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Xi Y, Abuduxiku M, Qu M. GRN knockdown regulates the expression and alternative splicing of genes associated with aphasia-related diseases in PC12 cells. Brain Res 2024; 1840:149031. [PMID: 38823507 DOI: 10.1016/j.brainres.2024.149031] [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: 01/16/2024] [Revised: 05/15/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Prior research has shown that granulin precursor (GRN, also termed PGRN) is closely linked to aphasia. However, there has been little research on the mechanism of action of GRN in post-stroke aphasia (PSA). METHODS In this study, RT-qPCR was used to identify variations in gene expression, while RNA sequencing (RNA-seq) was utilized to acquire transcriptional profiles. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases were employed for bioinformatics analysis. RESULTS GRN was considerably more active in PSA subjects. After silencing the GRN, 197 transcripts had differential expression, and 237 alternative splicing events (ASEs) were substantially affected. The analysis of differentially expressed genes (DEGs) using GO and KEGG approaches showed that these genes have various molecular functions and are significantly enriched in metabolic signaling pathways. Regarding Alternative Splicing (AS), the GO and KEGG analyses revealed numerous functional genes involved in transcription and metabolism. CONCLUSIONS The knockdown of GRN has been shown to be associated with alterations in transcription, metabolism, and ASEs, potentially impacting transcriptional and metabolic pathways through its involvement in AS. Furthermore, GRN knockdown is associated with nervous system disease-related gene transcription and AS processes, as well as its involvement in G protein-coupled receptor (GPCR) and wingless/integrated (Wnt) signaling pathways, which impact the initiation and resolution of PSA.
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Affiliation(s)
- Yanling Xi
- Department of Rehabilitation Medicine, Shanghai Pudong New Area Guangming Hospital of Traditional Chinese Medicine, China
| | - Munire Abuduxiku
- Department of Rehabilitation Medicine, The Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, China
| | - Mei Qu
- Department of Rehabilitation Medicine, Shanghai Pudong New Area Guangming Hospital of Traditional Chinese Medicine, China.
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Li TT, Zhang PP, Zhang MC, Zhang H, Wang HY, Yuan Y, Wu SL, Wang XW, Sun ZG. Meta-analysis and systematic review of the relationship between sex and the risk or incidence of poststroke aphasia and its types. BMC Geriatr 2024; 24:220. [PMID: 38438862 PMCID: PMC10910787 DOI: 10.1186/s12877-024-04765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE To analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based guidance for the prevention and treatment of poststroke aphasia in clinical practice. DATA SOURCES Embase, PubMed, Cochrane Library and Web of Science were searched from January 1, 2002, to December 1, 2023. STUDY SELECTION Including the total number of strokes, aphasia, the number of different sexes or the number of PSA corresponding to different sex. DATA EXTRACTION Studies with missing data, aphasia caused by nonstroke and noncompliance with the requirements of literature types were excluded. DATA SYNTHESIS 36 papers were included, from 19 countries. The analysis of 168,259 patients with stroke and 31,058 patients with PSA showed that the risk of PSA was 1.23 times higher in female than in male (OR = 1.23, 95% CI = 1.19-1.29, P < 0.001), with a prevalence of PSA of 31% in men and 36% in women, and an overall prevalence of 34% (P < 0.001). Analysis of the risk of the different types of aphasia in 1,048 patients with PSA showed a high risk in females for global, broca and Wenicke aphasia, and a high risk in males for anomic, conductive and transcortical aphasia, which was not statistically significant by meta-analysis. The incidence of global aphasia (males vs. females, 29% vs. 32%) and broca aphasia (17% vs 19%) were higher in females, and anomic aphasia (19% vs 14%) was higher in males, which was statistically significant (P < 0.05). CONCLUSIONS There are gender differences in the incidence and types of PSA. The risk of PSA in female is higher than that in male.
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Affiliation(s)
- Ting-Ting Li
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Ping-Ping Zhang
- Shanghai University of Medicine & Health Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ming-Chen Zhang
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Hui Zhang
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Hong-Ying Wang
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Ying Yuan
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Shan-Lin Wu
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China.
| | - Zhong-Guang Sun
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China.
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Kaylor SA, Singh SA. Clinical outcomes associated with speech, language and swallowing difficulties post-stroke. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2023; 70:e1-e15. [PMID: 37916686 PMCID: PMC10623651 DOI: 10.4102/sajcd.v70i1.957] [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: 11/21/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND There is a lack of prospective research in South Africa's speech therapy private sector, specifically, in the acute stroke population. There is a need to understand the quality of speech therapy services and outcomes post-stroke in the private sector. OBJECTIVES This prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), and outcomes post-stroke (i.e. length of hospital stay [LOS], degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). METHOD A prospective design was used to determine the incidence of speech, language, and swallowing conditions post-stroke. Convenience sampling was used to select participants (N = 68). Various statistical tests were used and the alpha level was set at Bonferroni correction p 0.01. RESULTS Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to speech therapy later than 24 h post-admission (52.94%) stayed in hospital for a median of 3 days longer than those who were referred within 24 h (p = 0.042). Dysphagia was significantly associated with moderate to severe physical disability (p 0.01). Dysphagia with aspiration was significantly associated with poor functional level of oral intake, at admission and at discharge (p 0.01). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p 0.01, r = 0.70). CONCLUSION In South Africa's private sector, co-occurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed speech therapy referrals.Contribution: This article contributes data on speech therapy services, communication and swallowing disorders post-stroke, and outcomes in South Africa's private sector.
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Affiliation(s)
- Stephanie A Kaylor
- Department of Communication Sciences and Disorders, Faculty of Health and Rehabilitation Sciences, University of Cape Town, Cape Town.
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Martzoukou M, Nousia A, Nasios G. Undetected language deficits in left or right hemisphere post-stroke patients. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 36997164 DOI: 10.1080/23279095.2023.2195111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Previous studies have reported that widely used tests for aphasia identification are unable to detect the subtle language deficits of left hemisphere brain damaged (LHBD) individuals. Similarly, the language disorders of individuals with right hemisphere brain damage (RHBD) usually remain undetected, due to the lack of any specialized test for the evaluation of their language processing skills. The aim of the present study was to evaluate the language deficits of 80 individuals suffering from the effects of either a LHBD or RHBD stroke, who were diagnosed as having no aphasia or language deficits based on the application of Boston Diagnostic Aphasia Examination. Their language abilities were examined with the use of the Adults' Language Abilities Test, which explores morpho-syntactic and semantic phenomena of the Greek language in both the comprehension and production modalities. Results revealed that both groups of stroke survivors performed significantly worse compared to the group of healthy participants. Thus, it appears that the latent aphasia of LHBD and the language deficits of RHBD patients are likely to remain undetected and that patients are at risk of not receiving appropriate treatment if their language abilities are not evaluated by an effective and efficient battery of language tests.
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Affiliation(s)
- Maria Martzoukou
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Anastasia Nousia
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
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Ghoreyshi Z, Nilipour R, Bayat N, Nejad SS, Mehrpour M, Azimi T. The Incidence of Aphasia, Cognitive Deficits, Apraxia, Dysarthria, and Dysphagia in Acute Post Stroke Persian Speaking Adults. Indian J Otolaryngol Head Neck Surg 2022; 74:5685-5695. [PMID: 36742896 PMCID: PMC9895668 DOI: 10.1007/s12070-021-03006-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023] Open
Abstract
Stroke is a major cause of serious disabilities in adults. While communication deficits post stroke are prevalent and disabling, early detection of them is important during acute phase. There is limited data published on the incidence of communication disorders in Persian speaking adults following post stroke to our knowledge. The present study aims to determine the incidence and associated factors of aphasia, cognitive deficits, motor speech disorders (apraxia and dysarthria) as well as dysphagia following acute post stroke in Persian speaking adults. 100 stroke patients were assessed using P-WAB, MMSE, Oral Apraxia test, Informal Dysarthria assessment, and MASA. The data was collected from 2 hospitals in Tehran using convenient sampling for the duration of 1 year. Based on our findings, the incidence of aphasia, cognitive deficits, oral apraxia, dysarthria, and dysphagia was in respectively 61.8%, 76%, 30%, 61%, and 39% of stroke patients during the acute phase. Patients with aphasia were significantly older (mean age, 59.29 vs. 64.95), and had fewer education years (9.21 vs. 5.45) compared to individuals without aphasia (p < .05). Co-occurrence of aphasia and dysarthria, dysphasia, cognitive deficits, and apraxia was in respectively 40%, 31%, 55%, and 25%. Due to the high incidence of neurogenic communication disorders and dysphagia during the acute post stroke, especially in the elderly and the less educated patients, prompt and rapid detection of these deficits and rehabilitation is essential to ameliorate patients' quality of life and social participation, and reduce the comorbidities risk.
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Affiliation(s)
- Zahra Ghoreyshi
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Second Floor, Building No 2, Koodakyar Ave., Daneshjo Blvd, 1985713834 Tehran, Iran
| | - Reza Nilipour
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Second Floor, Building No 2, Koodakyar Ave., Daneshjo Blvd, 1985713834 Tehran, Iran
| | - Narges Bayat
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Second Floor, Building No 2, Koodakyar Ave., Daneshjo Blvd, 1985713834 Tehran, Iran
| | - Samaneh Sazegar Nejad
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Second Floor, Building No 2, Koodakyar Ave., Daneshjo Blvd, 1985713834 Tehran, Iran
| | - Masoud Mehrpour
- Department of Neurology, Iran University of Medical Sciences, Hemat Highway, 1449614535 Tehran, Iran
| | - Tabassom Azimi
- Department of Speech Therapy, School of Rehabilitation, Babol University of Medical Sciences, Ganj Afrouz Ave., 47176-47745 Babol, Iran
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Nunes M, Teles AS, Farias D, Diniz C, Bastos VH, Teixeira S. A Telemedicine Platform for Aphasia: Protocol for a Development and Usability Study. JMIR Res Protoc 2022; 11:e40603. [PMID: 36422881 PMCID: PMC9732749 DOI: 10.2196/40603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/02/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Aphasia is a central disorder of comprehension and expression of language that cannot be attributed to a peripheral sensory deficit or a peripheral motor disorder. The diagnosis and treatment of aphasia are complex. Interventions that facilitate this process can lead to an increase in the number of assisted patients and greater precision in the therapeutic choice by the health professional. OBJECTIVE This paper describes a protocol for a study that aims to implement a computer-based solution (ie, a telemedicine platform) that uses deep learning to classify vocal data from participants with aphasia and to develop serious games to treat aphasia. Additionally, this study aims to evaluate the usability and user experience of the proposed solution. METHODS Our interactive and smart platform will be developed to provide an alternative option for professionals and their patients with aphasia. We will design 2 serious games for aphasia rehabilitation and a deep learning-driven computational solution to aid diagnosis. A pilot evaluation of usability and user experience will reveal user satisfaction with platform features. RESULTS Data collection began in June 2022 and is currently ongoing. Results of system development as well as usability should be published by mid-2023. CONCLUSIONS This research will contribute to the treatment and diagnosis of aphasia by developing a telemedicine platform based on a co-design process. Therefore, this research will provide an alternative method for health care to patients with aphasia. Additionally, it will guide further studies with the same purpose. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40603.
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Affiliation(s)
- Monara Nunes
- Federal University of Piauí, Regeneração, Brazil
| | | | - Daniel Farias
- Federal University of Delta do Parnaíba, Parnaíba, Brazil
| | - Claudia Diniz
- Federal University of Delta do Parnaíba, Parnaíba, Brazil
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Soto-Vidal C, Calvo-Fuente V, Muriel-García A, Gallego-Izquierdo T, González-Alted C, Pacheco-da-Costa S. Responsiveness of the Spanish Version of Newcastle Stroke-Specific Quality of Life Measure (NEWSQOL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10034. [PMID: 34639337 PMCID: PMC8507955 DOI: 10.3390/ijerph181910034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the responsiveness of the Spanish version of the Newcastle Stroke-specific Quality of Life measure (NEWSQOL) to assess quality of life in Spanish people after suffering a stroke. DESIGN A prospective observational study was conducted to assess the responsiveness of the Spanish version of NEWSQOL. The sample contained 128 patients who filled in the questionnaires before and after a physical therapy intervention. The responsiveness was assessed with p-values using the effect size (ES) and the standardized response means (SRMs) of the change. Besides, two other external criteria were used to distinguish patients who improved with the treatment from those who remained stable. This classification was based on one functional independence measure (the Barthel Index) and one disability measure (the modified Rankin Scale). RESULTS There was a statistically significant correlation (Spearman's coefficient = p < 0.01) between the domains of the Spanish version of NEWSQOL in relation to the Barthel Index and the modified Rankin Scale. All domains showed between marked-to-mild change responsiveness except sleep and relationships; mobility (ES 0.66 and SRM 0.92) and activities of daily living (ES 0.75 and SRM 0.87) were markedly responsive; communication (ES 0.38 and SRM 0.61) was moderately responsive; and pain, vision, cognition, feelings, emotions and fatigue were mildly responsive (ES 0.21-0.41 and SRM 0.23-0.44). CONCLUSION The Spanish version of NEWSQOL shows between marked and mild responsiveness to measure the perception of QoL in post-stroke patients. Therefore, its use can be suitable for evaluation studies, clinical trials and clinical practice.
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Affiliation(s)
- Concepción Soto-Vidal
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Victoria Calvo-Fuente
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Alfonso Muriel-García
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Tomás Gallego-Izquierdo
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | | | - Soraya Pacheco-da-Costa
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
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Grönberg A, Henriksson I, Lindgren A. Accuracy of NIH Stroke Scale for diagnosing aphasia. Acta Neurol Scand 2021; 143:375-382. [PMID: 33368189 PMCID: PMC7985870 DOI: 10.1111/ane.13388] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/10/2020] [Accepted: 11/26/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The National Institutes of Health Stroke Scale (NIHSS) has not been validated to diagnose aphasia in the stroke population. We therefore examined the diagnostic accuracy of NIHSS for detecting aphasia in acute ischemic stroke. METHODS Consecutive patients with acute first-ever ischemic stroke were included prospectively in Lund Stroke Register Study at Skåne University Hospital, Sweden. Exclusion criteria were: (a) non-native Swedish; (b) obtundation (c) dementia or psychiatric diagnosis. Patients were assessed with NIHSS item 9 (range 0-3, where 1-3 indicate aphasia) by a NIHSS certified research nurse in the acute phase after stroke onset (median 3 days). Within 24 h after this assessment, a speech therapist evaluated the patients' language function with the comprehensive language screening test (LAST, range 0-15 where 0-14 indicates aphasia). Data were analyzed using LAST as 'reference standard'. RESULTS We examined 221 patients. Among these, 23% (n = 50) had aphasia according to NIHSS (distribution of scores 0, 1, 2, 3 were n = 171, n = 29, n = 12, n = 9) compared to 26% (n = 58) with aphasia according to LAST (score ≤14; median = 11). Assuming LAST as reference standard, NIHSS gave 16 false negatives (NIHSS item 9 = 0) for aphasia (LAST scores range 8-14), and 8 false positives (NIHSS item 9 score = 1) for aphasia, yielding a sensitivity of 72% (0.59-0.83) and a specificity of 95% (0.91-0.98). CONCLUSIONS When using NIHSS for screening and diagnosing aphasia in adults with acute ischemic stroke, patients with severe aphasia can be detected, however, some mild aphasias might be misclassified. Given the 72% sensitivity, absence of aphasia on the NIHSS should not be used to guide stroke treatment.
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Affiliation(s)
- Angelina Grönberg
- Department of Clinical Sciences Lund Neurology Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics Skåne University Hospital Lund Sweden
| | - Ingrid Henriksson
- Speech and Language Pathology Unit Institute of Neuroscience and Physiology Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Arne Lindgren
- Department of Clinical Sciences Lund Neurology Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics Skåne University Hospital Lund Sweden
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Soto-Vidal C, Pacheco-da-Costa S, Calvo-Fuente V, Fernández-Guinea S, González-Alted C, Gallego-Izquierdo T. Validation of the Spanish Version of Newcastle Stroke-Specific Quality of Life Measure (NEWSQOL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4237. [PMID: 32545844 PMCID: PMC7345147 DOI: 10.3390/ijerph17124237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Stroke causes a wide variety of clinical manifestations that may have a negative impact on quality of life. Therefore, it is very important to use specific instruments for measuring quality of life in individuals who suffered a stroke. The aim of this study was to develop a psychometrically validated Spanish version of the Newcastle stroke-specific quality of life measure (NEWSQOL). METHODS A psychometric validation of the Spanish version of the NEWSQOL questionnaire was carried out in 159 patients. The reliability (intraclass correlation coefficient and Cronbach's alpha coefficient), validity (factorial analysis and Spearman's coefficient), feasibility (response rate), and the ceiling and floor effects were calculated. RESULTS Internal consistency showed that Cronbach's alpha coefficient was 0.93. The test-retest reliability was high or excellent for all domains (range 0.71-0.97 p < 0.001). The response rate of the questionnaire was 100% and the average administration time was 20.5 (±7.2) min. No ceiling effect was detected and two domains (pain and vision) may have a significant potential for floor effect. Construct validity showed that all the variables are important enough to keep them all in the questionnaire. Concerning convergent construct validity, a high correlation was found with the Nottingham Health Profile, the Barthel Index, and the Modified Rankin Scale. CONCLUSION The Spanish version of the NEWSQOL questionnaire is reliable, valid, and feasible to evaluate quality of life in the Spanish population.
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Affiliation(s)
- Concepción Soto-Vidal
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
| | - Soraya Pacheco-da-Costa
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
| | - Victoria Calvo-Fuente
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
| | - Sara Fernández-Guinea
- Department of Experimental Psychology, Complutense University of Madrid, 28040 Madrid, Spain;
| | | | - Tomás Gallego-Izquierdo
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
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