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Schmidt J, Düvel JA, Elkenkamp S, Greiner W. Comparing the EQ-5D-5L and stroke impact scale 2.0 in stroke patients: an analysis of measurement properties. Health Qual Life Outcomes 2024; 22:45. [PMID: 38835023 DOI: 10.1186/s12955-024-02252-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/20/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Stroke has evolved to become a chronic disease and a major public health challenge. To adequately capture the full disease burden of stroke patients, the assessment of health-related quality of life (HRQoL) and thus the performance of respective measures is increasingly relevant. The aim of this analysis was to compare the measurement properties of two self-report instruments, the EQ-5D-5L and the Stroke Impact Scale 2.0. METHODS The data used for the analysis was derived from a quasi-experimental case management study for mildly to moderately affected incident stroke and transient ischemic attack (TIA) patients aged ≥ 18 in Germany. Data was collected patient-individually at 3, 6 and 12 months after initial stroke. The EQ-5D-5L and SIS 2.0 were compared in terms of feasibility, ceiling and floor effects, responsiveness and known-groups validity (Kruskal-Wallis H and Wilcoxon rank-sum test). RESULTS A response for all three follow-ups is available for n = 855 patients. The feasibility of the EQ-5D-5L is determined as good (completion rate: 96.4-96.6%, ≥ one item missing: 3.2 - 3.3%), whereas the SIS 2.0 is moderately feasible (overall completion rate: 44.9-46.1%, ≥ one item missing in domains: 4.7 - 28.7%). The SIS 2.0 shows substantial ceiling effects in comparable domains (physical function: 10.4 - 13%, others: 3.5-31.3%) which are mainly larger than ceiling effects in the EQ-5D-5L index (17.1-21.5%). In terms of responsiveness, the EQ-5D-5L shows small to moderate change while the SIS 2.0 presents with moderate to large responsiveness. The EQ-5D-5L index, mobility, usual activities and Visual Analogue Scale show known-groups validity (p < 0.05). Content-related domains of the SIS 2.0 show known-groups validity as well (p < 0.05). However, it is compromised in the emotion domain in both measures (p > 0.05). CONCLUSIONS The EQ-5D-5L seems to be slightly more suitable for this cohort. Nonetheless, the results of both measures indicate limited suitability for TIA patients. Large-scale studies concerning responsiveness and known-groups validity are encouraged. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register, retrospective registration on 21.09.2022. REGISTRATION ID DRKS00030297.
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Affiliation(s)
- Juliana Schmidt
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Juliane Andrea Düvel
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Svenja Elkenkamp
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
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Srisomthrong K, Suwanno J, Klinjun N, Suwanno J, Kelly M. Psychometric Testing of the Thai Version of Self-Care of Chronic Illness Inventory Version 4c in Patients With Stroke. J Cardiovasc Nurs 2024:00005082-990000000-00196. [PMID: 38833309 DOI: 10.1097/jcn.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Self-Care of Chronic Illness Inventory version 4c is a non-disease-specific self-care measure used in individuals with multiple chronic conditions. This instrument may be applied to patients with specific diseases such as stroke. OBJECTIVE The aim of this study was to evaluate the psychometric properties of the Thai version of the Self-Care of Chronic Illness Inventory version 4c in patients with stroke. METHODS This multicenter, cross-sectional study adhered to the COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) guidelines and enrolled patients with stroke from 16 primary care centers in southern Thailand. Structural validity was assessed using confirmatory factor analysis, internal consistency reliability using Cronbach α coefficient and global reliability index, and test-retest reliability using intraclass correlation coefficients. RESULTS The final analysis included a total of 350 participants. Confirmatory factor analysis supported the 2-factor Self-Care Maintenance scale structure, although the item allocation to the dimensions differed from that of the original model. The Self-Care Monitoring scale demonstrated a 1-factor structure with permitted residual covariance. The Self-Care Management scale maintained a 2-factor structure, similar to that of the original model. Simultaneous confirmatory factor analysis of the combined items supported the general model with the 3 scales. The Self-Care Maintenance scale exhibited marginally adequate α (0.68) and ω (0.66) coefficients, and an adequate composite reliability index (0.79). The other 2 scales demonstrated adequate α (range, 0.79-0.86), ω (range, 0.75-0.86), and composite reliability (range, 0.83-0.86) indices. Intraclass correlation coefficients showed adequate test-retest reliability for all scales (range, 0.76-0.90). CONCLUSIONS The generic self-care measure, Self-Care of Chronic Illness Inventory version 4c, demonstrated strong psychometric properties in patients with stroke. This instrument may be a valuable tool for assessing stroke self-care in Thailand.
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Milosevich E, Kusec A, Pendlebury ST, Demeyere N. Domain-specific cognitive impairments, mood and quality of life 6 months after stroke. Disabil Rehabil 2024:1-10. [PMID: 38623852 DOI: 10.1080/09638288.2024.2340121] [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: 02/16/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To identify which acute and 6-month domain-specific cognitive impairments impact mood, participation, and stroke-related quality of life 6 months post-stroke. MATERIALS AND METHODS A prospective cohort of 430 stroke survivors completed the Oxford Cognitive Screen (OCS) acutely and 6 months post-stroke. Participants completed the Stroke Impact Scale (SIS) and Hospital Depression and Anxiety Scale (HADS) at 6 months. Multivariable regression analyses assessed whether severity of, and domain-specific, cognitive impairment acutely and at 6 months was associated with composite 6-month SIS scores, each SIS subscale, and HADS scores. RESULTS Increased severity of acute and 6-month cognitive impairment was associated with lower 6-month SIS composite scores independent of age, sex, education years, and stroke severity (both p < 0.001). Domain-specific impairments in memory (p < 0.001) and attention (p = 0.002) acutely, and language (p < 0.001), memory (p = 0.001) and number processing (p = 0.006) at 6 months showed the strongest associations with worse SIS composite scores. Severity of acute and 6-month cognitive impairment was associated with poorer functioning in each SIS subscale, and greater levels of depression (acute p = 0.021, 6-months p < 0.001), but not anxiety (p = 0.174, p = 0.129). CONCLUSIONS Both acute and 6-month domain-specific cognitive impairments, particularly in memory, were found to negatively impact overall functional and mood outcomes 6 months post-stroke.
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Affiliation(s)
| | - Andrea Kusec
- Department of Experimental Psychology, University of Oxford, UK
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
- NIHR Oxford Biomedical Research Centre and Departments of General Medicine and Geratology, John Radcliffe Hospital, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, UK
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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Bao Y, Ning B. The effect of stent retriever mechanical thrombectomy combined with tirofiban in treating acute ischemic stroke. Int J Neurosci 2024:1-8. [PMID: 38597661 DOI: 10.1080/00207454.2024.2341921] [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: 02/27/2024] [Accepted: 04/07/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To analyze the effectiveness of stent retriever mechanical thrombectomy combined with tirofiban in treating acute ischemic stroke. METHODS Markedly effective is defined as an SIS score of over 90, effective is indicated by an SIS score of between 50-90, and a score of below 50 suggests ineffective treatment results. RESULTS ①The treatment's overall effectiveness in the observation group (91.30%) was significantly higher than that in the control group (75.56%) (p < 0.05). ②The vascular recanalization rate in the observation group (89.13%) was significantly higher than that in the control group (71.11%) (p < 0.05). ③The stent retrieval operation count (2.41 ± 0.23) was significantly lower in the observation group than in the control group (1.29 ± 0.16) (p < 0.05). ④ After treatment, the platelet aggregation rate (10.74 ± 3.95) and NIHSS scores (6.58 ± 1.04) were significantly lower, and the Barthel index (77.86 ± 7.21) was significantly higher in the observation group compared to the control group (26.47 ± 5.12, 7.75 ± 2.36, 68.12 ± 6.15) (p < 0.05). All platelet aggregation rate, NIHSS scores and Barthel Index showed significant improvement after treatment when compared to those before treatment (p < 0.05). CONCLUSION The combined application of stent retriever mechanical thrombectomy and tirofiban in acute ischemic stroke treatment shows promising effectiveness. Compared to stent retriever alone, tirofiban adjunctive therapy enhances vascular recanalization, reduces retrieval procedures, shortens treatment duration, inhibits platelet aggregation, and improves neurological function recovery, daily living activities, and prognosis. Moreover, it doesn't significantly increase symptom-related risks.
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Fleming MK, Smejka T, Macey E, Luengo-Fernandez R, Henry AL, Robinson B, Kyle SD, Espie CA, Johansen-Berg H. Improving sleep after stroke: A randomised controlled trial of digital cognitive behavioural therapy for insomnia. J Sleep Res 2024; 33:e13971. [PMID: 37407096 DOI: 10.1111/jsr.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/11/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
Stroke is frequently accompanied by long-term sleep disruption. We therefore aimed to assess the efficacy of digital cognitive behavioural therapy for insomnia to improve sleep after stroke. A parallel group randomised controlled trial was conducted remotely in participant's homes/online. Randomisation was online with minimisation of between-group differences in age and baseline Sleep Condition Indicator-8 score. In total, 86 community-dwelling stroke survivors consented, of whom 84 completed baseline assessments (39 female, mean 5.5 years post-stroke, mean 59 years old), and were randomised to digital cognitive behavioural therapy or control (sleep hygiene information). Follow-up was at post-intervention (mean 75 days after baseline) and 8 weeks later. The primary outcome was self-reported insomnia symptoms, as per the Sleep Condition Indicator-8 (range 0-32, lower numbers indicate more severe insomnia, reliable change 7 points) at post-intervention. There were significant improvements in Sleep Condition Indicator-8 for digital cognitive behavioural therapy compared with control (intention-to-treat, digital cognitive behavioural therapy n = 48, control n = 36, 5 imputed datasets, effect of group p ≤ 0.02,η p 2 = 0.07-0.12 [medium size effect], pooled mean difference = -3.35). Additionally, secondary outcomes showed shorter self-reported sleep-onset latencies and better mood for the digital cognitive behavioural therapy group, but no significant differences for self-efficacy, quality of life or actigraphy-derived sleep parameters. Cost-effectiveness analysis found that digital cognitive behavioural therapy dominates over control (non-significant cost savings and higher quality-adjusted life years). No related serious adverse events were reported to the researchers. Overall, digital cognitive behavioural therapy for insomnia effectively improves sleep after stroke. Future research is needed to assess earlier stages post-stroke, with a longer follow-up period to determine whether it should be included as part of routine post-stroke care. Clinicaltrials.gov NCT04272892.
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Affiliation(s)
- Melanie K Fleming
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tom Smejka
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ellie Macey
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ramon Luengo-Fernandez
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alasdair L Henry
- Big Health Ltd, London, UK
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Barbara Robinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon D Kyle
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Colin A Espie
- Big Health Ltd, London, UK
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Lee SC, Chou CY, Chen PT, Wu TY, Hsueh IP, Hsieh CL. Validation of the Machine Learning-Based Stroke Impact Scale With a Cross-Cultural Sample. Am J Occup Ther 2024; 78:7802180060. [PMID: 38271640 DOI: 10.5014/ajot.2024.050356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
IMPORTANCE The machine learning-based Stroke Impact Scale (ML-SIS) is an efficient short-form measure that uses 28 items to provide domain scores comparable to those of the original 59-item Stroke Impact Scale-Third Edition (SIS 3.0). However, its utility is largely unknown because it has not been cross-validated with an independent sample. OBJECTIVE To examine the ML-SIS's comparability and test-retest reliability with that of the original SIS 3.0 in an independent sample of people with stroke. DESIGN Comparability was examined with the coefficient of determination (R2), mean absolute error, and root-mean-square error (RMSE). Test-retest reliability was examined using the intraclass correlation coefficient (ICC). SETTING Five hospitals in Taiwan. PARTICIPANTS Data of 263 persons with stroke were extracted from a previous study; 144 completed repeated assessments after a 2-wk interval. RESULTS High R2 (.87-.95) and low mean absolute error or RMSE (about 2.4 and 3.3) of the domain scores, except for the Emotion scores (R2 = .08), supported the comparability of the two measures. Similar ICC values (.39-.87 vs. .46-.87) were found between the two measures, suggesting that the ML-SIS is as reliable as the SIS 3.0. CONCLUSIONS AND RELEVANCE The ML-SIS provides scores mostly identical to those of the original measure, with similar test-retest reliability, except for the Emotion domain. Thus, it is a promising alternative that can be used to lessen the burden of routine assessments and provide scores comparable to those of the original SIS 3.0. Plain-Language Summary: The machine learning-based Stroke Impact Scale (ML-SIS) is as reliable as the original Stroke Impact Scale-Third Edition, except for the Emotion domain. Thus, the ML-SIS can be used to improve the efficiency of clinical assessments and also relieve the burden on people with stroke who are completing the assessments.
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Affiliation(s)
- Shih-Chieh Lee
- Shih-Chieh Lee, PhD, is Assistant Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, and Occupational Therapist, Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Yeh Chou
- Chia-Yeh Chou, MA, is Associate Professor, Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Po-Ting Chen
- Po-Ting Chen, MS, is PhD Student, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tzu-Yi Wu
- Tzu-Yi Wu, PhD, is Assistant Professor, Department of Occupational Therapy, College of Medical and Health Sciences, Asia University, Taichung,Taiwan;
| | - I-Ping Hsueh
- I-Ping Hsueh, MS, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Lin Hsieh
- Ching-Lin Hsieh, PhD, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Adjunct Professor, Department of Occupational Therapy, College of Medical and Health Sciences, Asia University, Taiwan; and Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan;
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Hainsworth R, Thompson AJ, Guthrie B, Payne K, Rogers G. International Systematic Review of Utility Values Associated with Cardiovascular Disease and Reflections on Selecting Evidence for a UK Decision-Analytic Model. Med Decis Making 2024; 44:217-234. [PMID: 38174427 PMCID: PMC10865747 DOI: 10.1177/0272989x231214782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/19/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Evaluating interventions for cardiovascular disease (CVD) requires estimates of its effect on utility. We aimed to 1) systematically review utility estimates for CVDs published since 2013 and 2) critically appraise UK-relevant estimates and calculate corresponding baseline utility multipliers. METHODS We searched MEDLINE and Embase (April 22, 2021) using CVD and utility terms. We screened results for primary studies reporting utility distributions for people with experience of heart failure, myocardial infarction, peripheral arterial disease, stable angina, stroke, transient ischemic attack, or unstable angina. We extracted characteristics from studies included. For UK estimates based on the EuroQoL 5-dimension (EQ-5D) measure, we assessed risk of bias and applicability to a decision-analytic model, pooled arms/time points as appropriate, and estimated baseline utility multipliers using predicted utility for age- and sex- matched populations without CVD. We sought utility sources from directly applicable studies with low risk of bias, prioritizing plausibility of severity ordering in our base-case model and highest population ascertainment in a sensitivity analysis. RESULTS Most of the 403 studies identified used EQ-5D (n = 217) and most assessed Organisation for Economic Co-operation and Development populations (n = 262), although measures and countries varied widely. UK studies using EQ-5D (n = 29) produced very heterogeneous baseline utility multipliers for each type of CVD, precluding meta-analysis and implying different possible severity orderings. We could find sources that provided a plausible ordering of utilities while adequately representing health states. CONCLUSIONS We cataloged international CVD utility estimates and calculated UK-relevant baseline utility multipliers. Modelers should consider unreported sources of heterogeneity, such as population differences, when selecting utility evidence from reviews. HIGHLIGHTS Published systematic reviews have summarized estimates of utility associated with cardiovascular disease published up to 2013.We 1) reviewed utility estimates for 7 types of cardiovascular disease published since 2013, 2) critically appraised UK-relevant studies, and 3) estimated the effect of each cardiovascular disease on baseline utility.Our review 1) recommends a consistent and reliable set of baseline utility multipliers for 7 types of cardiovascular disease and 2) provides systematically identified reference information for researchers seeking utility evidence for their own context.
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Affiliation(s)
- Rob Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Alexander J. Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Kähler M, Nilsson HM, Lexell J. The Life After Stroke In Northern Sweden Study (LASINS): Methodology, cohort demographics and initial results. NeuroRehabilitation 2024; 54:319-329. [PMID: 38277309 DOI: 10.3233/nre-230278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND To advance rehabilitation we need a comprehensive understanding of functioning and disability of people after stroke. OBJECTIVE To present an overview of the methodology of the Life After Stroke In Northern Sweden Study, compare participants and non-participants regarding gender and age, and describe baseline sociodemographics, stroke characteristics and the participants' self-rated degree of recovery. METHODS Data were collected through a study specific questionnaire, from the participants' medical records and with internationally established self-assessment tools focusing on sleep disturbances, depressive symptoms, fatigue, physical activity, and remaining physical and cognitive impairments, activity limitations, participation restrictions and life satisfaction. RESULTS Of 301 potential participants, 160 comprise the final sample (response rate 53%; 86 men and 74 women, mean age 73 years±11, mean time since stroke onset 35 months±11; 18- 61). Most participants had an ischemic stroke (87%), were retired (84%), cohabitant (63%) and walked independently (71%). The mean self-rated degree of recovery was 75 (SD±24; 0- 100). CONCLUSIONS These baseline data together with forthcoming studies will describe stroke-related impairments, activity limitations, participation restrictions and life satisfaction more than one year after stroke, and deepen our understanding of factors of importance for a healthy and successful life after stroke.
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Affiliation(s)
- Maria Kähler
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden
- Department of Rehabilitation, Sunderby Hospital, Luleå, Sweden
| | - Hanna M Nilsson
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden
- Department of Rehabilitation, Sunderby Hospital, Luleå, Sweden
| | - Jan Lexell
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden
- Department of Rehabilitation, Ängelholm Hospital, Ängelholm, Sweden
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Kusec A, Milosevich E, Williams OA, Chiu EG, Watson P, Carrick C, Drozdowska BA, Dillon A, Jennings T, Anderson B, Dawes H, Thomas S, Kuppuswamy A, Pendlebury ST, Quinn TJ, Demeyere N. Long-term psychological outcomes following stroke: the OX-CHRONIC study. BMC Neurol 2023; 23:426. [PMID: 38036966 PMCID: PMC10688008 DOI: 10.1186/s12883-023-03463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Stroke survivors rate longer-term (> 2 years) psychological recovery as their top priority, but data on how frequently psychological consequences occur is lacking. Prevalence of cognitive impairment, depression/anxiety, fatigue, apathy and related psychological outcomes, and whether rates are stable in long-term stroke, is unknown. METHODS N = 105 long-term stroke survivors (M [SD] age = 72.92 [13.01]; M [SD] acute NIH Stroke Severity Score = 7.39 [6.25]; 59.0% Male; M [SD] years post-stroke = 4.57 [2.12]) were recruited (potential N = 208). Participants completed 3 remote assessments, including a comprehensive set of standardized cognitive neuropsychological tests comprising domains of memory, attention, language, and executive function, and questionnaires on emotional distress, fatigue, apathy and other psychological outcomes. Ninety participants were re-assessed one year later. Stability of outcomes was assessed by Cohen's d effect size estimates and percent Minimal Clinically Important Difference changes between time points. RESULTS On the Montreal Cognitive Assessment 65.3% scored < 26. On the Oxford Cognitive Screen 45.9% had at least one cognitive impairment. Attention (27.1%) and executive function (40%) were most frequently impaired. 23.5% and 22.5% had elevated depression/anxiety respectively. Fatigue (51.4%) and apathy (40.5%) rates remained high, comparable to estimates in the first-year post-stroke. Attention (d = -0.12; 85.8% stable) and depression (d = 0.09, 77.1% stable) were the most stable outcomes. Following alpha-adjustments, only perceptuomotor abilities (d = 0.69; 40.4% decline) and fatigue (d = -0.33; 45.3% decline) worsened over one year. Cognitive impairment, depression/anxiety, fatigue and apathy all correlated with worse quality of life. CONCLUSION Nearly half of participants > 2 years post-event exhibited psychological difficulties including domains of cognition, mood, and fatigue, which impact long-term quality of life. Stroke is a chronic condition with highly prevalent psychological needs, which require monitoring and intervention development.
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Affiliation(s)
- Andrea Kusec
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Elise Milosevich
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Owen A Williams
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Pippa Watson
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Chloe Carrick
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Bogna A Drozdowska
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Avril Dillon
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | | | - Bloo Anderson
- Patient and Public Involvement Representative, Oxford, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Medical School Building, St Luke's Campus, Magdalen Road, Exeter, UK
| | - Shirley Thomas
- School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Annapoorna Kuppuswamy
- Institute of Neurology Department of Clinical and Movement Neurosciences, University College London, 33 Queen Square, London, UK
- Department of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Terence J Quinn
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK.
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Chou CY, Huang CY, Lee SC, Hsueh IP, Hsieh CL. Validation of two short forms of Stroke Impact Scale: unidimensionality and reliability. Disabil Rehabil 2023; 45:3748-3754. [PMID: 36288467 DOI: 10.1080/09638288.2022.2135770] [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: 02/22/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We examined the unidimensionality and Rasch reliability of both Jenkinson's and MacIsaac's eight-item short versions of the Stroke Impact Scale (SF-SIS), a questionnaire for assessing overall health-related quality of life (HRQOL). METHODS This study was a secondary data analysis in which 263 persons with stroke completed the SIS. The 263 persons, on average, had age of 60 years, mild stroke, and moderate disability of self-care. The unidimensionality of both versions was validated via testing of model fitting and principal component analysis (PCA) of residuals using the Rasch analysis to determine the Rasch reliability and measures. RESULTS The eight items in both SF-SIS versions met the criteria of infit and outfit MNSQ (<1.4 and >0.6), indicating good data-model fit. The PCA showed that no dominant factors existed in the residuals of the items. The person reliability of Jenkinson's and MacIsaac's SF-SIS versions was 0.80 and 0.79, respectively. The Rasch measures (i.e., person measure in logits) ranged from -1.06 to 1.87 in Jenkinson's SF-SIS and -0.82 to 1.88 in MacIsaac's version. CONCLUSIONS The unidimensionality of both versions was supported. The Rasch measures of both appear valid for representing overall HRQOL levels. Both versions also showed acceptable reliability for research purposes.Implications for rehabilitationThe unidimensionality was justified for both versions (Jenkinson's and MacIsaac's eight-item short-versions of Stroke Impact Scale).The Rasch scores of both versions appear valid for representing overall health-related quality of life.Both versions showed acceptable reliability for research purposes, but not sufficiently reliable for clinical use.
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Affiliation(s)
- Chia-Yeh Chou
- Department of Occupational Therapy, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chien-Yu Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Chieh Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung City, Taiwan
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Atama T, Leclair L, Pooyania S, Barclay R. Stroke Survivors and their Physiotherapists' Perceptions of Recovery: A Multiple Methods Approach. Physiother Can 2023; 75:377-386. [PMID: 38037584 PMCID: PMC10686302 DOI: 10.3138/ptc-2021-0068] [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: 07/01/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 12/02/2023]
Abstract
Purpose This multiple-methods study examined perceptions of recovery among stroke survivors and their physiotherapists at discharge from an in-patient rehabilitation program. Method The Functional Independence Measure (FIM) and Chedoke McMaster Stroke Assessment Activity Inventory scores were collected from chart review and the following outcome measures were completed by interview: Stroke Impact Scale (SIS) global recovery, Hospital Anxiety Depression Scale, and Montreal Cognitive Assessment. Physiotherapists also completed the SIS global recovery for each participant. Spearman and Pearson correlations between SIS recovery and observed measures were completed. The stroke survivors had a short interview about their perception of recovery and what recovery meant to them, and their physiotherapists answered two written questions about each participant's recovery. Responses were coded and categorized based on the International Classification of Functioning. Results A total of 31 stroke survivors with a mean age of 66.6 years (SD 10.7) and six physiotherapists participated. Nineteen stroke survivors were interviewed. The stroke survivors' SIS recovery scores correlated with FIM-motor change (rs = 0.36 p = 0.04) and the SIS-recovery scores reported by the physiotherapists (r = 0.51; p < 0.01). In relation to the factors related to recovery, the physiotherapists' focus was therapeutic mainly considering motor recovery while the stroke survivors' responses were broad, including being able to achieve recovery goals and nutrition. However, both perceived recovery to include functional activities. Conclusions SIS global recovery question helps to measure the overall perceived percentage of recovery. However, the complete picture of recovery is only possible with the stroke survivors' and physiotherapists' perceptions of recovery and what recovery means to them.
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Affiliation(s)
- Tolu Atama
- From the:
From the: Department of Physiotherapy, Health Sciences Centre, Shared Health, Winnipeg, Manitoba, Canada
| | - Leanne Leclair
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sepideh Pooyania
- Section of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Catalogna M, Hadanny A, Parag Y, Adler M, Elkarif V, Efrati S. Functional MRI evaluation of hyperbaric oxygen therapy effect on hand motor recovery in a chronic post-stroke patient: a case report and physiological discussion. Front Neurol 2023; 14:1233841. [PMID: 37840920 PMCID: PMC10570419 DOI: 10.3389/fneur.2023.1233841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Impairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have been correlated with low quality of life. In the current case report, we used both task-based and resting state functional MRI (fMRI) tools to investigate the neural response mechanisms and functional reorganization underlying hyperbaric oxygen therapy (HBOT)-induced motor rehabilitation in a chronic post-stroke patient suffering from severe upper-limb motor impairment. Methods We studied motor task fMRI activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb, 2 years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and at the end of the treatment using the Fugl-Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC). Results Following HBOT, the FMA score improved from 17 (severe impairment) to 31 (moderate impairment). Following the intervention during trials involving the affected hand, there was an observed increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity (P = 0.002) and a between-network connectivity increase (z-score: 0.35 ± 0.21 to 0.41 ± 0.21, P < 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex, and the premotor cortex. Conclusion This study provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients.
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Affiliation(s)
- Merav Catalogna
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Amir Hadanny
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Parag
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Moran Adler
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Vicktoria Elkarif
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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13
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Binks JA, Emerson JR, Scott MW, Wilson C, van Schaik P, Eaves DL. Enhancing upper-limb neurorehabilitation in chronic stroke survivors using combined action observation and motor imagery therapy. Front Neurol 2023; 14:1097422. [PMID: 36937513 PMCID: PMC10017546 DOI: 10.3389/fneur.2023.1097422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction For people who have had a stroke, recovering upper-limb function is a barrier to independence. When movement is difficult, mental practice can be used to complement physical therapy. In this within-participants study we investigated the effects of combined action observation and motor imagery (AO + MI) therapy on upper-limb recovery in chronic stroke survivors. Methods A Graeco-Latin Square design was used to counterbalance four mental practice conditions (AO + MI, AO, MI, Control) across four cup-stacking tasks of increasing complexity. Once a week, for five consecutive weeks, participants (n = 10) performed 16 mental practice trials under each condition. Each trial displayed a 1st person perspective of a cup-stacking task performed by an experienced model. For AO, participants watched each video and responded to an occasional color cue. For MI, participants imagined the effort and sensation of performing the action; cued by a series of still-images. For combined AO + MI, participants observed a video of the action while they simultaneously imagined performing the same action in real-time. At three time points (baseline; post-test; two-week retention test) participants physically executed the three mentally practiced cup-stacking tasks, plus a fourth unpractised sequence (Control), as quickly and accurately as possible. Results Mean movement execution times were significantly reduced overall in the post-test and the retention test compared to baseline. At retention, movement execution times were significantly shorter for combined AO + MI compared to both MI and the Control. Individual participants reported clinically important changes in quality of life (Stroke Impact Scale) and positive qualitative experiences of AO + MI (social validation). Discussion These results indicate that when physical practice is unsuitable, combined AO + MI therapy could offer an effective adjunct for neurorehabilitation in chronic stroke survivors.
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Affiliation(s)
- Jack Aaron Binks
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, United Kingdom
| | - Jonathan Reyes Emerson
- School of Health and Life Sciences, Allied Health Professions, Teesside University, Middlesbrough, United Kingdom
| | | | - Christopher Wilson
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, United Kingdom
| | - Paul van Schaik
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, United Kingdom
| | - Daniel Lloyd Eaves
- Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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The efficacy of therapist-supported acceptance and commitment therapy-based bibliotherapy for psychological distress after stroke: a single-case multiple-baseline study. Behav Cogn Psychother 2023; 51:87-104. [PMID: 36214628 DOI: 10.1017/s135246582200042x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psychological distress is common after stroke, and affects recovery. However, there are few evidence-based psychological treatments. This study evaluates a bibliotherapy-based approach to its amelioration. AIMS To investigate a stroke-specific self-management book, based on acceptance and commitment therapy (ACT), as a therapist-supported intervention for psychological distress after stroke. METHOD The design was a single case, randomised non-concurrent multiple-baseline design (MBD). Sixteen stroke survivors, eight males and eight females (mean age 60.6 years), participated in an MBD with three phases: A (randomised-duration baseline); B (intervention); and follow-up (at 3 weeks). During the baseline, participants received therapist contact only. In the bibliotherapy intervention, participants received bi-weekly therapist support. The primary measures of psychological distress (General Health Questionaire-12; GHQ-12) and quality of life (Satisfaction with Life Scale; SWLS) were completed weekly. Secondary measures of mood, wellbeing and illness impact were completed pre- and post-intervention. RESULTS Omnibus whole-group TAU-U analysis was statistically significant for each primary measure with a moderate effect size on both (0.6 and 0.3 for GHQ-12 and SWLS, respectively). Individual TAU-U analyses demonstrated that the majority of individuals exhibited positive change. All the secondary measures showed significant pre-post improvements. Eighty-one per cent of participants reported the book was helpful and 81% also found the ACT-based sections helpful. Relative risk calculations showed finding the book helpful was associated with improvement in GHQ-12 and SWLS scores. CONCLUSIONS ACT-based bibliotherapy, with therapist support, is a promising intervention for psychological difficulties after stroke.
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Lee SC, Wang I, Lin GH, Li PC, Lee YC, Chou CY, Huang CY, Hsieh CL. Development of a Short-Form Stroke Impact Scale Using a Machine Learning Algorithm for Patients at the Subacute Stage. Am J Occup Ther 2022; 76:23964. [DOI: 10.5014/ajot.2022.049136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Importance: Several short forms of the Stroke Impact Scale Version 3.0 (SIS 3.0) have been proposed in order to decrease its administration time of about 20 min. However, none of the short-form scores are comparable to those of the original measure.
Objective: To develop a short-form SIS 3.0 using a machine learning algorithm (ML–SIS).
Design: We developed the ML–SIS in three stages. First, we calculated the frequencies of items having the highest contribution to predicting the original domain scores across 50 deep neural networks. Second, we iteratively selected the items showing the highest frequency until the coefficient of determination (R2) of each domain was ≥.90. Third, we examined the comparability and concurrent and convergent validity of the ML–SIS.
Setting: Hospitals.
Participants: We extracted complete data for 1,010 patients from an existing data set.
Results: Twenty-eight items were selected for the ML–SIS. High average R2s (.90–.96) and small average residuals (mean absolute errors and root-mean-square errors = 0.49–2.84) indicate good comparability. High correlations (rs = .95–.98) between the eight domain scores of the ML–SIS and the SIS 3.0 indicate sufficient concurrent validity. Similar interdomain correlations between the two measures indicate satisfactory convergent validity.
Conclusions and Relevance: The ML–SIS uses about half of the items in the SIS 3.0, has an estimated administration time of 10 min, and provides valid scores comparable to those of the original measure. Thus, the ML–SIS may be an efficient alternative to the SIS 3.0.
What This Article Adds: The ML–SIS, a short form of the SIS 3.0 developed using a machine learning algorithm, shows good potential to be an efficient and informative measure for clinical settings, providing scores that are valid and comparable to those of the original measure.
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Affiliation(s)
- Shih-Chieh Lee
- Shih-Chieh Lee, PhD, is Postdoctoral Researcher, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Adjunct Assistant Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; and Adjunct Assistant Professor, Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan. At the time this article was submitted, Lee was Postdoctoral Researcher, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Inga Wang
- Inga Wang, OTR/L, PhD, is Associate Professor, Department of Occupational Sciences and Technology, University of Wisconsin–Milwaukee
| | - Gong-Hong Lin
- Gong-Hong Lin, PhD, is Assistant Professor, International PhD Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pei-Chi Li
- Pei-Chi Li, MS, is PhD Student, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. At the time this article was submitted, Li was Master’s Student, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ya-Chen Lee
- Ya-Chen Lee, PhD, is Associate Professor, Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan. At the time this article was submitted, Lee was Assistant Professor, Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan;
| | - Chia-Yeh Chou
- Chia-Yeh Chou, MA, is Associate Professor, Department of Occupational Therapy, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chien-Yu Huang
- Chien-Yu Huang, PhD, is Assistant Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Adjunct Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. At the time this article was submitted, Huang was Associate Professor, Department of Occupational Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Ching-Lin Hsieh
- Ching-Lin Hsieh, PhD, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Adjunct Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Adjunct Professor, Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan;
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Key considerations to reduce or address respondent burden in patient-reported outcome (PRO) data collection. Nat Commun 2022; 13:6026. [PMID: 36224187 PMCID: PMC9556436 DOI: 10.1038/s41467-022-33826-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022] Open
Abstract
Patient-reported outcomes (PROs) are used in clinical trials to provide evidence of the benefits and risks of interventions from a patient perspective and to inform regulatory decisions and health policy. The collection of PROs in routine practice can facilitate monitoring of patient symptoms; identification of unmet needs; prioritisation and/or tailoring of treatment to the needs of individual patients and inform value-based healthcare initiatives. However, respondent burden needs to be carefully considered and addressed to avoid high rates of missing data and poor reporting of PRO results, which may lead to poor quality data for regulatory decision making and/or clinical care. The collection of patient-reported outcomes (PROs) may capture patients’ assessments of their health status. Here authors highlight PRO-specific issues that should be considered to minimise respondent burden in clinical trials and routine care.
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Kim H, Shin JH. Assessment of Upper Extremity Function in People With Stroke Based on the Framework of the ICF: A Narrative Review. BRAIN & NEUROREHABILITATION 2022; 15:e16. [PMID: 36743205 PMCID: PMC9833478 DOI: 10.12786/bn.2022.15.e16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/20/2022] [Indexed: 11/08/2022] Open
Abstract
Although there are many assessment tools for upper extremity (UE) function, it is still difficult to select an appropriate outcome measurement for the rehabilitation process of individuals with stroke. This review aims to classify each tool within the International Classification of Functioning, Disability and Health (ICF) framework and provide an overview of UE assessments. Through a comprehensive understanding of assessments based on ICF, health care professionals will be able to choose suitable measurement tools for individuals, facilitating their rehabilitation.
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Affiliation(s)
- Hanna Kim
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
| | - Joon-Ho Shin
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
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18
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Morse N, Thomson LJ, Elsden E, Rogers H, Chatterjee HJ. Exploring the Potential of Creative Museum-led Activities to Support Stroke In-patient Rehabilitation and Wellbeing: A Pilot Mixed-methods Study. Arts Health 2022; 15:135-152. [PMID: 35094642 DOI: 10.1080/17533015.2022.2032224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This paper proposes a framework for studying the potential of museum-led interventions for supporting stroke rehabilitation goals. METHODS The intervention was based on Kirvevold et al.'s model for interventions for post-stroke wellbeing. Mixed-methods data was collected to review benefits in a pilot study, including retrospective video observations for six sessions with four patients; interviews with patients, carers and facilitators; pre-post patient assessments; and facilitator diaries. RESULTS Systematic analysis of videos showed high levels of concentration and engagement with museum objects, low levels of social interaction, and positive or neutral mood throughout. Thematic qualitative analysis suggested patients felt engaged in meaningful activities, which lifted negative mood, provided positive distraction from the ward, and increased self-esteem, including belief in patient abilities. CONCLUSION Further research is needed to fully establish the potential of museum-led interventions for stroke rehabilitation.
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Affiliation(s)
- Nuala Morse
- School of Museum Studies, University of Leicester, Leicester, U.K
| | - L J Thomson
- Division of Biosciences, University College London, London, U.K
| | - E Elsden
- Department of Arts and Sciences, University College London, London, U.K, (note current affiliation: Institute of Epidemiology and Public Health, University College London, London, U.K
| | - H Rogers
- Patient Safety & Clinical Governance, Manchester University NHS Foundation Trust, Manchester, UK
| | - H J Chatterjee
- Division of Biosciences, University College London, London, U.K
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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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Coppers A, Möller JC, Marks D. Psychometric properties of the short form of the Stroke Impact Scale in German-speaking stroke survivors. Health Qual Life Outcomes 2021; 19:190. [PMID: 34332592 PMCID: PMC8325839 DOI: 10.1186/s12955-021-01826-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The short form of the Stroke Impact Scale (SF-SIS) consists of eight questions and provides an overall index of health-related quality of life after stroke. The goal of the study was the evaluation of construct validity, reliability and responsiveness of the SF-SIS for the use in German-speaking stroke patients in rehabilitation. Methods The SF-SIS, the Stroke Impact Scale 2.0 (SIS 2.0), EQ-5D-5L, National Institutes of Health Stroke Scale (NIHSS) and de Morton Mobility Index were assessed in 150 inpatients after stroke, with a second measurement two weeks later for the analyses of responsiveness. In 55 participants, the test–retest-reliability was assessed one week after the first measurement. The study was designed following the recommendations of the COSMIN initiative. Results The correlations of the SF-SIS with the SIS 2.0 (ρ = 0.90), as well as the EQ-5D-5L (ρ = 0.79) were high, as expected. There was adequate discriminatory ability of the SF-SIS index between patients who were less and more severely affected by stroke, as assessed by the NIHSS. Exploratory factor analysis indicated a two-factor structure of the SF-SIS explaining 59.9% of the total variance, providing better model fit in the confirmatory factor analysis than the one-factorial structure. Analyses of test–retest-reliability showed an intraclass correlation coefficient of 0.88 (95% CI 0.75–0.94). Hypotheses concerning responsiveness were not confirmed due to lower correlations between the assessments change scores. Conclusion Results of this analysis of the SF-SIS’s psychometric properties are matching with the validity analysis of the English original version, confirming the high correlations with the Stroke Impact Scale and the EQ-5D-5L. Examination of structural validity did not confirm the presumed unidimensionality of the scale and found evidence of an underlying two-factor solution with a physical and cognitive domain. Sufficient test–retest reliability and internal consistency were found. In addition, this study provides first results for the responsiveness of the German version. Trial registration The study was registered at the German Clinical Trials Register. Trial registration number: DRKS00011933, date of registration: 07.04.2017
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Affiliation(s)
- Anna Coppers
- Center for Neurological Rehabilitation, Hauptstrasse 2, 8588, Zihlschlacht, Switzerland.
| | - Jens Carsten Möller
- Center for Neurological Rehabilitation, Hauptstrasse 2, 8588, Zihlschlacht, Switzerland.,Department of Neurology, Philipps University, Baldingerstr, 35043, Marburg, Germany
| | - Detlef Marks
- Center for Neurological Rehabilitation, Hauptstrasse 2, 8588, Zihlschlacht, Switzerland
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Wardlaw JM, Doubal F, Brown R, Backhouse E, Woodhouse L, Bath P, Quinn TJ, Robinson T, Markus HS, McManus R, O’Brien JT, Werring DJ, Sprigg N, Parry-Jones A, Touyz RM, Williams S, Mah YH, Emsley H. Rates, risks and routes to reduce vascular dementia (R4vad), a UK-wide multicentre prospective observational cohort study of cognition after stroke: Protocol. Eur Stroke J 2021; 6:89-101. [PMID: 33817339 PMCID: PMC7995325 DOI: 10.1177/2396987320953312] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Stroke commonly affects cognition and, by definition, much vascular dementia follows stroke. However, there are fundamental limitations in our understanding of vascular cognitive impairment, restricting understanding of prevalence, trajectories, mechanisms, prevention, treatment and patient-service needs. AIMS Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. We aim to recruit a wide range of patients with stroke, presenting to geographically diverse UK hospitals, into a longitudinal study to determine rates of, and risk factors for, cognitive and related impairments after stroke, to assess potential mechanisms and improve prediction models. METHODS We will recruit at least 2000 patients within six weeks of stroke with or without capacity to consent and collect baseline demographic, clinical, socioeconomic, lifestyle, cognitive, neuropsychiatric and informant data using streamlined patient-centred methods appropriate to the stage after stroke. We will obtain more detailed assessments at four to eight weeks after the baseline assessment and follow-up by phone and post yearly to at least two years. We will assess diagnostic neuroimaging in all and high-sensitivity inflammatory markers, genetics, blood pressure and diffusion tensor imaging in mechanistic sub-studies.Planned outputs: R4VaD will provide reliable data on long-term cognitive function after stroke, stratified by prior cognition, stroke- and patient-related variables and improved risk prediction. It will create a platform enabling sharing of data, imaging and samples. Participants will be consented for re-contact, facilitating future clinical trials and providing a resource for the stroke and dementia research communities.
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Affiliation(s)
- Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Rosalind Brown
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ellen Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Lisa Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Philip Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, UK
| | - Hugh S Markus
- Department of Neurology, University of Cambridge, Cambridge, UK
| | | | - John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David J Werring
- National Hospital for Neurology and Neurosurgery, London, UK
- NHS Foundation Trust and Stroke Research Centre, University College Hospitals, London, UK
- Institute of Neurology, University College, London, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Adrian Parry-Jones
- Division of Cardiovascular Sciences, School of Medicine, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Steven Williams
- King’s College Hospital NHS Foundation Trust, School of Biomedical Engineering and Imaging Sciences, King’s College London, UK
| | - Yee-Haur Mah
- King’s College Hospital NHS Foundation Trust, School of Biomedical Engineering and Imaging Sciences, King’s College London, UK
| | - Hedley Emsley
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust & Lancaster Medical School, Lancaster University, UK
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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] [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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23
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Langhammer B, Lindmark B, Stanghelle JK. Baseline walking ability as an indicator of overall walking ability and ADL at 3, 6, and 12 months after acute stroke. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1872700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Birgitta Langhammer
- Faculty of Health Sciences, Sunnaas Rehabilitation Hospital, Oslo Metropolitan University, Oslo, Norway
| | | | - Johan K. Stanghelle
- Faculty of Medicine, Sunnaas Rehabilitation Hospital, University of Oslo, Oslo, Norway
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Aquino MRJR, Mullis R, Kreit E, Johnson V, Grant J, Lim L, Sutton S, Mant J. Improving Primary Care After Stroke (IPCAS) randomised controlled trial: protocol for a multidimensional process evaluation. BMJ Open 2020; 10:e036879. [PMID: 32641334 PMCID: PMC7348649 DOI: 10.1136/bmjopen-2020-036879] [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: 11/16/2022] Open
Abstract
INTRODUCTION Primary care interventions are often multicomponent, with several targets (eg, patients and healthcare professionals). Improving Primary Care After Stroke (IPCAS) is a novel primary care-based model of long-term stroke care involving a review of stroke-related needs, a self-management programme, a direct point of contact in general practice, enhanced communication between care services, and a directory of national and local community services, currently being evaluated in a cluster randomised controlled trial (RCT). Informed by Medical Research Council guidance for complex interventions and the Behaviour Change Consortium fidelity framework, this protocol outlines the process evaluation of IPCAS within this RCT. The process evaluation aimed to explore how the intervention was delivered in context and how participants engaged with the intervention. METHODS AND ANALYSIS Mixed methods will be used: (1) design: intervention content will be compared with 'usual care'; (2) training: intervention training sessions will be audio/video-recorded where feasible; (3) delivery: healthcare professional self-reports, audio recordings of intervention delivery and observations of My Life After Stroke course (10% of reviews and sessions) will be coded separately; semistructured interviews will be conducted with a purposive sample of healthcare professionals; (4) receipt and (5) enactment: where available, structured stroke review records will be analysed quantitatively; semistructured interviews will be conducted with a purposive sample of study participants. Self-reports, observations and audio/video recordings will be coded and scored using specifically developed checklists. Semistructured interviews will be analysed thematically. Data will be analysed iteratively, independent of primary endpoint analysis. ETHICS AND DISSEMINATION Favourable ethical opinion was gained from Yorkshire & The Humber-Bradford Leeds NHS Research Ethics Committee (19 December 2017, 17/YH/0441). Study results will be published in a peer-reviewed journal and presented at relevant conferences. TRIAL REGISTRATION NUMBER NCT03353519; Pre-results.
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Affiliation(s)
- Maria Raisa Jessica Ryc Aquino
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Ricky Mullis
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Elizabeth Kreit
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Vicki Johnson
- Leicester Diabetes Centre, University Hospital Leicester NHS Trust, Leicester, UK
| | - Julie Grant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Lisa Lim
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Kariyawasam PN, Pathirana KD, Hewage DC, Dissanayake R. Cultural Adaptation and Preliminary Validation of the Proxy-Rated Sinhala Version of the Stroke and Aphasia Quality of Life Generic Scale-39. J Cent Nerv Syst Dis 2020; 12:1179573520924953. [PMID: 32528228 PMCID: PMC7262981 DOI: 10.1177/1179573520924953] [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: 03/08/2019] [Accepted: 04/17/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Health-related quality of life (HRQOL) is an important measure that enables evaluation of rehabilitation outcomes. Stroke and Aphasia Quality of Life Generic Scale–39 (SAQOL-39g) is a disease-specific questionnaire that measures HRQOL of patients with stroke. This study was conducted to adapt the preliminary version of proxy-rated Sinhala version of the SAQOL-39g. Methods: The study was conducted with the participation of 115 proxies of the patients with stroke. The SAQOL-39g was translated and back translated, and culturally adapted by evaluating the items of the questionnaire. The culturally adapted scale was evaluated for its internal consistency, test-retest reliability, and validity. Results: The mean age of the patients with stroke was 67.07 (standard deviation [SD] = 11.2) years; males comprising two-thirds of the study sample (67% [n = 77]). The proxy-rated Sinhala version of the SAQOL-39g showed excellent internal consistency (α = 0.98 [overall score]), 0.97, 0.96, and 0.95 for physical, communication, and psychosocial domains, respectively. The intraclass correlation coefficient (ICC) was 0.92 for overall, and 0.93, 0.92, and 0.91 for physical, communication, and psychosocial domains, respectively. Factor analysis extracted 3 factors with 72.4% of the variance. Conclusions: Proxy-rated Sinhala version of the SAQOL-39g is a psychometrically sound, reliable, and valid tool to assess the post-stroke quality of life of Sinhala-speaking patients with stroke and aphasia.
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Affiliation(s)
- P N Kariyawasam
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - K D Pathirana
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - D C Hewage
- Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Rda Dissanayake
- Speech and Language Pathology Unit, Teaching Hospital Karapitiya, Galle, Sri Lanka
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26
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Sewell K, Tse T, Harris E, Matyas T, Churilov L, Ma H, Davis SM, Donnan GA, Carey LM. Pre-existing Comorbidity Burden and Patient Perceived Stroke Impact. Int J Stroke 2020; 16:273-279. [PMID: 32326843 DOI: 10.1177/1747493020920838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pre-existing comorbidities can compromise recovery post-stroke. However, the association between comorbidity burden and patient-rated perceived impact has not been systematically investigated. To date, only observer-rated outcome measures of function, disability, and dependence have been used, despite the complexity of the impact of stroke on an individual. AIM Our aim was to explore the association between comorbidity burden and patient-rated perceived impact and overall recovery, within the first-year post-stroke, after adjusting for stroke severity, age, and sex. METHODS The sample comprised 177 stroke survivors from 18 hospitals throughout Australia and New Zealand. Comorbidity burden was calculated using the Charlson Comorbidity Index. Perceived impact and recovery were measured by the Stroke Impact Scale index and Stroke Impact Scale overall recovery scale. Quantile regression models were applied to investigate the association between comorbidity burden and perceived impact and recovery. RESULTS Significant negative associations between the Charlson Comorbidity Index and the Stroke Impact Scale index were found at three months. At the .25 quantile, a one-point increase on the Charlson Comorbidity Index was associated with 6.80-points decrease on the Stroke Impact Scale index (95%CI: -11.26, -2.34; p = .003). At the median and .75 quantile, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 3.58-points decrease (95%CI: -5.62, -1.54; p = .001) and 1.76-points decrease (95%CI: -2.80, -0.73; p = .001) on the Stroke Impact Scale index. At 12 months, at the .25 and .75 quantiles, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 6.47-points decrease (95%CI: -11.05, -1.89; p = .006) and 1.26-points decrease (95%CI: -2.11, -0.42; p = .004) on the Stroke Impact Scale index. For the Stroke Impact Scale overall recovery measure, significant negative associations were found only at the median at three months and at the .75 quantile at 12 months. CONCLUSION Comorbidity burden is independently associated with patient-rated perceived impact within the first-year post-stroke. The addition of patient-rated impact measures in personalized rehabilitation may enhance the use of conventional observer-rated outcome measures.
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Affiliation(s)
- Katherine Sewell
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Tamara Tse
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Department of Occupational Therapy, St Vincent's Hospital, Fitzroy, Australia
| | - Elizabeth Harris
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Thomas Matyas
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonid Churilov
- Faculty of Medicine and Health Sciences, Melbourne Medical School, University of Melbourne, Parkville, Australia.,Melbourne Brain Centre, Royal Melbourne and Austin Hospitals, University of Melbourne, Parkville, Australia
| | - Henry Ma
- Department of Medicine, Monash Health, Monash University, Clayton, Australia
| | - Stephen M Davis
- Melbourne Brain Centre, Royal Melbourne and Austin Hospitals, University of Melbourne, Parkville, Australia.,Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, Royal Melbourne and Austin Hospitals, University of Melbourne, Parkville, Australia
| | - Leeanne M Carey
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Wardlaw J, Bath PMW, Doubal F, Heye A, Sprigg N, Woodhouse LJ, Blair G, Appleton J, Cvoro V, England T, Hassan A, John Werring D, Montgomery A. Protocol: The Lacunar Intervention Trial 2 (LACI-2). A trial of two repurposed licenced drugs to prevent progression of cerebral small vessel disease. Eur Stroke J 2020; 5:297-308. [PMID: 33072884 PMCID: PMC7538764 DOI: 10.1177/2396987320920110] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background Small vessel disease causes a quarter of ischaemic strokes (lacunar subtype),
up to 45% of dementia either as vascular or mixed types, cognitive
impairment and physical frailty. However, there is no specific treatment to
prevent progression of small vessel disease. Aim We designed the LACunar Intervention Trial-2 (LACI-2) to test feasibility of
a large trial testing cilostazol and/or isosorbide mononitrate (ISMN) by
demonstrating adequate participant recruitment and retention in follow-up,
drug tolerability, safety and confirm outcome event rates required to power
a phase 3 trial. Methods and design LACI-2 is an investigator-initiated, prospective randomised open label
blinded endpoint (PROBE) trial aiming to recruit 400 patients with prior
lacunar syndrome due to a small subcortical infarct. We randomise
participants to cilostazol v no cilostazol and ISMN or no ISMN, minimising
on key prognostic factors. All patients receive guideline-based best medical
therapy. Patients commence trial drug at low dose, increment to full dose
over 2–4 weeks, continuing on full dose for a year. We follow-up
participants to one year for symptoms, tablet compliance, safety, recurrent
vascular events, cognition and functional outcomes, Trails B and brain MRI.
LACI-2 is registered ISRCTN 14911850, EudraCT 2016–002277-35. Trial outcome: Primary outcome is feasibility of recruitment and
compliance; secondary outcomes include safety (cerebral or systemic
bleeding, falls, death), efficacy (recurrent cerebral and cardiac vascular
events, cognition on TICS, Trails B) and tolerability. Summary LACI-2 will determine feasibility, tolerability and provide outcome rates to
power a large phase 3 trial to prevent progression of cerebral small vessel
disease.
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Affiliation(s)
| | - Philip M W Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, The University of Nottingham, Nottingham, UK
| | | | - Anna Heye
- The University of Edinburgh, Edinburgh, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, The University of Nottingham, Nottingham, UK
| | | | | | | | - Vera Cvoro
- The University of Edinburgh, Edinburgh, UK
| | | | - Ahamad Hassan
- University College London Institute of Neurology, London, UK
| | | | - Alan Montgomery
- Stroke Trials Unit, Division of Clinical Neuroscience, The University of Nottingham, Nottingham, UK
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McDicken JA, Elliott E, Blayney G, Makin S, Ali M, Larner AJ, Quinn TJ. Accuracy of the short-form Montreal Cognitive Assessment: Systematic review and validation. Int J Geriatr Psychiatry 2019; 34:1515-1525. [PMID: 31243810 DOI: 10.1002/gps.5162] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 06/01/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Short-form versions of the Montreal Cognitive Assessment (SF-MoCA) are increasingly used to screen for dementia in research and practice. We sought to collate evidence on the accuracy of SF-MoCAs and to externally validate these assessment tools. METHODS We performed systematic literature searching across multidisciplinary electronic literature databases, collating information on the content and accuracy of all published SF-MoCAs. We then validated all the SF-MoCAs against clinical diagnosis using independent stroke (n = 787) and memory clinic (n = 410) data sets. RESULTS We identified 13 different SF-MoCAs (21 studies, n = 6477 participants) with differing test content and properties. There was a pattern of high sensitivity across the range of SF-MoCA tests. In the published literature, for detection of post stroke cognitive impairment, median sensitivity across included studies: 0.88 (range: 0.70-1.00); specificity: 0.70 (0.39-0.92). In our independent validation using stroke data, median sensitivity: 0.99 (0.80-1.00); specificity: 0.40 (0.14-0.87). To detect dementia in older adults, median sensitivity: 0.88 (0.62-0.98); median specificity: 0.87 (0.07-0.98) in the literature and median sensitivity: 0.96 (range: 0.72-1.00); median specificity: 0.36 (0.14-0.86) in our validation. Horton's SF-MoCA (delayed recall, serial subtraction, and orientation) had the most favorable properties in stroke (sensitivity: 0.90, specificity: 0.87, positive predictive value [PPV]: 0.55, and negative predictive value [NPV]: 0.93), whereas Cecato's "MoCA reduced" (clock draw, animal naming, delayed recall, and orientation) performed better in the memory clinic (sensitivity: 0.72, specificity: 0.86, PPV: 0.55, and NPV: 0.93). CONCLUSIONS There are many published SF-MoCAs. Clinicians and researchers using a SF-MoCA should be explicit about the content. For all SF-MoCA, sensitivity is high and similar to the full scale suggesting potential utility as an initial cognitive screening tool. However, choice of SF-MoCA should be informed by the clinical population to be studied.
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Affiliation(s)
- Jennifer A McDicken
- Department Medicine for the Elderly, Queen Elizabeth University Hospital, Glasgow, UK
| | - Emma Elliott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gareth Blayney
- Department Medicine for the Elderly, Queen Elizabeth University Hospital, Glasgow, UK
| | - Stephen Makin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Myzoon Ali
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Mullis R, Aquino MRJR, Dawson SN, Johnson V, Jowett S, Kreit E, Mant J. Improving Primary Care After Stroke (IPCAS) trial: protocol of a randomised controlled trial to evaluate a novel model of care for stroke survivors living in the community. BMJ Open 2019; 9:e030285. [PMID: 31427339 PMCID: PMC6701584 DOI: 10.1136/bmjopen-2019-030285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Survival after stroke is improving, leading to increased demand on primary care and community services to meet the long-term care needs of people living with stroke. No formal primary care-based holistic model of care with clinical trial evidence exists to support stroke survivors living in the community, and stroke survivors report that many of their needs are not being met. We have developed a multifactorial primary care model to address these longer term needs. We aim to evaluate the clinical and cost-effectiveness of this new model of primary care for stroke survivors compared with standard care. METHODS AND ANALYSIS Improving Primary Care After Stroke (IPCAS) is a two-arm cluster-randomised controlled trial with general practice as the unit of randomisation. People on the stroke registers of general practices will be invited to participate. One arm will receive the IPCAS model of care including a structured review using a checklist; a self-management programme; enhanced communication pathways between primary care and specialist services; and direct point of contact for patients. The other arm will receive usual care. We aim to recruit 920 people with stroke registered with 46 general practices. The primary endpoint is two subscales (emotion and handicap) of the Stroke Impact Scale (SIS) as coprimary outcomes at 12 months (adjusted for baseline). Secondary outcomes include: SIS Short Form, EuroQol EQ-5D-5L, ICEpop CAPability measure for Adults, Southampton Stroke Self-management Questionnaire, Health Literacy Questionnaire and medication use. Cost-effectiveness of the new model will be determined in a within-trial economic evaluation. ETHICS AND DISSEMINATION Favourable ethical opinion was gained from Yorkshire and the Humber-Bradford Leeds NHS Research Ethics Committee. Approval to start was given by the Health Research Authority prior to recruitment of participants at any NHS site. Data will be presented at national and international conferences and published in peer-reviewed journals. Patient and public involvement helped develop the dissemination plan. TRIAL REGISTRATION NUMBER NCT03353519.
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Affiliation(s)
- Ricky Mullis
- General Practice and Primary Care Research Centre, University of Cambridge, Cambridge, UK
| | | | - Sarah Natalie Dawson
- MRC Biostatistics Unit, University of Cambridge Institute of Public Health, Cambridge, UK
| | - Vicki Johnson
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sue Jowett
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Elizabeth Kreit
- General Practice and Primary Care Research Centre, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- General Practice and Primary Care Research Centre, University of Cambridge, Cambridge, UK
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Almalki O, Alshehri MA, El-Fiky AAR, Abdelaal AA, Alzaidi JH, Al Attar WSA, Hegazy FA. Can the stroke impact scale 3.0 detect cognitive impairments in patients with a recent stroke? J Phys Ther Sci 2019; 31:563-568. [PMID: 31417222 PMCID: PMC6642892 DOI: 10.1589/jpts.31.563] [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: 02/09/2019] [Accepted: 04/22/2019] [Indexed: 01/16/2023] Open
Abstract
[Purpose] The aim of this study was to identify cognitive impairments in patients with a
recent stroke using Stroke Impact Scale 3.0 (SIS). [Participants and Methods] A
retrospective cohort study was conducted to evaluate 50 medical records in patients with a
recent stroke who have completed a stroke rehabilitation programme. All data were
evaluated at St. Finbarr’s Hospital in Cork, Ireland. [Results] A total of 41 records met
the inclusion criteria, of which 53.7% were male. Regarding the risk factors, most
patients complained of hypertension (85.4%), with most being diagnosed with embolic stroke
(56.1%). The SIS identified numerous issues in stroke patients, such as persistent
problems with memory (36.6%), concentration (29.3%), and solving everyday problems
(43.9%). In addition, some patients’ responses were negative regarding their emotion such
as feeling sad (51.2%), not enjoying things as much as ever (39%), feeling life is not
worth living (85.4%) and not smiling or laughing at least once a day (80.5%). [Conclusion]
The inclusion of the SIS in the stroke review clinic identified cognitive deficits that
may not have otherwise been detected. By using SIS in a systematic and standardised way,
deficits can be identified, and appropriate rehabilitation can be provided.
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Affiliation(s)
- Obaid Almalki
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork: College Road, Cork T12K8AF, Ireland
| | | | - Amir Abdel-Raouf El-Fiky
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Saudi Arabia
| | - Ashraf Am Abdelaal
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Saudi Arabia.,Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Egypt
| | - Jamal Hs Alzaidi
- Medical Rehabilitation Department, Makkah Health Affairs General Directorate, Saudi Arabia
| | - Wesam Saleh A Al Attar
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Saudi Arabia
| | - Fatma A Hegazy
- Physiotherapy Department, College of Health Sciences, University of Sharjah, United Arab Emirates.,Faculty of Physical Therapy, Cairo University, Egypt
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31
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Zirk M, Storm V. Subjective Stroke Impact and Depressive Symptoms: Indications for a Moderating Role of Health-Related Locus of Control. Front Psychiatry 2019; 10:918. [PMID: 31920764 PMCID: PMC6930911 DOI: 10.3389/fpsyt.2019.00918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Stroke is one of the most common causes of death and disability worldwide. Subsequently, depression occurs in about one third of the stroke survivors. Health-related locus of control might serve as a modifiable cognitive factor to aid the recovery process. Aims: The present study aims to explore the role of health-related locus of control in the relation between subjective stroke impact and depressive symptoms after stroke. Methods: In the present cross-sectional study, N = 44 stroke patients (n = 18 female and n = 24 male) were recruited at two rehabilitation centers in Germany. Mean age was M = 65.8 (SD = 11.52, Range = 48-88). Self-report instruments included the stroke impact scale, health-related locus of control questionnaire, and Beck depression inventory. Data analysis was conducted in R using correlation and regression methods. Results: Subjective stroke impact and depressive symptoms were not directly associated (r s = -.20, p = .216). However, health-related locus of control moderated the relationship between subjective stroke impact and depressive symptoms (β = -0.42, p = .015), revealing a stronger negative relationship when control of one`s health was attributed externally. Conclusion: The results indicate that health-related locus of control plays a role in the relationship of subjective stroke impact and depressive symptoms. It is recommended to focus on control beliefs during the recovery process of stroke survivors. For developing targeted interventions, it is necessary to further investigate these associations while incorporating various health-related control belief concepts and replicate the present findings among larger samples.
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Affiliation(s)
- Miriam Zirk
- Department of Movement Science, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Vera Storm
- Department of Exercise Psychology, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
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32
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Patient-reported outcomes in stroke clinical trials 2002–2016: a systematic review. Qual Life Res 2018; 28:1119-1128. [DOI: 10.1007/s11136-018-2053-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
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Heiberg G, Pedersen SG, Friborg O, Nielsen JF, Holm HS, Steinbüchel von N, Arntzen C, Anke A. Can the health related quality of life measure QOLIBRI- overall scale (OS) be of use after stroke? A validation study. BMC Neurol 2018; 18:98. [PMID: 30021558 PMCID: PMC6052666 DOI: 10.1186/s12883-018-1101-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 07/09/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Brief measures of health-related quality of life (HRQOL) that assess both patient-reported functioning and well-being after stroke are scarce. The objective of this study was to examine reliability and validity of one of these measures, the patient-reported Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS), in patients after stroke. METHODS Stroke survivors were examined prospectively using survey methods. Core survey data (n = 125) and retest data (n = 36) were obtained at 3 and 12 months, respectively. Item properties (distribution, floor and ceiling effects), psychometric properties (reliability and model fit), and validity (correlations with established measures of anxiety, depression and HRQOL) of the QOLIBRI-OS were examined. RESULTS Missing responses on the questionnaire were low (0.5%). All items were positively skewed. No floor effects were present, whereas five out of six items showed ceiling effects. The summary QOLIBRI-OS score exhibited no floor or ceiling effects, and had excellent internal consistency (Cronbach's α =0.93). All item-total correlations were high (0.73-0.88). The test-retest reliability of single items varied from 0.74 to 0.91 and was 0.93 for the overall score. The confirmatory factor analysis yielded an excellent fit for a five-item version and provided tentative support for the original six-item version. The convergent validity correlations were in the hypothesized directions, thus supporting the construct validity. CONCLUSIONS The brief QOLIBRI-OS is a valid and reliable brief health-related outcome measure that is appropriate for screening HRQOL in patients after stroke.
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Affiliation(s)
- Guri Heiberg
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Rehabilitation, University Hospital of North Norway- Harstad, 9480 Harstad, Norway
| | - Synne Garder Pedersen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø The Artic University of Norway, Tromsø, Norway
| | - Oddgeir Friborg
- Department of Psychology, Faculty of Health Sciences, University of Tromsø, the Artic University of Norway, Tromsø, Norway
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Henriette Stabel Holm
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | | | - Cathrine Arntzen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø The Artic University of Norway, Tromsø, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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Bobrovitz N, Santana MJ, Boyd J, Kline T, Kortbeek J, Widder S, Martin K, Stelfox HT. Short form version of the Quality of Trauma Care Patient-Reported Experience Measure (SF QTAC-PREM). BMC Res Notes 2017; 10:693. [PMID: 29208046 PMCID: PMC5718023 DOI: 10.1186/s13104-017-3031-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/29/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To enable the valid and reliable measurement of patient experiences we previously published a multicenter multi-center validation of the Quality of Trauma Care Patient-Reported Experience Measure (QTAC-PREM). The purpose of this study was to derive a simplified, short form version of the QTAC-PREM to further enhance the feasibility of measuring patient experiences in injury care. To identify candidate items for the short form we reviewed the results of the original multi-center long form validation cohort study, which included 400 injury care patients and their family members recruited from three trauma centers. We only included the best performing items on the revised short form. RESULTS The acute care component of the measure was shortened by 30% and the post-acute care component was shortened by 42%. We identified two subscales on the acute measure (information and communication; clinical and ancillary care) and one subscale on the post-acute measure (post-discharge information and communication). The measurement properties of the short form measure were similar to that of the validated long form. This short form assessment of patient injury care experiences offers a useful, practical, and easy tool for trauma centers to implement for service evaluation, quality improvement, and injury care research.
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Affiliation(s)
- Niklas Bobrovitz
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Maria J. Santana
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Jamie Boyd
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, AB Canada
| | - Theresa Kline
- Department of Psychology, University of Calgary, Calgary, AB Canada
| | - John Kortbeek
- Department of Surgery, University of Calgary, Calgary, AB Canada
| | - Sandy Widder
- Department of Surgery, University of Alberta, Edmonton, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
| | | | - Henry T. Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, AB Canada
- Department of Medicine, University of Calgary, Calgary, AB Canada
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MacIsaac R, Ali M, Peters M, English C, Rodgers H, Jenkinson C, Lees KR, Quinn TJ. Derivation and Validation of a Modified Short Form of the Stroke Impact Scale. J Am Heart Assoc 2016; 5:JAHA.115.003108. [PMID: 27207963 PMCID: PMC4889183 DOI: 10.1161/jaha.115.003108] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Stroke Impact Scale (SIS) is a stroke-specific, quality of life measure recommended for research and clinical practice. Completion rates are suboptimal and could relate to test burden. We derived and validated a short form SIS (SF-SIS). METHODS AND RESULTS We examined data from the Virtual International Stroke Trial Archive, generating derivation and validation populations. We derived an SF-SIS by selecting 1 item per domain of SIS, choosing items most highly correlated with total domain score. Our validation described agreement of SF-SIS with original SIS and the SIS-16 and correlation with Barthel Index, modified Rankin Scale, National Institutes of Health Stroke Scale, and Euro-QoL 5 dimensions visual analog scales. We assessed discriminative validity (associations between SF-SIS and factors known to influence outcome [age, physiological parameters, and comorbidity]). We assessed face validity and acceptability by sharing the SF-SIS with a focus group of stroke survivors and multidisciplinary stroke healthcare staff. From 5549 acute study patients (mean age 68.5 [SD 13] years, mean SIS 64 [SD 32]) and 332 rehabilitation patients (mean age 65.7 [SD 11] years, mean SIS 61 [SD 11]), we derived an 8-item SF-SIS that demonstrated good agreement with original SIS and good correlation with our chosen functional and quality of life measures (all ρ>0.70, P<0.0001). Significant associations were seen with our chosen predictors of stroke outcome in the acute group (P<0.0001). The focus group agreed with the choice of items for SF-SIS across 7 of 8 domains. CONCLUSIONS Using multiple, complementary methods, we have derived an SF-SIS and demonstrated content, convergent, and discriminant validity. This shortened SIS should allow collection of robust quality of life data with less associated test burden.
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Affiliation(s)
- Rachael MacIsaac
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Myzoon Ali
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, UK
| | - Coralie English
- School of Health Sciences, University of Newcastle, Australia
| | - Helen Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - Kennedy R Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
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Affiliation(s)
- Marijn Mulder
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Centre
| | - Rinske Nijland
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, Netherlands
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Patchick E, Vail A, Wood A, Bowen A. PRECiS (Patient Reported Evaluation of Cognitive State): psychometric evaluation of a new patient reported outcome measure of the impact of stroke. Clin Rehabil 2015; 30:1229-1241. [PMID: 26721872 DOI: 10.1177/0269215515624480] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/02/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Determine the psychometric properties of PRECiS (Patient Reported Evaluation of Cognitive State): A new patient-centred, patient reported outcome measure for perceived impact of cognitive problems, developed through qualitative work, systematic review and service user consultation. DESIGN An observational study exploring acceptability, internal consistency, construct validity, inter-rater reliability and test-retest reliability, with opportunistic qualitative data on sensitivity to change. SETTING Home visits in the community. PARTICIPANTS Stroke survivors with self-reported cognitive difficulties and informal carers. MEASURES The 27 item PRECiS was self-completed with support, and proxy completed by informal carers. We collected descriptive cognitive screening test data, and measures of overall stroke impact, mood and activities of daily living to explore construct validity. RESULTS Data were collected from 159 (visit 1) and 66 (visit 2) stroke survivors and 86 informal carers. PRECiS showed good acceptability (no missing values or floor/ceiling effects, minimal skewness); high internal consistency (α = 0.94, indicative of potential redundancy); with moderate to strong construct correlations in the directions hypothesised (0.40 to 0.74). An intraclass correlation coefficient of 0.85 indicated good test-retest reliability. Where self-reported change had occurred from visit 1 to 2, PRECiS appeared sensitive. Using carers as proxy respondents is not supported by this analysis (inter-rater ICC = 0.43). CONCLUSIONS PRECiS is a patient-centred, practical and reliable measure assessing perceived impact of cognitive problems from the unique perspective of stroke survivors.
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Affiliation(s)
- Emma Patchick
- Stroke Research, School of Psychological Sciences, University of Manchester MAHSC, Manchester UK
| | - Andy Vail
- Institute of Population Health, University of Manchester MAHSC, Manchester UK
| | - Alison Wood
- Community Rehab Service, Long Term Conditions Centre, Harold Wood, UK
| | - Audrey Bowen
- Stroke Research, School of Psychological Sciences, University of Manchester MAHSC, Manchester UK
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Richardson M, Campbell N, Allen L, Meyer M, Teasell R. The stroke impact scale: performance as a quality of life measure in a community-based stroke rehabilitation setting. Disabil Rehabil 2015; 38:1425-30. [DOI: 10.3109/09638288.2015.1102337] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Laura Allen
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Matthew Meyer
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Robert Teasell
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- St. Joseph’s Health Care London, London, Ontario, Canada
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Peters M, Crocker H, Dummett S, Jenkinson C, Doll H, Fitzpatrick R. Change in health status in long-term conditions over a one year period: a cohort survey using patient-reported outcome measures. Health Qual Life Outcomes 2014; 12:123. [PMID: 25113415 PMCID: PMC4243951 DOI: 10.1186/s12955-014-0123-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/04/2014] [Indexed: 12/21/2022] Open
Abstract
Background Enhancing quality of life for people with long-term conditions by monitoring patient-reported outcome measure scores is a key domain of health care policy. This study investigated the responsiveness of patient-reported outcome measures for long-term conditions. Methods A cohort survey was conducted in 33 primary care practices and 4485 patients (1334 asthma, 567 chronic obstructive pulmonary disease, 1121 diabetes, 525 epilepsy, 520 heart failure and 418 stroke) were sent a baseline survey containing a generic (EQ-5D) and a disease-specific measure. Baseline respondents were sent a follow-up after 1 year. Differences in scores for each long-term condition were assessed by paired t-tests. The relationship between scores and self-reported ‘change in health’ was assessed by analysis of variance. Results The baseline achieved a 38.4% response rate and the follow-up 71.5%. The only significant difference for the EQ-5D was found for the Visual Analogue Scale in heart failure between baseline and follow-up, and for change in health. Significant differences between baseline and follow-up scores were found on the disease-specific measures for 1 asthma dimension and 1 stroke dimension. No significant differences were found for other conditions. Significant differences between self-reported change in health and the disease-specific measures were found for 4 asthma dimensions and 2 stroke dimensions. Conclusions Few significant differences were found between the baseline and follow up or between ‘change in health’ and PROMs scores. This could be explained by the time frame of one year being too short for change to occur or by the PROMs not being responsive enough to change in a primary care sample. The latter is unlikely as the PROMs were in part chosen for their responsiveness to change. The baseline response rates may mean that the sample is not representative, and stable patients may have been more likely to participate. If PROMs are to be used routinely to monitor outcomes in LTCs, further research is needed to maximize response rates, to ensure that the PROMs used are reliable, valid and sensitive enough to detect change and that the time frame for data collection is appropriate. Electronic supplementary material The online version of this article (doi:10.1186/s12955-014-0123-2) contains supplementary material, which is available to authorized users.
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