Cognitive predictors of a performance-based measure of instrumental activities of daily living following stroke

Reablement of Instrumental Activities of Daily Living for Patients With Stroke: A Randomized Crossover Trial

IMPORTANCE

Reablement is a person-centered and goal-oriented rehabilitative intervention to optimize people's chances to live independently.

OBJECTIVE

To investigate the effects of a reablement intervention on performance of instrumental activities of daily living (IADLs) in three aspects (i.e., actual performance, ability, and self-perceived difficulty) for patients with stroke.

DESIGN

A single-blinded, randomized crossover study.

SETTING

Participants' home and community.

PARTICIPANTS

Twenty-seven patients with stroke.

INTERVENTIONS

Each participant received two interventions (IADL reablement and health education). Each intervention was administered for 6 wk. All participants were randomly assigned to one intervention and then received the other intervention after a 4-wk washout period.

OUTCOMES AND MEASURES

Outcomes of actual performance and self-perceived difficulty were derived from the Frenchay Activities Index (FAI) and the difficulty dimension of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), respectively. Outcomes of ability were measured with the Lawton Instrumental Activities of Daily Living Scale (LIADL) and the Canadian Occupational Performance Measure Performance score (COPM Performance).

RESULTS

No statistically significant differences were found in the three aspects between the IADL reablement and health education (ps = .148-.570). Compared with the health education, the IADL reablement showed better improvements on the FAI, LIADL, COPM Performance, and difficulty dimension of the PM-3D4D with trivial to small effect sizes (ds = 0.17-0.45).

CONCLUSIONS AND RELEVANCE

Our results reveal that the IADL reablement has the potential to increase the frequency of IADL administration, enhancing the capability to perform IADLs and reducing the self-perceived difficulty of carrying out IADLs. Plain-Language Summary: The results of this study showed positive outcomes for a reablement intervention that focuses on goal-oriented instrumental activities of daily living for patients with stroke. An IADL reablement intervention may be useful for improving the ability to carry out IADL tasks at home and in the community.

Transcranial Direct Current Stimulation for Global Cognitive Functioning and Ability in Daily Life Activities in Poststroke Cognitive Impairment: A Systematic Review and Meta-analysis

OBJECTIVE

The aim of the study is to determine the efficacy of transcranial direct current stimulation on global cognition and ability in daily life activities of patients with poststroke cognitive impairment.

DESIGN

Nine electronic databases were searched from their respective inceptions through January 2022. We included the randomized controlled trials that used transcranial direct current stimulation for poststroke cognitive impairment and included at least one global cognitive function or ability in daily life activities outcome indicators. Two reviewers appraised the risks of bias through the Cochrane Collaboration's tool and performed the meta-analysis. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

RESULTS

Twenty-two studies (1198 participants) were included. Most studies had no significant bias in the quality of the methodology. Meta-analyses found that compared with the control group, transcranial direct current stimulation increased Montreal cognitive assessment, Mini-mental state examination, Loewenstein occupational therapy cognitive assessment, total effective rate of cognition, modified Barthel Index, and decreased P300 latency (all P < 0.05). These results showed transcranial direct current stimulation can improve cognitive function and ability in daily life activities in poststroke cognitive impairment.

CONCLUSIONS

The transcranial direct current stimulation may have a significant rehabilitation effect on global cognitive functioning and ability in daily life activities of patients with poststroke cognitive impairment.

Memory, fluid reasoning, and functional capacity in adults experiencing homelessness

BACKGROUND AND OBJECTIVE

In individuals experiencing homelessness, determinants of functional capacity (i.e. the ability to perform activities of daily living) are poorly understood. Identifying potentially modifiable correlates of functional capacity, such as cognitive abilities, may inform treatment targets to address independence and housing stability. This study aimed to identify the strongest neuropsychological predictors of variance in functional performance in 100 adults living in a homeless shelter.

METHODS

Participants completed a brief cognitive screening test, from which four composite scores were derived, as well as tests of processing speed, fluid reasoning, premorbid intellectual function, and performance-based functional capacity. We conducted a hierarchical linear regression to predict variance in functional capacity.

RESULTS

Beyond the impact of education and premorbid intellectual function, better memory and fluid reasoning predicted better functional performance.

CONCLUSIONS

Although our cross-sectional design does not permit causal inference, it is possible that interventions targeting memory and fluid reasoning may improve functional ability in individuals experiencing homelessness.

Translation, cross-cultural adaptation and validation of the 10-item Weekly Calendar Planning Activity in Spanish-speaking ABI patients: a multicenter study

We present the process of translation, adaptation, and validation in the Spanish context of the 10-item version of the Weekly Calendar Planning Activity (WCPA-10), a performance-based measure of cognitive instrumental activities of daily living (C-IADL). The study consisted of two phases: I) translation/cultural adaptation of the WCPA, conducted by professional bilingual translators, a panel of experts, and a pilot study, and II) validation in a sample of 42 acquired brain injury patients (ABI) and 42 healthy participants (HC). WCPA primary outcomes showed expected convergent/discriminant validity patterns with socio-demographical and clinical variables and cognitive processes identifying those WCPA outcomes that best predicted executive and memory deficits measured with a battery of traditional neuropsychological tests. In addition, performance on the WCPA was a significant predictor of everyday functioning over variables such as socio-demographics or global cognition when measured with traditional tests. External validity was established by the WCPA's ability to identify everyday cognitive deficits in ABI patients compared to HC, even in those with subtle cognitive impairment based on neuropsychological tests. The Spanish WCPA-10 seems an appropriate and sensitive assessment tool to identify cognitive-functional impairment in ABI-patients, even those with subtle cognitive impairment. The results also highlight the relevance of this kind of test, as they indicate a better prediction of patients' real-world functioning than traditional neuropsychological tests.

High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) impacts activities of daily living of patients with post-stroke cognitive impairment: a systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the impact of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on activities of daily living (ADLs) of patients with post-stroke cognitive impairment (PSCI).

DATA SOURCES

Relevant studies published as of November 2022 (English and Chinese) were searched in Web of Science, PubMed, Embase, Cochrane Library, OVID, China Science and Technology Journal Database (VIP), Wanfang, Chinese National Knowledge Infrastructure (CNKI), and SinoMed databases.

REVIEW METHODS

Randomized controlled trials (RCTs) that used HF-rTMS for the treatment of ADLs in patients with PSCI were included in this meta-analysis. Two reviewers independently screened literature, extracted the data, evaluated the risk of bias using the Cochrane Risk of Bias Tool, and cross-checked.

RESULTS

Forty-one RCTs involving 2855 patients with PSCI were included. In 30 RCTs, the experimental group received HF-rTMS in addition to the interventions used in the control group. In 11 RCTs, the experimental group received HF-rTMS while the control group received sham-rTMS. Barthel Index (BI), Modified Barthel Index (MBI), and Functional Independence Measure (FIM) were higher in the HF-rTMS group than in the control group, whereas scores of Blessed Behavior Scale was lower in the HF-rTMS group than in the control group. All P < 0.05. In 36 studies, the stimulation sites were on the dorsolateral prefrontal cortex (DLPFC).

CONCLUSION

HF-rTMS can ameliorate ADLs of patients with PSCI and has a better rehabilitation effect on PSCI.

Functional dependence among stroke survivors: A concept analysis

AIM

To report an analysis of the concept of functional dependence among stroke survivors.

BACKGROUND

Functional dependence among stroke survivors is a focal stimulus that leads to caregiver burden and can be measured and applied to research and theory in different ways depending on the researcher's interpretation of the concept.

DESIGN

A concept analysis was conducted using the method described by Walker and Avant.

DATA SOURCE

A review of the literature was conducted using the CINAHL and PubMed databases. Lay literature, such as the Merriam-Webster dictionary was included.

RESULTS

Through the identification and analysis of definitions and uses of the concept, the defining attributes were found to be (1) inability to perform regular functions and (2) dependence on a caregiver to perform regular functions which form the conceptual and operational definitions. A model, borderline, and the related case of the conceptual definition are provided. One antecedent, two consequences, and four empirical referents are identified, alongside the instruments used to measure the empirical referents.

CONCLUSIONS

With functional dependence being so closely tied to caregiver burden, researchers and clinicians should take a dyadic approach to caring for this patient population to ensure both perspectives are considered, and optimal patient outcomes are achieved.

Motor Function and Activities of Daily Living Recovery after Cardiogenic Internal Carotid Artery Infarction: A Retrospective Cohort study

OBJECTIVES

this study determines recovery in physical activity and activities of daily living in the early stages after cardiogenic internal carotid artery infarction.

MATERIALS AND METHODS

this retrospective comfort study compares assessment data for 334 patients: 150 patients had atherosclerotic infarction (67 internal carotid artery, 87 middle cerebral artery) and 180 had cardiogenic infarction (32 internal carotid artery infarction, 148 middle cerebral artery). We used Brunnstrom recovery score, posture assessment scale for stroke, and functional independence measure.

RESULTS

on initial assessment, median Brunnstrom recovery for the cardiogenic internal carotid artery infarction group was I-II in the upper limb, I in the finger, I-II in the lower limb, and IV or higher in all other groups. The median Postural Assessment Scale for Stroke score for the cardiogenic internal carotid artery infarction group was 0; all other groups scored 14 or higher. The median Functional Independence Measure for the cardiogenic internal carotid artery infarction group was 18 (maximum of 100) and the median score for other infarct groups was 25-50 (maximum 126), with P < .01. After a month, final assessment results for the cardiogenic internal carotid artery infarction group were much lower than for the other groups. Only both internal carotid artery infarctions were compared. Atherosclerotic infarctions showed recovery across assessments, except understanding, onset, and memory (P < .01), and cardiogenic infarctions did not change from the initial assessment in all criteria assessed.

CONCLUSIONS

adapting cardiogenic internal carotid artery infarction as a stroke recovery model is difficult.