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Silva AC, Menezes KKP, Scianni AA, Avelino PR, Faria CDCDM. Predictors of health-related quality of life one year after stroke: a systematic review with meta-analysis. Int J Rehabil Res 2024; 47:53-63. [PMID: 38578257 DOI: 10.1097/mrr.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The objective was to investigate, through a systematic review, which independent variables predict health-related quality of life (HRQoL) one year after stroke. Searches were conducted in LILACS, MEDLINE, Scielo, Web of Science, and PEDro. The inclusion criteria were observational longitudinal studies, which included at least one independent variable measured at baseline, as a potential predictor of HRQoL measured 12 months after stroke. The predictors of interest were variables across all domains of the International Classification of Function, Disability and Health. The quality of evidence was rated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). A total of 17 papers were included, involving 8338 participants, and 10 possible predictors of the HRQoL one year after stroke. The meta-analysis was performed for six of them (cognition, depression, neurological deficit, stroke severity, motor impairment, and limitation in activities of daily living), and significant results were found only for limitation in activities of daily living (odds ratio, 1.30 [95% confidence interval, 1.09-1.57]; I2 = 72%; P < 0.01). The descriptive analysis of the remaining four predictors suggested a significant predictive value of balance and functional independence, whereas the results for trunk control were not significant and for social participation were unclear. In conclusion, individuals within the first 11.5 weeks after stroke with lower limitation in activities of daily living, higher functional independence, and better balance, are more likely to have a higher HRQoL one year after stroke. Thus, these predictors, all modifiable factors, need to be targeted during acute rehabilitation.
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Affiliation(s)
- Aryane Caroline Silva
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Braga MAF, Faria-Fortini ID, Dutra TMDFV, Silva EADM, Sant'Anna RV, Faria CDCDM. Functional independence measured in the acute phase of stroke predicts both generic and specific health-related quality of life: a 3-month prospective study in a middle-income country. Disabil Rehabil 2023; 45:4245-4251. [PMID: 36412142 DOI: 10.1080/09638288.2022.2147590] [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: 03/31/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To identify acute predictors of both generic and specific health-related quality of life (HRQoL) 3 months after stroke in individuals from a middle-income country. MATERIALS AND METHODS A 3-month prospective study with individuals who had suffered their first stroke, without previous disability, discharged from a stroke unit. The dependent outcomes, assessed 3 months after stroke, were generic and specific HRQoL (SF-36 and SSQOL total scores, respectively). The predictors assessed in the stroke unit were age, sex, education level, duration of hospital stay, current living arrangement, stroke severity (National Institutes of Health Stroke Scale-NIHSS), functional independence (Modified Barthel Index-MBI), motor impairment (Fugl-Meyer Assessment), and lower- and upper-limb residual muscle strength deficits. Linear multiple regression analyses were employed to identify predictors of both generic (model-1) and specific (model-2) HRQoL (α = 5%). RESULTS One hundred twenty-six individuals were assessed at 3-month post-stroke (61.3 ± 13.6 years). Regression analysis showed that functional independence was the best predictor of both generic (R2 = 21%; F = 34.82; p < 0.001) and specific (R2 = 29%; F = 51.71; p < 0.001) HRQoL at 3-month post-stroke. CONCLUSION Both generic and specific HRQoL at 3-month post-stroke can be predicted by functional independence assessed in the acute phase with the MBI.
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Affiliation(s)
| | - Iza de Faria-Fortini
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | | | | | - Romeu Vale Sant'Anna
- Risoleta Toletino Neves Hospital, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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Kim MS, Min JH, Shin YI, Sohn MK, Lee J, Kim DY, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Kim YH, Ko SH, Chang WH. Predictors of quality of life at 6 months in patients with mild stroke: A prospective observational cohort study. J Stroke Cerebrovasc Dis 2023; 32:107302. [PMID: 37703592 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107302] [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: 03/21/2023] [Revised: 07/04/2023] [Accepted: 08/06/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVES This study aimed to analyze the factors affecting the long-term quality of life of patients with mild stroke and evaluate the differences according to age and sex. MATERIALS AND METHODS The Korean Stroke Cohort for functioning and rehabilitation data was used, and patients with mild stroke with a National Institute of Health Stroke Scale score of < 5 were included. Quality of life after 6 months was analyzed using EuroQol-5 dimensions. Demographic and clinical characteristics were evaluated, and factors affecting the quality of life at 6 months were analyzed. RESULTS Age, current drinking, marital status, length of stay, and modified Rankin Scale, Fugl-Meyer assessment, Functional Independence Measure, and Geriatric Depression Scale scores affected the quality of life at 6 months in patients with mild stroke. Fugl-Meyer assessment score was a predictor for those aged < 65 years, while the functional ambulatory category was a predictor for those aged ≥ 65 years. Predictors of quality of life, excluding alcohol consumption, were comparable between male and female. CONCLUSIONS Among patients aged <65 years, individuals who consumed alcohol, and those who showed better motor function and fewer comorbidities had a higher quality of life. Among patients aged ≥65 years, quality of life was higher in males, younger age, married individuals, those with diabetes, and those with a better walking ability. Among male, individuals who consumed alcohol had a higher quality of life. Rehabilitation treatment should prioritize improving modifiable factors to enhance the quality of life in patients with mild stroke.
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Affiliation(s)
- Mu Su Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Yang Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Gurková E, Štureková L, Mandysová P, Šaňák D. Factors affecting the quality of life after ischemic stroke in young adults: a scoping review. Health Qual Life Outcomes 2023; 21:4. [PMID: 36653785 PMCID: PMC9850784 DOI: 10.1186/s12955-023-02090-5] [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: 05/31/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To synthesize the body of knowledge on the factors influencing the quality of life (QoL) after ischemic stroke (IS) in young adults. METHODS Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA-ScR checklist for a scoping review was used in this paper. A total of 1197 studies were identified through a bibliographic search in Web of Science, MEDLINE, PsycInfo, ScienceDirect, Scopus, and ProQuest Science Database. Articles published between the years 2000-2021 were included. RESULTS A total of nine papers were finally selected to respond to the research question. Three studies were prospective longitudinal studies compared QoL between young stroke and age-matched controls from the general population. Across all the analysed studies, 14 variables potentially associated with QoL were identified. QoL in young patients is mainly affected by clinical outcomes after IS (scored by the modified Rankin scale and the Barthel index-favourable initial functional status and higher independence in ADL leads to higher QoL) and psychological factors (post-stroke fatigue and depression-higher levels of fatigue and depression lead to lower QoL). The reviewed studies emphasized the importance of functional outcomes, post-stroke depression, fatigue and anxiety and early return to work. CONCLUSION Further longitudinal studies are needed to identify the trajectory of post-stroke psychosocial symptoms over time and other potential predictors of unfavourable long-term QoL, thus specific young stroke rehabilitation and stroke self-management support programmes should be developed (address physical, psychological factors which influence the psychosocial adaptation post-stroke and the perception of the QoL).
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Affiliation(s)
- Elena Gurková
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Lenka Štureková
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Petra Mandysová
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Daniel Šaňák
- grid.10979.360000 0001 1245 3953Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
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Lawan MM, Lawal IU, Yusuf AM. Correlates of participation restrictions and quality of life among Hausa women with post-stroke disabilities. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-022-00107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Almost all health professionals refer and use the term participation restrictions in activities of daily living as one of the successful outcomes of stroke rehabilitation. Higher occurrences of stroke-related functional disability among women who suffer stroke tend to affect their quality of life, participation in, and reintegration into the community in general. Hence, the aim of this study is to investigate the correlation of participation restrictions and quality of life of Hausa women post-stroke event.
Method
This study employed a cross-sectional design; 67 post-stroke patients were recruited and assessed for participation using Stoke Impact Scale (SIS 3.0), quality of life was assessed using SSQOL, and MRS was used to assess post-stroke disabilities.
Results
Findings of this study indicate participation to be significantly related to quality of life (r = 0.801, P = 0.000). Participation was significantly related to limb strength (r = 0.606, P = 0.000), mood and emotions (r = 0.399, P = 0.001), ADL (r = 0.733, P = 0.000), mobility (r = 0.564, P = 0.000), and hand function (r = 0.687, P = 0.000). Recovery from stroke was found to be a determinant of participation (r = 0.624, P = 0.000).
Conclusion
Correlates of participation in Hausa women who suffered stroke are quality of life, strength, mood and emotions, ADL, mobility, hand function, and level of recovery from stroke. Both participation and quality of life also inversely correlated significantly with demographic factors of age and stroke severity.
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Dos Santos HM, de Oliveira LC, Bonifácio SR, Brandão TCP, Silva WP, Pereira GS, Silva SM. Use of the International Classification of Functioning, Disability and Health (ICF) to expand and standardize the assessment of quality-of-life following a stroke: proposal for the use of codes and qualifiers. Disabil Rehabil 2022; 44:7449-7454. [PMID: 34752176 DOI: 10.1080/09638288.2021.1995055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Propose a way of coding and qualifying HRQoL following a stroke using the codes and qualifiers of the International Classification of Functioning, Disability and Health (ICF). METHODS An observational, cross-sectional study was conducted involving 51 individuals with hemiparesis resulting from a stroke. ICF codes related to the Stroke Specific Quality of Life (SS-QOL) scale were listed and subsequently classified using the generic ICF qualifiers, which range from .0 - no impairment to .4 - complete impairment. A simple mathematic calculation was proposed to convert the SS-QOL scores into ICF qualifiers. RESULTS The use of the ICF qualifiers revealed that the individuals exhibited a moderate level (.2) of quality of life, with mild impairment (.1) regarding upper limb function, language, self-care, and vision as well as severe impairment (.3) regarding social relations. CONCLUSIONS The proposal presented in this study allowed qualifying 43 ICF codes related to quality of life after a stroke in a simple, standardized manner, enabling the identification of different levels of impairment on each of the domains of the SS-QOL scale. This coding standardizes the evaluation, facilitates communication between healthcare providers, and systematizes the collection of data and information on health.Implications for rehabilitationProposal for qualifying concepts related to body functions, activity & participation, and environmental factors in a simple, standardized manner.The proposed mathematic calculation is simple and easy to understand, which minimizes the occurrence of errors.Possibility to identify different levels of impairment in each of the domains of the Stroke Specific Quality of Life scale, facilitating the establishment of individualized, longitudinal care.The ICF codes standardize the evaluation, facilitate communication between healthcare providers, and systematize the collection of data and information on health and functioning.
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Affiliation(s)
| | - Leia Cordeiro de Oliveira
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Sandra Regina Bonifácio
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | | | - Wallace Pereira Silva
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Gabriela Santos Pereira
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Soraia Micaela Silva
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
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Adigwe G. Quality of life of stroke survivors in Nigeria (Low-income country). Can outcome be predicted? J Clin Hypertens (Greenwich) 2021; 23:1459-1462. [PMID: 34196105 PMCID: PMC8678786 DOI: 10.1111/jch.14258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Gloria Adigwe
- School of Health and Bioscience, University of East London, London, UK
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Resilience is an independent correlate of the course of quality of life in patients with first-ever ischemic stroke. Int Psychogeriatr 2021; 33:567-575. [PMID: 32418551 DOI: 10.1017/s1041610220000587] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To explore the changes in quality of life from the acute hospitalization period to 6 months after discharge in patients with first-ever ischemic stroke and to identify the association between resilience and the course of quality of life. DESIGN A prospective longitudinal cohort study. SETTING This study was conducted in Shanghai, China. PARTICIPANTS Two hundred and seventeen stroke patients were recruited for an initial questionnaire survey from two tertiary hospitals from February 2017 to January 2018. INTERVENTION None. MEASUREMENTS Quality of life was measured using the Stroke Scale Quality of Life. Resilience was assessed using the Connor-Davidson Resilience Scale. Other validated measurement instruments included the modified Rankin Scale and Hospital Anxiety and Depression Scale. A multilevel model was used for the analysis of repeated measurements and to determine the association between resilience and quality of life. RESULTS Quality of life scores significantly improved over the 6 months after discharge (B = 7.31, p < .0001). The multilevel model indicated that resilience was positively correlated with the course of quality of life (B = .133, p < .0001), independent of stroke severity (B = -.051, p = .0006), neurological function (B = -.577, p < .0001), hospitalization days (B = .023, p = .0099), anxiety (B = -.100, p =< .0001), depression (B = -.149, p < .0001), time (B = .360, p < .0001), and the interactions of time with hospitalization days (B = -.008, p = .0002), neurological function (B = .021, p < .0024), depression (B = -.014, p = .0273), and time (B = -.031, p < .0001). CONCLUSIONS Resilience played an important role in predicting the self-reported course of quality of life in stroke patients. Our findings emphasized the reasonableness and importance of developing suitable resilience-targeted clinical strategies for improving prognosis in stroke patients.
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Kim CH, Chu H, Kang GH, Kim KH, Lee YU, Lim HS, Sung KK, Lee S. Comparison of gait recovery patterns according to the paralyzed side in stroke patients: An observational study based on a retrospective chart review (STROBE compliant). Medicine (Baltimore) 2021; 100:e25212. [PMID: 33879656 PMCID: PMC8078470 DOI: 10.1097/md.0000000000025212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
Gait rehabilitations have been abundantly performed for post-stroke patients, because gait is the most important factor for the return of post-stroke patients to daily life. However, conventional uniform gait rehabilitations tend to be tedious and reduce motivation. The aim of this study was to contribute to the development of personalized rehabilitation of gait by identifying differences in gait recovery pattern according to the paralyzed side of post-stroke patients.The gait analysis was performed on stroke patients who are right-handed and can walk independently. We retrospectively analyzed the results of pelvic movements and displacement of center of pressure (COP) during gait using corresponding equipments. To show the difference of gait recovery pattern according to the paralyzed side, we divided subjects into two groups, right (n = 19) and left (n = 20) hemiparesis group. The measured variables were as follows: tilt, obliquity, and rotation symmetries of pelvis; area, velocity, and lateral symmetry of COP.First, in the left hemiparesis group, obliquity (P < .01) and rotation (P < .01) symmetries of the movement of the pelvis were significantly improved in the follow-up compared to the initial gait analysis. In the right hemiparesis group, tilt (P < .001), obliquity (P < .001), and rotation (P < .05) symmetries were significantly improved in the follow-up compared to the initial gait analysis. Second, COP area and COP velocity values in the follow-up were significantly smaller than those in the initial gait analysis in the left (P < .001, P < .05) and right (P < .001, P < .01) hemiparesis groups. The positive value of lateral symmetry increased, although not a significant difference statistically, as walking ability improved in both groups. In the correlation analysis among variables obtained using Treadmill, there were significant positive linear relationships between the lateral symmetry and the COP area (P < .05), and between the COP velocity and the lateral symmetry (P < .001) of the follow-up gait analysis in the right hemiparesis group.It was confirmed that the gait recovery pattern differs according to the paralyzed side of post-stroke patients and the role of the intact side, such as moving the COP to the intact side, is important for the improvement of gait function in both groups.This study was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002984) and was approved by the Institutional Review Board (IRB) of the WKUGH (WKIRB [2018-25], November 28, 2018).
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Affiliation(s)
| | - Hongmin Chu
- Department of Internal Medicine and Neuroscience
| | - Geon-Hui Kang
- Hanbang Cardio-Renal Syndrome Research Center, College of Oriental Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Kwang-Ho Kim
- Department of Internal Medicine and Neuroscience
| | | | | | | | - Sangkwan Lee
- Department of Internal Medicine and Neuroscience
- Hanbang Cardio-Renal Syndrome Research Center, College of Oriental Medicine, Wonkwang University, Iksan, Republic of Korea
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Gadson DS, Wallace G, Young HN, Vail C, Finn P. The relationship between health-related quality of life, perceived social support, and social network size in African Americans with aphasia: a cross-sectional study. Top Stroke Rehabil 2021; 29:230-239. [PMID: 33866954 DOI: 10.1080/10749357.2021.1911749] [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: 10/21/2022]
Abstract
Stroke significantly impairs health-related quality of life (HRQL). Stroke survivors with aphasia (SWA) experience lower HRQL than stroke survivors without aphasia (SSA) as a result of poorer communication and social functioning. The extent to which aphasia influences HRQL in African-Americans and the components of social functioning that are most important to HRQL warrants further exploration.There were two main objectives of this paper. The first was to survey HRQL domains of communication, physical, mental/emotional, role, and social functioning in African American SWA and SSA. The second was to examine if social support and social network predicted HRQL in SWA.A total of 39 African American adults (62.4 ± 11.10) participated in this descriptive cross-sectional case control study. Patient-reported outcome measures were used to assess HRQL, perceived social support, and social network in SWA, SSA, and normal-aging healthy controls (NAH). Data analysis included an ANOVA and moderator regression to determine if social support or social network predicted HRQL in SWA.SWA reported a significantly lower overall HRQL (p = <.000) than NAH adults. Communication HRQL was the hallmark difference found between SWA and SSA (p = <.000). Social support and social network were relatively similar among all three groups. However, social support and social network did not predict HRQL in SWA.Findings from this study suggest that social HRQL continues to be significantly lower in SWA; however, social support and social network factors do not drive differences among African-Americans. Moreover, communication HRQL remains the hallmark difference between SWA and SSA.
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Affiliation(s)
- Davetrina Seles Gadson
- Department of Communication Sciences and Special Education, University of Georgia, Athens, United States
| | - Gloriajean Wallace
- Speech Language Pathology, Xavier University of Louisiana, New Orleans, United States
| | - Henry N Young
- Department of Clinical Administrative Pharmacy, University of Georgia, Athens, United States
| | - Cynthia Vail
- Department of Communication Sciences and Special Education, University of Georgia, Athens, United States
| | - Patrick Finn
- Department of Communication Sciences and Special Education, University of Georgia, Athens, United States
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Zhou X, Liu Z, Zhang W, Zhou L. Resilience is associated with post-stoke depression in Chinese stroke survivors: A longitudinal study. J Affect Disord 2020; 273:402-409. [PMID: 32560935 DOI: 10.1016/j.jad.2020.04.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/28/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Optimal strategies for prevention and treatment for post-stroke depression (PSD) remain unclear and a greater understanding of effect of resilience on PSD is promising. The aim was to examine the association between baseline resilience and depression at 1, 3, and 6 months after discharge, which contributes to early detection and management of PSD. METHODS A total of 217 ischemic stroke survivors were recruited in two tertiary hospitals in Shanghai, China from February 2017 to January 2018. The Chinese version of Connor-Davidson Resilience Scale (CD-RISC) was used to assess resilience at acute hospitalization. Hospital Anxiety and Depression Scale (HADS) was employed to ascertain baseline anxiety, baseline depression, and post-discharge depression. Social-demographic and disease-related information were obtained from participants' self-report and medical records. Logistic regression analysis was used to determine which factors were independently associated with PSD. RESULTS The prevalence of depression at baseline was 21.2% and at 1, 3, and 6 months after discharge was 34.4%, 33.2%, and 29.2%, respectively. Logistics regression analyses indicated that resilience may independently predict PSD at 1 month (OR: 0.22, 95%CI: 0.097, 0.518), 3 months (OR:0.302, 95%CI: 0.151, 0.607), and 6 months (OR: 0.03, 95%CI: 0.006, 0.153) after controlling for social-demographics, disease-related characteristics, baseline anxiety, and baseline depression. LIMITATIONS Non-multicenter survey and mild stroke severity may affect the generalization of these findings. Moreover, response bias should be acknowledged because some participants were read questionnaires out aloud. CONCLUSION Resilience is independently associated with PSD at different timepoints. Our findings reveal the important role of resilience as a protective factor against PSD.
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Affiliation(s)
- Xuan Zhou
- Nursing Department, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China; Clinical Nursing Department, School of Nursing, Second Military Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433, China
| | - Zhihui Liu
- Clinical Nursing Department, School of Nursing, Second Military Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433, China
| | - Wei Zhang
- Clinical Nursing Department, School of Nursing, Second Military Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433, China
| | - Lanshu Zhou
- Clinical Nursing Department, School of Nursing, Second Military Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433, China.
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Bello UM, Chutiyami M, Salihu D, Abdu SI, Tafida BA, Jabbo AA, Gamawa A, Umar L, Lawan A, Miller T, Winser SJ. Quality of life of stroke survivors in Africa: a systematic review and meta-analysis. Qual Life Res 2020; 30:1-19. [PMID: 32712933 DOI: 10.1007/s11136-020-02591-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Functional impairments and socioeconomic constraints associated with stroke affect quality of life (QoL). With limited care and social support resources, there is a greater anticipated decline in QoL among stroke survivors in Africa. This study aims to examine post-stroke QoL, properties of outcome measures adopted and predictors of the QoL among African stroke survivors. METHODS African Journals Online, CINAHL, PsychINFO, PubMed and Web of Science databases were searched from inception to February 2020. Methodological quality was assessed using the Agency for Healthcare Research and Quality (ARHQ) methodology checklist for observational studies. RESULTS Twenty-eight studies recruiting 2572 (76.4%) stroke survivors and 795 (23.6%) healthy volunteers were included. Studies were conducted in eight African countries between 2007 and 2019. Methodological quality of studies was good. Overall, stroke survivors reported a low QoL. Six studies comparing QoL between stroke survivors and healthy controls were pooled for meta-analysis. Results showed a biased-adjusted standardised mean difference (Hedges's g) of 1.13 (95% CI 0.71 to 1.56; p < 0.001), indicating better QoL among healthy controls. Only 4 (14.3%) studies used translated or cross-culturally adapted QoL assessment tools. The most commonly reported predictor of QoL was post-stroke disability (35.8% of studies) which is followed by depression (28.6%) and stroke severity (28.6%). CONCLUSIONS Overall, African stroke survivors reported comparatively lower QoL as compared to age-matched healthy controls. This highlights the need for cross-culturally validated assessment tools and more robust post-stroke QoL evaluation across the African continent. To improve QoL of stroke survivors in Africa, early interventions should focus on reducing disability and depression associated with stroke. PROSPERO registration number: CRD42019137653.
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Affiliation(s)
- Umar Muhammad Bello
- Yobe State University Teaching Hospital, Damaturu, Yobe State, Nigeria.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Muhammad Chutiyami
- Faculty of Human Sciences, Macquarie University, Sydney, Australia. .,Shehu Sule College of Nursing and Midwifery Damaturu, Damaturu, Yobe State, Nigeria.
| | - Dauda Salihu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Sham'un Isah Abdu
- Physiotherapy Department, Kazaure General Hospital, Kazaure, Jigawa State, Nigeria
| | | | - Abdulhamid Ardo Jabbo
- Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Adamu Gamawa
- Physiotherapy Department, Bauchi State Specialist Hospital, Bauchi, Bauchi State, Nigeria
| | - Lawan Umar
- Physiotherapy Department, Federal Medical Centre, Azare, Bauchi State, Nigeria
| | - Aliyu Lawan
- Department of Rehabilitation Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Stanley John Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Queralt-Tomas L, Clua-Espuny JL, Fernández-Saez J, Lleixà-Fortuño MM, Albiol-Zaragoza I, Gil-Guillen V, Carratala-Munuera C. Risk of Dependency: A Challenge for Health and Social Care Planning-Observational Stroke Cohort. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1083-1091. [PMID: 31563250 DOI: 10.1016/j.jval.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND After a stroke, families require the coordinated assistance of health and social care. Currently there is a lack of comprehensive evaluation and assessment tools to identify discharge needs, and there is separate management of health and social resources, and access to these services is variable between regions. OBJECTIVE The main objective of this study was to assess the factors associated with risk of dependency after stroke and propose a suitable instrument for identifying patients at higher risk. METHODS This was a 2-year prospective and community study of a stroke cohort. The primary outcome was recognized dependency. The potential predictors were considered in a multivariate regression and area under curve (AUC) to evaluate its discriminative capacity. RESULTS Overall, 233 stroke survivors were recruited, 49.8% of whom were women, and the average age was 78.1 ± 11.6 years. The total rate of dependency was 31.5 (95% confidence interval [CI] 26.1-37.7) cases/100 person-years. The independent factors associated with dependency outcome were age >80 years (hazard ratio [HR] 2.03, 95% CI 1.32-3.12, P = .001), Pfeiffer score ≥4 (HR 1.82, 95% CI 1.25-1.2.66, P = .002), Barthel score <60 (HR 1.79, 95% CI 1.21-2.66, P = .003), and Charlson score ≥3 (HR 1.49, 95% CI 1.02-2.16, P = .039). The AUC was 0.84 (95% CI 0.79-0.89; P < .001). CONCLUSIONS Stroke has serious effects on the dependency outcomes. The patient's age, cognitive or physical impairment, and comorbidities as measured on the Pfeiffer score, Barthel Index, and Charlson score identified people at high risk and may ease the integrated role of social and health services.
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Affiliation(s)
- Luisa Queralt-Tomas
- Catalonian Health Institute, Primary Care Service Terres de l'Ebre, Health Department, Generalitat de Catalunya, Primary Care Centre, Xerta, Spain.
| | - J L Clua-Espuny
- Research Institute University Primary Care (IDIAP) Jordi Gol, Catalonian Health Institute, Tortosa, Spain
| | - J Fernández-Saez
- Unitat de Suport a la Recerca Terres de l'Ebre, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Grupo de investigación de Salud Pública, Universidad de Alicante, Spain
| | - M Mar Lleixà-Fortuño
- Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Hospital Verge de la Cinta, Tortosa, Spain
| | - Irene Albiol-Zaragoza
- Departament de Treball, Afers Socials i Famílies, Serveis Territorials de les Terres de l' Ebre, Amposta, Spain
| | - Vicente Gil-Guillen
- Family Medicine Department, Universidad Miguel Hernández, Ctra. Valencia, Sant Joan d'Alacant, Spain
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Sarfo FS, Agbenorku M, Adamu S, Obese V, Berchie P, Ovbiagele B. The dynamics of Poststroke depression among Ghanaians. J Neurol Sci 2019; 405:116410. [PMID: 31425901 DOI: 10.1016/j.jns.2019.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/17/2019] [Accepted: 07/22/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The very few published data on post-stroke depression (PSD) among indigenous Africans have covered its prevalence and predictors. We sought to evaluate the dynamics of PSD in a cohort of Ghanaian stroke survivors followed for 9 months after an acute stroke. METHODS Stroke survivors in this prospective cohort were adults aged >18 years with CT scan confirmed stroke, recruited into a randomized controlled trial to assess the feasibility of an mHealth technology-enabled, nurse guided intervention for blood pressure control. PSD was assessed a secondary outcome measure using the Hamilton Depression Rating Scale (HDRS) at enrollment, months 3, 6, and 9. Those with a score of >7 points on HDRS were categorized as depressed. A multivariate logistic regression analysis was performed to identify independent predictors of PSF. RESULTS Mean age of study participants was 55.1 ± 12.7 years with 65% being males. Ischemic strokes comprised 76.6% of study population. Prevalence of PSD at baseline was 78.6%, 43.6% at month 3, 41.1% at month 6 and 18.2% at month 9 (p < .0001). Factors significantly associated with PSD at baseline were higher NIH Stoke Scale score (adjusted OR 1.51, 95% CI: 1.03-2.23) and pain (adjusted OR 7.18, 95% CI: 1.52-33.89). NIHSS score (adjusted OR, 1.99, 95% CI: 1.12-3.52) as associated with PSD at month 9. CONCLUSION 80% Ghanaian stroke survivors have early PSD declining to 20% at month 9. Stroke severity is the persistent factor associated with PSD at baseline and follow-up, and good be a target for screening and promptly treating PSD.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Manolo Agbenorku
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sheila Adamu
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Vida Obese
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Patrick Berchie
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
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Peng LN, Chen LJ, Lu WH, Tsai SL, Chen LK, Hsiao FY. Post-acute care regains quality of life among middle-aged and older stroke patients in Taiwan. Arch Gerontol Geriatr 2019; 83:271-276. [DOI: 10.1016/j.archger.2019.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 12/25/2022]
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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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17
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Depression after Stroke in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Behav Neurol 2017; 2017:4160259. [PMID: 28819339 PMCID: PMC5551463 DOI: 10.1155/2017/4160259] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/15/2017] [Accepted: 05/31/2017] [Indexed: 11/27/2022] Open
Abstract
Objective We aimed to conduct a systematic review and meta-analysis of prevalence and characteristics of poststroke depression (PSD) in sub-Saharan Africa (SSA). Methods We searched Medline, PsycINFO, and African Journals OnLine using keywords for stroke and depression and the .mp. operator for all 54 SSA countries/regions. Further information was retrieved through a manual search of references from relevant published and unpublished articles. We included only peer-reviewed original studies with epidemiological or experimental designs, conducted random-effect meta-analysis, and identified the most commonly associated factors by weight (inverse of variance method). Results Seventeen studies, comprising 1483 stroke survivors, met the criteria for syntheses. The pooled frequency of clinically diagnosed PSD was 31% (95% CI = 26%–36%), versus 13.9% in healthy control pairs. Prevalence did not vary much across healthcare settings but was affected by methods of depression ascertainment. PSD was significantly associated with low education, cognitive impairment, physical disability, poor quality of life, and divorced marital status. Conclusion Almost 1 in 3 individuals with stroke in SSA has clinical depression. Despite limitations around quality of identified studies, results of the present systematic review overlap with findings in the global literature and highlight useful targets for the design and trial of tailored intervention for PSD in SSA.
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Sarfo FS, Jenkins C, Singh A, Owolabi M, Ojagbemi A, Adusei N, Saulson R, Ovbiagele B. Post-stroke depression in Ghana: Characteristics and correlates. J Neurol Sci 2017; 379:261-265. [PMID: 28716256 DOI: 10.1016/j.jns.2017.06.032] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/16/2017] [Accepted: 06/19/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poststroke depression (PSD) is prevalent and is an important determinant of functional recovery, quality of life and mortality after stroke. Scanty data on the nature of PSD among stroke survivors in sub-Saharan Africa prompted this study. OBJECTIVE To assess the prevalence and predictors of depression in a convenience sample of Ghanaian stroke survivors. METHODS We evaluated consecutive stroke survivors encountered at a comprehensive neurology clinic in a tertiary medical center in Ghana. The Center for Epidemiologic Studies Depression Scale (CES-D) and Geriatric Depression Scale (GDS) were both used to screen for depressive symptoms and subjects were considered as depressed if they scored ≥16 on the CES-D scale and >5 on the GDS. Demographic and clinical data on stroke type and severity as well as health-related quality of life indicators were collected. Predictors of stroke-related depression were assessed using a logistic regression model. RESULTS Of 200 stroke survivors, mean±SD age was 62.0±14.4years, and 105 (52.5%) patients were men. Among the cohort 78.5% were classified as being depressed by CES-D, 42.5% by GDS, and 36.5% on both CES-D and GDS. In multivariable analyses, for each unit increase on the Modified Rankin scale (i.e. worsening disability), there were higher odds of depression (adjusted OR 1.85; 1.28-2.69, p=0.001), and being divorced (vs. being married) was linked to depression (adjusted 2.82; 1.18-6.71, p=0.02). Stroke survivors with depression demonstrated profound diminutions in the physical, psycho-social, cognitive and eco-social domains of quality of life compared with those without depression (p<0.05). CONCLUSION Almost 4 out of 10 stroke survivors in this Ghanaian cohort displayed clinically significant depression. Prospective interventional studies are urgently needed to provide solid evidence-based and culturally tailored interventions to address post-stroke depression particularly in LMICs.
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Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | - Arti Singh
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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Tse T, Binte Yusoff SZ, Churilov L, Ma H, Davis S, Donnan GA, Carey LM. Increased work and social engagement is associated with increased stroke specific quality of life in stroke survivors at 3 months and 12 months post-stroke: a longitudinal study of an Australian stroke cohort. Top Stroke Rehabil 2017; 24:405-414. [PMID: 28438076 DOI: 10.1080/10749357.2017.1318339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a relative lack of longitudinal studies investigating stroke-specific outcomes and quality of life (QOL). This study aimed to identify which factors (level of disability, cognitive functioning, depressive symptoms, physical activity, and work and social engagement) were independently associated with each stroke-specific domain of QOL, adjusting for age and gender, at 3 months and 12 months post-stroke in an Australian cohort. METHOD Survivors of ischemic stroke were recruited from 18 sites of the STroke imAging pRevention and Treatment (START) longitudinal cohort study. Survivors were assessed at 3 months (n = 185) and 12 months (n = 170) post-stroke using the Stroke Impact Scale (SIS), modified Rankin Scale (mRS), Montreal Cognitive Assessment (MoCA), Montgomery-Asberg Depression Rating Scale, Rapid Assessment of Physical Activity, and Work and Social Adjustment Scale (WSAS). RESULTS WSAS was independently associated with the SIS domains of: Physical Composite function; Participation; and Perceived Recovery at 3 months and 12 months and SIS domain of Emotion at 12 months post-stroke. The presence of depressive symptoms was independently associated with the SIS domains of: Memory and Thinking; and Emotion at 3 months. At 12 months post-stroke, mRS was independently associated with SIS domain of Physical Composite function and MoCA with SIS domain of Communication. CONCLUSION Engaging in work and social activities is an important factor associated with stroke-specific domains of QOL over time. It is recommended that services focus on improving work and social engagement given their importance related to QOL in the first year of recovery post-stroke. Identifying and treating those with depressive symptoms may enhance QOL in the early months post-stroke. TRIAL REGISTRATION START-PrePARE Australian New Zealand Clinical Trials, www.anzctr.org.au , Registry number: ACTRN12610000987066. EXTEND ClinicalTrial.gov identifier: NCT00887328.
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Affiliation(s)
- Tamara Tse
- a Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health , La Trobe University , Melbourne , Australia.,b Neurorehabilitation and Recovery, Stroke Division , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia
| | - Siti Zubaidah Binte Yusoff
- a Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health , La Trobe University , Melbourne , Australia.,c Ang Mo Kio - Thye Hua Kwan Hospital , Ang Mo Kio , Singapore
| | - Leonid Churilov
- d Statistics and Decision Analysis Academic Platform , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia.,e School of Mathematical and Geospatial Sciences , RMIT University , Melbourne , Australia
| | - Henry Ma
- f Department of Medicine, Stroke Unit, Monash Health , Monash University , Clayton , Australia.,g The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia
| | - Stephen Davis
- h Department of Medicine, Melbourne Brain Centre , Royal Melbourne Hospital, University of Melbourne , Parkville , Australia
| | - Geoffrey Alan Donnan
- g The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia.,i Florey Department of Neuroscience and Mental Health , The University of Melbourne , Parkville , Australia
| | - Leeanne M Carey
- a Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health , La Trobe University , Melbourne , Australia.,b Neurorehabilitation and Recovery, Stroke Division , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia
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Comparison of Two Post-Stroke Rehabilitation Programs: A Follow-Up Study among Primary versus Specialized Health Care. PLoS One 2016; 11:e0166242. [PMID: 27835673 PMCID: PMC5106026 DOI: 10.1371/journal.pone.0166242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 10/25/2016] [Indexed: 12/11/2022] Open
Abstract
Objective To compare home-based rehabilitation (RITH) and standard outpatient rehabilitation in a hospital setting, in terms of improving the functional recovery and quality of life of stroke patients. Study Design and Setting This was a prospective cohort study in Andalusia (Spain). Participants One hundred and forty-five patients completed the outcome data. Measures Daily activities were measured by the Barthel index, Canadian Neurological Scale (to assess mental state), Tinetti scale (balance and gait), and Short Form Health Survey-36 (SF-36 to compare the quality of life). Results No statistically significant differences were found between the two groups regarding the clinical characteristics of patients in the initial measurement, except for age and mental state (younger and with greater neurological impairment in the hospital group). After physical therapy, both groups showed statistically significant improvements from baseline in each of the measures. These improvements were better in RITH patients than in the hospital patients on all functionality scales with a smaller number of sessions. Conclusions Home rehabilitation is at least as effective as the outpatient rehabilitation programs in a hospital setting, in terms of recovery of functionality in post-stroke patients. Overall quality of life is severely impaired in both groups, as stroke is a very disabling disease that radically affects patients’ lives.
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Wondergem R, Pisters MF, Wouters EJ, Olthof N, de Bie RA, Visser-Meily JM, Veenhof C. The Course of Activities in Daily Living: Who Is at Risk for Decline after First Ever Stroke? Cerebrovasc Dis 2016; 43:1-8. [DOI: 10.1159/000451034] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 09/16/2016] [Indexed: 11/19/2022] Open
Abstract
Background: Stroke is not only an acute disease, but for the majority of patients, it also becomes a chronic condition. There is a major concern about the long-term follow-up with respect to activities of daily living (ADL) in stroke survivors. Some patients seem to be at risk for decline after a first-ever stroke. The purpose of this study was to determine the course of ADL from 3 months after the first-ever stroke and onward and identify factors associated with decline in ADL. Methods: A systematic literature search of 3 electronic databases through June 2015 was conducted. Longitudinal studies evaluating changes in ADL from 3 months post stroke onward were included. Cohorts including recurrent strokes and transient ischemic attacks were excluded. Regarding the course of ADL, a meta-analysis was performed using random-effects model. A best evidence synthesis was performed to identify factors associated with decline in ADL. Results: Out of 10,473 publications, 28 unique studies were included. A small but significant improvement in ADL was found from 3 to 12 months post stroke (standardized mean difference (SMD) 0.17 (0.04-0.30)), which mainly seemed to occur between 3 and 6 months post stroke (SMD 0.15 (0.05-0.26)). From 1 to 3 years post stroke, no significant change was found. Five studies found a decline in ADL status over time in 12-40% of patients. Nine factors were associated with ADL decline. There is moderate evidence for being dependent in ADL and impaired motor function of the leg. Limited evidence was found associated with insurance status, living alone, age ≥80, inactive state and having impaired cognitive function, depression and fatigue with decline in ADL. Conclusion: Although on an average patients do not seem to decline in ADL for up to 3 years, there is considerable variation within the population. Some modifiable factors associated with decline in ADL were identified. However, more research is needed before patients at risk of deterioration in ADL can be identified.
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Oyewole OO, Ogunlana MO, Gbiri CAO, Oritogun KS. Prevalence and impact of disability and sexual dysfunction on Health-Related Quality of Life of Nigerian stroke survivors. Disabil Rehabil 2016; 39:2081-2086. [PMID: 27548503 DOI: 10.1080/09638288.2016.1219395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the impact of disability and sexual dysfunction on Health-Related Quality of Life (HRQoL) among Nigerian stroke survivors (SSv) and to determine their association using sexual functioning (SF), Global Disability Measure and Function (GDMF), and demographic profiles. METHODS This study involved 121 consecutive SSv attending healthcare services in two tertiary health facilities in Nigeria. Demographic details were obtained through interview while HRQoL, SF, and Global Disability (GD) were assessed using Stroke-Specific Quality of Life (SS-QoL-12), Changes in Sexual Functioning Questionnaire (CSFQ-14), and World Health Organization Disability Assessment Schedule (WHODAS-2.0), respectively. Determinants of HRQoL were explored using the Poisson regression analysis. RESULTS Most of the SSv had moderate/severe GD (95%) and low SF (86.8%). Their HRQoL decreased with increase in their age (p = 0.005) and with increase in GD (p = 0.001). This association remained unchanged even when adjusted for SF (p = 0.001). Those with low SF but with mild GD had relatively better HRQoL than those with moderate/severe GD even when they had higher SF. Their HRQoL was negatively impacted by their GD but not by their SF despite direct correlation between SF and HRQoL. With a unit increase in level of GD, there was 8% decrease in HRQoL scores in psychosocial and 17% decrease in physical domains. CONCLUSION Although sexual dysfunction and global disability are prevalent among Nigerian SSv, their low HRQoL is determined by their disability and not by SF. Hence, effort at reducing global disability should be the focus of rehabilitation after stroke. Implication for Rehabilitation Global functional and sexual deficiencies abound in stroke survivors and they impact negatively on their overall quality of life. Sexual dysfunction correlates negatively on physical and psychosocial wellbeing of stroke survivors. Rehabilitation goal(s) should focus disability reduction and improvement of sexual functioning to enhance quality of life. Rehabilitation professionals should equip themselves with tools to counsel stroke survivors on sex issue since sexual dysfunction is common post stroke.
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Affiliation(s)
- Olufemi O Oyewole
- a Department of Physiotherapy , Olabisi Onabanjo University Teaching Hospital , Sagamu , Nigeria
| | - Michael O Ogunlana
- b Department of Physiotherapy , Federal Medical Centre , Abeokuta , Nigeria
| | - Caleb A O Gbiri
- c Department of Physiotherapy, College of Medicine , University of Lagos , Lagos , Nigeria
| | - Kolawole S Oritogun
- d Department of Community Medicine and Primary Care , Olabisi Onabanjo University, OACHS , Sagamu , Nigeria
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Shi YZ, Xiang YT, Yang Y, Zhang N, Wang S, Ungvari GS, Chiu HFK, Tang WK, Wang YL, Zhao XQ, Wang YJ, Wang CX. Depression after minor stroke: the association with disability and quality of life--a 1-year follow-up study. Int J Geriatr Psychiatry 2016; 31:421-7. [PMID: 26343540 DOI: 10.1002/gps.4353] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 08/03/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Minor stroke is characterized by mild neurological functional impairment and relatively good outcome. Little is known about the association between post-stroke depression (PSD) and outcomes of minor stroke. The aim of this study was to investigate the association between PSD and disability and quality of life (QoL) at 1 year after minor ischemic stroke. METHODS Patients with first-ever minor ischemic stroke (n = 747) were followed up at 14 ± 2 days, 3 months, 6 months, and 1 year after stroke. Depressive symptoms were assessed at each follow-up. Patients diagnosed with depression at 14 ± 2 days formed the early-onset PSD group; those who were diagnosed with depression at any subsequent follow-ups for the first time constituted the late-onset PSD group. The outcomes of minor stroke including disability (modified Rankin score ≥ 2) and QoL (Short Form-36 Health Survey) were assessed at the 1-year follow-up. RESULTS A total of 198 (26.5%) patients were diagnosed with PSD over the 1-year follow-up; 136 and 62 patients were allocated to the early-onset PSD group and late-onset PSD group, respectively. Both early-onset and late-onset PSD were independently associated with disability and poor physical and mental health at 1 year after stroke. Recovery from depression (n = 112) within 1 year decreased the adverse impacts of PSD on functional outcome and QoL. CONCLUSIONS Post-stroke depression was independently associated with disability and poor QoL at 1 year after first-ever minor ischemic stroke. Recovery from PSD decreased but did not eliminate the adverse impacts of PSD on outcomes of minor stroke.
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Affiliation(s)
- Yu Zhi Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yu Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Yang Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ning Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Gabor S Ungvari
- University of Notre Dame Australia/Marian Centre, Perth, Australia.,School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yi Long Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xing Quan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, 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, China
| | - Chun Xue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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24
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Olaniyan O, Owolabi MO, Akinyemi RO, Salako BL, Hurst S, Arulogun O, Gebregziabher M, Uvere E, Ovbiagele B. Cost and cost-effectiveness analysis of a bundled intervention to enhance outcomes after stroke in Nigeria: Rationale and design. eNeurologicalSci 2015; 1:38-45. [PMID: 26640824 PMCID: PMC4667801 DOI: 10.1016/j.ensci.2015.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/07/2015] [Accepted: 09/13/2015] [Indexed: 11/29/2022] Open
Abstract
The economic and social costs of stroke to the society can be enormous. These costs can cause serious economic damage to both the individual and the nation. It is thus important to conduct a cost effectiveness analysis to indicate whether an intervention provides high value where its health benefits justify its costs. This study will provide evidence based on the costs of stroke with a view of improving intervention and treatments of stoke survivors in Nigeria. This study utilizes two types of economic evaluation methods - cost-effectiveness analysis and cost-benefit analysis - to determine the economic impact of Tailored Hospital-based Risk Reduction to Impede Vascular Events after Stroke (THRIVES) intervention. The study is conducted in four Nigerian hospitals where 400 patients are recruited to participate in the study. The cost-effectiveness of THRIVES post-discharge intervention is compared with the control Intervention scenario, which is the usual and customary care delivered at each health facility in terms of cost per quality adjusted life years (QALYs). It is expected that successful implementation of the project would serve as a model of cost-effective quality stroke care for implementation.
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Affiliation(s)
| | | | - Rufus O Akinyemi
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria ( )
| | | | - Samantha Hurst
- Department of Family and Preventive Medicine, University of California, San Diego, CA ( )
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Nigeria ( )
| | | | - Ezinne Uvere
- Department of Medicine, University of Ibadan, Nigeria ( )
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC ( )
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