and WANFANG and three clinical trial registries from inception to February 2022. Randomised controlled trials (RCTs) applied VNS+Rehab in stroke were included. RESULTS Seven RCTs involving 263 (analysed) participants was included. The effect size of VNS+Rehab over Rehab for motor function was medium postintervention (g=0.432; 95% CI 0.186 to 0.678) and large at the end of follow-up (g=0.840; 95% CI 0.288 to 1.392). No difference was found in the effect of VNS+Rehab over traditional rehabilitation for ADL, mental health or safety outcomes. Subgroup analyses revealed larger effects for patients received taVNS (transcutaneous auricular VNS) devices (at acute/subacute phase of stroke, with lower VNS stimulation frequency or pluses per session, greater VNS on-off time or sessions, higher VNS intervention weekly frequency). CONCLUSION The results suggest VNS+Rehab showed better motor function outcomes in patients after stroke, while no better than Rehab on mental health or ADL. Combinations of phase of stroke, specific parameters of VNS and VNS intervention frequency are key modulators of VNS effects. TRIAL REGISTRATION NUMBER CRD42022310194.
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Affiliation(s)
- Yong Gao
- Department of Rehabilitation, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Yi Zhu
- Department of Rehabilitation, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Xiao Lu
- Department of Rehabilitation, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Nannan Wang
- Department of Epidemiology and Biostatistics, Nanjing Medical University School of Public Health, Nanjing, Jiangsu, China
| | - Shizhe Zhu
- Department of Rehabilitation, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Jianqiu Gong
- Department of Rehabilitation, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Tong Wang
- Department of Rehabilitation, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Shao-Wen Tang
- Department of Epidemiology and Biostatistics, Nanjing Medical University School of Public Health, Nanjing, Jiangsu, China
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Zhang H, Ma J, Sun Y, Xiao LD, Yan F, Tang S. Anxiety subtypes in rural ischaemic stroke survivors: A latent profile analysis. Nurs Open 2023; 10:4083-4092. [PMID: 36807562 PMCID: PMC10170921 DOI: 10.1002/nop2.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/04/2023] [Indexed: 02/22/2023] Open
Abstract
AIM To determine the potential profile classes of anxiety reported by ischaemic stroke survivors in rural China, and to explore the characteristics of patients having different types of post-stroke anxiety. DESIGN A cross-sectional survey. METHODS A cross-sectional survey was conducted by using convenience sampling to collect data from 661 ischaemic stroke survivors in rural Anyang city, Henan Province, China, from July 2021 to September 2021. The parameters included in the study were the socio-demographic characteristics, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and the Barthel index of daily activity ability. Potential profile analysis was done to recognize subgroups of post-stroke anxiety. The Chi-square test was performed to explore the characteristics of individuals with different types of post-stroke anxiety. RESULTS The model fitting indices of stroke survivors supported three classes of anxiety models which were as follows: (a) Class 1, low-level, stable group (65.3%, N = 431); (b) Class 2, moderate-level, unstable group (17.9%, N = 118) and (c) Class 3, high-level, stable group (16.9%, N = 112). The risk factors associated with post-stroke anxiety were female patients, lower levels of education, living alone, lower monthly household income, other chronic diseases, impaired daily activity ability and depression. CONCLUSIONS This study identified three different subgroups of post-ischaemic stroke anxiety and their characteristics in patients in rural China. IMPACT This study has significance in providing evidence for the development of targeted intervention measures to reduce negative emotions in different subgroups of post-stroke anxiety patients. PATIENT OR PUBLIC CONTRIBUTION In this study, the researchers arranged the time of questionnaire collection with the village committee in advance, gathered the patients to the village committee for face-to-face questionnaire survey and collected the household data of the patients with mobility difficulties.
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Affiliation(s)
- Huimin Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.,College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Junyan Ma
- College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Yuyan Sun
- College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - Fang Yan
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Potter T, Gange N, Whiteside E, Gyawali P. Scoping review of molecular biomarkers associated with fatigue, stress, and depression in stroke survivors: A protocol. PLoS One 2023; 18:e0281238. [PMID: 36735703 PMCID: PMC9897583 DOI: 10.1371/journal.pone.0281238] [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: 09/07/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
The prevalence of stroke increases each year and while mortality from stroke has decreased, the prevalence of comorbidities such as anxiety, depression and fatigue affects as many as 75% of stroke survivors. The aetiology of post-stroke fatigue is not clear, although it has been shown to be interrelated with comorbidities such as stress and depression. Due to the interconnected nature of these comorbidities, it is important to improve the specificity of diagnosis and identify novel therapeutic targets to improve the quality of life for stroke survivors. The investigation of molecular biomarkers associated with post-stroke stress, fatigue, and depression may shed light on the relationships between comorbidities and also contribute to the development of novel diagnostics and therapies. Several biomarkers have been identified for stress, depression, and fatigue, some of which are specific to stroke survivors. However, there remain several gaps in understanding, particularly in relation to the physiological mechanisms underlying these side effects and molecular biomarkers associated with post-stroke fatigue. The aim of this scoping review protocol is to outline the methodologies that will be used to provide a comprehensive understanding of the current literature on biomarkers associated with post-stroke fatigue, stress, and depression, informing future research questions.
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Affiliation(s)
- Tarynn Potter
- School of Health and Medical Science, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
- * E-mail:
| | - Nisal Gange
- Geriatric Adult Rehabilitation and Stroke Service (GARSS), Darling Downs Health Service (DDHS), Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Eliza Whiteside
- School of Health and Medical Science, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Prajwal Gyawali
- School of Health and Medical Science, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
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20
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Ke X, Deng M, Wu Z, Yu H, Yu D, Li H, Lu Y, Shu K, Pei L. miR-34b-3p Inhibition of eIF4E Causes Post-stroke Depression in Adult Mice. Neurosci Bull 2023; 39:194-212. [PMID: 35802246 PMCID: PMC9905405 DOI: 10.1007/s12264-022-00898-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022] Open
Abstract
Post-stroke depression (PSD) is a serious and common complication of stroke, which seriously affects the rehabilitation of stroke patients. To date, the pathogenesis of PSD is unclear and effective treatments remain unavailable. Here, we established a mouse model of PSD through photothrombosis-induced focal ischemia. By using a combination of brain imaging, transcriptome sequencing, and bioinformatics analysis, we found that the hippocampus of PSD mice had a significantly lower metabolic level than other brain regions. RNA sequencing revealed a significant reduction of miR34b-3p, which was expressed in hippocampal neurons and inhibited the translation of eukaryotic translation initiation factor 4E (eIF4E). Furthermore, silencing eIF4E inactivated microglia, inhibited neuroinflammation, and abolished the depression-like behaviors in PSD mice. Together, our data demonstrated that insufficient miR34b-3p after stroke cannot inhibit eIF4E translation, which causes PSD by the activation of microglia in the hippocampus. Therefore, miR34b-3p and eIF4E may serve as potential therapeutic targets for the treatment of PSD.
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Affiliation(s)
- Xiao Ke
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Manfei Deng
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhuoze Wu
- Department of Pathophysiology, Basic Medical School, North Sichuan Medical College, Nanchong, 637100, China
| | - Hongyan Yu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dian Yu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hao Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Youming Lu
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Pei
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Almhdawi KA, Jaber H, Alghwiri A, Arabiat A, Alazrai A, Tariah HA, Obeidat D, Alrabbaie H. Health-related quality of life and its correlates among individuals with stroke during the COVID-19 pandemic. Neuropsychol Rehabil 2023; 33:69-84. [PMID: 34663187 DOI: 10.1080/09602011.2021.1984256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Strict safety procedures including lockdowns were adopted during the Corona virus (COVID-19) pandemic worldwide which might have influenced mental and physical health in affected communities. This study aimed to investigate the level of Health-related quality of life (HRQoL) and its correlates among individuals with stroke in Jordan during the COVID-19 pandemic. This was a cross-sectional study with a self-administered questionnaire, which included demographics, 12-item Short Form (SF-12) health survey, Depression Anxiety Stress Scale (DASS 21), and The Stroke Impact Scale 16 (SIS-16). Descriptive analyses were used to summarize study data. Factors significantly correlated with HRQoL were determined using Pearson correlation. A total of 97 individuals successfully completed the study with a mean age of 57.9 years (±57.9). The level of HRQoL (measured by SF-12) was significantly and negatively associated with mental health symptoms (depression, anxiety, and stress) and the stroke recovery subscale of the SIS-16. Furthermore, participants' HRQoL level was significantly and positively associated with participants' age, stroke chronicity, receiving rehabilitation, and amount of help asked from caregivers. Jordanians with stroke demonstrated a relatively low level of HRQoL and high levels of mental health symptoms during the COVID-19 pandemic. Healthcare administrators should carefully consider individuals with stroke HRQoL and its correlates while planning for future crises.
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Affiliation(s)
- Khader A Almhdawi
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid - Jordan
| | - Hanan Jaber
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid - Jordan
| | - Alia Alghwiri
- Department of Physical Therapy, The University of Jordan, Amman, Jordan
| | - Alaa Arabiat
- Department of Family Medicine, The Jordanian Ministry of Health, Amman, Jordan
| | - Alza Alazrai
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid - Jordan
| | - Hashem Abu Tariah
- Department of Occupational Therapy, The Hashemite University, Zarqa, Jordan
| | - Donia Obeidat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid - Jordan
| | - Hassan Alrabbaie
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid - Jordan
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Yuliana S, Yu E, Rias YA, Atikah N, Chang HJ, Tsai HT. Associations among disability, depression, anxiety, stress, and quality of life between stroke survivors and their family caregivers: An Actor-Partner Interdependence Model. J Adv Nurs 2023; 79:135-148. [PMID: 36257927 DOI: 10.1111/jan.15465] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 12/15/2022]
Abstract
AIM To explore the effects of disability, depressive, anxiety and stress symptoms on patients' and their partners' quality of life (QoL) using the actor-partner interdependence model (APIM). DESIGN A cross-sectional study using actor-partner interdependence model. METHODS We recruited 183 dyads of stroke survivors and their family caregivers in Indonesia. The World Health Organization Disability Assessment (WHODAS 2.0), Depression, Anxiety and Stress (DASS-42) and Rand Short Form Health Survey (SF-36) were used to measure disability, depressive, anxiety and stress symptoms and QoL of stroke survivors and family caregivers. The actor-partner interdependence model was tested using multilevel modelling. The actor-partner interdependence mediation model (APIMeM) was applied to estimate the direct and indirect effect. RESULTS Disability had actor effects on stroke survivor's overall QoL and partner effect on family caregiver's overall QoL. More severe disability of stroke survivors was associated with a lower overall QoL of their own and that of family caregiver's overall QoL. Depressive symptoms of stroke survivors had actor effects on stroke survivors' overall QoL and partner effects on family caregivers' overall QoL. Actor and partner effects also exist on family caregiver's depression symptoms to their own overall QoL and stroke survivor's overall QoL. Moreover, higher anxiety symptoms were associated with lower levels of their own and partner's overall QoL in both stroke survivors and family caregivers. Stroke survivor's stress symptoms also negatively associated with their own and family caregiver's overall QoL. However, a family caregiver's stress without a partner effects on stroke survivor's overall QoL. The APIMeM analysis showed that disability of stroke survivors directly decreased their own overall, physical (PCS) and mental QoL (MCS). Also, disability mediated by stroke survivor's depression, anxiety and stress symptoms decreased both stroke survivor's and family caregiver's physical (PCS) and mental QoL (MCS). CONCLUSION The findings suggest that stroke survivors and family caregivers may influence each other during the caregiving process and social life. The disability of stroke survivors, and the depression, anxiety and stress symptoms of stroke survivors and family caregivers affect their own QoL and their partners' QoL. Disability of stroke survivors directly decreased their own overall, physical (PCS) and mental QoL (MCS). Also, it indirectly via stroke survivor's depression, anxiety and stress symptoms decreased both stroke survivor's and family caregiver's physical (PCS) and mental QoL (MCS). IMPACT Dyadic actor-partner interdependence models have shown promising potential to predict the QoL among patients and family caregivers. The dyadic effects of disability, depression, anxiety and stress symptoms on the QoL of stroke survivors and family caregivers can be applied to guide the future development of nursing intervention addressed decreasing depression, anxiety and stress symptoms to optimize health outcomes among stroke survivors and their family caregivers.
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Affiliation(s)
- Sri Yuliana
- Department of Nursing, Sekolah Tinggi Ilmu Kesehatan Yahya Bima, West Nusa Tenggara, Indonesia.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC
| | - Erica Yu
- Cizik School of Nursing, The University of Texas Health Science Center, Houston, Texas, USA
| | - Yohanes Andy Rias
- College of Nursing, Institut Ilmu Kesehatan Bhakti Wiyata, Kediri, Indonesia
| | - Nur Atikah
- Department of Pharmacy, Poltekkes Kemenkes Surakarta, Middle of Java, Indonesia
| | - Hsiu Ju Chang
- School of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsiu Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC
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Alwledat K, Al-Amer R, Ali AM, Abuzied Y, Adnan Khudeir F, Alzahrani NS, Alshammari SR, AlBashtawy M, Thananayagam T, Dehghan M. Creative Art Therapy for Improving Depression, Anxiety, and Stress in Patients with Stroke: A Quasi-Interventional Study. SAGE Open Nurs 2023; 9:23779608231160473. [PMID: 36895711 PMCID: PMC9989432 DOI: 10.1177/23779608231160473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/12/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Creative art therapy is a psychotherapeutic approach used to enhance the mental health status of patients. Objectives This study aimed to evaluate the effect of creative art therapy on the levels of depression, anxiety, and stress in Jordanian patients following stroke. Methods One-group pretest-posttest design was used; it included four sessions of creative art therapy which were conducted as two sessions for two weeks. This study recruited 85 participants who were within three months poststroke diagnosis. The Depression, Anxiety, and Stress Scale was used to assess the levels of psychological reactions pre and post creative art therapy intervention. Results The data showed that there was a statistically significant improvement in the levels of depression (t = 37.98; p < .001), anxiety (t = 20.59, p < .001), and stress (t = 35.52, p < .001) post-intervention. There was a statistically significant improvement in the study-related psychological aspects following creative art therapy. Conclusion The findings of this study suggest that creative art therapy is a valuable method to complement other types of treatments among patients with stroke, resulting in positive patient mental health outcomes. Creative art therapy could be used as a psychotherapeutic approach to manage mental health complexities among patients with stroke. Health policymakers are invited to use the findings of this study to establish tailored counselor services using this new psychotherapeutic approach.
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Affiliation(s)
| | - Rasmieh Al-Amer
- Faculty of Nursing, Isra University, Amman, Jordan.,Western Sydney University, School of Nursing and Midwifery, Penrith South, Australia
| | - Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Smouha, Egypt
| | - Yacoub Abuzied
- Department of Nursing, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Naif S Alzahrani
- Department of Medical-Surgical Nursing, College of Nursing, Taibah University, Medina, Saudi Arabia
| | - Saleh R Alshammari
- Department of Nursing, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed AlBashtawy
- Nursing Community Health, Prince Salma Faculty of Nursing, Al-Bayt University, Mafraq, Jordan
| | | | - Mahlagha Dehghan
- Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
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The effect of intensive family-centered health education on the awareness rate, diagnosis, and treatment of post-stroke depression in community families. BMC PRIMARY CARE 2022; 23:282. [PMID: 36371180 PMCID: PMC9655796 DOI: 10.1186/s12875-022-01895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
Abstract
Objective To investigate the effects of intensive family-centered health education on the awareness rate, diagnosis, and treatment of post-stroke depression (PSD) in community families. Methods Elderly patients (60–90 years) from 20 community service centers affiliated with the Department of Neurology and the Medical Association of Tongling Municipal Hospital who had been diagnosed with stroke between January 2017 and June 2020 were screened using the hospital and community electronic medical record system. In this randomized cluster trial, 119 patients from 10 communities were assigned as the control group and received routine community treatment, while 126 patients from the other 10 communities were assigned as the experimental group and received routine treatment plus family-centered intensive health education. After 12 months of medical intervention, the assessment of PSD in the two groups was performed by a neurologist and a psychiatrist, both blind to the study design, using the Hamilton Rating Scale for Depression. Results The awareness rates of the causes, clinical manifestations, treatment plan, and family care of PSD in the experimental group were 88.89, 91.30, 93.65, and 92.06%, respectively. In the control group, the awareness rates of these parameters were 72.27, 69.75, 71.43, and 65.55%, respectively, and the differences between the two groups were statistically significant (P < 0.05). In the experimental group, the rates of PSD diagnosis, prompt medical attendance, drug treatment compliance, and psychotherapeutic treatment compliance were 27.78, 22.22, 18.25, and 11.90%, respectively. In the control group, the rates of these parameters were 13.79, 6.03, 3.48, and 1.72%, respectively, and the differences between the two groups were statistically significant (P < 0.05). Conclusion Intensive family-centered health education can improve the level of knowledge of PSD in the community, promote the timely treatment and diagnosis of PSD in patients, and improve the compliance rates of drug therapy and psychotherapy, so this is worthy of promotion.
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Li S, Guo B, Yang Q, Yin J, Tian L, Zhu H, Ji Y, Zhou Z, Jiang Y. Evaluation of depression status and its influencing factors in convalescent elderly patients with first-episode stroke. Asian J Psychiatr 2022; 77:103252. [PMID: 36095881 DOI: 10.1016/j.ajp.2022.103252] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/27/2022] [Accepted: 09/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the occurrence and the influencing factors of post-stroke depression (PSD) in first-episode stroke. METHODS A total of 350 elderly stroke patients who were admitted to Wuxi Central Rehabilitation Hospital for the first time from January 2020 to December 2020 were enrolled in this study. The Hamilton Depression Scale (HAMD) was used to evaluate the depression status of stroke patients. The sociodemographic data, clinical symptoms, social environment and behavioral patterns of the patients were collected to analyze the related factors of depression after stroke through SPSS 20.0 software. RESULTS The incidence of PSD was 45.71%. There were statistical differences among different gender, lesion nature, lesion location, smoking, hypertension, diabetes, hospitalization enpenses, season of onset, BMI index, NIHSS score, barthel index score, blood pressure variation coefficient and other factors (p = 0.000). Post-stroke depression score was positively correlated with NIHSS score and coefficient of variation of systolic blood pressure (r = 0.935, p = 0.000; r = 0.921, p = 0.000), and negatively correlated with barthel index score (r = -0.964, p = 0.000). Through multivariate Logistic regression analysis, it was found that male (OR=8.624, 95%CI: 5.672-11.715), cerebral infarction (OR=2.561, 95%CI: 1.256-3.567), and the right side lesion (OR=1.933, 95%CI: 1.024-3.026), smoking (OR=2.457, 95%CI: 1.611-3.625), onset in autumn and winter (OR=2.049, 95%CI: 1.201-2.919), high BMI (OR=2.461, 95%CI): 1.426-3.432) were risk factors for depression after stroke, and low SBPV (OR=0.567, 95%CI: 0.352-0.758) and low NISHH score (OR=0.256, 95%CI: 0.105-0.486) were the protective factor for subsequent depression of stroke. CONCLUSION Males, smoking, patients with onset in autumn and winter, lesions on the right side, high BMI, high NISHH score and high systolic blood pressure variation were closely related to PSD, which should be paid for attention for such patients to prevent the occurrence of PSD and take intervention measures.
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Affiliation(s)
- Shiming Li
- The affiliated Wuxi Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
| | - Bingbing Guo
- The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, China
| | - Queping Yang
- The affiliated Wuxi Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
| | - Jieyun Yin
- School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123, China
| | - Lin Tian
- The affiliated Wuxi Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
| | - Haohao Zhu
- The affiliated Wuxi Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China.
| | - Yingying Ji
- The affiliated Wuxi Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China.
| | - Zhenhe Zhou
- The affiliated Wuxi Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China.
| | - Ying Jiang
- The affiliated Wuxi Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China.
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Basheti IA, Ayasrah SM, Ahmad MM, Abu-Snieneh HM, Abuadas FH. Medications adherence and associated factors among patients with stroke in the Kingdom of Saudi Arabia. Pharm Pract (Granada) 2022; 20:2736. [PMID: 36793903 PMCID: PMC9891775 DOI: 10.18549/pharmpract.2022.4.2736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/27/2022] [Indexed: 12/14/2022] Open
Abstract
Background Stroke is one of the most significant neurological problems around the world, and is considered a leading cause of death. Due to polypharmacy and multimorbidity, stroke patients are susceptible to have lower levels of adherence to their medications and self-care activities. Methods Patients who have suffered a stroke and had recently been admitted to public hospital were approached for recruitment. Patients' adherence to their medications was examined using a validated questionnaire during an interview between the principal investigator and the patients, where patients' adherence to their self-care activities was assessed using a developed, validated and previously published questionnaire as well. Reasons for lack of adherence was explored from the patients. Verification of patient's details and medications was done via the patient's hospital file. Results The mean age of the participants (n=173) was 53.21 (SD= 8.61) years. Assessing patients' adherence to medications showed that more than half of them stated that they sometimes/often forgot to take their medication/s, while 41.0% sometimes/often stopped their medication/s from time to time. The mean adherence to medications score (out of 28) was 18.39 (SD=2.1), with 83.8% having a low adherence level. It is found that patients who did not take their medications were due to forgetfulness (46.8%) and complications from taking the medications (20.2%). Better adherence was associated with higher educational level, higher number of medical conditions, and higher frequency of glucose monitoring. Adherence to self-care activities showed that majority of patients performed correct self-care activities three times a week. Conclusion Post-stroke patients in Saudi Arabia have indicated low levels of medication adherence, while reporting good adherence to their self-care activities. Better adherence was associated with certain patient characteristics such as higher educational level. These findings can help in focusing the efforts to improve adherence and health outcomes for stroke patients in the future.
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Affiliation(s)
- Iman A Basheti
- Faculty of Pharmacy, Applied Science Private University, 11931, Amman, Jordan; Faculty of Pharmacy, The University of Sydney, 2006, Sydney, Australia.
| | - Shahnaz M Ayasrah
- PhD. Associate professor, Department of Applied Science/Nursing, Al-Balqa Applied University, Al-Salt - Jordan.
| | - Muayyad M Ahmad
- PhD. Professor, Clinical Nursing Department, School of Nursing, University of Jordan, Amman 11942 - Jordan.
| | - Hana M Abu-Snieneh
- RN, PhD. Assistant professor, Faculty of Nursing/ The University of Jordan/ Aqaba Campus Aqaba- Jordan. ;
| | - Fuad H Abuadas
- Assistant professor, College of Nursing, Community Health Nursing Department, Jouf University, Sakaka, 72388, Saudi Arabia.
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Song SI, Hong HT, Lee C, Lee SB. A machine learning approach for predicting suicidal ideation in post stroke patients. Sci Rep 2022; 12:15906. [PMID: 36151132 PMCID: PMC9508242 DOI: 10.1038/s41598-022-19828-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
Currently, the identification of stroke patients with an increased suicide risk is mainly based on self‐report questionnaires, and this method suffers from a lack of objectivity. This study developed and validated a suicide ideation (SI) prediction model using clinical data and identified SI predictors. Significant variables were selected through traditional statistical analysis based on retrospective data of 385 stroke patients; the data were collected from October 2012 to March 2014. The data were then applied to three boosting models (Xgboost, CatBoost, and LGBM) to identify the comparative and best performing models. Demographic variables that showed significant differences between the two groups were age, onset, type, socioeconomic, and education level. Additionally, functional variables also showed a significant difference with regard to ADL and emotion (p < 0.05). The CatBoost model (0.900) showed higher performance than the other two models; and depression, anxiety, self-efficacy, and rehabilitation motivation were found to have high importance. Negative emotions such as depression and anxiety showed a positive relationship with SI and rehabilitation motivation and self-efficacy displayed an inverse relationship with SI. Machine learning-based SI models could augment SI prevention by helping rehabilitation and medical professionals identify high-risk stroke patients in need of SI prevention intervention.
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Affiliation(s)
- Seung Il Song
- Department Occupational Therapy, Gumi University, Yaeun-ro 37, Gumi, 39213, South Korea
| | - Hyeon Taek Hong
- Department Rehabilitation Science, Daegu University, Gyeongsan, South Korea
| | - Changwoo Lee
- Office Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Seung Bo Lee
- Department of Medical Informatics, Keimyung University School of Medicine, Dalgubeol-daero 1095, Dalseo-gu, Daegu, 42601, South Korea.
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Zhou J, Fan L, Hu H, Shen K, Wu L, Lin X, Gao H. The Efficacy of Integrated Rehabilitation for Post-Stroke Anxiety: Study Protocol for a Prospective, Multicenter, Randomized Controlled Trial. Int J Gen Med 2022; 15:7101-7111. [PMID: 36097565 PMCID: PMC9464039 DOI: 10.2147/ijgm.s381434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Conclusion Trial Registration
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Affiliation(s)
- Jie Zhou
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Lijuan Fan
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Hantong Hu
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ke Shen
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Liya Wu
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xiaoqi Lin
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Hong Gao
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Correspondence: Hong Gao, Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Hangzhou, People’s Republic of China, Email
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Chen G, Lin T, Wu M, Cai G, Ding Q, Xu J, Li W, Wu C, Chen H, Lan Y. Effects of repetitive transcranial magnetic stimulation on upper-limb and finger function in stroke patients: A systematic review and meta-analysis of randomized controlled trials. Front Neurol 2022; 13:940467. [PMID: 35968309 PMCID: PMC9372362 DOI: 10.3389/fneur.2022.940467] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for stroke rehabilitation. Several studies have demonstrated the effectiveness of rTMS in restoring motor function. This meta-analysis aimed to summarize the current evidence of the effect of rTMS in improving upper limb function and fine motor recovery in stroke patients. Methods Three online databases (Web of Science, PubMed, and Embase) were searched for relevant randomized controlled trials. A total of 45 studies (combined n = 2064) were included. Random effects model was used for meta-analysis and effect size was reported as standardized mean difference (SMD). Results rTMS was effective in improving fine motor function in stroke patients (SMD, 0.38; 95% CI 0.19–0.58; P = 0). On subgroup analyses, for post-stroke functional improvement of the upper extremity, bilateral hemisphere stimulation was more effective than unilateral stimulation during the acute phase of stroke, and a regimen of 20 rTMS sessions produced greater improvement than <20 sessions. In the subacute phase of stroke, affected hemispheric stimulation with a 40-session rTMS regimen was superior to unaffected hemispheric stimulation or bilateral hemispheric stimulation with <40 sessions. Unaffected site stimulation with a 10-session rTMS regimen produced significant improvement in the chronic phase compared to affected side stimulation and bilateral stimulation with >10 rTMS sessions. For the rTMS stimulation method, both TBS and rTMS were found to be significantly more effective in the acute phase of stroke, but TBS was more effective than rTMS. However, rTMS was found to be more effective than TBS stimulation in patients in the subacute and chronic phases of stroke. rTMS significantly improved upper limb and fine function in the short term (0–1-month post-intervention) and medium term (2–5 months), but not for upper limb function in the long term (6 months+). The results should be interpreted with caution due to significant heterogeneity. Conclusions This updated meta-analysis provides robust evidence of the efficacy of rTMS treatment in improving upper extremity and fine function during various phases of stroke. Systematic Review Registration https://inplasy.com/inplasy-2022-5-0121/, identifier: INPLASY202250121.
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Affiliation(s)
- Gengbin Chen
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Postgraduate Research Institute, Guangzhou Sport University, Guangzhou, China
| | - Tuo Lin
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Manfeng Wu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Guiyuan Cai
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Qian Ding
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jiayue Xu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wanqi Li
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Cheng Wu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hongying Chen
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Guangzhou Key Laboratory of Aging Frailty and Neurorehabilitation, Guangzhou, China
- *Correspondence: Yue Lan
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Zhang S, Yuan Y, Zhuang W, Xiong T, Xu Y, Zhang J, Tao C, Liang J, Wang Y. Contributing Factors and Induced Outcomes of Psychological Stress Response in Stroke Survivors: A Systematic Review. Front Neurol 2022; 13:843055. [PMID: 35812095 PMCID: PMC9257184 DOI: 10.3389/fneur.2022.843055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRemarkable evidence indicates that psychological stress is significantly associated with stroke. However, a uniform recommendation to identify and alleviate poststroke psychological stress responses and improve postmorbid outcomes is not currently available. Thus, this systematic review aimed to summarize the types of poststroke psychological stress, measurement tools, contributing factors, and outcomes.MethodsThis systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search was conducted in PubMed, Web of Science, Embase, CNKI, WanFangData, and CQVIP from database inception to November 2021. Cross-sectional and longitudinal studies were included in this research. Quality assessment was performed based on the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.ResultsEighteen quantitative, peer-reviewed studies were included for analysis. Selected articles mainly investigated perceived stress and posttraumatic stress disorder after stroke. We classified the contributing factors into four categories: sociodemographic factors, clinical disease factors, psychological factors, and behavioral and lifestyle factors. The postmorbid outcomes were divided into three categories: clinical disease outcomes, psychological outcomes, and behavioral and quality of life outcomes.ConclusionsCompared to common patients, stroke survivors with the following characteristics suffered an increased psychological stress response: younger age, the presence of caregivers, depression, unsuitable coping strategies, etc. Meanwhile, lower quality of life, worse drug compliance, worse functional independence, and more severe mental disorders were significantly associated with increased psychological stress symptoms. Further studies are required to provide more trustworthy and meaningful references for mitigating the damage caused by psychological stress after stroke.
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Affiliation(s)
- Song Zhang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Yuan Yuan
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Wenwen Zhuang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Tianqing Xiong
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yijun Xu
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Jingwen Zhang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Chunhua Tao
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Jingyan Liang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yingge Wang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- *Correspondence: Yingge Wang
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Al Qawasmeh M, Aldabbour B, Abuabada A, Abdelrahman K, Elamassie S, Khweileh M, Zahran M, El-Salem K. Prevalence, Severity, and Predictors of Poststroke Depression in a Prospective Cohort of Jordanian Patients. Stroke Res Treat 2022; 2022:6506326. [PMID: 35035872 PMCID: PMC8759919 DOI: 10.1155/2022/6506326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 01/01/2023] Open
Abstract
Poststroke depression (PSD) is common and remains a significant risk factor for poor outcomes. This prospective study is aimed at assessing the prevalence, severity, and predictors of PSD among Jordanian stroke survivors. A total of 151 patients who were consequently admitted to a tertiary teaching hospital with ischemic or hemorrhagic strokes were enrolled. Participants were screened on admission for premorbid depression using the PHQ-9 questionnaire; then, screening for PSD was repeated one and three months after stroke using the same tool. Depression prevalence at each screening was reported, and logistic regression analysis was conducted to evaluate for significant predictors. PHQ-9 scores suggestive of depression were reported by 15%, 24.83%, and 17.39% of respondents on admission and after one and three months, respectively. Scores suggesting severe depression were reported by 0.71%, 2.13%, and 6.52% of respondents, respectively. Significant predictors of PSD were having chronic kidney disease, current smoking status, moderate or severe disability (mRS score) at stroke onset, and severe dependence (BI) after one month (p values 0.007, 0,002, 0.014, and 0.031, respectively). Patients with secondary and high school education levels were less likely to get depression compared with illiterate patients (p 0.042). This study showed that nearly one in four Jordanian stroke survivors experienced PSD after one month. In contrast, while the overall PSD prevalence declined towards the end of follow-up period, patients who remained depressed showed a tendency towards higher PSD severity.
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Affiliation(s)
- Majdi Al Qawasmeh
- Neurology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Belal Aldabbour
- Neuroscience Department, Faculty of Medicine, Islamic University of Gaza, P.O. Box 108, Gaza, State of Palestine
| | - Amal Abuabada
- Psychiatry Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid Abdelrahman
- Psychiatry Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Samah Elamassie
- Health Services, United Nations Relief and Works Agency (UNRWA), Gaza, State of Palestine
| | - Mays Khweileh
- Neurology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Zahran
- Psychiatry Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid El-Salem
- Neurology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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32
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Amarasekera S, Jha P. Understanding the links between cardiovascular and psychiatric conditions. eLife 2022; 11:84524. [PMID: 36459082 PMCID: PMC9718521 DOI: 10.7554/elife.84524] [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: 12/05/2022] Open
Abstract
Individuals recently diagnosed with a cardiovascular disease are at higher risk of developing a mental illness, with mortality increasing when both conditions are present.
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Affiliation(s)
- Sonali Amarasekera
- Dalla Lana School of Public Health, Epidemiology Division, University of TorontoTorontoCanada
| | - Prabhat Jha
- Centre for Global Health, Dalla Lana School of Public Health, University of TorontoTorontoCanada
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33
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Wang X, Hu CX, Lin MQ, Liu SY, Zhu FY, Wan LH. Family Functioning is Associated with Post-Stroke Depression in First-Ever Stroke Survivors: A Longitudinal Study. Neuropsychiatr Dis Treat 2022; 18:3045-3054. [PMID: 36601104 PMCID: PMC9807129 DOI: 10.2147/ndt.s393331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) can aggravate the mortality and recurrence rate in stroke patients. The relationship between family functioning and PSD at different phases after a first-ever stroke is unclear. The purpose of this longitudinal study was to investigate the patterns and relationship of family functioning and PSD at acute hospitalization and 6 months post-discharge in first-ever stroke survivors. METHODS This is a longitudinal study conducted in Guangzhou, China. Family functioning and depression were measured by the Short Form Family Assessment Device (SF-FAD) and Self-Rating Depression Scale (SDS) at baseline and 6 months post-discharge. Multiple linear regression analysis was used to explore the relationship between family functioning and PSD. RESULTS The prevalence of PSD at acute hospitalization and 6 months post-discharge was 32.9% and 20.0%, respectively. SDS scores decreased significantly from baseline to 6 months post-discharge, while SF-FAD scores did not change significantly during this period. The Pearson correlation coefficient showed that SF-FAD scores were positively associated with SDS scores at the two time points (r 1 = 0.341, r 2 = 0.510, P < 0.05). Multiple linear regression analyses indicated that SF-FAD scores could predict PSD at baseline (unstandardized coefficient: 7.010, P < 0.05) and 6 months post-discharge (unstandardized coefficient: 9.672, P < 0.001). CONCLUSION This study found that first-ever stroke survivors had good family functioning at baseline and 6 months post-discharge. The findings in this study verified that poor family functioning is positively associated with PSD at different phases post-stroke. Good family functioning is an important protective factor against PSD.
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Affiliation(s)
- Xiao Wang
- School of Nursing, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Cai-Xia Hu
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, People's Republic of China
| | - Man-Qiu Lin
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, People's Republic of China
| | - Shu-Ying Liu
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, People's Republic of China
| | - Fen-Yan Zhu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Li-Hong Wan
- School of Nursing, Sun Yat-sen University, Guangzhou, People's Republic of China
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34
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Zhang Q, Fu Y, Lu Y, Zhang Y, Huang Q, Yang Y, Zhang K, Li M. Impact of Virtual Reality-Based Therapies on Cognition and Mental Health of Stroke Patients: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e31007. [PMID: 34787571 PMCID: PMC8663637 DOI: 10.2196/31007] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 01/22/2023] Open
Abstract
Background Stroke remains one of the major chronic illnesses worldwide that health care organizations will need to address for the next several decades. Individuals poststroke are subject to levels of cognitive impairment and mental health problems. Virtual reality (VR)-based therapies are new technologies used for cognitive rehabilitation and the management of psychological outcomes. Objective This study performed a meta-analysis to evaluate the effects of VR-based therapies on cognitive function and mental health in patients with stroke. Methods A comprehensive database search was performed using PubMed, MEDLINE (Ovid), Embase, Cochrane Library, and APA PsycINFO databases for randomized controlled trials (RCTs) that studied the effects of VR on patients with stroke. We included trials published up to April 15, 2021, that fulfilled our inclusion and exclusion criteria. The literature was screened, data were extracted, and the methodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.3 software. Results A total of 894 patients from 23 RCTs were included in our meta-analysis. Compared to traditional rehabilitation therapies, the executive function (standard mean difference [SMD]=0.88, 95% confidence interval [CI]=0.06-1.70, P=.03), memory (SMD=1.44, 95% CI=0.21-2.68, P=.02), and visuospatial function (SMD=0.78, 95% CI=0.23-1.33, P=.006) significantly improved among patients after VR intervention. However, there were no significant differences observed in global cognitive function, attention, verbal fluency, depression, and the quality of life (QoL). Conclusions The findings of our meta-analysis showed that VR-based therapies are efficacious in improving executive function, memory, and visuospatial function in patients with stroke. For global cognitive function, attention, verbal fluency, depression, and the QoL, further research is required. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021252788; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=252788
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Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Yu Fu
- Department of Computer Science, Aberystwyth University, Wales, United Kingdom
| | - Yanhui Lu
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Qifang Huang
- School of Nursing, Peking University, Beijing, China
| | - Yajie Yang
- School of Nursing, Peking University, Beijing, China
| | - Ke Zhang
- Department of Psychology, Shanxi Datong University, Datong City, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
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35
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Babkair LA, Chyun D, Dickson VV, Almekhlafi MA. The Effect of Psychosocial Factors and Functional Independence on Poststroke Depressive Symptoms: A Cross-Sectional Study. J Nurs Res 2021; 30:e189. [PMID: 34690332 DOI: 10.1097/jnr.0000000000000464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke is the second leading cause of death and a major cause of serious, long-term disability worldwide. The approximately 15 million people each year who experience stroke are at risk of developing depression. Poststroke depressive symptoms affect one third of survivors of stroke. Patients who develop poststroke depressive symptoms experience decreased functional independence, poor cognitive recovery, decreased quality of life, and increased mortality. Survivors of stroke use social support to deal with stress and defend against the adverse effects of negative stroke outcomes. PURPOSE This study was designed to examine the influence of perceived social support (emotional and informational, tangible, affectionate, and positive social interaction), stress level, and functional independence on depressive symptoms in survivors of stroke. METHODS A cross-sectional observational study design in outpatient settings and rehabilitation centers was conducted. A convenience sample of 135 survivors of stroke completed the psychometrically valid instruments. RESULTS Most of the sample had mild or moderate depressive symptoms (26% and 29%, respectively). The mean score for perceived social support was 77.53 (SD = 21.44) on the Medical Outcomes Study Social Support Survey. A negative association was found between depressive symptoms and the social support total score (r = -.65, p < .01). All of the social support subcategories were negatively associated with depressive symptoms. Hierarchical multiple linear regression showed that social support, stress level, and literacy were associated with depressive symptoms (β = -.31, p < .001; β = .45, p < .001; and β = .16, p = .01, respectively) and partially mediated the association between depressive symptoms and functional independence. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Poststroke depressive symptoms are common among survivors of stroke. Social support may improve health by protecting these individuals from the negative outcomes of stroke and enhance their recovery. Future research is required to examine how related interventions improve social support in caregivers and reduce depressive symptoms in stroke survivors.
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Affiliation(s)
| | - Deborah Chyun
- PhD, RN, FAHA, FAAN, Professor, School of Nursing, University of Connecticut, USA
| | - Victoria Vaughan Dickson
- PhD, RN, FAAN, FAHA, FHFSA, Associate Professor, Pless Center for Research, Rory Meyers College of Nursing, New York University, USA
| | - Mohammed A Almekhlafi
- MD, MSc, FRCPC, Assistant Professor, Clinical Neurosciences, Radiology, University of Calgary, Canada
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36
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Wang J, Zhao D, Lin M, Huang X, Shang X. Post-stroke Anxiety Analysis via Machine Learning Methods. Front Aging Neurosci 2021; 13:657937. [PMID: 34248599 PMCID: PMC8267915 DOI: 10.3389/fnagi.2021.657937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Post-stroke anxiety (PSA) has caused wide public concern in recent years, and the study on risk factors analysis and prediction is still an open issue. With the deepening of the research, machine learning has been widely applied to various scenarios and make great achievements increasingly, which brings new approaches to this field. In this paper, 395 patients with acute ischemic stroke are collected and evaluated by anxiety scales (i.e., HADS-A, HAMA, and SAS), hence the patients are divided into anxiety group and non-anxiety group. Afterward, the results of demographic data and general laboratory examination between the two groups are compared to identify the risk factors with statistical differences accordingly. Then the factors with statistical differences are incorporated into a multivariate logistic regression to obtain risk factors and protective factors of PSA. Statistical analysis shows great differences in gender, age, serious stroke, hypertension, diabetes mellitus, drinking, and HDL-C level between PSA group and non-anxiety group with HADS-A and HAMA evaluation. Meanwhile, as evaluated by SAS scale, gender, serious stroke, hypertension, diabetes mellitus, drinking, and HDL-C level differ in the PSA group and the non-anxiety group. Multivariate logistic regression analysis of HADS-A, HAMA, and SAS scales suggest that hypertension, diabetes mellitus, drinking, high NIHSS score, and low serum HDL-C level are related to PSA. In other words, gender, age, disability, hypertension, diabetes mellitus, HDL-C, and drinking are closely related to anxiety during the acute stage of ischemic stroke. Hypertension, diabetes mellitus, drinking, and disability increased the risk of PSA, and higher serum HDL-C level decreased the risk of PSA. Several machine learning methods are employed to predict PSA according to HADS-A, HAMA, and SAS scores, respectively. The experimental results indicate that random forest outperforms the competitive methods in PSA prediction, which contributes to early intervention for clinical treatment.
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Affiliation(s)
- Jirui Wang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Defeng Zhao
- The First Clinical Department, China Medical University, Shenyang, China
| | - Meiqing Lin
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinyu Huang
- Software College, Northeastern University, Shenyang, China
| | - Xiuli Shang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
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37
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Rabat Y, Houeze R, Sagnier S, Olindo S, Poli M, Debruxelles S, Renou P, Rouanet F, Berthoz S, Sibon I. Association between neurological outcome and poststroke comorbid mood and anxiety disorders: A real-life experience. Brain Behav 2021; 11:e02158. [PMID: 33951353 PMCID: PMC8213928 DOI: 10.1002/brb3.2158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Poststroke depression (PSD) and anxiety (PSA) are prevalent and have a strong impact on functional outcome. Beside stroke severity, little is known on their clinical determinants. This study investigated the association between stroke mechanism, neurological poststroke complications and remaining vascular risk factors and the presence of comorbid PSD and PSA, termed poststroke emotional distress (PSED). METHODS This was a retrospective analysis of a prospectively compiled medical records database of consecutive patients evaluated during a follow-up visit 3- to 4-month poststroke. HAD scale was used to define PSED category (PSD+PSA vs. NoPSD+NoPSA). Stroke mechanism and poststroke complications were identified clinically or using appropriate scales. Their association with PSED was tested using a multivariate logistic regression model. RESULTS The sample included 2,300 patients (male: 64.8%); 19% had a PSED and 56.39% were free of any depression or anxiety. The most frequent poststroke complications were fatigue/fatigability (58.4%), sleep problems (26.7%), and pain (20.4%). While no association was observed between PSED and stroke mechanism, higher functional disability (OR:1.572), lower cognitive abilities (OR:0.953), sleep problems (OR:2.334), pain (OR:1.478), fatigue/fatigability (OR:2.331), and abnormal movements (OR:2.380) were all independent risk factors. Persisting tobacco consumption (OR:1.360) was the only vascular significant risk factor. CONCLUSIONS The frequency of comorbid PSED remains high (1/5 patient) despite improved awareness of these conditions. The association between poststroke complications and the presence of PSED emphasizes the need for standardized neurological and psychological evaluations at follow-up. These results foster the need to improve the management of addictive behaviors to reduce the burden of PSED.
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Affiliation(s)
- Yolaine Rabat
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, France
| | - Richard Houeze
- CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France.,Centre Hospitalier de la Police Républicaine, Cotonou, Bénin
| | - Sharmila Sagnier
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, France.,CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
| | - Stephane Olindo
- CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
| | - Mathilde Poli
- CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
| | | | - Pauline Renou
- CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
| | - François Rouanet
- CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
| | - Sylvie Berthoz
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, France.,Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
| | - Igor Sibon
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, France.,CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
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38
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Sadanandan S, D Silva F, Renjith V. Depression among Rural Stroke Survivors: A Cross-Sectional Study. Indian J Community Med 2021; 46:309-312. [PMID: 34321749 PMCID: PMC8281862 DOI: 10.4103/ijcm.ijcm_875_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Depression is a major neuropsychiatric complication of stroke. Poststroke depression (PSD) can lead to inadequate functional recovery, social withdrawal, poor quality of life, and suicidal ideations. OBJECTIVE The study explored the PSD among stroke survivors. MATERIALS AND METHODS A cross-sectional survey was conducted among 151, purposively selected rural stroke survivors of Kozhikode district, Kerala, India. Patient health questionnaire-9 (PHQ-9) was used to assess PSD. RESULTS The age of participants ranged from 28 to 80 years with a mean (standard deviation) age of 64.58 (10.3) years. The majorities of the participants were males (53.6%), had an ischemic stroke (76.2%), and had left-sided brain lesions (75.5%). The median (interquartile range) depression scores on PHQ-9 were 9 (12-6). Most of the participants had either mild (47%), moderate (21.2%), or moderately severe depression (11.9%). Low energy, sleep disturbances, low self-esteem, and anhedonia were the common depressive symptoms experienced by the stroke survivors. CONCLUSIONS High prevalence of undiagnosed depression remains as a significant challenge to primary care.
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Affiliation(s)
- Soumya Sadanandan
- Department of Medicine, Government Medical College, Kozhikode, Kerala, India
| | - Fatima D Silva
- Department of Medical Surgical Nursing, Nitte Usha Institute of Nursing Sciences, Constituent College of Nitte (Deemed to be University), Deralakattee, Karnataka, India
| | - Vishnu Renjith
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland
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39
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Liu F, Yang Y, Wang S, Zhang XL, Wang AX, Liao XL, Fang HJ, Qu Y, Ma WG, Zhang N, Wang CX, Wang YJ. Impact of Sleep Duration on Depression and Anxiety After Acute Ischemic Stroke. Front Neurol 2021; 12:630638. [PMID: 33841304 PMCID: PMC8032928 DOI: 10.3389/fneur.2021.630638] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Abnormal sleep duration predicts depression and anxiety. We seek to evaluate the impact of sleep duration before stroke on the occurrence of depression and anxiety at 3 months after acute ischemic stroke (AIS). Methods: Nationally representative samples from the Third China National Stroke Registry were used to examine cognition and sleep impairment after AIS (CNSR-III-ICONS). Based on baseline sleep duration before onset of stroke as measured by using the Pittsburgh Sleep Quality Index (PSQI), 1,446 patients were divided into four groups: >7, 6-7, 5-6, and <5 h of sleep. Patients were followed up with the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) for 3 months. Poststroke anxiety (PSA) was defined as GAD-7 of ≥5 and poststroke depression (PSD) as PHQ-9 of ≥5. The association of sleep duration with PSA and PSD was evaluated using multivariable logistic regression. Results: The incidences of PSA and PSD were 11.2 and 17.6% at 3 months, respectively. Compared to a sleep duration of >7 h, 5-6 h, and <5 h of sleep were identified as risk factors of PSA [odds ratio (OR), 1.95; 95% confidence interval (CI), 1.24-3.07; P < 0.01 and OR, 3.41; 95% CI, 1.94-6.04; P < 0.01) and PSD (OR, 1.47; 95% CI, 1.00-2.17; P = 0.04 and OR, 3.05; 95% CI, 1.85-5.02; P < 0.01), while 6-7 h of sleep was associated with neither PSA (OR, 1.09; 95% CI, 0.71-1.67; P = 0.68) nor PSD (OR, 0.92; 95% CI, 0.64-1.30; P = 0.64). In interaction analysis, the impact of sleep duration on PSA and PSD was not affected by gender (P = 0.68 and P = 0.29, respectively). Conclusions: Sleep duration of shorter than 6 h was predictive of anxiety and depression after ischemic stroke.
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Affiliation(s)
- Fei Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuo Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Li Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - An-Xin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Ling Liao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong-Juan Fang
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yue Qu
- Independent Researcher, Ithaca, NY, United States
| | - Wei-Guo Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ning Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Xue Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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40
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Thayabaranathan T, Andrew NE, Stolwyk R, Lannin NA, Cadilhac DA. Comparing the EQ-5D-3L anxiety or depression domain to the Hospital Anxiety and Depression Scale to identify anxiety or depression after stroke. Top Stroke Rehabil 2021; 29:146-155. [PMID: 33726636 DOI: 10.1080/10749357.2021.1895494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Anxiety and depression are common post-stroke and impact quality-of-life (QoL). The EQ-5D three-level version (EQ-5D-3L) is increasingly used to routinely measure health-related QoL in stroke populations, but its potential value for detecting anxiety or depression is uncertain. We sought to examine the agreement and convergent validity of the EQ-5D-3L anxiety or depression domain in survivors of stroke.Methods: Cross-sectional survey data obtained from participants in the Australian Stroke Clinical Registry (AuSCR) between 90 and 180 days after stroke were used. Correlation, sensitivity, specificity, and the area under the curve were calculated for the EQ-5D-3L anxiety or depression domain against the Hospital Anxiety Depression Scale (HADS, reference standard), which has been validated as a screening measure following stroke.Results: Data were obtained from 245 respondents (median time post-stroke 143 days), median age 74 years; 42% female. Nearly 50% reported problems (43% moderate; 7% extreme) in the EQ-5D-3L anxiety or depression domain. The median HADS-Anxiety score was 6 (Q1:3, Q3:9), and the median HADS-Depression score was 5 (Q1:2, Q3:9). The EQ-5D-3L anxiety or depression scores were strongly correlated (r = 0.58) with scores of the HADS-Anxiety, but moderately correlated with HADS-Depression (r = 0.37), and combined HADS-Anxiety or HADS-Depression (r = 0.46). The EQ-5D-3L anxiety or depression domain had greater sensitivity and specificity in identifying cases with anxiety than in identifying depressive symptoms in survivors of stroke.Conclusions: The EQ-5D-3L appears to have value as a population level indicator of anxiety or depression following stroke. Further validation against "gold standard" clinical assessment is required for clinical applications.
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Affiliation(s)
- Tharshanah Thayabaranathan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Nadine E Andrew
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Rene Stolwyk
- Turner Institutefor Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Ahmed ZM, Khalil MF, Kohail AM, Eldesouky IF, Elkady A, Shuaib A. The Prevalence and Predictors of Post-Stroke Depression and Anxiety During COVID-19 Pandemic. J Stroke Cerebrovasc Dis 2020; 29:105315. [PMID: 32958396 PMCID: PMC7834239 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105315] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction Stroke is associated with a rise in post-stroke depression (PSD) and anxiety (PSA). In this study, we evaluated the impact of COVID-19 pandemic on the rates of PSD and PSA. Methods All stroke admissions to two hospitals in Saudi Arabia during two months were prospectively evaluated for PSD and PSA. NIHSS and serum TSH assessed on admission. PSD and PSA were evaluated using Hospital Anxiety and Depression Scale (HADS). Post-stroke disability was assessed by mRS, while social support assessed by Multidimensional Scale of Perceived Social Support (MSPSS). Results Among 50 participants (28 males), clinically significant PSD was found in 36%, while PSA in 32%. PSD associated with higher NIHSS (P < 0.001); lower MSPSS (P = 0.003); higher mRS (P = 0.001); and discontinuation of rehabilitation (P = 0.02). PSA was associated with higher TSH (P = 0.01); lower MSPSS (P = 0.03); while discontinuation of rehabilitation was related to less PSA (P = 0.034). Multivariate analysis showed that NIHSS (OR: 1.58, 95% CI: 742–3.37; P = 0.01); and MSPSS score (OR: 0.66, 95% CI: 0.47–0.94; P = 0.002) were associated with PSD; while PSA was related to TSH level (OR: 8.32, 95% CI:1.42–47.23; P = 0.02), and discontinuation of rehabilitation (OR: -0.96, 95% CI: -1.90–0.02; P = 0.04). Conclusions Our research shows that the rise in PSD is related to stroke severity and this has not changed significantly during the pandemic; however, PSA showed a noticeable peak. Social deprivation and the lacking levels of rehabilitation related significantly to both.
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Affiliation(s)
- Zakaria M Ahmed
- Neurology Department, Saudi German Hospital, Madinah, Saudi Arabia; Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed F Khalil
- Neurology Department, Saudi German Hospital, Madinah, Saudi Arabia; Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Kohail
- Neurology Department, Saudi German Hospital, Madinah, Saudi Arabia; Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Islam F Eldesouky
- Neurology Department, Saudi German Hospital, Madinah, Saudi Arabia; Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Elkady
- Neurology Department, Saudi German Hospital, Jeddah, Saudi Arabia.
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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