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Ogwumike OO, Omoregie AA, Dada OO, Badaru UM. Quality of life of stroke survivors: A cross-sectional study of association with functional independence, self-reported fatigue and exercise self-efficacy. Chronic Illn 2022; 18:599-607. [PMID: 34120490 DOI: 10.1177/17423953211023960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Stroke is a leading cause of disability and one of the most debilitating conditions especially in the developing world. Rehabilitation focuses on improving functional ability which may enhance quality of life (QoL). The aims of this study were to investigate the association between QoL and each of functional independence (FI), self-reported fatigue (SRF) and exercise self-efficacy (ESE) in stroke survivors. METHODS This is a descriptive cross-sectional survey, documenting QoL, FI, SRF and ESE of stroke survivors seen at the physiotherapy outpatient clinics of two health care facilities in Oyo state, Nigeria. Descriptive and inferential statistics were used to analyse the data with significance level set at 0.05. RESULTS Participants were 110 stroke survivors (64 males; 46 females) aged 60.9 ± 11.9 years. Significant associations were found between QoL and each of FI and ESE (p < 0.01) while no significant association was observed for SRF. FI strongly predicts good QoL in stroke survivors (OR = 16.34; p < 0.01) and high ESE is a determinant of QoL (OR = 6.46; p = 0.04). Stroke survivors with SRF were less likely to report good QoL. DISCUSSION Functional independence and exercise self-efficacy were directly associated with QoL and were also major predictors of good QoL in stroke survivors.
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Affiliation(s)
- Omoyemi O Ogwumike
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Physiotherapy, University College Hospital, Ibadan, Nigeria
| | | | - Olumide O Dada
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Physiotherapy, University College Hospital, Ibadan, Nigeria
| | - Umaru M Badaru
- Department of Physiotherapy, Bayero University, Kano, Nigeria
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Mahadevan S, Chan MF, Moghadas M, Shetty M, Burke DT, Al-Rasadi K, Al-Adawi S. Post-Stroke Psychiatric and Cognitive Symptoms in West Asia, South Asia and Africa: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:3655. [PMID: 34441951 PMCID: PMC8397184 DOI: 10.3390/jcm10163655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/17/2022] Open
Abstract
Recent research has shown that the prevalence of stroke incidents and the number of survivors in developing countries surpass those from developed countries. This study aimed to enumerate the prevalence of post-stroke psychiatric and cognitive symptoms among stroke survivors from West and South Asia and Africa through a systematic review and meta-analysis. Data from each country was systematically acquired from five major databases (PsycINFO, Web of Science, Scopus, PubMed/Medline, and Google Scholar (for any missing articles and grey literature)). Meta-analytic techniques were then used to estimate the prevalence of various post-stoke psychiatric and cognitive symptoms. A total of 36 articles were accrued from 11 countries, of which 25 were evaluated as part of the meta-analysis. The pooled prevalence of post-stroke depression as per the Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Rating Scale, Patient Health Questionnaire, Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Geriatric Depression Scale, and the Montgomery-Asberg Depression Rating Scale ranged from 28.00 to 50.24%. Pooled prevalence of post-stroke anxiety based on the HADS and SCAN was 44.19% and 10.96%, respectively. The pooled prevalence of post-stroke cognitive impairment as per the Mini-Mental Status Examination was 16.76%. This present review has suggested that both psychiatric and cognitive symptoms are common among stroke survivors. Concerted efforts are needed to institute robust studies using culturally sensitive measures to contemplate mechanisms that address the unmet needs of this vulnerable population.
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Affiliation(s)
- Sangeetha Mahadevan
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
| | - Moon Fai Chan
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
| | - Marzieh Moghadas
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
| | - Maithili Shetty
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
| | - David T. Burke
- Department of Rehabilitation Medicine in the Emory University School of Medicine, 1441 Clifton Road N.E., Atlanta, GA 30322, USA;
| | - Khalid Al-Rasadi
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
| | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
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Vitturi BK, Mitre LP, Kim AIH, Gagliardi RJ. Prevalence and Predictors of Fatigue and Neuropsychiatric Symptoms in Patients with Minor Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 30:105964. [PMID: 34245946 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105964] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/14/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Patients who are victims of a mild stroke are vulnerable to several invisible and neglected neurological sequelae. In parallel, it is known that fatigue and neuropsychiatric symptoms are common complications after a stroke in general. Our aim was to describe the prevalence and the factors associated with these two outcomes after a minor stroke. MATERIALS AND METHODS We conducted a prospective observational cohort study that included consecutive patients diagnosed with minor ischemic stroke between 2015 and 2019. Minor stroke was defined as NIHSS < 4 and modified Rankin Scale (mRS) < 2. Patients were followed for 12 months after the index stroke. The primary endpoints included fatigue and neuropsychiatric impairment, which were evaluated with the Fatigue Severity Scale (FSS) and the Hospital Anxiety Depression Scale (HADS), respectively. RESULTS A total of sixty patients were followed in our cohort. The mean age was 53.0 (SD 15.0) and 51.7% were male. There were 32 (53.3%) and 25 (41.7%) patients who developed PSF and post-stroke neuropsychiatric symptoms, respectively. The use of antidepressants and statins were associated with post-stroke fatigue, while women and younger patients were more likely to develop neuropsychiatric symptoms after the stroke (p < 0.05). Eighteen (30.0%) patients were diagnosed with both post-stroke fatigue and psychiatric disorders. CONCLUSIONS Post-stroke fatigue and neuropsychiatric symptoms are prevalent in minor stroke and should be independently addressed as a part of the recovery goal.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo 01221-020, Brazil.
| | - Lucas Pari Mitre
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo 01221-020, Brazil
| | - Alexandre In Han Kim
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo 01221-020, Brazil
| | - Rubens José Gagliardi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo 01221-020, Brazil
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Oyake K, Otaka Y, Matsuura D, Honaga K, Mori N, Kondo K. Poststroke Fatigue at Admission is Associated With Independence Levels of Activities of Daily Living at Discharge From Subacute Rehabilitation Wards. Arch Phys Med Rehabil 2020; 102:849-855. [PMID: 33161009 DOI: 10.1016/j.apmr.2020.10.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/15/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether poststroke fatigue at admission is associated with the degree of independence in activities of daily living in patients with stroke at discharge from subacute rehabilitation wards. DESIGN Retrospective cohort study. SETTING Subacute rehabilitation hospital. PARTICIPANTS A consecutive sample of patients (N=156) with stroke who were admitted to a subacute rehabilitation ward between December 2012 and November 2013 were enrolled in the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Poststroke fatigue was assessed using the Fatigue Severity Scale within 2 weeks of admission. Poststroke fatigue was defined as the mean score of 4 points or more from among 9 items in the Fatigue Severity Scale. Functional outcome was assessed by using FIM motor items. RESULTS Fifty-six (35.9%) of the 156 participants had poststroke fatigue at admission. The scores of the FIM motor items at admission and discharge were significantly lower in the fatigue group than in the nonfatigue group (P<.05). Multiple regression analysis with potentially confounding variables revealed that poststroke fatigue was a significant independent factor for discharge FIM motor items score (P<.05). CONCLUSION Poststroke fatigue at admission was significantly associated with functional outcome at discharge from subacute rehabilitation wards. Our findings emphasize that rehabilitation professionals need to manage poststroke fatigue in addition to providing the interventions to improve daily activities in patients with subacute stroke.
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Affiliation(s)
- Kazuaki Oyake
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Daisuke Matsuura
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Naoki Mori
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
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Non-Pharmacological Interventions for Post-Stroke Fatigue: Systematic Review and Network Meta-Analysis. J Clin Med 2020; 9:jcm9030621. [PMID: 32106490 PMCID: PMC7141106 DOI: 10.3390/jcm9030621] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/04/2020] [Accepted: 02/21/2020] [Indexed: 01/02/2023] Open
Abstract
Post-stroke fatigue (PSF) is one of the most serious sequelae, which often interferes with the rehabilitation process and impairs the functional recovery of patients. Due to insufficient evidence, it is unclear which specific pharmacological interventions should be recommended. Therefore, in this paper, we compare the effectiveness of non-pharmacological interventions in PSF. A systematic review and network meta-analysis of randomized controlled trials were performed using EMBASE, MEDLINE, CINAHL, Cochrane library, ClinicalTrials.gov, CNKI, and CQVIP, from inception to January 2018, in the English and Chinese languages. RCTs involving different non-pharmacological interventions for PSF with an outcome of fatigue measured using the Fatigue Severity Scale were included. Multiple intervention comparisons based on a Bayesian network are used to compare the relative effects of all included interventions. Ten RCTs with eight PSF non-pharmacological interventions were identified, comprising 777 participants. For effectiveness, most interventions did not significantly differ from one another. The cumulative probabilities of the best non-pharmacological intervention for fatigue reduction included Community Health Management (CHM), followed by Traditional Chinese Medicine (TCM) and Cognitive Behavioral Therapy (CBT). Network meta-analysis based on data from the selected RCTs indicated that the eight PSF non-pharmacological interventions shared equivalent efficacy, but CHM, TCM, and CBT showed potentially better efficacy. In the future, fatigue needs to be recognized and more accurate assessment methods for PSF are required for diagnosis and to develop more effective clinical interventions.
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Olibamoyo O, Adewuya A, Ola B, Coker O, Atilola O. Prevalence and correlates of depression among Nigerian stroke survivors. S Afr J Psychiatr 2019; 25:1252. [PMID: 31205780 PMCID: PMC6556991 DOI: 10.4102/sajpsychiatry.v25i0.1252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 01/22/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is mixed evidence for the hypothesis that the risk of depression after stroke is influenced by the location of lesions in the hemispheres, demographic and clinical factors, and disability of stroke survivors. AIM The current study determined the prevalence of depression and its socio-demographic and clinico-pathological correlates among stroke survivors in a tertiary hospital in Lagos, Nigeria. METHOD The cross-sectional study was carried out among 112 adult patients with a clinical history of stroke confirmed by neuroimaging. Depression was diagnosed using Mini International Neuropsychiatric Interview. The socio-demographic profile was obtained, and cognitive impairment was assessed using the Mini-Mental State Examination. Stroke severity was assessed retrospectively using the National Institute of Health Stroke Scale and current disability was measured using the Modified Rankin Scale. RESULTS There were 48 (42.9%) stroke survivors with a clinical diagnosis of depression. Using binary logistic regression, the independent determinants of depression were younger age, unemployment, perceived poor social support, increasing number of previous admissions because of stroke, cognitive impairment, severity of stroke and current disability status. However, there was no significant association between depression and lesion location. CONCLUSION Depression is a common associate of stroke, and there is a need for sustained focus on young stroke survivors with severe stroke, especially those who do not have social support and have low socio-economic status, who may have a higher risk of developing depression following stroke.
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Affiliation(s)
- Olushola Olibamoyo
- Department of Psychiatry, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Abiodun Adewuya
- Department of Behavioural Medicine, Lagos State University College of Medicine, Lagos, Nigeria
| | - Bolanle Ola
- Department of Behavioural Medicine, Lagos State University College of Medicine, Lagos, Nigeria
| | - Olurotimi Coker
- Department of Behavioural Medicine, Lagos State University College of Medicine, Lagos, Nigeria
| | - Olayinka Atilola
- Department of Behavioural Medicine, Lagos State University College of Medicine, Lagos, Nigeria
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7
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Ezema CI, Akusoba PC, Nweke MC, Uchewoke CU, Agono J, Usoro G. Influence of Post-Stroke Depression on Functional Independence in Activities of Daily Living. Ethiop J Health Sci 2019; 29:841-846. [PMID: 30700951 PMCID: PMC6341441 DOI: 10.4314/ejhs.v29i1.5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Little attention has been paid to screening of depression among stroke survivors in outpatient physiotherapy clinics. Post-stroke depression is reported to have a negative impact on functional recovery. However, the exact influence on the outcome of rehabilitation such as level of functional independence remains controversial. This study aims at ascertaining the influence of post-stroke depression on functional independence in activities of daily living. Methods The study is a cross sectional survey of stroke survivors attending outpatient physiotherapy clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, and the Enugu State University Teaching Hospital (ESUTH). Participants were evaluated for socio-demographic characteristics. Post-stroke depression and level of functional recovery in Activities of Daily Living were assessed using the Hamilton Depression Rating Scale and the Barthel Index respectively. Data was analyzed using SPSS version 23, with α set at 0.01. Results A total of 66 participants, 42 females and 24 males, were purposively recruited into the study. Over 80% (56) of the participant had depression, with over 50% (32) being severely depressed. Post-stroke depression was associated with less functional independence in activities of daily living (p=0.000). A significant difference was found in the level of functional independence between participants with and without depression (p=0.00). Conclusion Participants with post-stroke depression have less independence in activities of daily living. A longitudinal study with a larger sample size is, however, recommended so as to improve the external validity. In the mean time, outpatient rehabilitation of depressed stroke survivors should include pharmacological and psychological components.
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Affiliation(s)
- Charles I Ezema
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
| | - Petronella C Akusoba
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
| | - Martins C Nweke
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
| | - Chigozie U Uchewoke
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
| | - Joshua Agono
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
| | - Godspower Usoro
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
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8
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Investigating post-stroke fatigue: An individual participant data meta-analysis. J Psychosom Res 2018; 113:107-112. [PMID: 30190042 DOI: 10.1016/j.jpsychores.2018.08.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/19/2018] [Accepted: 08/13/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The prevalence of post-stroke fatigue differs widely across studies, and reasons for such divergence are unclear. We aimed to collate individual data on post-stroke fatigue from multiple studies to facilitate high-powered meta-analysis, thus increasing our understanding of this complex phenomenon. METHODS We conducted an Individual Participant Data (IPD) meta-analysis on post-stroke fatigue and its associated factors. The starting point was our 2016 systematic review and meta-analysis of post-stroke fatigue prevalence, which included 24 studies that used the Fatigue Severity Scale (FSS). Study authors were asked to provide anonymised raw data on the following pre-identified variables: (i) FSS score, (ii) age, (iii) sex, (iv) time post-stroke, (v) depressive symptoms, (vi) stroke severity, (vii) disability, and (viii) stroke type. Linear regression analyses with FSS total score as the dependent variable, clustered by study, were conducted. RESULTS We obtained data from 14 of the 24 studies, and 12 datasets were suitable for IPD meta-analysis (total n = 2102). Higher levels of fatigue were independently associated with female sex (coeff. = 2.13, 95% CI 0.44-3.82, p = 0.023), depressive symptoms (coeff. = 7.90, 95% CI 1.76-14.04, p = 0.021), longer time since stroke (coeff. = 10.38, 95% CI 4.35-16.41, p = 0.007) and greater disability (coeff. = 4.16, 95% CI 1.52-6.81, p = 0.010). While there was no linear association between fatigue and age, a cubic relationship was identified (p < 0.001), with fatigue peaks in mid-life and the oldest old. CONCLUSION Use of IPD meta-analysis gave us the power to identify novel factors associated with fatigue, such as longer time since stroke, as well as a non-linear relationship with age.
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9
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De Doncker W, Dantzer R, Ormstad H, Kuppuswamy A. Mechanisms of poststroke fatigue. J Neurol Neurosurg Psychiatry 2018; 89:287-293. [PMID: 28939684 DOI: 10.1136/jnnp-2017-316007] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/04/2022]
Abstract
Poststroke fatigue is a debilitating symptom and is poorly understood. Here we summarise molecular, behavioural and neurophysiological changes related to poststroke fatigue and put forward potential theories for mechanistic understanding of poststroke fatigue.
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Affiliation(s)
| | - Robert Dantzer
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Heidi Ormstad
- Faculty of Health and Social Sciences, University of South West Norway, Oslo, Norway
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Park EY, Kim JH. An analysis of depressive symptoms in stroke survivors: verification of a moderating effect of demographic characteristics. BMC Psychiatry 2017; 17:132. [PMID: 28390402 PMCID: PMC5385085 DOI: 10.1186/s12888-017-1292-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/30/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The rehabilitation of depressed stroke patients is more difficult because poststroke depression is associated with disruption of daily activities, functioning, and quality of life. However, research on depression in stroke patients is limited. The aim of our study was to evaluate the interaction of demographic characteristics including gender, age, education level, the presence of a spouse, and income status on depressive symptoms in stroke patients and to identify groups that may need more attention with respect to depressive symptoms. METHODS We completed a secondary data analysis using data from a completed cross-sectional study of people with stroke. Depression was measured using the Center for Epidemiologic Studies Depression Scale. RESULTS In this study, depressive symptoms in women living with a spouse were less severe than among those without a spouse. For those with insufficient income, depressive symptom scores were higher in the above high school group than in the below high school group, but were lower in patients who were living with a spouse than in those living without a spouse. CONCLUSION Assessing depressive symptoms after stroke should consider the interaction of gender, economic status, education level, and the presence/absence of a spouse. These results would help in comprehensive understanding of the importance of screening for and treating depressive symptoms during rehabilitation after stroke.
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Affiliation(s)
- Eun-Young Park
- grid.411845.dDepartment of Secondary Special Education, College of Education, Jeonju University, PO Box 560-759, 45 Baengma-gil, Wansan-gu, Jeonju, Korea
| | - Jung-Hee Kim
- Department of Clinical Nursing, College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
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Lerdal A, Gay CL. Acute-Phase Fatigue Predicts Limitations with Activities of Daily Living 18 Months after First-Ever Stroke. J Stroke Cerebrovasc Dis 2016; 26:523-531. [PMID: 28040378 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.130] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 10/21/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Fatigue during the acute phase following stroke has been shown to predict long-term physical health, specifically increased bodily pain and poorer self-rated general health. The aim of this analysis was to determine whether acute-phase fatigue also predicts patients' limitations in activities of daily living (ADL) 18 months after the first stroke. METHODS Patients with first-ever stroke (N = 88) were recruited upon admission at 2 hospitals in Norway. Patients were assessed within 2 weeks following admission and at 18 months using the Barthel Index of Activities of Daily Living (BI), Fatigue Severity Scale, and Beck Depression Inventory II. The relationship between acute-phase fatigue and later activity limitations (BI < 20) was evaluated using multivariate logistic regression analysis controlling for relevant covariates and acute-phase ADL function. RESULTS Acute-phase fatigue was associated with activity limitations at 18-month follow-up (P = .002), even when controlling for other predictors of ADL function, including age, gender, baseline work status, and acute-phase depressive symptoms and ADL function. Examining the reverse relationship, acute-phase activity limitations were unrelated to fatigue 18 months after stroke. CONCLUSION Our study indicates that acute-phase fatigue may be an independent risk factor for activity limitations 18 months after stroke. This finding suggests that effective treatments for poststroke fatigue both in the acute phase and later in the recovery period may contribute to better stroke rehabilitation.
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Affiliation(s)
- Anners Lerdal
- Department of Research, Lovisenberg Diakonale Hospital, Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Caryl L Gay
- Department of Research, Lovisenberg Diakonale Hospital, Oslo, Norway; Department of Family Health Care Nursing, University of California, San Francisco, California
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Hu Y, Xing H, Dong X, Lu W, Xiao X, Gao L, Cui M, Chen J. Pioglitazone is an effective treatment for patients with post-stroke depression combined with type 2 diabetes mellitus. Exp Ther Med 2015; 10:1109-1114. [PMID: 26622448 DOI: 10.3892/etm.2015.2593] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 02/06/2015] [Indexed: 12/30/2022] Open
Abstract
The antidepressive effects of the antidiabetic medicine, pioglitazone, were recently reported in several studies. These effects may ameliorate the depressive symptoms of patients with post-stroke depression (PSD). The present study aimed to evaluate the antidepressive effect of pioglitazone in patients with PSD combined with type 2 diabetes. A total of 118 consecutive patients with stroke who had depression were studied for an average of 3 months. The Diagnostic and Statistical Manual of Mental Disorders (fourth edition) was used to assess whether a patient was depressed or not. The severity of depression was evaluated by the Hamilton depression rating scale (HAMD). In accordance with their HAMD scores, the 118 patients were divided into a severe depression group (n=40) and a mild and moderate (MM) depression group (n=78). These subjects were then divided into pioglitazone [30 mg once daily (qd)] and metformin (0.5 g twice daily) subgroups. All patients were given fluoxetine (20 mg qd). Follow-up evaluations, which included HAMD scores, activities of daily living (ADL) scores, fasting blood glucose (FBG) levels and fasting insulin (FINS) levels, were conducted on the first and third month following the beginning of the treatment. In the MM depression group, the HAMD score in the pioglitazone subgroup was lower than that in the metformin subgroup following treatment for 1 or 3 months. In the severe depression group, the HAMD score in the pioglitazone subgroup was lower than that in the metformin subgroup following 3 months of treatment. The FINS levels of the pioglitazone subgroup gradually decreased in the 3 months of treatment. No noticeable improvement was observed in the ADL scores and FBG values. In conclusion, the results of the current study demonstrate that pioglitazone effectively decreased HAMD scores and FINS values in patients with PSD, suggesting that pioglitazone may be useful for the treatment of patients with PSD combined with type 2 diabetes.
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Affiliation(s)
- Yaozhi Hu
- Department of Neurology, Binzhou Medical University Affiliated Hospital, Binzhou, Shandong 256603, P.R. China
| | - Haiyan Xing
- Department of Intensive Care Unit, Binzhou People's Hospital, Binzhou, Shandong 256603, P.R. China
| | - Xiaomeng Dong
- Department of Neurology, Binzhou Medical University Affiliated Hospital, Binzhou, Shandong 256603, P.R. China
| | - Wenxian Lu
- Department of Neurology, Binzhou Medical University Affiliated Hospital, Binzhou, Shandong 256603, P.R. China
| | - Xinxing Xiao
- Department of Neurology, Binzhou Medical University Affiliated Hospital, Binzhou, Shandong 256603, P.R. China
| | - Lilin Gao
- Department of Neurology, Binzhou Medical University Affiliated Hospital, Binzhou, Shandong 256603, P.R. China
| | - Minghu Cui
- Department of Psychiatry, Binzhou Medical University Affiliated Hospital, Binzhou, Shandong 256603, P.R. China
| | - Jinbo Chen
- Department of Neurology, Binzhou Medical University Affiliated Hospital, Binzhou, Shandong 256603, P.R. China
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Factors Associated with Poststroke Fatigue: A Systematic Review. Stroke Res Treat 2015; 2015:347920. [PMID: 26101691 PMCID: PMC4458555 DOI: 10.1155/2015/347920] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/20/2015] [Accepted: 05/12/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Poststroke fatigue (PSF) is a frequent, disabling symptom that lacks a consensual definition and a standardized evaluation method. The (multiple) causes of PSF have not been formally characterized. Objective. To identify factors associated with PSF. Method. A systematic review of articles referenced in MEDLINE. Only original studies having measured PSF and potentially associated factors were included. Data was extracted from articles using predefined data fields. Results. Although PSF tends to be more frequent in female patients and older patients, sociodemographic factors do not appear to have a major impact. There are strong associations between PSF and emotional disturbances (such as depression and anxiety). PSF may also be linked to attentional disturbances (mainly slowing in processing speed). The literature data have failed to demonstrate a clear impact of the type and severity of stroke. It has been suggested that PSF results from alterations in the frontothalamostriatal system and/or inflammatory processes. Pain, sleep disorders, and prestroke fatigue also appeared to be associated with PSF. Implications. A better understanding of PSF may improve stroke patient care and facilitate the development of effective treatments.
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Nadarajah M, Goh HT. Post-stroke fatigue: a review on prevalence, correlates, measurement, and management. Top Stroke Rehabil 2015; 22:208-20. [DOI: 10.1179/1074935714z.0000000015] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sugawara N, Metoki N, Hagii J, Saito S, Shiroto H, Tomita T, Yasujima M, Okumura K, Yasui-Furukori N. Effect of depressive symptoms on the length of hospital stay among patients hospitalized for acute stroke in Japan. Neuropsychiatr Dis Treat 2015; 11:2551-6. [PMID: 26491334 PMCID: PMC4599635 DOI: 10.2147/ndt.s91303] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression after stroke is one of the most serious complications of stroke. Although many studies have shown that the length of hospital stay (LOHS) is a measurable and important stroke outcome, research has found limited evidence concerning the effect of depression on LOHS among patients who have experienced acute stroke. The objective of this study was to assess the effect of depression on LOHS among patients hospitalized for acute ischemic stroke in Japan. METHODS We retrospectively examined 421 patients who had experienced acute ischemic stroke. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS) on the 7th day of hospitalization. On the 10th day of hospitalization, depressive symptoms and functional assessment were assessed by the Japan Stroke Scale (Depression Scale) and the Functional Independence Measure, respectively. A general linear model was employed to assess the effect of probable depression on LOHS. RESULTS The prevalence of probable depression in the current sample was 16.3% in males and 17.8% in females. The mean LOHS of participants with probable depression (76.4±49.2 days) was significantly longer than that of participants without probable depression (44.9±39.2 days). An analysis using the general linear model to assess the effect on LOHS revealed a significant interaction between the presence of probable depression and NIHSS scores. CONCLUSION Depression after stroke was associated with significant increases in LOHS. Early detection and treatment for depression are necessary for patients with ischemic stroke.
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Affiliation(s)
- Norio Sugawara
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | | | - Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Shin Saito
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | | | - Tetsu Tomita
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | | | - Ken Okumura
- Department of Cardiology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
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Chen YK, Qu JF, Xiao WM, Li WY, Weng HY, Li W, Liu YL, Luo GP, Fang XW, Ungvari GS, Xiang YT. Poststroke fatigue: risk factors and its effect on functional status and health-related quality of life. Int J Stroke 2014; 10:506-12. [PMID: 25472471 DOI: 10.1111/ijs.12409] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/13/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fatigue is a common problem in ischemic stroke survivors. The mechanisms of poststroke fatigue are uncertain yet. The effects of it on functional status have rarely been studied. AIMS The aim of this study was to investigate the risk factors of poststroke fatigue and its effect on activities of daily living and health-related quality of life in Chinese patients with ischemic stroke. METHODS Two hundred and eighteen patients with ischemic stroke formed the study sample. A comprehensive assessment, including the Fatigue Severity Scale, Hamilton Depression Rating Scale, Lawton activities of daily living scale, and the stroke-specific quality of life scale, was conducted three-months after stroke. Magnetic resonance imaging scans focused on the evaluation of infarctions, white matter lesions, and brain atrophy. RESULTS In the whole sample, with Fatigue Severity Scale as the dependent variable in a linear regression model, Hamilton Depression Rating Scale, prestroke fatigue, and the National Institutes of Health Stroke Scale score at admission were significant correlates of Fatigue Severity Scale, accounting for 36% of the variance of it. When subjects with depression (Hamilton Depression Rating Scale ≥ 20 or current usage of antidepressants) were excluded, only Hamilton Depression Rating Scale and prestroke fatigue remained significant correlates of Fatigue Severity Scale, accounting for 33% of the variance of Fatigue Severity Scale. No magnetic resonance imaging variables correlated with Fatigue Severity Scale. In bivariate correlation analyses, Fatigue Severity Scale was significantly correlated with both activities of daily living and stroke-specific quality of life. In linear regression models, Fatigue Severity Scale independently contributed to activities of daily living accounting for 27% of the variance. Fatigue Severity Scale was also a significant contributor to stroke-specific quality of life accounting for 39% of the variance. CONCLUSION Depressive symptoms and prestroke fatigue are major correlates of poststroke fatigue while more severe poststroke fatigue is associated with poorer activities of daily living and health-related quality of life.
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Affiliation(s)
- Yang Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, China
| | - Wei Min Xiao
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, China
| | - Wan Yi Li
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, China
| | - Han Yu Weng
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, China
| | - Wei Li
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, China
| | - Yong Lin Liu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, China
| | - Gen Pei Luo
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, China
| | - Xue Wen Fang
- Department of Radiology, Dongguan People's Hospital, Dongguan, Guangdong Province, China
| | - Gabor S Ungvari
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.,Medical School, The University of Notre Dame Australia/Marian Centre, Perth, Australia
| | - Yu Tao Xiang
- Faculty of Health Sciences, University of Macau, Macau SAR, China
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Abdullahi A. Is time spent using constraint induced movement therapy an appropriate measure of dose? A critical literature review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.3.140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Auwal Abdullahi
- Assistant Lecturer at the Department of Physiotherapy, Bayero University Kano, Nigeria
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