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Das A, Osypuk TL, Yoo PY, Magnuson K, Gennetian LA, Noble KG, Bruckner TA. Poverty reduction and childhood opportunity moves: A randomized trial of cash transfers to low-income U.S. families with infants. Health Place 2024; 89:103320. [PMID: 39096582 DOI: 10.1016/j.healthplace.2024.103320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/06/2024] [Accepted: 07/14/2024] [Indexed: 08/05/2024]
Abstract
Black and Hispanic children have a higher likelihood of experiencing neighborhood poverty than white children. This study uses data from the Baby's First Years (BFY) randomized trial to examine whether an unconditional cash transfer causes families to make opportunity moves to better quality neighborhoods. We use Intent to Treat linear regression models to test whether the BFY treatment, of receiving $333/month (vs. $20/month) for three years, leads to moves to neighborhoods of greater childhood opportunity. Overall, we find no relation between the BFY treatment and neighborhood opportunity across time. However, we find effect modification by maternal baseline health. High-cash receipt among mothers with poor health at baseline corresponds with moves to neighborhoods of greater childhood opportunity.
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Affiliation(s)
- Abhery Das
- University of Illinois Chicago, Department of Health Policy & Administration, USA.
| | - Theresa L Osypuk
- University of Minnesota, School of Public Health, Division of Epidemiology & Community Health, USA; Minnesota Population Center, University of Minnesota, USA
| | - Paul Y Yoo
- University of California, Irvine, School of Education, USA
| | - Katherine Magnuson
- University of Wisconsin - Madison, Sandra Rosenbaum School of Social Work, USA
| | | | | | - Tim A Bruckner
- University of California, Irvine, Department of Health, Society & Behavior, USA; University of California, Irvine, Center for Population, Inequality, and Policy, USA
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2
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Yao A, Gao L, Zhang J, Cheng JM, Kim DH. Frailty as an Effect Modifier in Randomized Controlled Trials: A Systematic Review. J Gen Intern Med 2024; 39:1452-1473. [PMID: 38592606 PMCID: PMC11169165 DOI: 10.1007/s11606-024-08732-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The effect of clinical interventions may vary by patients' frailty status. Understanding treatment effect heterogeneity by frailty could lead to frailty-guided treatment strategies and reduce overtreatment and undertreatment. This systematic review aimed to examine the effect modification by frailty in randomized controlled trials (RCTs) that evaluate pharmacological, non-pharmacological, and multicomponent interventions. METHODS We searched PubMed, Web of Science, EMBASE, and ClinicalTrial.gov, from their inception to 8 December 2023. Two reviewers independently extracted trial data and examined the study quality with senior authors. RESULTS Sixty-one RCTs that evaluated the interaction between frailty and treatment effects in older adults were included. Frailty was evaluated using different tools such as the deficit accumulation frailty index, frailty phenotype, and other methods. The effect of several pharmacological interventions (e.g., edoxaban, sacubitril/valsartan, prasugrel, and chemotherapy) varied according to the degree of frailty, whereas other treatments (e.g., antihypertensives, vaccinations, osteoporosis medications, and androgen medications) demonstrated consistent benefits across different frailty levels. Some non-pharmacological interventions had greater benefits in patients with higher (e.g., chair yoga, functional walking, physical rehabilitation, and higher dose exercise program) or lower (e.g., intensive lifestyle intervention, psychosocial intervention) levels of frailty, while others (e.g., resistance-type exercise training, moderate-intensive physical activity, walking and nutrition or walking) produced similar intervention effects. Specific combined interventions (e.g., hospital-based disease management programs) demonstrated inconsistent effects across different frailty levels. DISCUSSION The efficacy of clinical interventions often varied by frailty levels, suggesting that frailty is an important factor to consider in recommending clinical interventions in older adults. REGISTRATION PROSPERO registration number CRD42021283051.
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Affiliation(s)
- Aaron Yao
- VillageMD Research Institute, Chicago, IL, USA.
- Virginia Commonwealth University, Richmond, VA, USA.
| | | | - Jiajun Zhang
- Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Joyce M Cheng
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Egan M, Kessler D, Gurgel-Juarez N, Chopra A, Linkewich E, Sikora L, Montgomery P, Duong P. Stroke rehabilitation adaptive approaches: A theory-focused scoping review. Scand J Occup Ther 2024; 31:1-13. [PMID: 37976402 DOI: 10.1080/11038128.2023.2257228] [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: 09/22/2022] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Stroke rehabilitation consists of restorative and adaptive approaches. Multiple adaptive approaches exist. AIMS/OBJECTIVES The objective of this study was to develop a framework for categorising adaptive stroke rehabilitation interventions, based on underlying theory. MATERIAL AND METHODS We searched multiple databases to April 2020 to identify studies of interventions designed to improve participation in valued activities. We extracted the name of the intervention, underlying explicit or implicit theory, intervention elements, and anticipated outcomes. Using this information, we proposed distinct groups of interventions based on theoretical drivers. RESULTS Twenty-nine adaptive interventions were examined in at least one of 77 studies. Underlying theories included Cognitive Learning Theory, Self-determination Theory, Social Cognitive Theory, adult learning theories, and Psychological Stress and Coping Theory. Three overarching theoretical drivers were identified: learning, motivation, and coping. CONCLUSIONS At least 29 adaptive approaches exist, but each appear to be based on one of three underlying theoretical drivers. Consideration of effectiveness of these approaches by theoretical driver could help indicate underlying mechanisms and essential elements of effective adaptive approaches. SIGNIFICANCE Our framework is an important advance in understanding and evaluating adaptive approaches to stroke rehabilitation.
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Affiliation(s)
- Mary Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dorothy Kessler
- School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | | | - Anchal Chopra
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | | | - Patrick Duong
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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Kokorelias KM, Cronin SM, Munce SEP, Eftekhar P, McGilton KS, Vellani S, Colella TJF, Kontos P, Grigorovich A, Furlan A, Salbach NM, Jaglal S, Chan B, Cameron JI. Conceptualization of frailty in rehabilitation interventions with adults: a scoping review. Disabil Rehabil 2023; 45:117-153. [PMID: 34889703 DOI: 10.1080/09638288.2021.2012844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: We aimed to synthesize the literature that considered frailty in the evaluation of rehabilitation interventions for adults (aged ≥18) by answering: (1) how is frailty defined in rehabilitation intervention research?; (2) how is frailty operationalized in rehabilitation intervention research?; (3) what are the characteristics of rehabilitation interventions for frail adults and what frailty related outcomes are assessed?Materials and methods: A scoping review was conducted. Data were analyzed using descriptive statistics and qualitative content analysis.Results: 53 articles met the inclusion criteria. Most studies were conducted in Europe and involved randomized control trials. The included studies reported on rehabilitation interventions that only included individuals aged 50 or older. Thirteen studies used Fried's definition of frailty, but most (n = 27) did not use any definition. Many studies did not differentiate between the conceptualization (e.g., definition) and operationalization (e.g., use of inclusion/exclusion criteria, outcome measures) of frailty. Most interventions focused on exercise. Instrumental activities of daily living reported most frequently as outcomes (n = 11).Conclusions: There is an absence of consistent definitions of frailty in rehabilitation interventions and current definitions tend to focus on physical functioning. The authors suggest rehabilitation researchers consider an expanded definition of frailty informed by the International Classification of Functioning, Disability and Health framework.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals should use an expanded definition of frailty, informed by the International Classification of Functioning, Disability and Health framework, should include physical, mental, personal, environmental, and social factors to decrease, delay, or prevent frailty in adults.Rehabilitation professionals should consider a broader operationalization of frailty that is not dependent on age and physical functioning.Rehabilitation professionals that consider a broader conceptualization of frailty should tailor interventions to the specific needs of frail adults.
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Affiliation(s)
- Kristina M Kokorelias
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Shawna M Cronin
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Sarah E P Munce
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Parvin Eftekhar
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Katherine S McGilton
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Shirin Vellani
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tracey J F Colella
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Pia Kontos
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | | | - Andrea Furlan
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Institute for Work & Health, Toronto, Toronto, Canada
| | - Nancy M Salbach
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Susan Jaglal
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Brian Chan
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Thyden NH, Schmidt NM, Joshi S, Kim H, Nelson TF, Osypuk TL. Housing mobility protects against alcohol use for children with socioemotional health vulnerabilities: An experimental design. Alcohol Clin Exp Res 2022; 46:1695-1709. [PMID: 36121443 PMCID: PMC9509446 DOI: 10.1111/acer.14911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Neighborhood context may influence alcohol use, but effects may be heterogeneous, and prior evidence is threatened by confounding. We leveraged a housing voucher experiment to test whether housing vouchers' effects on alcohol use differed for families of children with and without socioemotional health or socioeconomic vulnerabilities. TRIAL DESIGN In the Moving to Opportunity (MTO) study, low-income families in public housing in five US cities were randomized in 1994 to 1998 to receive one of three treatments: (1) a housing voucher redeemable in a low-poverty neighborhood plus housing counseling, (2) a housing voucher without locational restriction, or (3) no voucher (control). Alcohol use was assessed 10 to 15 years later (2008 to 2010) in youth ages 13 to 20, N = 4600, and their mothers, N = 3200. METHODS Using intention-to-treat covariate-adjusted regression models, we interacted MTO treatment with baseline socioemotional health vulnerabilities, testing modifiers of treatment on alcohol use. RESULTS We found treatment effect modification by socioemotional factors. For youth, MTO voucher treatment, compared with controls, reduced the odds of ever drinking alcohol if youth had behavior problems (OR = 0.26, 95% CI [0.09, 0.72]) or problems at school (OR = 0.46, [0.26, 0.82]). MTO low-poverty treatment (vs. controls) also reduced the number of drinks if their health required special medicine/equipment (OR = 0.50 [0.32, 0.80]). Yet treatment effects were nonsignificant among youth without socioemotional vulnerabilities. Among mothers of children with learning problems, MTO voucher treatment (vs. controls) reduced past-month drinking (OR = 0.69 [0.47, 0.99]), but was harmful otherwise (OR = 1.22 [0.99, 1.45]). CONCLUSIONS For low-income adolescents with special needs/socioemotional problems, housing vouchers protect against alcohol use.
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Affiliation(s)
- Naomi H. Thyden
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Nicole M. Schmidt
- Minnesota Population CenterUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Spruha Joshi
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA,New York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Huiyun Kim
- Minnesota Population CenterUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Toben F. Nelson
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Theresa L. Osypuk
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA,Minnesota Population CenterUniversity of MinnesotaMinneapolisMinnesotaUSA
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Crocker TF, Brown L, Lam N, Wray F, Knapp P, Forster A. Information provision for stroke survivors and their carers. Cochrane Database Syst Rev 2021; 11:CD001919. [PMID: 34813082 PMCID: PMC8610078 DOI: 10.1002/14651858.cd001919.pub4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and cognitive impairment and can have long lasting psychological and social implications. Research shows that stroke survivors and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. OBJECTIVES The primary objective is to assess the effects of active or passive information provision for stroke survivors (people with a clinical diagnosis of stroke or transient ischaemic attack (TIA)) or their identified carers. The primary outcomes are knowledge about stroke and stroke services, and anxiety. SEARCH METHODS We updated our searches of the Cochrane Stroke Group Specialised Register on 28 September 2020 and for the following databases to May/June 2019: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) and the Cochrane Database of Systematic Reviews (CDSR; 2019, Issue 5) in the Cochrane Library (searched 31 May 2019), MEDLINE Ovid (searched 2005 to May week 4, 2019), Embase Ovid (searched 2005 to 29 May 2019), CINAHL EBSCO (searched 2005 to 6 June 2019), and five others. We searched seven study registers and checked reference lists of reviews. SELECTION CRITERIA Randomised trials involving stroke survivors, their identified carers or both, where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision without other differences in treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We categorised interventions as either active information provision or passive information provision: active information provision included active participation with subsequent opportunities for clarification and reinforcement; passive information provision provided no systematic follow-up or reinforcement procedure. We stratified analyses by this categorisation. We used GRADE methods to assess the overall certainty of the evidence. MAIN RESULTS We have added 12 new studies in this update. This review now includes 33 studies involving 5255 stroke-survivor and 3134 carer participants. Twenty-two trials evaluated active information provision interventions and 11 trials evaluated passive information provision interventions. Most trials were at high risk of bias due to lack of blinding of participants, personnel, and outcome assessors where outcomes were self-reported. Fewer than half of studies were at low risk of bias regarding random sequence generation, concealment of allocation, incomplete outcome data or selective reporting. The following estimates have low certainty, based on the quality of evidence, unless stated otherwise. Accounting for certainty and size of effect, analyses suggested that for stroke survivors, active information provision may improve stroke-related knowledge (standardised mean difference (SMD) 0.41, 95% confidence interval (CI) 0.17 to 0.65; 3 studies, 275 participants), may reduce cases of anxiety and depression slightly (anxiety risk ratio (RR) 0.85, 95% CI 0.68 to 1.06; 5 studies, 1132 participants; depression RR 0.83, 95% CI 0.68 to 1.01; 6 studies, 1315 participants), may reduce Hospital Anxiety and Depression Scale (HADS) anxiety score slightly, (mean difference (MD) -0.73, 95% CI -1.10 to -0.36; 6 studies, 1171 participants), probably reduces HADS depression score slightly (MD (rescaled from SMD) -0.8, 95% CI -1.27 to -0.34; 8 studies, 1405 participants; moderate-certainty evidence), and may improve each domain of the World Health Organization Quality of Life assessment short-form (WHOQOL-BREF) (physical, MD 11.5, 95% CI 7.81 to 15.27; psychological, MD 11.8, 95% CI 7.29 to 16.29; social, MD 5.8, 95% CI 0.84 to 10.84; environment, MD 7.0, 95% CI 3.00 to 10.94; 1 study, 60 participants). No studies evaluated positive mental well-being. For carers, active information provision may reduce HADS anxiety and depression scores slightly (MD for anxiety -0.40, 95% CI -1.51 to 0.70; 3 studies, 921 participants; MD for depression -0.30, 95% CI -1.53 to 0.92; 3 studies, 924 participants), may result in little to no difference in positive mental well-being assessed with Bradley's well-being questionnaire (MD -0.18, 95% CI -1.34 to 0.98; 1 study, 91 participants) and may result in little to no difference in quality of life assessed with a 0 to 100 visual analogue scale (MD 1.22, 95% CI -7.65 to 10.09; 1 study, 91 participants). The evidence is very uncertain (very low certainty) for the effects of active information provision on carers' stroke-related knowledge, and cases of anxiety and depression. For stroke survivors, passive information provision may slightly increase HADS anxiety and depression scores (MD for anxiety 0.67, 95% CI -0.37 to 1.71; MD for depression 0.39, 95% CI -0.61 to 1.38; 3 studies, 227 participants) and the evidence is very uncertain for the effects on stroke-related knowledge, quality of life, and cases of anxiety and depression. For carers, the evidence is very uncertain for the effects of passive information provision on stroke-related knowledge, and HADS anxiety and depression scores. No studies of passive information provision measured carer quality of life, or stroke-survivor or carer positive mental well-being. AUTHORS' CONCLUSIONS Active information provision may improve stroke-survivor knowledge and quality of life, and may reduce anxiety and depression. However, the reductions in anxiety and depression scores were small and may not be important. In contrast, providing information passively may slightly worsen stroke-survivor anxiety and depression scores, although again the importance of this is unclear. Evidence relating to carers and to other outcomes of passive information provision is generally very uncertain. Although the best way to provide information is still unclear, the evidence is better for strategies that actively involve stroke survivors and carers and include planned follow-up for clarification and reinforcement.
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Affiliation(s)
- Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Faye Wray
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford, UK
| | - Peter Knapp
- Department of Health Sciences, University of York and the Hull York Medical School, York, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford, UK
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Evans NR, Todd OM, Minhas JS, Fearon P, Harston GW, Mant J, Mead G, Hewitt J, Quinn TJ, Warburton EA. Frailty and cerebrovascular disease: Concepts and clinical implications for stroke medicine. Int J Stroke 2021; 17:251-259. [PMID: 34282986 PMCID: PMC8864332 DOI: 10.1177/17474930211034331] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Frailty is a distinctive health state in which the ability of older people to cope with
acute stressors is compromised by an increased vulnerability brought by age-associated
declines in physiological reserve and function across multiple organ systems. Although
closely associated with age, multimorbidity, and disability, frailty is a discrete
syndrome that is associated with poorer outcomes across a range of medical conditions.
However, its role in cerebrovascular disease and stroke has received limited attention.
The estimated rise in the prevalence of frailty associated with changing demographics over
the coming decades makes it an important issue for stroke practitioners, cerebrovascular
research, clinical service provision, and stroke survivors alike. This review will
consider the concept and models of frailty, how frailty is common in cerebrovascular
disease, the impact of frailty on stroke risk factors, acute treatments, and
rehabilitation, and considerations for future applications in both cerebrovascular
clinical and research settings.
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Affiliation(s)
| | - Oliver M Todd
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Jatinder S Minhas
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Patricia Fearon
- Department of Stroke Medicine, Royal Victoria Hospital, Belfast, UK
| | - George W Harston
- Acute Stroke Programme, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jonathan Mant
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jonathan Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Taft K, Laing B, Wensley C, Nielsen L, Slark J. Health promotion interventions post-stroke for improving self-management: A systematic review. JRSM Cardiovasc Dis 2021; 10:20480040211004416. [PMID: 33996032 PMCID: PMC8082985 DOI: 10.1177/20480040211004416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background It is well-documented that women tend to be worse off post-stroke. They are often frailer, have less independence, lower functionality, increased rates of depression, and overall a lower quality of life. People who have had strokes benefit from rehabilitative support to increase their independence and reduce the risk of stroke reoccurrence. Despite the gender differences in the effects of stroke, interventions explicitly aimed at helping women have not been identified. Purpose This systematic review aimed to summarize the effectiveness of the health promoting behavioural interventions for reducing risk factors and improved self-management in women post-stroke, compared to usual care. Method Seven databases, Medline (Ovid), CINAHL, PsychInfo, Embase, PubMed, Scopus, and Google Scholar, were reviewed for randomized controlled trials covering post-stroke interventions. The following keywords were used: health promotion, secondary prevention, woman, women, female, sex difference, gender difference, after stroke, and post-stroke. Results Ten randomised controlled trials were found. These demonstrated common successful approaches for rehabilitation, but none specifically described health promotion strategies for women. Core components of successful programs appeared to be a structured approach, tailored to clientele and formalised support systems through their carer, family networks, or community engagement. Comprehensive reminder systems were successful for stroke risk reduction. Conclusion Women are disproportionately affected by stroke and are often in the frail category. Tailored structured health promotion programs with family and caregiver support combined with a comprehensive reminder system would appear to enable women post-stroke.
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Affiliation(s)
- Karenza Taft
- Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Bobbi Laing
- Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Cynthia Wensley
- Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lorraine Nielsen
- Te Tumu Herenga/Libraries & Learning Services, The University of Auckland, Auckland, New Zealand
| | - Julia Slark
- Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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9
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Lin S, Xiao LD, Chamberlain D, Newman P, Xie S, Tan JY. The effect of transition care interventions incorporating health coaching strategies for stroke survivors: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:2039-2060. [PMID: 32532632 DOI: 10.1016/j.pec.2020.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To systematically analyse health coaching strategies in transition care and synthesise the effect of these strategies on health care outcomes for stroke survivors. METHODS A systematic search of nine databases in two languages was conducted. Meta-analysis was conducted when data were available. RESULTS Twenty-five randomised controlled trials met the inclusion criteria. The meta-analysis revealed that health coaching strategies in transition care interventions significantly improve quality of life (QoL) (p < 0.001), activities of daily living (ADL) (p = 0.002) and reduce depression (p = 0.001) for stroke survivors at 3 months. Further subgroup analysis demonstrated that transition care interventions with a greater number of health coaching strategies are associated with a larger effect size on QoL (SMD=1.15) and ADL (SMD=1.177) at 3 months, and a medium effect size (SMD=0.674) on depression reduction. However, the effects of health coaching strategies on readmission, mortality and falls in stroke survivors remain inconclusive. CONCLUSIONS This review provides evidence that incorporating health coaching strategies in transitional care improves health outcomes of stroke survivors. PRACTICE IMPLICATION More trials of health coaching interventions to improve transition care with a rigorous study design are much needed to address the lack of support for stroke survivors and their caregivers in this crucial care period.
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Affiliation(s)
- Shuanglan Lin
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Peter Newman
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Shiqi Xie
- Nursing College of Chongqing Medical University, Chongqing, China
| | - Jing-Yu Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, NT, Australia
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Lewis LA, Corbett T, Burrows K, Spice C, Davies C, Wallis K. Wessex Acute Frailty Audit: applying quality improvement methodology to design and implement a regional frailty audit using a collaborative, multiprofessional approach. BMJ Open Qual 2020; 9:e000870. [PMID: 32019752 PMCID: PMC7011879 DOI: 10.1136/bmjoq-2019-000870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION An acute hospital stay increases the risk of negative outcomes for those living with frailty. This paper describes the application of quality improvement methodology to design and implement a regional audit to gain an understanding of care provision. METHODS Small scale tests of change (Plan-Do-Study-Act cycles) were used to design the audit structure and questions. Data collectors met face to face with 2-3 multiprofessional clinicians on 58 wards in 10 hospitals across the region, using an electronic tool to gather data. Outcomes were analysed manually in Excel by extracting from the electronic audit tool. RESULTS 58 wards across 10 hospitals participated in the audit, which identified three key themes: lack of awareness and frailty training outside medicine for older people specialties, and significant variability of both frailty identification and comprehensive geriatric assessment. CONCLUSION Combining quality improvement methodology with a collaborative, regional approach to design and implementation of a frailty audit creates a reliable tool ensuring all stakeholders are considering improvement from the outset. The results have facilitated an agreed regional approach on how best to use local resources to improve and standardise frailty care provision. By highlighting areas of good practice and significant gaps in frailty identification, personalised care planning and hospital wide provision of frailty training, this region of the UK will now be able to drive up standards of care.
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Affiliation(s)
- Lucy Anne Lewis
- Consultant Practitioner Development Programme, Health Education England Wessex, Winchester, UK
| | - Teresa Corbett
- Department of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Kerry Burrows
- Medcine for Older People, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Claire Spice
- Medcine for Older People, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Cheryl Davies
- Healthy Ageing Programme, Wessex Academic Health Science Network, Southampton, UK
| | - Kathy Wallis
- Healthy Ageing Programme, Wessex Academic Health Science Network, Southampton, UK
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11
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Olson DM, Juengst SB. The Hospital to Home Transition Following Acute Stroke. Nurs Clin North Am 2019; 54:385-397. [DOI: 10.1016/j.cnur.2019.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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12
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Minshall C, Pascoe MC, Thompson DR, Castle DJ, McCabe M, Chau JPC, Jenkins Z, Cameron J, Ski CF. Psychosocial interventions for stroke survivors, carers and survivor-carer dyads: a systematic review and meta-analysis. Top Stroke Rehabil 2019; 26:554-564. [PMID: 31258017 DOI: 10.1080/10749357.2019.1625173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To evaluate the effectiveness of psychosocial interventions on depressive symptoms, anxiety symptoms, quality of life, self-efficacy, coping, carer strain and carer satisfaction among stroke survivors, carers and survivor-carer dyads. Data sources: MEDLINE, CINAHL, PsycINFO, SocINDEX, Cochrane Library, Web of Science and Scopus databases and the grey literature were searched up to September 2018. Methods: A systematic review and meta-analysis of randomized controlled trials of psychosocial interventions for stroke survivors, carers and survivor-carer dyads, compared to usual care. Outcomes measured were depressive symptoms, anxiety symptoms, quality of life, coping, self-efficacy, carer strain, and carer satisfaction. Results: Thirty-one randomized controlled trials (n = 5715) were included in the systematic review which found improvements in depressive symptoms, anxiety symptoms, quality of life and coping, though the number of trials assessing each outcome varied. A meta-analysis (11 trials; n = 1280) on depressive symptoms found that in seven trials psychosocial interventions reduced depressive symptoms in stroke survivors (SMD: -0.36, 95% CI -0.73 to 0.00; p = .05) and in six trials reduced depressive symptoms in carers (SMD: -0.20, 95% CI -.40 to 0.00; p = .05). Conclusion: Psychosocial interventions reduced depressive symptoms in stroke survivors and their carers. There was limited evidence that such interventions reduced anxiety symptoms, or improved quality of life and coping for stroke survivors and carers and no evidence that they improved self-efficacy, carer strain or carer satisfaction.
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Affiliation(s)
- Catherine Minshall
- Faculty of Health Sciences, Australian Catholic University , Melbourne , Australia.,Mental Health Service, St. Vincent's Hospital , Melbourne , Australia
| | - Michaela C Pascoe
- Institute of Sport, Exercise and Active Living, Victoria University , Melbourne , Australia.,Department of Cancer Experiences, Peter MacCallum Cancer Centre , Melbourne , Australia
| | - David R Thompson
- Department of Psychiatry, University of Melbourne , Melbourne , Australia.,School of Nursing and Midwifery, Queen's University , Belfast , UK
| | - David J Castle
- Mental Health Service, St. Vincent's Hospital , Melbourne , Australia.,Department of Psychiatry, University of Melbourne , Melbourne , Australia
| | - Marita McCabe
- Faculty of Health Sciences, Swinburne University of Technology , Melbourne , Australia
| | - Janita P C Chau
- Nethersole School of Nursing, Chinese University of Hong Kong , Shatin , Hong Kong
| | - Zoe Jenkins
- Mental Health Service, St. Vincent's Hospital , Melbourne , Australia
| | - Jan Cameron
- School of Nursing and Midwifery, Monash University , Melbourne , Australia
| | - Chantal F Ski
- Department of Psychiatry, University of Melbourne , Melbourne , Australia.,School of Nursing and Midwifery, Queen's University , Belfast , UK
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13
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Stewart C, Subbarayan S, Paton P, Gemmell E, Abraha I, Myint PK, O’Mahony D, Cruz-Jentoft AJ, Cherubini A, Soiza RL. Non-pharmacological interventions for the improvement of post-stroke activities of daily living and disability amongst older stroke survivors: A systematic review. PLoS One 2018; 13:e0204774. [PMID: 30286144 PMCID: PMC6171865 DOI: 10.1371/journal.pone.0204774] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/13/2018] [Indexed: 01/11/2023] Open
Abstract
Globally, stroke remains a leading cause of death and disability, with older adults disproportionately affected. Numerous non-pharmacological stroke rehabilitation approaches are in use to address impairments, but their efficacy in older persons is largely unknown. This systematic review examined the evidence for such interventions as part of the Optimal Evidence-Based Non-Drug Therapies in Older Persons (ONTOP) project conducted under an European Union funded project called the Software Engine for the Assessment and Optimisation of Drug and Non-Drug Therapies in Older Persons (SENATOR) [http://www.senator-project.eu]. A Delphi panel of European geriatric experts agreed activities of daily living and disability to be of critical importance as stroke rehabilitation outcomes. A comprehensive search strategy was developed and five databases (Pubmed, CINAHL, Embase, PsycInfo and Cochrane Database of Systematic Reviews) searched for eligible systematic reviews. Primary studies meeting our criteria (non-pharmacologic interventions, involving stroke survivors aged ≥65 years, assessing activities of daily living and/or disability as outcome) were then identified from these reviews. Eligible papers were double reviewed, and due to heterogeneity, narrative analysis performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence, allowing us to make recommendations regarding specific non-pharmacologic rehabilitation in older stroke survivors. In total, 72 primary articles were reviewed spanning 14 types of non-pharmacological intervention. Non-pharmacological interventions based on physiotherapy and occupational therapy techniques improved activities of daily living amongst older stroke survivors. However, no evidence was found to support use of any non-pharmacological approach to benefit older stroke survivors' disability. Evidence was limited by poor study quality and the small number of studies targeting older stroke survivors. We recommend future studies explore such interventions exclusively in older adult populations and improve methodological and outcome reporting.
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Affiliation(s)
- Carrie Stewart
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Selvarani Subbarayan
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Pamela Paton
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Elliot Gemmell
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Iosief Abraha
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Phyo Kyaw Myint
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Denis O’Mahony
- Department of Geriatric Medicine, University College Cork, Cork, Ireland
| | - Alfonso J. Cruz-Jentoft
- Fundación para la Investigación Biomédica del Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Roy L. Soiza
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, United Kingdom
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14
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Schmidt NM, Krohn MD, Osypuk TL. Modification of Housing Mobility Experimental Effects on Delinquency and Educational Problems: Middle Adolescence as a Sensitive Period. J Youth Adolesc 2018; 47:2009-2026. [PMID: 29740733 PMCID: PMC6222002 DOI: 10.1007/s10964-018-0859-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/22/2018] [Indexed: 10/17/2022]
Abstract
Residential mobility is one documented stressor contributing to higher delinquency and worse educational outcomes. Sensitive period life course models suggest that certain developmental stages make individuals more susceptible to the effects of an exposure, like residential mobility, on outcomes. However, most prior research is observational, and has not examined heterogeneity across age or gender that may inform sensitive periods, even though it may have important implications for the etiology of adolescent development. Moreover, there are important translational implications for identifying the groups most vulnerable to residential mobility to inform how to buffer adverse effects of moving. In this study, low-income families were randomized to residential mobility out of public housing into lower poverty neighborhoods using a rental subsidy voucher ("experimental voucher condition"), and were compared to control families remaining in public housing. The sample was comprised of 2829 youth (51% female; 62% Non-Hispanic Black, 31% Hispanic, 7% other race). At baseline, youth ranged from 5 to 16 years old. This study hypothesized that random assignment to the housing voucher condition would generate harmful effects on delinquency and educational problems, compared to the control group, among boys who were older at baseline. The results confirmed this hypothesis: random assignment to the experimental voucher condition generating residential mobility caused higher delinquency among boys who were 13-16 years old at baseline, compared to same-age, in-place public housing controls. However, residential mobility did not affect delinquency among girls regardless of age, or among boys who were 5-12 years old at baseline. The pattern of results for educational problems was similar but weaker. Families with teenage boys are particularly vulnerable to residential transitions. Incorporating additional supports into housing programs may help low-income, urban families to successfully transition to lower poverty neighborhoods.
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Affiliation(s)
- Nicole M Schmidt
- Minnesota Population Center, University of Minnesota, 225 19th Avenue South, 50 Willey Hall, Minneapolis, MN, 55455, USA.
| | - Marvin D Krohn
- Department of Sociology and Criminology & Law, University of Florida, P.O. Box 117330, Gainesville, FL, 32611, USA
| | - Theresa L Osypuk
- Division of Epidemiology & Community Health, University of Minnesota, 1300 S 2nd St Room 300 West Bank Office Building, Minneapolis, MN, 55454, USA
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15
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Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J, Armstrong JJ, Rockwood K. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr 2018; 18:139. [PMID: 29898673 PMCID: PMC6000922 DOI: 10.1186/s12877-018-0823-2] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background The ability of acute care providers to cope with the influx of frail older patients is increasingly stressed, and changes need to be made to improve care provided to older adults. Our purpose was to conduct a scoping review to map and synthesize the literature addressing frailty in the acute care setting in order to understand how to tackle this challenge. We also aimed to highlight the current gaps in frailty research. Methods This scoping review included original research articles with acutely-ill Emergency Medical Services (EMS) or hospitalized older patients who were identified as frail by the authors. We searched Medline, CINAHL, Embase, PsycINFO, Eric, and Cochrane from January 2000 to September 2015. Results Our database search initially resulted in 8658 articles and 617 were eligible. In 67% of the articles the authors identified their participants as frail but did not report on how they measured frailty. Among the 204 articles that did measure frailty, the most common disciplines were geriatrics (14%), emergency department (14%), and general medicine (11%). In total, 89 measures were used. This included 13 established tools, used in 51% of the articles, and 35 non-frailty tools, used in 24% of the articles. The most commonly used tools were the Clinical Frailty Scale, the Frailty Index, and the Frailty Phenotype (12% each). Most often (44%) researchers used frailty tools to predict adverse health outcomes. In 74% of the cases frailty predicted the outcome examined, typically mortality and length of stay. Conclusions Most studies (83%) were conducted in non-geriatric disciplines and two thirds of the articles identified participants as frail without measuring frailty. There was great variability in tools used and more recently published studies were more likely to use established frailty tools. Overall, frailty appears to be a good predictor of adverse health outcomes. For frailty to be implemented in clinical practice frailty tools should help formulate the care plan and improve shared decision making. How this will happen has yet to be determined. Electronic supplementary material The online version of this article (10.1186/s12877-018-0823-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga Theou
- Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada. .,Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.
| | - Emma Squires
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Kayla Mallery
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Jacques S Lee
- Sunnybrook Health Service, 2075 Bayview Avenue, BG-04, Toronto, ON, M4N 3M5, Canada
| | - Sherri Fay
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Judah Goldstein
- Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, B3B 2B2, Canada
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B 5E1, Canada
| | - Kenneth Rockwood
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.,Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
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16
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Kessler D, Egan M, Dubouloz CJ, McEwen S, Graham FP. Occupational Performance Coaching for Stroke Survivors: A Pilot Randomized Controlled Trial. Am J Occup Ther 2017; 71:7103190020p1-7103190020p7. [PMID: 28422628 DOI: 10.5014/ajot.2017.024216] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the feasibility of study procedures and explored the potential efficacy of Occupational Performance Coaching for stroke survivors (OPC-Stroke), an intervention designed to improve participation after stroke. METHOD In this pilot randomized controlled trial, 21 participants were randomized to receive the intervention or usual care. Recruitment, retention, and outcome completion rates were calculated. Direction of change and effect sizes were examined for the outcomes of participation, goal performance and satisfaction, goal self-efficacy, emotional well-being, and cognition. RESULTS Rates of recruitment (66%) and retention (81%) were satisfactory. Participation scores improved for both groups with different trajectories. Results showed a moderate effect of OPC-Stroke for goal performance (η²partial d = .075) and satisfaction (η²partial d = .078) and a large effect for cognition (η²partial d = .167). Other outcome measures did not change as expected. CONCLUSION Study procedures were generally feasible. Preliminary findings support testing to examine the efficacy of OPC-Stroke.
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Affiliation(s)
- Dorothy Kessler
- Dorothy Kessler, PhD, is Postdoctoral Fellow, Bruyère Research Institute, Ottawa, ON, Canada;
| | - Mary Egan
- Mary Egan, PhD, is Professor, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Claire-Jehanne Dubouloz
- Claire-Jehanne Dubouloz, PhD, is Professor, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sara McEwen
- Sara McEwen, PhD, is Scientist, Sunnybrook Research Institute, St. John's Rehabilitation Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Fiona P Graham
- Fiona P. Graham, PhD, is Senior Lecturer, Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
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17
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Does Mother Know Best? Treatment Adherence as a Function of Anticipated Treatment Benefit. Epidemiology 2017; 27:265-75. [PMID: 26628424 DOI: 10.1097/ede.0000000000000431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We describe bias resulting from individualized treatment selection, which occurs when treatment has heterogeneous effects and individuals selectively choose treatments of greatest benefit to themselves. This pernicious bias may confound estimates from observational studies and lead to important misinterpretation of intent-to-treat analyses of randomized trials. Despite the potentially serious threat to inferences, individualized treatment selection has rarely been formally described or assessed. METHODS The Moving To Opportunity trial randomly assigned subsidized rental vouchers to low-income families in high-poverty public housing. We assessed the Kessler-6 psychological distress and Behavior Problems Index outcomes for 2,829 adolescents 4-7 years after randomization. Among families randomly assigned to receive vouchers, we estimated probability of moving (treatment), predicted by prerandomization characteristics (c statistic = 0.63). We categorized families into tertiles of this estimated probability of moving, and compared instrumental variable effect estimates for moving on behavior problems index and Kessler-6 across tertiles. RESULTS Instrumental variable estimated effects of moving on behavioral problems index were most adverse for boys least likely to move (b = 0.93; 95% confidence interval: 0.33, 1.53) compared with boys most likely to move (b = 0.14; 95% confidence interval: -0.15, 0.44; P = 0.02 for treatment × tertile interaction). Effects on Kessler-6 were more beneficial for girls least likely to move compared with girls most likely to move (-0.62 vs. 0.02; interaction; P = 0.03). CONCLUSIONS Evidence of individualized treatment selection differed by child gender and outcome and should be evaluated in randomized trial reports, especially when heterogeneous treatment effects are likely and nonadherence is common.
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18
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Sieber CC. Frailty – From concept to clinical practice. Exp Gerontol 2017; 87:160-167. [DOI: 10.1016/j.exger.2016.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/03/2016] [Accepted: 05/13/2016] [Indexed: 12/26/2022]
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19
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Glymour MM, Rudolph KE. Causal inference challenges in social epidemiology: Bias, specificity, and imagination. Soc Sci Med 2016; 166:258-265. [PMID: 27575286 DOI: 10.1016/j.socscimed.2016.07.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 07/26/2016] [Accepted: 07/31/2016] [Indexed: 12/16/2022]
Affiliation(s)
- M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
| | - Kara E Rudolph
- Center for Health and Community, University of California, San Francisco, USA; School of Public Health, University of California, Berkeley, USA
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20
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Nguyen QC, Rehkopf DH, Schmidt NM, Osypuk TL. Heterogeneous Effects of Housing Vouchers on the Mental Health of US Adolescents. Am J Public Health 2016; 106:755-62. [PMID: 26794179 DOI: 10.2105/ajph.2015.303006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the mental health effects on adolescents of low-income families residing in high-poverty public housing who received housing vouchers to assist relocation. METHODS We defined treatment effects to compare 2829 adolescents aged 12 to 19 years in families offered housing vouchers versus those living in public housing in the Moving to Opportunity experiment (1994-1997; Boston, MA; Baltimore, MD; Chicago, IL; Los Angeles, CA; New York, NY). We employed model-based recursive partitioning to identify subgroups with heterogeneous treatment effects on psychological distress and behavior problems measured in 2002. We tested 35 potential baseline treatment modifiers. RESULTS For psychological distress, Chicago participants experienced null treatment effects. Outside Chicago, boys experienced detrimental effects, whereas girls experienced beneficial effects. Behavior problems effects were null for adolescents who were aged 10 years or younger at baseline. For adolescents who were older than 10 years at baseline, violent crime victimization, unmarried parents, and unsafe neighborhoods increased adverse treatment effects. Adolescents who were older than 10 years at baseline without learning problems or violent crime victimization, and whose parents moved for better schools, experienced beneficial effects. CONCLUSIONS Health effects of housing vouchers varied across subgroups. Supplemental services may be necessary for vulnerable subgroups for whom housing vouchers alone may not be beneficial.
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Affiliation(s)
- Quynh C Nguyen
- Quynh C. Nguyen is with the Department of Health Promotion and Education, College of Health, University of Utah, Salt Lake City. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA. Theresa L. Osypuk and Nicole M. Schmidt are with the Minnesota Population Center, University of Minnesota, Minneapolis. Theresa L. Osypuk is also with the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - David H Rehkopf
- Quynh C. Nguyen is with the Department of Health Promotion and Education, College of Health, University of Utah, Salt Lake City. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA. Theresa L. Osypuk and Nicole M. Schmidt are with the Minnesota Population Center, University of Minnesota, Minneapolis. Theresa L. Osypuk is also with the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Nicole M Schmidt
- Quynh C. Nguyen is with the Department of Health Promotion and Education, College of Health, University of Utah, Salt Lake City. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA. Theresa L. Osypuk and Nicole M. Schmidt are with the Minnesota Population Center, University of Minnesota, Minneapolis. Theresa L. Osypuk is also with the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Theresa L Osypuk
- Quynh C. Nguyen is with the Department of Health Promotion and Education, College of Health, University of Utah, Salt Lake City. David H. Rehkopf is with the Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA. Theresa L. Osypuk and Nicole M. Schmidt are with the Minnesota Population Center, University of Minnesota, Minneapolis. Theresa L. Osypuk is also with the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
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21
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Glymour MM, Osypuk TL, Rehkopf DH. Invited commentary: Off-roading with social epidemiology--exploration, causation, translation. Am J Epidemiol 2013; 178:858-63. [PMID: 24008902 DOI: 10.1093/aje/kwt145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Population health improvements are the most relevant yardstick against which to evaluate the success of social epidemiology. In coming years, social epidemiology must increasingly emphasize research that facilitates translation into health improvements, with continued focus on macro-level social determinants of health. Given the evidence that the effects of social interventions often differ across population subgroups, systematic and transparent exploration of the heterogeneity of health determinants across populations will help inform effective interventions. This research should consider both biological and social risk factors and effect modifiers. We also recommend that social epidemiologists take advantage of recent revolutionary improvements in data availability and computing power to examine new hypotheses and expand our repertoire of study designs. Better data and computing power should facilitate underused analytic approaches, such as instrumental variables, simulation studies and models of complex systems, and sensitivity analyses of model biases. Many data-driven machine-learning approaches are also now computationally feasible and likely to improve both prediction models and causal inference in social epidemiology. Finally, we emphasize the importance of specifying exposures corresponding with realistic interventions and policy options. Effect estimates for directly modifiable, clearly defined health determinants are most relevant for building translational social epidemiology to reduce disparities and improve population health.
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22
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Osypuk TL, Tchetgen ET, Acevedo-Garcia D, Earls FJ, Lincoln A, Schmidt NM, Glymour MM. Differential mental health effects of neighborhood relocation among youth in vulnerable families: results from a randomized trial. ARCHIVES OF GENERAL PSYCHIATRY 2012; 69:1284-94. [PMID: 23045214 PMCID: PMC3629812 DOI: 10.1001/archgenpsychiatry.2012.449] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Extensive observational evidence indicates that youth in high-poverty neighborhoods exhibit poor mental health, although not all children may be affected similarly. OBJECTIVE To use experimental evidence to assess whether gender and family health problems modify the mental health effects of moving from high- to low-poverty neighborhoods. DESIGN Randomized controlled trial. SETTING Volunteer low-income families in public housing in 5 US cities between 1994-1997. PARTICIPANTS We analyze 4- to 7-year outcomes in youth aged 12 to 19 years (n = 2829, 89% effective response rate) in the Moving to Opportunity Study. INTERVENTION Families were randomized to remain in public housing (control group) or to receive government-funded rental subsidies to move into private apartments (experimental group). Intention-to-treat analyses included intervention interactions by gender and health vulnerability (defined as prerandomization health/developmental limitations or disabilities in family members). MAIN OUTCOME MEASURES Past-year psychological distress (Kessler 6 scale [K6]) and the Behavioral Problems Index (BPI). Supplemental analyses used past-year major depressive disorder (MDD). RESULTS Male gender (P = .02) and family health vulnerability (P = .002) significantly adversely modified the intervention effect on K6 scores; male gender (P = .01), but not health vulnerability (P = .17), significantly adversely modified the intervention effect on the BPI. Girls without baseline health vulnerabilities were the only subgroup to benefit on any outcome (K6: β = -0.21; 95% CI, -0.34 to -0.07; P = .003; MDD: odds ratio = 0.42; 95% CI, 0.20 to 0.85; P = .02). For boys with health vulnerabilities, intervention was associated with worse K6 (β = 0.26; 95% CI, 0.09 to 0.44; P = .003) and BPI (β = 0.24; 95% CI, 0.09 to 0.40; P = .002) values. Neither girls with health vulnerability nor boys without health vulnerability experienced intervention benefits. Adherence-adjusted instrumental variable analysis found intervention effects twice as large. Patterns were similar for MDD, but estimates were imprecise owing to low prevalence. CONCLUSIONS Although some girls benefited, boys and adolescents from families with baseline health problems did not experience mental health benefits from housing mobility policies and may need additional program supports.
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Affiliation(s)
- Theresa L. Osypuk
- Northeastern University, Bouvé College of Health Sciences, Department of Health Sciences; 360 Huntington Avenue, Robinson 316, Boston, MA 02115
| | - Eric Tchetgen Tchetgen
- Harvard School of Public Health, Departments of Biostatistics and Epidemiology; 677 Huntington Avenue, Boston, MA 02115
| | - Dolores Acevedo-Garcia
- Northeastern University, Bouvé College of Health Sciences, Department of Health Sciences; 360 Huntington Avenue, Robinson 316, Boston, MA 02115
| | - Felton James Earls
- Harvard School of Public Health, Department of Society, Human Development, and Health; 677 Huntington Avenue, Boston, MA 02115
- Harvard Medical School, Department of Global Health and Social Medicine; 25 Shattuck Street, Boston, MA 02115
| | - Alisa Lincoln
- Northeastern University, Bouvé College of Health Sciences, Department of Health Sciences; 360 Huntington Avenue, Robinson 316, Boston, MA 02115
- Northeastern University, Bouvé College of Health Sciences, Institute for Urban Health Research, International Village 310, Boston, MA 02115
| | - Nicole M. Schmidt
- Northeastern University, Bouvé College of Health Sciences, Institute for Urban Health Research, International Village 310, Boston, MA 02115
| | - M. Maria Glymour
- Harvard School of Public Health, Department of Society, Human Development, and Health; 677 Huntington Avenue, Boston, MA 02115
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Forster A, Brown L, Smith J, House A, Knapp P, Wright JJ, Young J. Information provision for stroke patients and their caregivers. Cochrane Database Syst Rev 2012; 11:CD001919. [PMID: 23152210 PMCID: PMC6544775 DOI: 10.1002/14651858.cd001919.pub3] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Research shows that stroke patients and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. OBJECTIVES To assess the effectiveness of information provision strategies in improving the outcome for stroke patients or their identified caregivers, or both. SEARCH METHODS For this update we searched the Cochrane Stroke Group Trials Register (June 2012), the Cochrane Central Register of Controlled trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the NHS Economic Evaluation Database (EED), and the Health Technology Assessment (HTA) Database (The Cochrane Library June, 2012), MEDLINE (1966 to June 2012), EMBASE (1980 to June 2012), CINAHL (1982 to June 2012) and PsycINFO (1974 to June 2012). We also searched ongoing trials registers, scanned bibliographies of relevant articles and books and contacted researchers. SELECTION CRITERIA Randomised trials involving patients or carers of patients with a clinical diagnosis of stroke or transient ischaemic attack (TIA) where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and methodological quality and extracted data. Primary outcomes were knowledge about stroke and stroke services, and impact on mood. MAIN RESULTS We have added four new trials to this update. This review now includes 21 trials involving 2289 patient and 1290 carer participants. Nine trials evaluated a passive and 12 trials an active information intervention. Meta-analyses showed a significant effect in favour of the intervention on patient knowledge (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.12 to 0.46, P < 0.001), carer knowledge (SMD 0.74, 95% CI 0.06 to 1.43, P = 0.03), one aspect of patient satisfaction (odds ratio (OR) 2.07, 95% CI 1.33 to 3.23, P = 0.001), and patient depression scores (mean difference (MD) -0.52, 95% CI -0.93 to -0.10, P = 0.01). There was no significant effect (P > 0.05) on number of cases of anxiety or depression in patients, carer mood or satisfaction, or death. Qualitative analyses found no strong evidence of an effect on other outcomes. Post-hoc subgroup analyses showed that active information had a significantly greater effect than passive information on patient mood but not on other outcomes. AUTHORS' CONCLUSIONS There is evidence that information improves patient and carer knowledge of stroke, aspects of patient satisfaction, and reduces patient depression scores. However, the reduction in depression scores was small and may not be clinically significant. Although the best way to provide information is still unclear there is some evidence that strategies that actively involve patients and carers and include planned follow-up for clarification and reinforcement have a greater effect on patient mood.
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Affiliation(s)
- Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK.
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Osypuk TL, Schmidt NM, Bates LM, Tchetgen-Tchetgen EJ, Earls FJ, Glymour MM. Gender and crime victimization modify neighborhood effects on adolescent mental health. Pediatrics 2012; 130:472-81. [PMID: 22908105 PMCID: PMC3428753 DOI: 10.1542/peds.2011-2535] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Leverage an experimental study to determine whether gender or recent crime victimization modify the mental health effects of moving to low-poverty neighborhoods. METHODS The Moving to Opportunity (MTO) study randomized low-income families in public housing to an intervention arm receiving vouchers to subsidize rental housing in lower-poverty neighborhoods or to controls receiving no voucher. We examined 3 outcomes 4 to 7 years after randomization, among youth aged 5 to 16 years at baseline (n = 2829): lifetime major depressive disorder (MDD), psychological distress (K6), and Behavior Problems Index (BPI). Treatment effect modification by gender and family's baseline report of recent violent crime victimization was tested via interactions in covariate-adjusted intent-to-treat and instrumental variable adherence-adjusted regression models. RESULTS Gender and crime victimization significantly modified treatment effects on distress and BPI (P < .10). Female adolescents in families without crime victimization benefited from MTO treatment, for all outcomes (Distress B = -0.19, P = .008; BPI B = -0.13, P = .06; MDD B = -0.036, P = .03). Male adolescents in intervention families experiencing crime victimization had worse distress (B = 0.24, P = .004), more behavior problems (B = 0.30, P < .001), and nonsignificantly higher MDD (B = 0.022, P = .16) versus controls. Other subgroups experienced no effect of MTO treatment. Instrumental variable estimates were similar but larger. CONCLUSIONS Girls from families experiencing recent violent crime victimization were significantly less likely to achieve mental health benefits, and boys were harmed, by MTO, suggesting need for cross-sectoral program supports to offset multiple stressors.
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Affiliation(s)
| | - Nicole M. Schmidt
- Institute on Urban Health Research, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Lisa M. Bates
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| | | | - Felton J. Earls
- Society, Human Development, and Health, Harvard School of Public Health, and,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Cambridge, Massachusetts
| | - M. Maria Glymour
- Society, Human Development, and Health, Harvard School of Public Health, and
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Legg LA, Quinn TJ, Mahmood F, Weir CJ, Tierney J, Stott DJ, Smith LN, Langhorne P. Non-pharmacological interventions for caregivers of stroke survivors. Cochrane Database Syst Rev 2011:CD008179. [PMID: 21975778 DOI: 10.1002/14651858.cd008179.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND A substantial component of care is provided to stroke survivors by informal caregivers. However, providing such care is often a new and challenging experience and has been linked to a number of adverse outcomes. A range of interventions targeted towards stroke survivors and their family or other informal caregivers have been tested in randomised controlled trials (RCTs). OBJECTIVES To evaluate the effect of interventions targeted towards informal caregivers of stroke survivors or targeted towards informal caregivers and the care recipient (the stroke survivor). SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (March 2011), CENTRAL (The Cochrane Library Issue 2010, Issue 4), MEDLINE (1950 to August 2010), EMBASE (1980 to December 2010), CINAHL (1982 to August 2010), AMED (1985 to August 2010), PsycINFO (1967 to August 2010) and 11 additional databases. In an effort to identify further published, unpublished and ongoing studies, we searched conference proceedings and trials registers, scanned reference lists of relevant articles and contacted authors and researchers. There were no language restrictions. SELECTION CRITERIA We included RCTs if they evaluated the effect of non-pharmacological interventions (compared with no care or routine care) on informal caregivers of stroke survivors. We included trials of interventions delivered to stroke survivors and informal caregivers only if the stroke survivor and informal caregiver were randomised as a dyad. We excluded studies which included stroke survivors and caregivers if the stroke survivors were the primary target of the intervention. DATA COLLECTION AND ANALYSIS Two review authors selected studies for inclusion, independently extracted data and assessed methodological quality. We sought original data from trialists. We categorised interventions into three groups: support and information, teaching procedural knowledge/vocational training type interventions, and psycho-educational type interventions. The primary outcome was caregivers' stress or strain. We resolved disagreements by consensus. MAIN RESULTS Eight studies, including a total of 1007 participants, met our inclusion criteria. We did not pool the results of all the studies because of substantial methodological, statistical and clinical heterogeneity. For caregivers' stress or strain we found no significant results within categories of intervention, with the exception of one single-centre study examining the effects of a 'vocational training' type intervention which found a mean difference between the intervention and comparator group at the end of scheduled follow-up of -8.67 (95% confidence interval -11.30 to -6.04, P < 0.001) in favour of the 'teaching procedural knowledge' type intervention group. AUTHORS' CONCLUSIONS It was not possible to carry out a meta-analysis of the evidence from RCTs because of methodological, clinical and statistical heterogeneity. One limitation across all studies was the lack of a description of important characteristics that define the informal caregiver population. However, 'vocational educational' type interventions delivered to caregivers prior to the stroke survivor's discharge from hospital appear to be the most promising intervention. However, this is based on the results from one, small, single-centre study.
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Affiliation(s)
- Lynn A Legg
- Academic Section of Geriatric Medicine, Division of Cardiovascular & Medical Sciences, Faculty of Medicine, University of Glasgow, Room 5, 4th Floor, Walton Building, Royal Infirmary, Glasgow, UK, G4 0SF
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Graven C, Brock K, Hill K, Joubert L. Are rehabilitation and/or care co-ordination interventions delivered in the community effective in reducing depression, facilitating participation and improving quality of life after stroke? Disabil Rehabil 2011; 33:1501-20. [DOI: 10.3109/09638288.2010.542874] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Berkman LF. Social epidemiology: social determinants of health in the United States: are we losing ground? Annu Rev Public Health 2009; 30:27-41. [PMID: 19705554 DOI: 10.1146/annurev.publhealth.031308.100310] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The United States ranks in the lower tiers of OECD countries in life expectancy, and recent studies indicate that socioeconomic inequalities in health have been widening in the past decades. Over this period, many rigorous longitudinal studies have identified important social, behavioral, and environmental conditions that might reduce health disparities if we could design effective interventions and make specific policy changes to modify them. Often, however, neither our policy changes nor our interventions are as effective as we hoped they would be on the basis of findings from observational studies. Reviewed here are issues related to causal inference and potential explanations for the discrepancy between observational and experimental studies. We conclude that more attention needs to be devoted to (a) identifying the correct etiologic period within a life-course perspective and (b) understanding the dynamic interplay between interventions and the social, economic, and environmental contexts in which interventions are delivered.
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Affiliation(s)
- Lisa F Berkman
- Harvard Center for Population and Development Studies, Harvard School of Public Health, USA.
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Glymour MM, Weuve J, Fay ME, Glass T, Berkman LF. Social ties and cognitive recovery after stroke: does social integration promote cognitive resilience? Neuroepidemiology 2008; 31:10-20. [PMID: 18535395 DOI: 10.1159/000136646] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 12/31/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Little is known about the possible effects of social resources on stroke survivors' level and change in cognitive outcomes. Understanding this association may help us identify strategies to improve stroke recovery and help elucidate the etiology of dementia. METHODS We examined the relationship of social ties and social support to cognitive function and cognitive change 6 months after stroke. Participants in the Families in Recovery from Stroke Trial (FIRST) (n = 272) were interviewed approximately 17 days (baseline) and 6 months (follow-up) after stroke. Cognition was assessed with the Mini Mental State Examination (MMSE) and a summary battery of 7 neuropsychological tests. Median-based regression was used to model cognitive outcomes by level of baseline intimate, personal and organizational social ties and received emotional and instrumental support. RESULTS Baseline social ties and emotional support independently predicted 6-month Cognitive Summary Scores. Emotional support also predicted greater improvements in Cognitive Summary Scores from baseline to the 6-month follow-up. No other social exposures predicted improvements in the MMSE or the Cognitive Summary. CONCLUSIONS Our results suggest that emotional support may promote cognitive resilience while social ties provide cognitive reserve that protects against impaired cognition after stroke. Social ties did not predict cognitive recovery however, so reverse causation cannot be ruled out.
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Affiliation(s)
- M Maria Glymour
- Columbia University Mailman School of Public Health, New York, NY 10032, USA.
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Bauer JM, Sieber CC. Sarcopenia and frailty: a clinician's controversial point of view. Exp Gerontol 2008; 43:674-678. [PMID: 18440743 DOI: 10.1016/j.exger.2008.03.007] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 03/11/2008] [Accepted: 03/17/2008] [Indexed: 11/25/2022]
Abstract
Sarcopenia and frailty are both highly relevant entities with regard to functionality and independence in the elderly. The term sarcopenia has been introduced already in the late 80s and since then attracted the interest of many researchers, the majority being interested in its pathophysiology. Nevertheless there is still no consensus on the definition of sarcopenia and its diagnosis. Despite its relevance for functionality and autonomy most clinicians caring for the elderly are not familiar with sarcopenia and it has not become part of the routine geriatric evaluation. The concept of frailty has recently been supported by the introduction of two new working definitions. Since then clinical research on frailty has steeply increased. The influence of frailty on different age-associated diseases has been investigated and populations at risk for complications of medical or operative therapy are identified with the help of this concept. Simultaneously the pathophysiologic mechanisms involved in the development of frailty are explored. While sarcopenia may be regarded as a clinical sign that is not specific for the elderly, frailty may be seen as a multidimensional geriatric syndrome which implies a greater relevance for the clinician than the one dimensional approach of sarcopenia.
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Affiliation(s)
- J M Bauer
- Department of Internal Medicine/Geriatric Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Prof.-Ernst-Nathan-Strasse 1, D-90419 Nuremberg, Germany.
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