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Kurup A, Alby A, Saju AM, Anil A, Jayan A, Chandrababu A, Nazer A, Sankaran R. The Impact of Poststroke Aphasia on Quality of Life: A Comparative Cross-Sectional Study. Cureus 2024; 16:e66988. [PMID: 39280459 PMCID: PMC11402482 DOI: 10.7759/cureus.66988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 08/16/2024] [Indexed: 09/18/2024] Open
Abstract
OBJECTIVES The study aimed to analyze the impact of aphasia on quality of life (QoL) in persons with ischemic stroke per radiological severity, compare equally severe but nonaphasic stroke survivors, and analyze the impact of hyperbaric oxygen therapy (HBOT) exposure. Methods: Patients with first-ever middle cerebral artery (MCA) stroke were categorized by radiological severity into high, intermediate, and low Alberta Stroke Program Early CT Score (ASPECTS). The Stroke Aphasia Quality of Life (SAQoL) Scale was used for outcome analysis. Inclusion criteria were age 40-65, 12-16 months after stroke, MCA distribution, first stroke, and ischemic stroke. Exclusion criteria were mixed vessel involvement and concomitant neurological, orthopedic, or psychiatric comorbidities. RESULTS Among 93 patients with ischemic stroke, 87% presented with intermediate-to-low ASPECTS. According to the SAQoL, locomotion and transfers were the most compromised. QoL was significantly negatively correlated with higher ASPECTS and greater stroke impact in those with aphasia overall (p = 0.001). Those who received HBOT overall were significantly better than those who did not, regardless of group (p = 0.02 and 0.03). CONCLUSION The present study shows that the radiological severity of stroke relates to QoL in those with poststroke aphasia. Among those with equal radiological severity, those with aphasia are worse off. Those who receive HBOT have better QoL.
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Affiliation(s)
- Anupama Kurup
- Department of Physical Medicine and Rehabilitation, Amrita School of Medicine, Kochi, IND
| | - Andrea Alby
- Department of Physical Medicine and Rehabilitation, Amrita School of Medicine, Kochi, IND
| | - Anna M Saju
- Department of Physical Medicine and Rehabilitation, Amrita School of Medicine, Kochi, IND
| | - Anuja Anil
- Department of Physical Medicine and Rehabilitation, Amrita School of Medicine, Kochi, IND
| | - Anuja Jayan
- Department of Physical Medicine and Rehabilitation, Amrita School of Medicine, Kochi, IND
| | - Aparna Chandrababu
- Department of Physical Medicine and Rehabilitation, Amrita School of Medicine, Kochi, IND
| | - Arfaz Nazer
- Department of Physical Medicine and Rehabilitation, Amrita School of Medicine, Kochi, IND
| | - Ravi Sankaran
- Department of Physical Medicine and Rehabilitation, Amrita School of Medicine, Kochi, IND
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Van de Winckel A, Ottiger B, Veerbeek JM, Nyffeler T, Vanbellingen T. Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale. Front Neurol 2023; 14:1154322. [PMID: 37492854 PMCID: PMC10364475 DOI: 10.3389/fneur.2023.1154322] [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: 03/02/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction About 77% of adults with stroke have upper limb impairments. Many scales are available to measure the impairment and activity level of the affected limb. However, an observational scale to assess dependency on others in upper limb performance during daily life activities instead of laboratory settings is lacking. Therefore, we developed a new 5-item Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale (UL-LIMOS). As next step in the psychometric analysis, we evaluated the unidimensionality and structural validity of the UL-LIMOS with Rasch Measurement Theory and we calculated a cut-off score for independent arm use in daily life activities at discharge. Methods This is a single-center cross-sectional study in adults with (sub) acute stroke. We applied Rasch Measurement Theory (RMT) to analyze the structural validation and unidimensionality of the UL-LIMOS. The outputs provide evidence of unidimensionality, item and person fit, overall fit, differential item functioning (DIF), principal component analysis of residuals (PCAR), person separation reliability (PSR), and residual item correlations (to identify local item dependence). Person mean location, floor and ceiling effects identify proper targeting. Results We recruited 407 adults with (sub) acute stroke (median age 63 years, 157 women). All items and persons fit the Rasch model. The PSR of 0.90 indicates that clinicians and researchers can reliably use the scale for individual decision-making. There were small floor (2.70%) and ceiling (13.00%) effects. The average person mean location was 1.32 ± 2.99 logits. There was no DIF. PCAR eigenvalue was 2.46 with 49.23% explained variance. Paired t-tests revealed that 0.89% of person locations were significantly different, confirming unidimensionality. One pair of items (arm and hand use and fine hand use) showed residual item correlations. The ROC's AUC was 0.90, CI95% = [0.85-0.96] with cut-off score of ≥14/20, and high sensitivity (87%, CI95% = [81%-91%]), specificity (83%, CI95% = [77%-87%]) for independent arm use in daily living at discharge. Discussion The new Rasch-based UL-LIMOS is a valid ICF-based observation performance scale at the ICF-activity level, to evaluate dependency during upper limb use in daily life in adults with stroke. Additional psychometric analyses are warranted. The UL-LIMOS would be a valuable addition to the core assessments of adults with (sub) acute stroke.
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Affiliation(s)
- Ann Van de Winckel
- Brain Body Mind Laboratory, Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
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Smith S, Parkinson J, Caitens T, Sanders A, Murphy L, Hamilton K. Promoting adherence to stroke secondary prevention behaviours by imparting behaviour change skills: protocol for a single-arm pilot trial of Living Well After Stroke. BMJ Open 2023; 13:e068003. [PMID: 36693692 PMCID: PMC9884915 DOI: 10.1136/bmjopen-2022-068003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Survivors of stroke have an elevated risk of recurrent stroke. Prompt intervention to support healthy lifestyle modification following an initial stroke is crucial for effective secondary prevention of stroke. However, many patients do not receive adequate postdischarge support for secondary prevention, particularly if not referred to inpatient rehabilitation. Living Well After Stroke is a health promotion programme based on the health action process approach (HAPA), which is designed to support this underserviced group to improve and self-manage secondary prevention behavioural performance (eg, diet, exercise, medication-adherence) by equipping participants with a toolkit of theory-based and evidence-based behaviour change strategies and techniques that are transferable to different behavioural contexts. METHODS AND ANALYSIS The target sample is 118 adults living in Queensland, Australia, with stroke or transient ischaemic attack not referred to inpatient rehabilitation. Adopting a prospective single-arm trial design, the intervention comprises five behaviour change sessions over an 8-week period. Participants will receive a mix of individual-based and group-based assessments and interventions, based on the HAPA theoretical framework, delivered via telehealth or in-person (eg, public library). Measures of primary (ie, goal behaviours 1 and 2) and secondary outcomes (intention, outcome expectancy, risk perception, self-efficacy, planning, action control, subjective well-being) will be taken at 2 weeks, 4 weeks, 8 weeks and 16 weeks. The primary outcomes of the trial will be behavioural performance and transferability of behaviour change skills at 16 weeks. ETHICS AND DISSEMINATION The study has received ethical approval from the Griffith University Human Research Ethics Committee (Ref no: 2022/308). Informed consent is obtained via telephone prior to data collection. Findings will be presented in the form of peer-reviewed journal articles, industry reports and conference presentations, and will be used to inform the continued development and refinement of the programme for testing in a future fully powered trial.
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Affiliation(s)
- Stephanie Smith
- National Stroke Foundation, Brisbane, Queensland, Australia
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Joy Parkinson
- Australian eHealth Research Centre, CSIRO, Herston, Queensland, Australia
| | - Thomas Caitens
- National Stroke Foundation, Brisbane, Queensland, Australia
| | - Andrea Sanders
- National Stroke Foundation, Brisbane, Queensland, Australia
| | - Lisa Murphy
- National Stroke Foundation, Melbourne, Victoria, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Health Sciences Research Institute, University of California, Merced, California, USA
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Concurrent locomotor adaptation and retention to visual and split-belt perturbations. PLoS One 2022; 17:e0279585. [PMID: 36584009 PMCID: PMC9803095 DOI: 10.1371/journal.pone.0279585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022] Open
Abstract
Gait asymmetry is a common symptom in groups with neurological disorders and significantly reduces gait efficiency. To develop efficient training for gait rehabilitation, we propose a novel gait rehabilitation paradigm that combines two distinct perturbation strategies: visual feedback distortion (VFD) and split-belt treadmill (SBT) walking. In SBT walking, spatiotemporal gait adaptation can be readily achieved, but it quickly fades after training. Gait adaptation to implicit VFD in an unconscious manner tends to persist longer, potentially due to a greater engagement of implicit learning during training. Thus, we investigated whether the combined strategies would lead to more effective changes in symmetric gait patterns with longer retention periods. We compared the retention of the preserved asymmetric pattern acquired by "implicit VFD+SBT walking" with "SBT-only walking" and with "SBT walking with conscious correction". In the implicit VFD+SBT walking, the speed of the two belts was gradually changed, the visual representation of gait symmetry was implicitly distorted, and no instructions were given to subjects except to watch the visual feedback. In the SBT walking with conscious correction, subjects were instructed to consciously correct their steps with the help of visual feedback while SBT walking. The SBT-only walking consisted of SBT walking with no visual feedback. After the 7-minute adaptation period, we removed the visual feedback and the split-belt perturbations, and we assessed the retention of the preserved asymmetric pattern while subjects continued walking for the 15-minute post-adaptation period. In a group of subjects who spontaneously showed visuomotor adaptation in response to the implicit VFD (16 out of 27 subjects), we found a greater retention rate during the implicit VFD+SBT walking trial than the SBT-only walking or the SBT walking with conscious correction trials. The implicit visual distortion paradigm delivered in an attention-independent (unconscious) manner can be utilized and integrated into SBT walking to improve the efficacy of symmetric gait adaptation by producing longer-lasting effects on the retention of a newly learned motor pattern.
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Ahmed U, Karimi H, Gilani SA, Ahmad A. Translation and validation of the stroke impact scale 3.0 into urdu for Pakistan. NeuroRehabilitation 2021; 49:391-402. [PMID: 34420984 DOI: 10.3233/nre-210064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Stroke Impact Scale version 3.0 (SIS 3.0) is a self-reported outcome measure designed to assess quality of life (QoL) following a stroke. Although the psychometric properties of the SIS 3.0 are identified as superior to the generic QoL scales, it has not been translated and tested in Pakistan. OBJECTIVE To validate the Urdu version of the SIS 3.0 (USIS 3.0) for Pakistan. METHODS A prospective cohort of 116 patients with mild to moderate stroke reported their recovery using the USIS 3.0. The patients were concurrently assessed on the established tools to assess the validity and were re-evaluated to determine the test-retest reliability, precision, minimal detectable change (MDC), and minimal clinically important difference (MCID). RESULTS The reliability and internal consistency of USIS were satisfactory except for the emotion domain. The correlations of USIS with the established tools were strong. The discriminant validity was also significant across the levels of the modified Rankin scale (MRS). Only hand function and communication domains exhibited significant floor and ceiling effects, respectively. Regarding weighted K, values ranged from 0.53 to 0.88. CONCLUSIONS The USIS 3.0 has satisfactory psychometric properties and can be used in clinical and research settings for stroke survivors.
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Affiliation(s)
- Umair Ahmed
- University Institute of Physical Therapy, The University of Lahore, Pakistan
| | - Hossein Karimi
- University Institute of Physical Therapy, The University of Lahore, Pakistan
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Pakistan
| | - Ashfaq Ahmad
- Faculty of Allied Health Sciences, The University of Lahore, Pakistan
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Adamit T, Shames J, Rand D. Effectiveness of the Functional and Cognitive Occupational Therapy (FaC oT) Intervention for Improving Daily Functioning and Participation of Individuals with Mild Stroke: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7988. [PMID: 34360299 PMCID: PMC8345490 DOI: 10.3390/ijerph18157988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mild stroke can cause subtle cognitive-behavioral symptoms, which although might be hidden, can restrict community reintegration and participation. Cognitive rehabilitation programs exist for stroke but not specifically for mild stroke and the research evidence varies. The Functional and Cognitive Occupational Therapy (FaCoT) intervention was developed specifically for this population. OBJECTIVE To examine the effectiveness of FaCoT intervention for improving daily functioning and participation compared with standard care. METHOD A single blind randomized controlled trial with assessments pre (T1), post (T2) and 3-month follow-up (T3). Individuals in the FaCoT group received 10 weekly sessions practicing cognitive and behavioral strategies. The Canadian Occupational Performance Measure (COPM) was the primary outcome measure, IADL-questionnaire, Reintegration to Normal Living questionnaire (RNL) were secondary measures. RESULTS In total, 66 community-dwelling individuals with mild stroke were randomly allocated to FaCoT (n = 33, mean (SD) age 64.6 (8.2), 33% women), or control group (n = 33, mean (SD) age 64.4 (10.8), 45% women). Time X Group interaction effects were found for the COPM performance (F(1.4,90.3) = 11.75, p < 0.000) and satisfaction (F(1.5,96.8) = 15.70, p < 0.000), with large effect size values. Significant between-group effects were found for RNL (F = 10.02, p < 0.002, ɳP2 = 0.13). Most participants in FaCoT achieved a clinically important difference in COPM between T1-T2, T1-T3, and in RNL between T1 to T3 compared with the control group. CONCLUSIONS FaCoT intervention is effective to improve daily functioning, participation and satisfaction of individuals with mild stroke compared with standard care, therefore FaCoT should be implemented in community rehabilitation settings.
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Affiliation(s)
- Tal Adamit
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
- Maccabi Health-Care Services, Tel-Aviv 6812509, Israel;
| | | | - Debbie Rand
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
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7
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Self-reported quality of life following stroke: a systematic review of instruments with a focus on their psychometric properties. Qual Life Res 2021; 31:329-342. [PMID: 34247327 DOI: 10.1007/s11136-021-02944-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the psychometric properties of common health-related quality-of-life instruments used post stroke and provide recommendations for research and clinical use with this diagnostic group. METHODS A systematic review of the psychometric properties of the five most commonly used quality-of-life measurement tools (EQ-5D, SF-36, SF-6D, AQoL, SS-QOL) was conducted. Electronic searches were performed in MEDLINE, CINAHL, and EMBASE on November 27th 2019. Two authors screened papers against the inclusion criteria and where consensus was not reached, a third author was consulted. Included papers were appraised using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist and findings synthesized to make recommendations. RESULTS A total of n = 50,908 papers were screened and n = 45 papers reporting on 40 separate evaluations of psychometric properties met inclusion criteria (EQ-5D = 19, SF-36 = 16, SF-6D = 4, AQoL = 2, SS-QOL = 4). Studies reported varied psychometric quality of instruments, and results show that psychometric properties of quality-of-life instruments for the stroke population have not been well established. The strongest evidence was identified for the use of the EQ-5D as a quality-of-life assessment for adult stroke survivors. CONCLUSIONS This systematic evaluation of the psychometric properties of self-reported quality-of-life instruments used with adults after stroke suggests that validity across tools should not be assumed. Clinicians and researchers alike may use findings to help identify the most valid and reliable measurement instrument for understanding the impact of stroke on patient-reported quality of life.
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8
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Pike S, Cusick A, Wales K, Cameron L, Turner-Stokes L, Ashford S, Lannin NA. Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation-A systematic review. PLoS One 2021; 16:e0246288. [PMID: 33571238 PMCID: PMC7877653 DOI: 10.1371/journal.pone.0246288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This systematic review appraises the measurement quality of tools which assess activity and/or participation in adults with upper limb spasticity arising from neurological impairment, including methodological quality of the psychometric studies. Differences in the measurement quality of the tools for adults with a neurological impairment, but without upper limb spasticity, is also presented. METHODS 29 measurement tools identified in a published review were appraised in this systematic review. For each identified tool, we searched 3 databases (Medline, Embase, CINAHL) to identify psychometric studies completed with neurorehabilitation samples. Methodological quality of instrument evaluations was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Synthesis of ratings allowed an overall rating of the psychometric evidence for each measurement tool to be calculated. RESULTS 149 articles describing the development or evaluation of psychometric properties of 22 activity and/or participation measurement tools were included. Evidence specific to tool use for adults with spasticity was identified within only 15 of the 149 articles and provided evidence for 9 measurement tools only. Overall, COSMIN appraisal highlighted a lack of evidence of measurement quality. Synthesis of ratings demonstrated all measures had psychometric weaknesses or gaps in evidence (particularly for use of tools with adults with spasticity). CONCLUSIONS The systematic search, appraisal and synthesis revealed that currently there is insufficient measurement quality evidence to recommend one tool over another. Notwithstanding this conclusion, newer tools specifically designed for use with people with neurological conditions who have upper limb spasticity, have emergent measurement properties that warrant further research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014013190.
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Affiliation(s)
- Shannon Pike
- School of Allied Health, Human Services and Sport (Occupational Therapy), La Trobe University, Melbourne, Victoria, Australia
- Wagga Wagga Ambulatory Rehabilitation Service, Murrumbidgee Local Health District, Wagga Wagga, New South Wales, Australia
| | - Anne Cusick
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kylie Wales
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | | | - Lynne Turner-Stokes
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, United Kingdom
- King’s College London, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, United Kingdom
- King’s College London, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
- Centre for Nursing, Midwifery and Allied health led Research, University College London Hospitals, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Natasha A. Lannin
- School of Allied Health, Human Services and Sport (Occupational Therapy), La Trobe University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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9
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Slenders JPL, Van den Berg-Vos RM, van Heugten CM, Visser-Meily JMA, Evers SMAA, de Haan RJ, de Man-van Ginkel JM, Kwa VIH. Screening and patient-tailored care for emotional and cognitive problems compared to care as usual in patients discharged home after ischemic stroke (ECO-stroke): a protocol for a multicenter, patient-blinded, cluster randomized controlled trial. BMC Health Serv Res 2020; 20:1049. [PMID: 33203405 PMCID: PMC7670662 DOI: 10.1186/s12913-020-05902-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/04/2020] [Indexed: 11/15/2022] Open
Abstract
Background Ischemic stroke patients with a good outcome in terms of motor functioning and communication are likely to be discharged home without further rehabilitation. A significant number of these patients experience cognitive and emotional problems resulting in lower quality of life and decreased participation in society. This paper presents the protocol of a study examining the clinical effectiveness, cost-effectiveness and implementation of an intervention focused on screening and patient-tailored care for cognitive and emotional problems as compared to usual care in patients discharged home after ischemic stroke. Methods / design A multicenter, patient-blinded, cluster randomized controlled trial will be performed. Centers will be randomized (1:1) to the intervention group or the usual care group. Patients (> 18 years old) with a neurological confirmed diagnosis of ischemic stroke who can be discharged home without follow-up treatment at an outpatient rehabilitation clinic will be included. In the intervention group, patients will receive a short, individualized, semi-structured consultation by specialized nurses in addition to usual care. This consultation includes 1) screening for cognitive and emotional problems, 2) screening for restrictions in participation, 3) promotion of self-management strategies and 4) a decision tool for referral to rehabilitation services. The intervention will be performed approximately 6 weeks after the stroke at the neurology outpatient clinics and will take approximately 60 min. The control group will receive care as usual. Both groups will be followed-up at 6 weeks, 3 months and 12 months after stroke. The primary outcome will be the level of participation measured with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation on the level of Participation (USER-Participation-R) at 12 months. A cost-effectiveness analysis and process evaluation will be performed alongside. Discussion This trial is the first to evaluate clinical effectiveness, cost-effectiveness and implementation of screening and patient-tailored care for cognitive and emotional problems compared to care as usual in patients discharged home after ischemic stroke. Potentially, this will improve the outcomes for patients with frequently occurring cognitive and emotional problems after stroke. Trial registration Netherlands Trial Register: NL7295, registered 25 September 2018
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Affiliation(s)
- J P L Slenders
- Department of Neurology, Amsterdam UMC, Amsterdam, the Netherlands. .,Department of Neurology, OLVG, Amsterdam, the Netherlands.
| | - R M Van den Berg-Vos
- Department of Neurology, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - C M van Heugten
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, the Netherlands.,School for Mental Health & Neuroscience, Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University Medical Center, Maastricht, the Netherlands
| | - J M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - S M A A Evers
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI) of the Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre of Economic Evaluation & Machine Learning, Utrecht, The Netherlands
| | - R J de Haan
- Clinical Research Unit, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - J M de Man-van Ginkel
- Department of Nursing Science, Julius Center for Health Science and Primary Care & UMC Utrecht Brain Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - V I H Kwa
- Department of Neurology, OLVG, Amsterdam, the Netherlands
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10
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Ahmed T, Kumar R, Bahurupi Y. Factors Affecting Quality of Life among Post-Stroke Patients in the Sub-Himalayan Region. J Neurosci Rural Pract 2020; 11:616-622. [PMID: 33144800 PMCID: PMC7595802 DOI: 10.1055/s-0040-1716927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Stroke is one of the most debilitating conditions contributing to significant disability and death globally. Identifying risk factors for quality of life (QoL) will enable to improve home-based rehabilitation in post-stroke phase.
Objective
This study was aimed to identify the risk factors of QoL in stroke patients in the sub-Himalayan region.
Materials and Methods
A cross-sectional hospital-based study assessed the QoL among stroke patients within a week after the onset of acute stroke and then re-evaluated at 3 months. World Health Organization QoL-BREF, Beck Depression Inventory, the Barthel Index, and Montreal Cognitive Assessment (MOCA) were used to seek data on QoL, depression, cognitive, and functional dependence status, respectively. Appropriate statistics were used to compute the results.
Results
In total, 129 stroke patients recruited, out of which 102 returned to a 3-month follow-up. QoL, MOCA, disability index, and depression score were compared using Wilcoxon Singed-rank test. In multivariate analysis, depression and disability together predicted 60% of the variance for physical QoL (
p
< 0.0001). Similarly, poststroke depression and disability together predicted 61% of the variance for psychological QoL (
p
< 0.0001) in stroke patients.
Conclusion
Findings indicated that depression and disability are leading risk factors of QoL in stroke patients. Early identification of poststroke depression and functional dependence status is, therefore, essential to devise screening procedure and to develop targeted intervention to improve rehabilitation outcomes.
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Affiliation(s)
- Tarannum Ahmed
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Rajesh Kumar
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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11
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Patel P, Kaingade SR, Wilcox A, Lodha N. Force control predicts fine motor dexterity in high-functioning stroke survivors. Neurosci Lett 2020; 729:135015. [PMID: 32360934 DOI: 10.1016/j.neulet.2020.135015] [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: 12/12/2019] [Revised: 02/25/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE High-functioning stroke survivors with mild to moderate motor impairments show greater functional autonomy in activities of daily living, and often return to work or prior activities. Increased functional independence necessitates dexterous use of hands to execute tasks such as typing, using a phone, and driving. Despite the absence of any pronounced motor impairments, high-functioning individuals with stroke report challenges in performing skilled manual tasks. Two prominent motor deficits that limit functional performance after stroke are decline in strength and force control. Here, we quantify the deficits in fine motor dexterity in high-functioning stroke survivors and determine the relative contribution of strength and force control to fine motor dexterity. METHODS Fifteen high-functioning participants with stroke (upper-limb Fugl-Meyer score ≥43/66) and 15 controls performed following tasks with the paretic and non-dominant hands respectively: i) Nine-hole peg pest, ii) maximum voluntary contraction and iii) dynamic force tracking with isometric finger flexion. RESULTS High-functioning stroke participants required greater time to complete the pegboard task, showed reduced finger strength, and increased force variability relative to the controls. Importantly, the time to complete pegboard task in high-functioning stroke participants was explained by finger force variability, not strength. DISCUSSION AND CONCLUSIONS High-functioning stroke survivors show persistent deficits in fine motor dexterity, finger strength, and force control. The ability to modulate forces (control) contributes to fine motor dexterity in high-functioning stroke survivors. Interventions to improve fine motor dexterity in these individuals should include the assessment and training of force control.
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Affiliation(s)
- Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Sarthak R Kaingade
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Anthony Wilcox
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA.
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Persson CU, Holmegaard L, Redfors P, Jern C, Blomstrand C, Jood K. Increased muscle tone and contracture late after ischemic stroke. Brain Behav 2020; 10:e01509. [PMID: 31893564 PMCID: PMC7010575 DOI: 10.1002/brb3.1509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/21/2019] [Accepted: 11/24/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Systematic studies on increased muscle tone and spasticity late after ischemic stroke, without any selection, are limited. Therefore, we aimed to determine the prevalence of increased muscle tone, classical spasticity and contracture and predictors of increased muscle tone seven years after stroke. METHODS Consecutive patients with acute ischemic stroke <70 years of age (n = 411) were recruited to the Sahlgrenska Academy Study on Ischemic Stroke. Symptoms at index stroke were assessed using the Scandinavian Stroke Scale. Seven years after stroke, survivors (n = 358) were invited for follow-up assessments, of whom 292 agreed to participate and 288 contributed data. Muscle tone according to the Modified Ashworth scale, classical spasticity, and contracture was assessed by a neurologist. The associations between increased muscle tone and characteristics at index stroke and recurrent strokes during follow-up were investigated using logistic regression analysis. RESULTS Increased muscle tone was recognized in 99 participants (34%): 94 (33%) in the upper limbs, and 72 (25%) in the lower limbs. Classical spasticity was found in 51 participants (18%) and contracture in 26 (9%). Age (odds ratio [OR] 1.03 [95% confidence interval [CI] 1.00-1.06]), arm paresis (OR 1.76 [95% CI 1.40-2.2]), aphasia (OR 1.68 [95% CI 1.12-2.51]), and facial palsy (OR 2.12 [95% CI 1.10-4.07]) were independent predictors of increased muscle tone. CONCLUSIONS One-third of patients with ischemic stroke before 70 years of age showed increased muscle tone at 7-year follow-up. Half of them also had classical spasticity. Age, arm paresis, aphasia, and facial palsy at index stroke were predictors of increased muscle tone poststroke.
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Affiliation(s)
- Carina U Persson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Lukas Holmegaard
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Jern
- Department of Clinical Pathology and Genetics, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Stroke Centre West, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Stroke Centre West, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Lam KH, Blom E, Kwa VIH. Predictors of quality of life 1 year after minor stroke or TIA: a prospective single-centre cohort study. BMJ Open 2019; 9:e029697. [PMID: 31678939 PMCID: PMC6830651 DOI: 10.1136/bmjopen-2019-029697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/05/2019] [Accepted: 10/03/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In patients after a transient ischaemic attack (TIA) or minor stroke, dysfunction is often underestimated by clinical measures due to invisible symptoms, including cognitive and emotional problems. Many of these patients need stroke care programme, but others do not. In this study, we aim to identify potential predictors of quality of life (QoL) in patients with TIA or minor stroke 1 year poststroke to be able to select which of these patients will need aftercare. DESIGN Prospective observational cohort study. SETTING Single-centre hospital in the Netherlands. PARTICIPANTS 120 patients, diagnosed with TIA or minor stroke and discharged without rehabilitation treatment, completed the study. PRIMARY AND SECONDARY OUTCOME MEASURES QoL (RAND-36), anxiety and depressive symptoms (Hospital Anxiety and Depression scale), the degree of disability or functional dependence after stroke (modified Rankin Scale (mRS)) and symptoms of anxiety and depression specific to stroke (SSADQ) were assessed at baseline (2-6 weeks poststroke) and compared with follow-up at 1 year poststroke. RESULTS Depression (B=-1.35, p<0.001) and anxiety (B=-0.57, p=0.041) at baseline predicted a worse mental component of QoL after 1 year. Depression (B=-1.100, p<0.001) at baseline, but also age (B=-0.261, p=0.002) and female sex (B=4.101, p=0.034) predicted a worse physical component of QoL after 1 year. CONCLUSION With the identification of these predictors, we might be able to select more efficiently and timely the patients with TIA or minor stroke who need stroke aftercare.
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Affiliation(s)
- Ka-Hoo Lam
- Department of Neurology, OLVG, Amsterdam, Noord-Holland, Netherlands
| | - Emma Blom
- Department of Neurology, OLVG, Amsterdam, Noord-Holland, Netherlands
| | - Vincent I H Kwa
- Department of Neurology, OLVG, Amsterdam, Noord-Holland, Netherlands
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14
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Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Tanaka A, Takazawa A, Yoshida K, Ido Y, Ishida T, Kawasaki K, Kato H. Using the Barthel Index to Assess Activities of Daily Living after Musculoskeletal Tumour Surgery: A Single-centre Observational Study. Prog Rehabil Med 2019; 4:20190010. [PMID: 32789257 DOI: 10.2490/prm.20190010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/06/2019] [Indexed: 12/19/2022] Open
Abstract
Objective The objective of the current study was to find the factors affecting the activities of daily living, as evaluated by the Barthel Index, at the end of rehabilitation after musculoskeletal tumour surgery. Further, we evaluated whether the Barthel Index correlates with functional scores that are specific to musculoskeletal tumours at final follow-up. Methods The activities of daily living of 190 patients who underwent postoperative rehabilitation after surgery to treat musculoskeletal tumours were evaluated at the end of the program using the Barthel Index. Functional evaluation at the time of final follow-up observation was evaluated using the Musculoskeletal Tumour Society Score and the Toronto Extremity Salvage Score. Results The post-rehabilitation Barthel Index was significantly lower in elderly patients aged more than 60 years and in those with malignant tumours and tumours larger than 10 cm. Malignancy and large tumour size were risk factors for a low Barthel Index. There was significant correlation between the Musculoskeletal Tumour Society Score/Toronto Extremity Salvage Score at final functional evaluation and the Barthel Index at the end of rehabilitation. Conclusion The Barthel Index is a simple method to assess the activities of daily living and can potentially predict disease-specific health-related quality of life at final functional evaluation after musculoskeletal tumour surgery.
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Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuo Yoshimura
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kaoru Aoki
- Department of Applied Physical Therapy, Shinshu University School of Health Sciences, Matsumoto, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazushige Yoshida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshikazu Ido
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takaaki Ishida
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keiko Kawasaki
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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15
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Schwartz JK, Capo-Lugo CE, Akinwuntan AE, Roberts P, Krishnan S, Belagaje SR, Kovic M, Burns SP, Hu X, Danzl M, Devos H, Page SJ. Classification of Mild Stroke: A Mapping Review. PM R 2019; 11:996-1003. [PMID: 30746896 DOI: 10.1002/pmrj.12142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/28/2019] [Indexed: 11/11/2022]
Abstract
Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential for clinicians and researchers to precisely identify mild stroke survivors. Despite the fact that half of all strokes are categorized as mild, no standards exist on what constitutes a "mild" stroke. The purpose of this study is to summarize the current classification of mild stroke using a mapping review approach. Strategies to categorize "mild stroke" severity were explored in 188 papers indexed in the PubMed database. The results indicate that there was substantial variability in the procedures and scoring criteria used to determine mild stroke. To identify persons with mild stroke, researchers have largely applied assessment instruments developed to inform acute stroke care (eg, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index). Unfortunately, these approaches demonstrate floor effects and fail to detect the long-term disabling impairments that often limit the outcomes of mild stroke survivors. Additional research is warranted to suggest an evidence-based mild stroke categorization strategy that enhances diagnosis, treatment, and referral decisions to the benefit of mild stroke survivors.
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Affiliation(s)
- Jaclyn K Schwartz
- Department of Occupational Therapy, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Carmen E Capo-Lugo
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | | | - Pamela Roberts
- Department of Physical Medicine and Rehabilitation and Department of Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, CA
| | - Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, School of Medicine, Atlanta, GA
| | - Samir R Belagaje
- Depts. of Neurology and Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mark Kovic
- Midwestern University, Downers Grove, IL
| | | | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Megan Danzl
- Doctor of Physical Therapy Program, School of Movement and Rehabilitation Sciences, College of Health Professions, Bellarmine University, Louisville, KY
| | - Hannes Devos
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, KS
| | - Stephen J Page
- B.R.A.I.N. Laboratory (Better Rehabilitation and Assessment for Improved Neurorecovery); Division of Occupational Therapy, The Ohio State University, Columbus, OH
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Rosenbaum Halevi D, Bursaw AW, Karamchandani RR, Alderman SE, Breier JI, Vahidy FS, Aden JK, Cai C, Zhang X, Savitz SI. Cognitive deficits in acute mild ischemic stroke and TIA and effects of rt-PA. Ann Clin Transl Neurol 2019; 6:466-474. [PMID: 30911570 PMCID: PMC6414481 DOI: 10.1002/acn3.719] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/21/2018] [Accepted: 12/06/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction It is unknown if treatment with rt-PA in mild acute ischemic stroke (MIS) is associated with improvement in long term cognition. Methods Forty-five patients with suspected acute mild stroke or transient ischemic attacks with NIHSS ≤6 were enrolled in a prospective cohort. Cognitive testing was performed within 24 h of symptom onset. Follow-up assessment was performed at Day 90 on 25 patients. Prestroke baseline cognition was based on age, years of education (YrE), history of cognitive impairment, and the Fazekas score. Results Eighty-five percent patients with suspected MIS or TIA showed cognitive abnormalities within 24 h of onset. There was no significant difference in age, sex, Fazekas score, or YrE between rt-PA versus No-rt-PA groups (N = 8 vs. 17).Two sample t-test for change in performance in the WMS-III sub-tests (follow-up - baseline) ± SD, indicated a difference between rt-PA 0.74 ± 0.77 and no-rt-PA groups -0.02 ± 0.83 (P = 0.044). Logistic regression for predicting normal status using the mental control subtest, at follow-up showed an OR 8.96, CI 0.98-82.12 (P = 0.05) favoring the rt-PA group. Improvement in Mental Control at 90 days occurred in patients with low white matter disease compared to high white matter disease, 0.60 ± 0.46 (P = 0.048). A statistical trend was observed and suggested an improvement on SDMT and Trail Making tests, 1.43 ± 0.8 (P = 0.077). Conclusion Suspected MIS and TIA patients have cognitive impairment within 24 h of onset. rt-PA administration might be associated with improvement on some cognitive tests at 90 days.
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Affiliation(s)
- David Rosenbaum Halevi
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | | | | | | | | | - Farhaan S Vahidy
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | - James K Aden
- Institute for Surgical Research Joint Base San Antonio San Antonio Texas
| | - Chunyan Cai
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | - Xu Zhang
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | - Sean I Savitz
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
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17
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Lotan E, Tavor I, Barazany D, Ben-Amitay S, Hoffmann C, Tsarfaty G, Assaf Y, Tanne D. Selective atrophy of the connected deepest cortical layers following small subcortical infarct. Neurology 2019; 92:e567-e575. [PMID: 30635479 DOI: 10.1212/wnl.0000000000006884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/02/2018] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To explore whether in patients with chronic small subcortical infarct the cortical layers of the connected cortex are differentially affected and whether these differences correlate with clinical symptomatology. METHODS Twenty patients with a history of chronic small subcortical infarct affecting the corticospinal tracts and 15 healthy controls were included. Connected primary motor cortex was identified with tractography starting from infarct. T1-component probability maps were calculated from T1 relaxation 3T MRI, dividing the cortex into 5 laminar gaussian classes. RESULTS Focal cortical thinning was observed in the connected cortex and specifically only in its deepest laminar class compared to the nonaffected mirrored cortex (p < 0.001). There was loss of microstructural integrity of the affected corticospinal tract with increased mean diffusivity and decreased fractional anisotropy compared to the contralateral nonaffected tract (p ≤ 0.002). Clinical scores were correlated with microstructural damage of the corticospinal tracts and with thinning of the cortex and specifically only its deepest laminar class (p < 0.001). No differences were found in the laminar thickness pattern of the bilateral primary motor cortices or in the microstructural integrity of the bilateral corticospinal tracts in the healthy controls. CONCLUSION Our results support the concept of secondary neurodegeneration of connected primary motor cortex after a small subcortical infarct affecting the corticospinal tract, with observations that the main cortical thinning occurs in the deepest cortex and that the clinical symptomatology is correlated with this cortical atrophy pattern. Our findings may contribute to a better understanding of structural reorganization and functional outcomes after stroke.
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Affiliation(s)
- Eyal Lotan
- From the Department of Diagnostic Imaging (E.L., I.T., C.H., G.T.) and Stroke Center (D.T.), Department of Neurology and Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan; and Sackler Faculty of Medicine (E.L., I.T., C.H., G.T., D.T.), Sagol School of Neuroscience (I.T., Y.A.), Strauss Center for Computational Neuroimaging (D.B.), and Department of Neurobiology (S.B.-A., Y.A.), George S. Wise Faculty of Life Sciences, Tel Aviv University, Israel
| | - Ido Tavor
- From the Department of Diagnostic Imaging (E.L., I.T., C.H., G.T.) and Stroke Center (D.T.), Department of Neurology and Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan; and Sackler Faculty of Medicine (E.L., I.T., C.H., G.T., D.T.), Sagol School of Neuroscience (I.T., Y.A.), Strauss Center for Computational Neuroimaging (D.B.), and Department of Neurobiology (S.B.-A., Y.A.), George S. Wise Faculty of Life Sciences, Tel Aviv University, Israel
| | - Daniel Barazany
- From the Department of Diagnostic Imaging (E.L., I.T., C.H., G.T.) and Stroke Center (D.T.), Department of Neurology and Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan; and Sackler Faculty of Medicine (E.L., I.T., C.H., G.T., D.T.), Sagol School of Neuroscience (I.T., Y.A.), Strauss Center for Computational Neuroimaging (D.B.), and Department of Neurobiology (S.B.-A., Y.A.), George S. Wise Faculty of Life Sciences, Tel Aviv University, Israel
| | - Shani Ben-Amitay
- From the Department of Diagnostic Imaging (E.L., I.T., C.H., G.T.) and Stroke Center (D.T.), Department of Neurology and Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan; and Sackler Faculty of Medicine (E.L., I.T., C.H., G.T., D.T.), Sagol School of Neuroscience (I.T., Y.A.), Strauss Center for Computational Neuroimaging (D.B.), and Department of Neurobiology (S.B.-A., Y.A.), George S. Wise Faculty of Life Sciences, Tel Aviv University, Israel
| | - Chen Hoffmann
- From the Department of Diagnostic Imaging (E.L., I.T., C.H., G.T.) and Stroke Center (D.T.), Department of Neurology and Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan; and Sackler Faculty of Medicine (E.L., I.T., C.H., G.T., D.T.), Sagol School of Neuroscience (I.T., Y.A.), Strauss Center for Computational Neuroimaging (D.B.), and Department of Neurobiology (S.B.-A., Y.A.), George S. Wise Faculty of Life Sciences, Tel Aviv University, Israel
| | - Galia Tsarfaty
- From the Department of Diagnostic Imaging (E.L., I.T., C.H., G.T.) and Stroke Center (D.T.), Department of Neurology and Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan; and Sackler Faculty of Medicine (E.L., I.T., C.H., G.T., D.T.), Sagol School of Neuroscience (I.T., Y.A.), Strauss Center for Computational Neuroimaging (D.B.), and Department of Neurobiology (S.B.-A., Y.A.), George S. Wise Faculty of Life Sciences, Tel Aviv University, Israel
| | - Yaniv Assaf
- From the Department of Diagnostic Imaging (E.L., I.T., C.H., G.T.) and Stroke Center (D.T.), Department of Neurology and Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan; and Sackler Faculty of Medicine (E.L., I.T., C.H., G.T., D.T.), Sagol School of Neuroscience (I.T., Y.A.), Strauss Center for Computational Neuroimaging (D.B.), and Department of Neurobiology (S.B.-A., Y.A.), George S. Wise Faculty of Life Sciences, Tel Aviv University, Israel
| | - David Tanne
- From the Department of Diagnostic Imaging (E.L., I.T., C.H., G.T.) and Stroke Center (D.T.), Department of Neurology and Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan; and Sackler Faculty of Medicine (E.L., I.T., C.H., G.T., D.T.), Sagol School of Neuroscience (I.T., Y.A.), Strauss Center for Computational Neuroimaging (D.B.), and Department of Neurobiology (S.B.-A., Y.A.), George S. Wise Faculty of Life Sciences, Tel Aviv University, Israel.
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Sackley CM, Mant J, McManus RJ, Humphreys G, Sharp L, Mares K, Savva GM. Functional and emotional outcomes after transient ischemic attack: A 12-month prospective controlled cohort study. Int J Stroke 2019; 14:522-529. [DOI: 10.1177/1747493018823158] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Symptoms of transient ischemic attack are believed to fully resolve within 24 h of onset. Emerging evidence suggests that there may be prolonged functional and psychological impact, although studies have not been able to robustly identify whether these are the effect of transient ischemic attack or changes usually associated with ageing. We describe trajectories of disability and risk of anxiety and depression among patients seen at transient ischemic attack clinics over 12 months, compared to healthy controls. Methods Thirty transient ischemic attack clinics across England participated. A total of 1320 participants were included: 373 diagnosed with transient ischemic attack, 186 with minor stroke, 310 with “possible transient ischemic attack,” 213 with another condition mimicking a transient ischemic attack and 238 controls recruited from primary care providers. Participants completed questionnaires after diagnosis then after 3, 6 and 12 months. Outcomes were the Nottingham Extended Activities of Daily Living Scale and the Hospital Anxiety and Depression Scale. Mixed effects regression was used to estimate group differences and trajectories. Results At baseline, confirmed transient ischemic attack patients scored 1.31 HADS-Anxiety points (s.e. = 0.28; p < 0.001) , 0.51 HADS-Depression points (s.e. = 0.26; p = 0.056), and 2.6 NEADL points (s.e. = 1.1; p = 0.020) worse than controls. At 12 months, the deficits were 0.78 (s.e. = 0.30; p = 0.008), 0.97 (s.e. = 0.23; p < 0.001), and 0.96 (s.e. = 0.92; p = 0.294) respectively. Differences among patients diagnosed with minor stroke were like or worse than transient ischemic attack patients. Conclusions Transient ischemic attack clinic patients may have functional and emotional impairments compared to the general population irrespective of final diagnosis. The presence of emotional symptoms or risk of developing anxiety or depression did not always fully recover and may increase.
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Affiliation(s)
- Catherine M Sackley
- School of Public Health and Environmental Sciences, Kings College, London, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Richard J McManus
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Glyn Humphreys
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Leslie Sharp
- School of Public Health and Environmental Sciences, Kings College, London, UK
| | - Kathryn Mares
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - George M Savva
- Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
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Measurement Properties of the Barthel Index in Geriatric Rehabilitation. J Am Med Dir Assoc 2018; 20:420-425.e1. [PMID: 30448338 DOI: 10.1016/j.jamda.2018.09.033] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/22/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The Barthel index (BI) is a widely used observer-based instrument to measure physical function. Our objective is to assess the structural validity, reliability, and interpretability of the BI in the geriatric rehabilitation setting. DESIGN Two studies were performed. First, a prospective cohort study was performed in which the attending nurses completed the BI at admittance and discharge (n = 207). At discharge, patients rated their change in physical function on a 5-point Likert rating scale. To assess the internal structure of the BI, a confirmatory factor analysis was performed. Unidimensionality was defined by comparative fit index and Tucker-Lewis index of >0.95, and root mean square error of approximation of <0.06. To evaluate interpretability, floor/ceiling effects and the minimal important change (MIC) were assessed. Predictive modeling was used to calculate the MIC. The MIC was defined as going home and minimal patient-reported improvement defined as slightly or much improved physical function, which served as anchors to obtain a clinical- and patient-based MIC. A second group of 37 geriatric rehabilitation patients were repeatedly assessed by 2 attending nurses to assess reliability of the BI. The intraclass correlation coefficient, standard error of measurement, and smallest detectable change were calculated. SETTING AND PARTICIPANTS Patients receiving inpatient geriatric rehabilitation admitted to 11 Dutch nursing homes (n = 244). RESULTS Confirmatory factor analysis showed partly acceptable fit of a unidimensional model (comparative fit index 0.96, Tucker-Lewis index 0.95, and root mean square error of approximation 0.12). The clinical-based MIC was 3.1 [95% confidence interval (CI) 2.0-4.2] and the patient-based MIC was 3.6 (95% CI 2.8-4.3). The intraclass correlation coefficient was 0.96 (95% CI 0.93-0.98). The standard error of measurement and smallest detectable change were 1.1 and 3.0 points, respectively. CONCLUSIONS/IMPLICATIONS The structural validity, reliability, and interpretability of the BI are considered sufficient for measuring and interpreting changes in physical function of geriatric rehabilitation patients.
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Comprehensive Cardiac Rehabilitation for Secondary Prevention After Transient Ischemic Attack or Mild Stroke: PSYCHOLOGICAL PROFILE AND OUTCOMES. J Cardiopulm Rehabil Prev 2018; 37:428-436. [PMID: 28727668 DOI: 10.1097/hcr.0000000000000274] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Having previously reported that comprehensive cardiac rehabilitation (CCR) is effective for secondary prevention post-transient ischemic attack (TIA)/mild nondisabling stroke (MNDS), we present psychometric findings for the same sample that elucidate subacute TIA/MNDS psychological outcomes and test whether CCR would be independently associated with psychological improvements. METHODS In this prospective cohort trial patients with ≥1 risk factor, recruited from a stroke prevention clinic within 12 months (mean = 11.5 weeks) post-TIA/MNDS, entered CCR. RESULTS Of the 110 recruited patients, 100 (mean age = 65.4 years; 46 females) entered CCR and 80 completed CCR (mean duration = 7.6 months). At CCR entry, 16.5% and 39.2% screened positively for depression and anxiety, decreasing nonsignificantly at exit to 4.2%, and significantly to 16.9% (P = .008), respectively. Age-corrected deficits occurred more frequently than expected (P ≤ .03); at entry, mental health status (13.3%), clock-drawing (31.6%), oral-verbal fluency (16.9%), word-list learning (11.2%), and recall (12.6%); at exit, clock-drawing (30.0%). Entry-to-exit, mean depression, anxiety, mental and physical health status, word-list learning, memory, digit-symbol coding, and oral-verbal fluency scores improved significantly (P ≤ .031). No reliable change indices were significant. Psychological service recipients improved significantly more than nonrecipients in depression (P = .049). Baseline North American Adult Reading Test score predicted exercise attendance (R = 0.275; P = .044); New York Heart Association (NYHA) class and depression score predicted exit physical health status (R = 0.770, P < .001); and depression score predicted exit mental health status (R = 0.523, P < .001). CONCLUSIONS Anxiety and executive dysfunction persisted post-TIA/MNDS. Although promising for secondary prevention post-TIA/MNDS, CCR was not independently associated with psychological improvements. CCR psychological treatment may benefit depression. Subacute NYHA class and depression may later affect quality of life.
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Lam KH, Kwa VIH. Validity of the PROMIS-10 Global Health assessed by telephone and on paper in minor stroke and transient ischaemic attack in the Netherlands. BMJ Open 2018; 8:e019919. [PMID: 29997135 PMCID: PMC6089319 DOI: 10.1136/bmjopen-2017-019919] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Dysfunction after transient ischaemic attack (TIA) and minor stroke is often underestimated by clinical measures. Patient-reported outcome measures used in value-based healthcare may help in detecting these problems. The Patient-Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10 Global Health) is a concise patient-centred outcome measuring tool proposed for assessing health status in patients who had stroke. This study aims to address the validity of the Dutch PROMIS-10 in patients who had stroke in the Netherlands and also aims to compare telephone versus on-paper assessment. DESIGN Observational cohort study. SETTING Single-centre hospital in the Netherlands. PARTICIPANTS 75 patients who were diagnosed with TIA or minor stroke and discharged without rehabilitation treatment 1 year ago (between December 2014 and January 2016) completed the study. PRIMARY AND SECONDARY OUTCOME MEASURES PROMIS-10 physical (PH) and mental health (MH) scores assessed 1 year poststroke on paper (n=37) and by telephone (n=38) was compared with RAND-36 physical and mental component scores assessed on paper. RESULTS PROMIS-10 and RAND-36 correlated significantly in PH, r=0.81 (95% CI 0.69 to 0.88), and MH, r=0.76 (95% CI 0.64 to 0.85). Paper-and-pencil assessed correlations were r=0.87 and 0.79 for PH and MH, respectively. Telephone assessed correlations were r=0.76 and 0.73 for PH and MH, respectively. Internal consistency analysis indicated high reliabilities for both health components of the PROMIS-10, all Cronbach's α>0.70. CONCLUSIONS The Dutch PROMIS-10 was found to strongly correlate with the RAND-36. Paper-and-pencil assessment was found to have a higher correlation than telephone assessment. This study provides support for the use of the Dutch PROMIS-10 in assessing health status in patients after TIA and minor stroke.
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Affiliation(s)
- Ka Hoo Lam
- Department of Neurology, OLVG Hospital, Amsterdam, The Netherlands
| | - Vincent I H Kwa
- Department of Neurology, OLVG Hospital, Amsterdam, The Netherlands
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Response shift in quality of life assessment among cancer patients: A study from Iran. Med J Islam Repub Iran 2018; 31:120. [PMID: 29951421 PMCID: PMC6014782 DOI: 10.14196/mjiri.31.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
Background: During the course of disease, particularly of chronic diseases, changes in internal standards cause certain changes in the estimation of quality of life (QOL). These changes indicate the phenomenon of ‘response shift’. The present study aimed at assessing response shift in different scales of QOL in Iranian cancer patients. Methods: To assess response shift through the ‘then test’ approach, we asked 211 cancer patients to complete the EORTC QLQ-C30 questionnaire at pretest (at the beginning of the study), posttest (3 months later), and then test (administered immediately after the posttest). Paired t test and Cohen’s effect size were used for comparison. Results: Response shift was significant in all 4 scales under study, i.e. fatigue, pain, emotional functioning, and general QOL (p<0.001). Fatigue, pain, and global QOL have deteriorated significantly with then test approach and emotional function was significantly improved. Conclusion: We observed a response shift in Iranian cancer patients in our study. Thus, in light of the multifactorial nature of QOL and the effect of the response shift bias on different aspects of QOL changes, it is of utmost importance to keep this bias in mind when interpreting the results and managing cancer patients’ treatment regimens.
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Akioyamen LE, Genest J, Shan SD, Inibhunu H, Chu A, Tu JV. Anxiety, depression, and health-related quality of life in heterozygous familial hypercholesterolemia: A systematic review and meta-analysis. J Psychosom Res 2018; 109:32-43. [PMID: 29773150 DOI: 10.1016/j.jpsychores.2018.03.170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/24/2018] [Accepted: 03/24/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Heterozygous familial hypercholesterolemia (FH) is a common genetic disease predisposing affected individuals to a high risk of cardiovascular disease. Yet, considerable uncertainty exists regarding its impact on psychosocial wellbeing. OBJECTIVES We performed a systematic review and meta-analysis of the association between FH and symptoms of anxiety and depression, and health-related quality of life (HRQL). METHODS We searched MEDLINE, EMBASE, Global Health, the Cochrane Library, PsycINFO, and PubMed for peer-reviewed literature published in English between January 1, 1990 and January 1, 2018. Quantitative and qualitative studies were eligible if they included patients with confirmed FH and evaluated its association with symptoms of anxiety or depression, or HRQL. We performed a narrative synthesis of studies, including thematic analysis of qualitative studies, and where data permitted, random-effects meta-analysis reporting standardized mean differences (SMD) and 95% confidence intervals. RESULTS We found 10 eligible studies measuring HRQL, depression and anxiety. Random-effects meta-analysis of 4 (n = 4293) and 5 studies (n = 5098), respectively, showed that patients with FH had slightly lower symptoms of anxiety (SMD: -0.29 [95% CI: -0.53, -0.04]) and mental HRQL (SMD: -0.10 [95% -0.20, -0.00]) relative to general population controls. No significant differences existed in depressive symptoms (SMD: 0.04 [95% CI: -0.12, 0.19]) or physical HRQL scores (SMD: 0.02 [95% CI: -0.09, 0.12]). CONCLUSIONS Our systematic review suggests that patients with FH may report small but measurable differences in anxiety symptoms and mental HRQL.
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Affiliation(s)
- Leo E Akioyamen
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada.
| | - Jacques Genest
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada; McGill University Health Centre, Royal Victoria Hospital, Montreal, QC H3A 1A1, Canada.
| | - Shubham D Shan
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada.
| | - Happy Inibhunu
- Faculty of Science, University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada.
| | - Anna Chu
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada.
| | - Jack V Tu
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
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Ganesh S, Mohapatra S, Mohanty P, Pattnaik M, Mishra C. Identification of the components associated with functioning using the international classification of functioning, disability and health comprehensive core set for stroke in Indian stroke survivors. Top Stroke Rehabil 2017; 24:517-526. [PMID: 28545344 DOI: 10.1080/10749357.2017.1330231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Rehabilitation interventions are expected to ensure best possible recovery and minimize functional disability in stroke survivors. However, not many studies have investigated patterns of recovery and outcomes after stroke in low-income countries. The objective of this study is to identify the biological, psychological, and social components associated with functioning over time in Indian stroke patients using the International Classification of Functioning, Disability and Health (ICF)-based tools and the Functional Independence Measure (FIM). METHODS The functioning profile of stroke survivors who received a standard multi-disciplinary rehabilitation was prospectively assessed using the ICF and the FIM at admission (baseline), at 12 & 24 weeks. Descriptive analyses were performed to identify changes in the frequencies of ICF categories and qualifiers from admission to follow-up. RESULTS One hundred and twenty-seven participants (mean age of 56 years) with mean FIM score 68 at baseline participated and completed the study. The mean FIM score at follow-up was 108. The numbers and frequency of ICF categories for activities and participation reduced after rehabilitation. More numbers of environmental factors were identified as barriers at follow-up (15 out of 33) compared to baseline. Within the components of Activities and Participation, significant improvement in functioning was found in 43 out of 51 categories. CONCLUSION The results show a reduction in frequencies in ICF activities and participation categories corresponding to basic activities of daily living. Categories corresponding to employment and social integration showed little or no improvement.
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Affiliation(s)
- Shankar Ganesh
- a Department of Physiotherapy, Demonstrator in Physiotherapy , SVNIRTAR , Cuttack , India
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Raw RK, Wilkie RM, Mon-Williams M, Ross SA, Deniz K, Goddard T, Patankar T. Kinematic measures provide useful information after intracranial aneurysm treatment. J Rehabil Assist Technol Eng 2017; 4:2055668317744999. [PMID: 31186944 PMCID: PMC6453038 DOI: 10.1177/2055668317744999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/23/2017] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Current methods of assessing the outcomes of intracranial aneurysm treatment for aneurysmal subarachnoid haemorrhage are relatively insensitive, and thus unlikely to detect subtle deficits. Failures to identify cognitive and motor outcomes of intracranial aneurysm treatment might prevent delivery of optimal post-operative care. There are also concerns over risks associated with using intracranial aneurysm treatment as a preventative measure. METHODS We explored whether our kinematic tool would yield useful information regarding motor/cognitive function in patients who underwent intracranial aneurysm treatment for aneurysmal subarachnoid haemorrhage or unruptured aneurysm. Computerised kinematic motor and learning tasks were administered alongside standardised clinical outcome measures of cognition and functional ability, in 10 patients, as a pilot trial. Tests at post-intracranial aneurysm treatment discharge and six-week follow-up were compared to see which measures detected changes. RESULTS Kinematic tests captured significant improvements from discharge to six-week follow-up, indexed by reduced motor errors and improved learning. Increased Addenbrooke's Cognitive Examination-Revised scores reflected some recovery of memory function for most individuals, but other standardised cognitive measures, functional outcome scores and a psychological questionnaire showed no changes. CONCLUSIONS Kinematic measures can identify variation in performance in individuals with only slightly improved abilities post-intracranial aneurysm treatment. These measures may provide a sensitive way to explore post-operative outcomes following intracranial aneurysm treatment, or other similar surgical procedures.
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Affiliation(s)
- Rachael K Raw
- Faculty of Medicine and Health, School
of Psychology, University of Leeds, Leeds, UK
| | - Richard M Wilkie
- Faculty of Medicine and Health, School
of Psychology, University of Leeds, Leeds, UK
| | - Mark Mon-Williams
- Faculty of Medicine and Health, School
of Psychology, University of Leeds, Leeds, UK
| | - Stuart A Ross
- Department of Neurosciences, Leeds General Infirmary, Leeds, UK
| | - Kenan Deniz
- Department of Neurosciences, Leeds General Infirmary, Leeds, UK
| | - Tony Goddard
- Department of Neurosciences, Leeds General Infirmary, Leeds, UK
| | - Tufail Patankar
- Department of Neurosciences, Leeds General Infirmary, Leeds, UK
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Persons JE, Robinson JG, Payne ME, Fiedorowicz JG. Serum lipid changes following the onset of depressive symptoms in postmenopausal women. Psychiatry Res 2017; 247:282-287. [PMID: 27940323 PMCID: PMC6004601 DOI: 10.1016/j.psychres.2016.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 12/01/2016] [Indexed: 01/23/2023]
Abstract
A cross-sectional association between depression and serum low-density lipoprotein cholesterol (LDL-c) has been noted in psychiatric literature, raising the question of temporality: does low LDL-c predict depression, does depression lead to changes in LDL-c levels, or is this relationship bidirectional? In a previous longitudinal analysis of postmenopausal women ages 50-79 who participated in the Women's Health Initiative (WHI), we detected an association between low LDL-c and the subsequent onset of depressive symptoms (HR=1.25, 95% CI 1.05-1.49, p=0.01). This current study uses the WHI cohort to explore the question of temporality in the opposite direction, examining the influence of depressive symptoms on subsequent changes in LDL-c levels. This study provides no evidence to suggest an association between depression and subsequent changes in LDL-c level (-2.78mg/dL, 95% CI=-7.49 to 1.92, p=0.25), nor was any association detected for total cholesterol, HDL, or triglyceride changes over time. Further, this study demonstrates that the relationship between depression and serum LDL changes is not mediated by changes in weight, exercise, or energy intake.
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Affiliation(s)
- Jane E. Persons
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Jennifer G. Robinson
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA,Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Martha E. Payne
- Office of Research Development, Duke University Medical Center, Durham, NC, USA
| | - Jess G. Fiedorowicz
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA,Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA,Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA,François M. Abboud Cardiovascular Research Center, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
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Seok H, Lee SY, Kim J, Yeo J, Kang H. Can Short-Term Constraint-Induced Movement Therapy Combined With Visual Biofeedback Training Improve Hemiplegic Upper Limb Function of Subacute Stroke Patients? Ann Rehabil Med 2016; 40:998-1009. [PMID: 28119829 PMCID: PMC5256315 DOI: 10.5535/arm.2016.40.6.998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/24/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To Investigate the synergic effects of short-term constraint-induced movement therapy (CIMT) and visual biofeedback training (VBT) in subacute stroke patients. Methods Thirty-two subacute stroke patients were enrolled and randomly assigned to one of three groups: short-term CIMT with VBT, VBT only, and control groups. We applied CIMT for an hour daily during VBT instead of the ordinary restraint time, referred to as 'short-term' CIMT. Short-term CIMT with VBT group received simultaneous VBT with CIMT, whereas the VBT the only group received VBT without CIMT for an hour a day for 2 weeks. The control group received conventional occupational therapy (OT) alone. Patients underwent the Purdue Pegboard Test, the JAMAR grip strength test, the Wolf Motor Function Test, the Fugl-Meyer Assessment (upper extremity), Motricity index and the Korean version of Modified Barthel Index test to evaluate motor functions of the hemiplegic upper limb at baseline, post-treatment, and 2 weeks after treatment. Results No significant differences were observed between short-term CIMT with VBT and VBT only groups. Both groups showed significantly higher scores compared to the control group in the WMFT and FMA tests. However, the short-term CIMT with VBT group showed significant improvement (p<0.05) compared with the control group in both grasp and pad pinch at post-treatment and 2 weeks after treatment while the VBT only group did not. Conclusion Short-term CIMT with VBT group did not show significant improvement of hemiplegic upper limb function of subacute stroke patients, compared to VBT only group. Larger sample sizes and different restraint times would be needed to clarify the effect.
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Affiliation(s)
- Hyun Seok
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jihoon Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jungho Yeo
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyungdong Kang
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Brittle N, Lett K, Littlechild R, Sackley C. The Disability Profile of Adults Who Receive Adaptive Equipment from Local Authority Occupational Therapy Services. Br J Occup Ther 2016. [DOI: 10.1177/030802260707001105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jacob-Lloyd HA, Dunn OM, Brain ND, Lamb SE. Effective Measurement of the Functional Progress of Stroke Clients. Br J Occup Ther 2016. [DOI: 10.1177/030802260506800603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a need for occupational therapists to establish a range of outcome measures that can measure change effectively. The aim of this study was to identify effective methods of measuring the functional performance of individuals who had experienced a stroke and had been discharged from a rehabilitation ward. Measures with recorded validity and reliability and in clinical use were selected. The measures were the Barthel Index (Shah version), Nottingham Extended Activities of Daily Living scale, Motricity Index (Upper and Lower Limb), Rivermead Mobility Index and Nine-Hole Peg Test. Assessments were carried out at the point of discharge from hospital and 6 months later. Responsiveness was analysed using effect size and relative efficiency statistics. The practicality (feasibility) was established by comparing completion rates. The Nottingham Extended Activities of Daily Living scale and the Rivermead Mobility Index were found to be more responsive than the Barthel Index and Lower Limb Motricity Index respectively and to be practical after discharge from hospital. The Nine-Hole Peg Test was found to be more responsive than the Upper Limb Motricity Index but less practical. The analysis suggested that some measures are more suitable than others for tracking change in function after discharge from hospital for a wide case mix of people who have experienced a stroke.
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Vanbellingen T, Ottiger B, Pflugshaupt T, Mehrholz J, Bohlhalter S, Nef T, Nyffeler T. The Responsiveness of the Lucerne ICF-Based Multidisciplinary Observation Scale: A Comparison with the Functional Independence Measure and the Barthel Index. Front Neurol 2016; 7:152. [PMID: 27725808 PMCID: PMC5035834 DOI: 10.3389/fneur.2016.00152] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/02/2016] [Indexed: 11/23/2022] Open
Abstract
Background Good responsive functional outcome measures are important to measure change in stroke patients. The aim of study was to compare the internal and external responsiveness, floor and ceiling effects of the motor, cognition, and communication subscales of the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) with the motor and cognition subscales of the Functional Independence Measure (FIM), and the Barthel Index (BI), in a large cohort of stroke patients. Methods One hundred eighteen stroke patients participated in this study. Admission and discharge score distributions of the LIMOS motor, LIMOS cognition and communication, FIM motor and FIM cognition, and BI were analyzed based on skewness and kurtosis. Floor and ceiling effects of the scales were determined. Internal responsiveness was assessed with t-tests, effect sizes (ESs), and standardized response means (SRMs). External responsiveness was investigated with linear regression analyses. Results The LIMOS motor and LIMOS cognition and communication subscales were more responsive, expressed by higher ESs (ES = 0.65, SRM = 1.17 and ES = 0.52, SRM = 1.17, respectively) as compared with FIM motor (ES = 0.54, SRM = 0.96) and FIM cognition (ES = 0.41, SRM = 0.88) and the BI (ES = 0.41, SRM = 0.65). The LIMOS subscales showed neither floor nor ceiling effects at admission and discharge (all <15%). In contrast, ceiling effects were found for the FIM motor (16%), FIM cognition (15%) at discharge and the BI at admission (22%) and discharge (43%). LIMOS motor and LIMOS cognition and communication subscales significantly correlated (p < 0.0001) with a change in the FIM motor and FIM cognition subscales, suggesting good external responsiveness. Conclusion We found that the LIMOS motor and LIMOS cognition and communication, which are ICF-based multidisciplinary standardized observation scales, might have the potential to better detect changes in functional outcome of stroke patients, compared with the FIM motor and FIM cognition and the BI.
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Affiliation(s)
- Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland; Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Beatrice Ottiger
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital , Luzern , Switzerland
| | - Tobias Pflugshaupt
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital , Luzern , Switzerland
| | - Jan Mehrholz
- Wissenschaftliches Institut, Klinik Bavaria in Kreischa GmbH , Kreischa , Germany
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital , Luzern , Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland; Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
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Flinn NA, Schamburg S, Fetrow JM, Flanigan J. The Effect of Constraint-Induced Movement Treatment on Occupational Performance and Satisfaction in Stroke Survivors. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/153944920502500305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is a leading cause of disability and impaired arm function is a common consequence. Constraint-induced movement treatment is a technique used to increase weak arm use and to decrease motor deficits resulting from stroke. Eleven stroke survivors participated in a constraint-induced movement treatment protocol of 3 ½ hours of treatment per day for 8 days. Participants experienced significantly increased use of the weak arm in daily activities, which was measured by the Motor Activity Log, and a trend toward improved coordination in the weak arm, which was measured by the Wolf Motor Function Test. Participants did not report significant improvements in average performance or satisfaction in self-identified occupational performance problems. When these problems were analyzed individually, no significant differences were seen immediately post-treatment. However, significant improvements were seen for satisfaction at 4 to 6 months post-treatment. The occupational performance problems identified by the participants were equally divided between problems related to hand use and problems not related to hand use. Approximately half of the non-hand use problems involved endurance. Although participants in this study did make improvements in arm use and coordination, they did not identify improvements in average occupational performance or satisfaction as an outcome of constraint-induced movement treatment.
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Kilshaw L, Sammut H, Asher R, Williams P, Saxena R, Howse M. A study to describe the health trajectory of patients with advanced renal disease who choose not to receive dialysis. Clin Kidney J 2016; 9:470-5. [PMID: 27274835 PMCID: PMC4886902 DOI: 10.1093/ckj/sfw005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/13/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Some patients with end-stage renal failure (ESRF) are unlikely to benefit from dialysis and conservative management (CM) is offered as a positive alternative. Understanding the trajectory of illness by health care professionals may improve end-of-life care. METHODS We aimed to describe the trajectory of functional status within our CM population through a prospective, observational study using the objective Timed Up and Go (TUG) test and subjective Barthel Index (BI) and health-related quality of life (HRQoL) [EuroQol 5D-5L (EQ-5D-5L)] measurements and correlating them with demographic and laboratory data and with sentinel events. RESULTS There was a significant increase in TUG scores over the 6 months prior to death {2.24 [95% confidence interval (CI) 1.16-4.32], P = 0.017} and a significant decrease in EQ-5D-5L [-0.19 (95% CI -0.33 to -0.06), P = 0.006]. The only significant associations with mortality were serum albumin [hazard ratio (HR) 0.81 (95% CI 0.67-0.97), P = 0.024] and male gender [HR 5.94 (95% CI 1.50-23.5), P = 0.011]. CONCLUSIONS We have shown there is a significant decline in functional status in the last 6 months before death in the CM population. Of interest, there was a significant relationship of lower serum albumin with functional decline and risk of death. We hope that with improved insight into disease trajectories we can improve our ability to identify and respond to the changes in needs of these patients, facilitate complex and sensitive end-of-life discussions and improve end-of-life care.
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Affiliation(s)
- Lindsey Kilshaw
- Department of Physiotherapy , Royal Liverpool and Broadgreen Hospitals NHS Trust , Liverpool , UK
| | - Hannah Sammut
- Department of Nephrology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK; Department of Palliative Care Medicine, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Rebecca Asher
- Medical Statistics, Cancer Research UK Liverpool Cancer Trials Unit , University of Liverpool , Liverpool , UK
| | - Peter Williams
- Department of Nephrology , Royal Liverpool and Broadgreen Hospitals NHS Trust , Liverpool , UK
| | - Rema Saxena
- Department of Nephrology , Royal Liverpool and Broadgreen Hospitals NHS Trust , Liverpool , UK
| | - Matthew Howse
- Department of Nephrology , Royal Liverpool and Broadgreen Hospitals NHS Trust , Liverpool , UK
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Is health-related quality of life between 90 and 180 days following stroke associated with long-term unmet needs? Qual Life Res 2016; 25:2053-62. [PMID: 26847339 DOI: 10.1007/s11136-016-1234-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Understanding the relationship between health-related quality of life (HRQoL) and long-term unmet needs is important for guiding services to optimise life following stroke. We investigated whether HRQoL between 90 and 180 days following stroke was associated with long-term unmet needs. METHODS Data from Australian Stroke Clinical Registry (AuSCR) registrants who participated in the Australian Stroke Survivor Needs Survey were used. Outcome data, including the EQ-5D, are routinely collected in AuSCR between 90 and 180 days post-stroke. Unmet needs were assessed at a median of 2 years and categorised into: health; everyday living; work/leisure; and support domains. Multivariable regression was used to determine associations between the EQ-5D dimensions and the likelihood of experiencing unmet needs and the visual analogue scale (VAS) (rating 0-100) and number of reported unmet needs. RESULTS In total, 173 AuSCR registrants completed the Needs Survey (median age 69 years, 67 % male; 77 % ischaemic stroke). VAS scores were negatively associated with the number of reported long-term unmet needs [irr 0.98, (95 % CI 0.97, 0 99) p < 0.001]. Having EQ-5D activity limitations was associated with unmet living needs (aOR 4.5, 95 % CI 1.1, 18.8). Requiring living supports at 90-180 days was associated with unmet health needs (aOR 4.9, 95 % CI 1.5, 16.1). Those with pain at 90-180 days were less likely to report unmet health (aOR 0.09, 95 % CI 0.02, 0.4) and support needs (aOR 0.2, 95 % CI 0.06, 0.6). CONCLUSION Routinely collected HRQoL data can identify survivors at risk of experiencing long-term unmet needs. This information is important for targeting service delivery to optimise outcomes following stroke.
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Persons JE, Robinson JG, Coryell WH, Payne ME, Fiedorowicz JG. Longitudinal study of low serum LDL cholesterol and depressive symptom onset in postmenopause. J Clin Psychiatry 2016; 77:212-20. [PMID: 26930520 PMCID: PMC4906804 DOI: 10.4088/jcp.14m09505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/13/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to characterize the relationship between serum low-density lipoprotein cholesterol (LDL-c) and subsequent depressive symptoms onset in postmenopausal women. We secondarily assessed serum high-density lipoprotein (HDL-c), total cholesterol, and triglycerides. METHOD This population-based prospective cohort study utilizes data from 24,216 women between 50 and 79 years of age who were participants of the Women's Health Initiative, which originally ran from 1993 to 2005 and has since incorporated 2 extension studies, with the most recent culminating in 2015. Fasting lipids were measured for all participants at baseline and for a subset through 6 years of follow-up. Depressive symptoms were characterized using the Burnam 8-item scale for depressive disorders (Center for Epidemiologic Studies-Depression/Diagnostic Interview Schedule short form) at baseline and during follow-up, using a cut point of 0.06 to indicate presence of depressive symptoms. RESULTS The lowest quintile of LDL-c was associated with an increased risk of subsequent depressive symptoms (hazard ratio [HR] = 1.25, 95% CI = 1.05-1.49, P = .01), and follow-up analyses demonstrated that the elevated risk appeared to be confined to the lowest decile (LDL-c < 100 mg/dL). Further, this elevated risk was moderated by lipid-lowering drug treatment. Elevated risk was demonstrated among those who reported no lipid-lowering medication use (HR = 1.23, 95% CI = 1.03-1.47, P = .02), but not among those reporting use (HR = 0.65, 95% CI = 0.18-2.29, P = .50). CONCLUSIONS Among postmenopausal women, untreated serum LDL-c below 100 mg/dL was associated with an increased risk of developing depressive symptoms. No excess risk was observed in those attaining LDL-c < 100 mg/dL with lipid-lowering therapy. These findings have important implications for risk assessment, treatment considerations, and mechanistic insight.
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Affiliation(s)
- Jane E Persons
- The University of Iowa, Department of Epidemiology, 145 N Riverside Dr, Iowa City, IA 52246
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Chen J, Jin W, Zhang XX, Xu W, Liu XN, Ren CC. Telerehabilitation Approaches for Stroke Patients: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Stroke Cerebrovasc Dis 2015; 24:2660-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.014] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/15/2015] [Indexed: 01/18/2023] Open
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Peters HT, White SE, Page SJ. The National Institutes of Health Stroke Scale Lacks Validity in Chronic Hemiparetic Stroke. J Stroke Cerebrovasc Dis 2015; 24:2207-12. [PMID: 26231474 DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/10/2015] [Accepted: 05/10/2015] [Indexed: 10/23/2022] Open
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Kim J, Kim Y, Yang KI, Kim DE, Kim SA. The Relationship Between Sleep Disturbance and Functional Status in Mild Stroke Patients. Ann Rehabil Med 2015; 39:545-52. [PMID: 26361590 PMCID: PMC4564701 DOI: 10.5535/arm.2015.39.4.545] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/12/2014] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the sleep state of mild stroke patients and relationship between sleep disturbance and functional status. Methods A total of 80 acute stroke patients were enrolled in this study. The criteria for inclusion in the study was as following: 1) first stroke, 2) cognitive function preserved enough to perform the test (Mini Mental State Examination ≥24), 3) good functional levels (Modified Rankin Scale ≤3), 4) upper extremity motor function preserved enough to perform occupational tests (hand strength test, Purdue pegboard test, 9-hole peg test, and Medical Research Council score ≥3), and 5) less than 2 weeks between the stroke and the assessment. Quality of sleep was assessed by using Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS). Activities of daily living was assessed by using the Modified Barthel Index (MBI) and depressed mood was assessed by using the Beck Depression Inventory (BDI). Gross and fine motor function of the upper extremity was assessed by using hand strength test (Jamar dynamometer), Purdue pegboard test, and the 9-hole peg test. Results The results of the occupational assessment were fine in the good sleepers. The PSQI, ESS, and ISI were correlated with some of the assessment tools (BDI, MBI, Purdue pegboard, 9-hole peg, and hand strength). Conclusion In conclusion, this study emphasizes that sleep disturbance can affect the functional status in mild acute stroke patients. Therefore, clinicians must consider sleep status in stroke patients and need to work to control it.
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Affiliation(s)
- Jinil Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Yuntae Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Doh-Eui Kim
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Soo A Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Min KB, Min JY. Health-related quality of life is associated with stroke deficits in older adults. Age Ageing 2015; 44:700-4. [PMID: 25994186 DOI: 10.1093/ageing/afv060] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 01/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/OBJECTIVES although the functional impairments of stroke survivors are associated with poor health-related quality of life (HRQoL), few studies have demonstrated the impact of individual stroke deficits on the quality of life of survivors. In this study, we investigated the association between HRQoL and stroke-related deficits, especially with respect to the number and types of deficits, in older adults. METHODS the data were obtained from the 2008 and 2009 Korean Community Health Survey. The EuroQoL 5 Dimension (EQ-5D) questionnaire used as the HRQoL index, and stroke-related information included the number of stroke deficits and five types of deficits. RESULTS of the 122,095 participants, 6,698 (5.5%) subjects had a history of stroke, of whom 2,222 patients (33.2%) reported one or more stroke-related deficits. After adjustments for potential variables, the EQ-5D scores of the stroke survivors with persisting deficits were significantly reduced as the number of stroke deficits increased (β = -0.080, -0.147, -0.229, -0.252 and -0.293 for one, two, three, four and five deficits, respectively). The type of stroke deficits was associated with the level of HRQoL. Specifically, the adjusted EQ-5D score of patients who suffered from hemiplegia (β = -0.143; P value < .00001) was worse than that of patients with any stroke deficits. The most frequent problems were related to mobility and pain/discomfort, regardless of the number or type of stroke deficits. CONCLUSION we found that impaired HRQoL was significantly associated with the number and type of stroke deficits in older adults with a history of stroke.
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Affiliation(s)
- Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jin-Young Min
- Institute of Health and Environment, Seoul National University, Seoul 151-742, Republic of Korea
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Rand D, Zeilig G, Kizony R. Rehab-let: touchscreen tablet for self-training impaired dexterity post stroke: study protocol for a pilot randomized controlled trial. Trials 2015; 16:277. [PMID: 26081864 PMCID: PMC4476080 DOI: 10.1186/s13063-015-0796-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/08/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Impaired dexterity of the weaker upper extremity is common post stroke and it is recommended that these individuals practice many repetitions of movement to regain function. However, stroke rehabilitation methods do not achieve the required intensity to be effective. Touchscreen tablet technology may be used as a motivating tool for self-training impaired dexterity of the weaker upper extremity post stroke. METHODS/DESIGN Rehab-let is a self-training protocol utilizing game apps on a touchscreen for practicing movement of the weaker upper extremity. We will conduct a pilot randomized controlled trial to assess Rehab-let compared to traditional self-training to improve dexterity of the weaker hand, and to increase self-training time and satisfaction in individuals with subacute stroke. Forty individuals with stroke undergoing subacute rehabilitation will be randomly allocated to Rehab-let or a traditional self-training program using therapeutic aids such as balls, blocks and pegs. All participants will be requested to perform self-training for 60 minutes a day, 5 times a week for 4 weeks. Dexterity assessed by The Nine Hole Peg Test is the main outcome measure. Assessments will be administered pre and post the self-training intervention by assessors blind to the group allocation. DISCUSSION The outcomes of this study will inform the design of a fully powered randomized controlled trial to evaluate the effectiveness of Rehab-let. If found to be effective, Rehab-let can be used during subacute rehabilitation to increase treatment intensity and improve dexterity. Potentially, Rehab-let can also be used after discharge and might be ideal for individuals with mild stroke who are often not referred to formal rehabilitation. TRIAL REGISTRATION Current Controlled Trials NCT02136433 registered on 17 September 2014.
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Affiliation(s)
- Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center at Tel-HaShomer, Tel-HaShomer, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Rachel Kizony
- Department of Occupational Therapy, University of Haifa, Haifa, Israel.
- Department of Occupational Therapy, The Chaim Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel.
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Duncan PW, Wallace D, Studenski S, Lai SM, Johnson D. Conceptualization of a New Stroke-Specific Outcome Measure: The Stroke Impact Scale. Top Stroke Rehabil 2015; 8:19-33. [PMID: 14523743 DOI: 10.1310/brhx-pkta-0tuj-uywt] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Current stroke outcome measures are unable to detect some consequences of stroke that affect patients, families, and providers. The objective of this study was to ensure the content validity of a new stroke outcome measure. This was a qualitative study using individual interviews with patients and focus group interviews with patients, caregivers, and health care professionals. Participants included 30 individuals with mild and moderate stroke, 23 caregivers, and 9 stroke experts. Qualitative analysis of the individual and focus group interviews generated a list of potential items. Consensus panels reviewed the potential items, established domains for the measure, developed item scales, and decided on mechanisms for administration and scoring. Although the participants with stroke appeared highly recovered based on scores from conventional stroke assessments (Barthel Index and NIH Stroke Scale), stroke survivors and their caregivers identified numerous persisting impairments, disabilities, and handicaps. In general, stroke survivors described themselves as only about 50% recovered and reported that they had difficulty in activities in which they were not independent. To fully assess the impact of stroke on patients, we used the results of this qualitative study to develop a new stroke-specific outcome, the Stroke Impact Scale.
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Affiliation(s)
- P W Duncan
- Center on Aging, University of Kansas Medical Center and Department of Veterans Affairs Medical Center, Kansas City, Missouri, USA
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King RB, Shade-Zeldow Y, Carlson CE, Feldman JL, Philip M. Adaptation to Stroke: A Longitudinal Study of Depressive Symptoms, Physical Health, and Coping Process. Top Stroke Rehabil 2015; 9:46-66. [PMID: 14523722 DOI: 10.1310/kdta-welc-t2wr-x51w] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purposes of this study were to describe the natural history of adaptation to stroke and to identify survivor and caregiver predictors of depressive symptoms. Data were collected for 53 stroke survivors at four times from acute rehabilitation (T1) to 2 years post discharge (T4). Significant improvement occurred in depressive symptoms and perception of health, but change in the rate of depression was not significant. Family functioning became less healthy. Significant predictors of greater levels of depressive symptoms were lower levels of total support, finding meaning, and avoidance coping (T1) and lower levels of family functioning and belonging support (T4). Treatments to promote adaptation can be developed based on these predictors.
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Affiliation(s)
- Rosemarie B King
- Northwestern University Medical School, Department of Physical Medicine & Rehabilitation, and Rehabilitation Institute of Chicago, Illinois, USA
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Balucani C, Bianchi R, Feldmann E, Weedon J, Kolychev D, Levine SR. To treat or not to treat? Pilot survey for minor and rapidly improving stroke. Stroke 2015; 46:874-6. [PMID: 25604250 DOI: 10.1161/strokeaha.114.008290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Minor strokes and rapidly improving stroke symptoms are frequent exclusions for intravenous tissue-type plasminogen activator. We explored factors influencing tissue-type plasminogen activator treatment decision for minor strokes/rapidly improving stroke symptoms. METHODS A pilot survey, including 110 case scenarios, was completed by 17 clinicians from 2 academic medical centers. Respondents were asked whether they would treat each case with tissue-type plasminogen activator at 60 minutes after emergency department admission. Cases varied by (1) National Institutes of Health Stroke Scale score at treatment decision time, (2) symptom pattern over time (improvement or worsening and then improving), (3) type of neurological deficit (3 main domains: motor, visual/sensory/ataxia, and language/neglect), and (4) age/occupation (4 profiles). Logistic regression was used to predict probability of omission (pO). A binomial regression model was used to predict probability of treatment decision. RESULTS Predicted probability of treatment decision was affected by National Institutes of Health Stroke Scale score (P<0.001) and age/occupation profiles (P<0.001) but not by symptom patterns (P=0.334). There were significant, albeit modest, main effects on probability of treatment decision for neurological domains. Responses were most likely omitted (P=0.027) for cases improvement pattern and language/neglect domain (pO=0.74; 95% confidence interval, 0.52-0.89) and with visual/sensory/ataxia domain (pO=0.74; confidence interval, 0.37-0.93) when compared with improvement pattern and motor domain (pO=0.17; confidence interval, 0.06-0.42) and to any worsening and then improving patterns (0.37<pO<0.56). CONCLUSIONS This pilot survey provides the first quantitative evidence that National Institutes of Health Stroke Scale score is not the only determinant of treatment decision. A National Institutes of Health Stroke Scale score of 2 is the potential equipoise point, with the least consensus on treatment decision. These preliminary findings require validation in larger population surveys.
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Affiliation(s)
- Clotilde Balucani
- From the Department of Neurology and Stroke Center (C.B., S.R.L.), Department of Physiology and Pharmacology (R.B.), Department of Scientific Computing (J.W.), and Department of Emergency Medicine (S.R.L.), The State University of New York (SUNY) Downstate Medical Center, Brooklyn; Department of Neurology, TUFTS Medical Center, Boston, MA (E.F., D.K.); and Department of Neurology, The Kings County Hospital Center, Brooklyn, NY (S.R.L.).
| | - Riccardo Bianchi
- From the Department of Neurology and Stroke Center (C.B., S.R.L.), Department of Physiology and Pharmacology (R.B.), Department of Scientific Computing (J.W.), and Department of Emergency Medicine (S.R.L.), The State University of New York (SUNY) Downstate Medical Center, Brooklyn; Department of Neurology, TUFTS Medical Center, Boston, MA (E.F., D.K.); and Department of Neurology, The Kings County Hospital Center, Brooklyn, NY (S.R.L.)
| | - Edward Feldmann
- From the Department of Neurology and Stroke Center (C.B., S.R.L.), Department of Physiology and Pharmacology (R.B.), Department of Scientific Computing (J.W.), and Department of Emergency Medicine (S.R.L.), The State University of New York (SUNY) Downstate Medical Center, Brooklyn; Department of Neurology, TUFTS Medical Center, Boston, MA (E.F., D.K.); and Department of Neurology, The Kings County Hospital Center, Brooklyn, NY (S.R.L.)
| | - Jeremy Weedon
- From the Department of Neurology and Stroke Center (C.B., S.R.L.), Department of Physiology and Pharmacology (R.B.), Department of Scientific Computing (J.W.), and Department of Emergency Medicine (S.R.L.), The State University of New York (SUNY) Downstate Medical Center, Brooklyn; Department of Neurology, TUFTS Medical Center, Boston, MA (E.F., D.K.); and Department of Neurology, The Kings County Hospital Center, Brooklyn, NY (S.R.L.)
| | - Dmitri Kolychev
- From the Department of Neurology and Stroke Center (C.B., S.R.L.), Department of Physiology and Pharmacology (R.B.), Department of Scientific Computing (J.W.), and Department of Emergency Medicine (S.R.L.), The State University of New York (SUNY) Downstate Medical Center, Brooklyn; Department of Neurology, TUFTS Medical Center, Boston, MA (E.F., D.K.); and Department of Neurology, The Kings County Hospital Center, Brooklyn, NY (S.R.L.)
| | - Steven R Levine
- From the Department of Neurology and Stroke Center (C.B., S.R.L.), Department of Physiology and Pharmacology (R.B.), Department of Scientific Computing (J.W.), and Department of Emergency Medicine (S.R.L.), The State University of New York (SUNY) Downstate Medical Center, Brooklyn; Department of Neurology, TUFTS Medical Center, Boston, MA (E.F., D.K.); and Department of Neurology, The Kings County Hospital Center, Brooklyn, NY (S.R.L.)
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Tellier M, Rochette A. Falling Through the Cracks: A Literature Review to Understand the Reality of Mild Stroke Survivors. Top Stroke Rehabil 2015; 16:454-62. [DOI: 10.1310/tsr1606-454] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wu AJ, Burgard E, Radel J. Inpatient Rehabilitation Outcomes of Patients With Apraxia After Stroke. Top Stroke Rehabil 2014; 21:211-9. [DOI: 10.1310/tsr2103-211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rochette A, Desrosiers J, Bravo G, St-Cyr-Tribble D, Bourget A. Changes in Participation After a Mild Stroke: Quantitative and Qualitative Perspectives. Top Stroke Rehabil 2014; 14:59-68. [PMID: 17577968 DOI: 10.1310/tsr1403-59] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE AND METHOD This descriptive study is aimed at documenting changes in participation level (accomplishment of daily activities and social roles) from quantitative (n = 35) and qualitative (n = 5) perspectives in individuals who have had a first "mild" stroke compared to their prestroke level. With advances in technology (e.g., increased use of thrombolitic therapy), the prevalence of mild stroke is expected to increase. Yet these strokes are rarely referred to rehabilitation, and little is known about the consequences of stroke on patients' lives. CONCLUSION Results of both methods confirmed significant impact of the stroke on participation level that is persistent even 6 months poststroke.
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Affiliation(s)
- Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Québec, Canada
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Eriksson G, Carolyn Baum M, Wolf TJ, Connor LT. Perceived participation after stroke: the influence of activity retention, reintegration, and perceived recovery. Am J Occup Ther 2014; 67:e131-8. [PMID: 24195908 DOI: 10.5014/ajot.2013.008292] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We sought to determine the extent to which perceptions of participation in everyday occupations were affected in a sample of people with predominantly mild stroke. Demographic variables, stroke severity, community integration, participation in everyday occupations, and perceptions of recovery were examined as potential contributors to their perceptions of participation. METHOD We conducted a cross-sectional study with 116 people with mild to moderate first stroke assessed approximately 6 mo after stroke. RESULTS Perceptions of participation assessed using the Stroke Impact Scale varied (range = 19-100), with a mean score of 82. Regression analyses revealed three factors that contributed to perceptions of participation: retention of previous activities, reintegration in home and community, and perception of stroke recovery. CONCLUSION Although the majority of participants reported a high level of perceived participation, more than a third failed to report successful participation.
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Affiliation(s)
- Gunilla Eriksson
- Gunilla Eriksson, PhD, OT reg, is Assistant Professor, Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Research and Development Officer, Department of Speech Pathology, Physiotherapy and Occupational Therapy, University Hospital, Akademiska Sjukhuset, Uppsala, Sweden; and Researcher and Assistant Professor, Department of Public Health and Caring Science, Disability and Habilitation, Uppsala University, Uppsala, Sweden
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Thanakiatpinyo T, Suwannatrai S, Suwannatrai U, Khumkaew P, Wiwattamongkol D, Vannabhum M, Pianmanakit S, Kuptniratsaikul V. The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients. Clin Interv Aging 2014; 9:1311-9. [PMID: 25143717 PMCID: PMC4136956 DOI: 10.2147/cia.s66416] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To study the efficacy of traditional Thai massage (TTM) versus conventional physical therapy (PT) programs in treating muscle spasticity, functional ability, anxiety, depression, and quality of life (QoL) in Thai stroke patients. METHODS This randomized controlled trial with a blinded assessor was carried out at the Department of Rehabilitation Medicine, Siriraj Hospital (Bangkok, Thailand). The study included 50 stroke (onset ≥ 3 months) outpatients experiencing spasticity at the elbow or knee muscles at a grade of ≥ 1+ on the modified Ashworth Scale who were ≥ 50 years old and able to communicate. The subjects were randomly allocated to the treatment group receiving TTM (24 subjects) or the control group receiving the PT program (26 subjects). Both groups received treatment (either TTM or PT) twice a week for 6 weeks. Spasticity grade, functional ability, anxiety, depression, and QoL were measured at Week 0 and Week 6. RESULTS At Week 6, the percentage of patients whose modified Ashworth Scale score had decreased by at least one grade was not statistically significant between the two groups. Both TTM and PT groups experienced a significant increase in functional ability and QoL, but no difference was found between the groups. Anxiety and depression scores showed a decreasing trend in the TTM group. CONCLUSION This preliminary report showed no evidence that TTM differed from the PT program in decreasing spasticity. However, both interventions may relieve spasticity, increase functional ability, and improve QoL after 6 weeks. Only TTM can decrease anxiety and depression scores. Further studies with adequate sample size are necessary.
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Affiliation(s)
| | - Supakij Suwannatrai
- Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ueamphon Suwannatrai
- Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phanitanong Khumkaew
- Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Dokmai Wiwattamongkol
- Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manmas Vannabhum
- Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somluck Pianmanakit
- Department of Rehabilitation Medicine, Mahidol University, Bangkok, Thailand
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Foot placement and arm position affect the five times sit-to-stand test time of individuals with chronic stroke. BIOMED RESEARCH INTERNATIONAL 2014; 2014:636530. [PMID: 25032220 PMCID: PMC4083881 DOI: 10.1155/2014/636530] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/04/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022]
Abstract
Objectives. To investigate the effect of two foot placements (normal or posterior placement) and three arm positions (hands on the thighs, arms crossed over chest, and augmented arm position with elbow extended) on the five times sit-to-stand (FTSTS) test times of individuals with chronic stroke. Design. Cross-sectional study. Setting. University-based rehabilitation clinic.
Participants. A convenience sample of community-dwelling individuals with chronic stroke (N = 45). Methods. The times in completing the FTSTS with two foot placements and the three arm positions were recorded by stopwatch. Results. Posterior foot placement led to significantly shorter FTSTS times when compared with normal foot placement in all the 3 arm positions (P ≤ 0.001). In addition, hands on thigh position led to significantly longer FTSTS times than the augmented arm position (P = 0.014). Conclusion. Our results showed that foot placement and arm position could influence the FTSTS times of individuals with chronic stroke. Standardizing the foot placement and arm position in the test procedure is essential, if FTSTS test is intended to be used repeatedly on the same subject.
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Adamit T, Maeir A, Ben Assayag E, Bornstein NM, Korczyn AD, Katz N. Impact of first-ever mild stroke on participation at 3 and 6 month post-event: the TABASCO study. Disabil Rehabil 2014; 37:667-73. [PMID: 24889677 DOI: 10.3109/09638288.2014.923523] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE This study focused on the relationships between cognition, participation and quality of life (QoL) among first-ever mild ischemic stroke patients 3 months post-event. We hypothesized that significant correlations exist between cognition, executive functions (EF), QoL and participation; and that EF and QoL will significantly contribute to participation beyond demographics and stroke severity at 3 and from 3 to 6 months post-stroke. METHODS A prospective cohort study, recruiting consecutive first-ever stroke patients from a large tertiary hospital. The inclusion criteria were first event, mild stroke (NIHSS ≤ 5), and no previous significant neurological or cognitive impairment. In addition to assessment every 6 month at the hospital, an assessment battery was administered at home 3 months post-stroke. RESULTS Participants showed mild to moderate difficulties in cognition and participation (n = 249). Low to moderate correlations were found between cognition and EF with participation (-0.380, p < 0.05; r = 0.460, p < 0.001, respectively); and cognition with QoL (r = 0.421, p < 0.001). EF and QoL contributed significantly to participation at 3 months (R(2) = 0.961) and in addition education at 6 months (R(2) = 0.701). CONCLUSIONS Participants after mild ischemic stroke experienced cognitive and EF difficulties that affect their participation and QoL. Further studies are needed of mild stroke survivors to enhance our understanding of the variables that affect participation. IMPLICATIONS FOR REHABILITATION The findings of the current study have significant implications for the participation of people after mild stroke in the community. Health care systems in general and rehabilitation programs, in particular, do not consider that these clients need rehabilitation as most of them perform basic daily functions independently. Thus, although cognitive and EF deficits are found in people following even mild stroke, but are not externally apparent, these impairments are mostly neglected by the health care system. Mild stroke has long-term effects in most cases and effect family members as well. The implications of the study's results, as well as those of other studies, emphasize the necessity of follow-up and rehabilitation efforts at home and in the community. These efforts should focus on re-enabling the individual to participate in previous activities as much as possible and on providing support for family members. The strength of this study lies in the large number of participants who were evaluated at home in their natural environments. Studies of this kind are rarely performed in the participants' real-life settings, thus the current study provides an important perspective on the participation of this population in the community.
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Affiliation(s)
- Tal Adamit
- School of Occupational Therapy, Hebrew University , Jerusalem , Israel
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