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Pullano A, Melmed KR, Lord A, Olivera A, Frontera J, Brush B, Ishida K, Torres J, Zhang C, Dickstein L, Kahn E, Zhou T, Lewis A. Negative disease-related stigma 3-months after hemorrhagic stroke is related to functional outcome and female sex. J Stroke Cerebrovasc Dis 2024; 33:107830. [PMID: 38909872 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107830] [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: 02/12/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024] Open
Abstract
OBJECTIVES The objective of this study was to determine factors associated with negative disease-related stigma after hemorrhagic stroke. MATERIALS AND METHODS Patients with non-traumatic hemorrhage (ICH or SAH) admitted between January 2015 and February 2021 were assessed by telephone 3-months after discharge using the Quality of Life in Neurological Disorders (Neuro-QoL) Negative Disease-Related Stigma Short Form inventory. We evaluated the relationship between disease-related stigma (T-score >50) and pre-stroke demographics, admission data, and poor functional outcome (3-month mRS score 3-5 and Barthel Index <100). RESULTS We included 89 patients (56 ICH and 33 SAH). The median age was 63 (IQR 50-69), 43 % were female, and 67 % graduated college. Admission median GCS score was 15 (IQR 13-15) and APACHE II score was 12 (IQR 9-17). 31 % had disease-related stigma. On univariate analysis, disease-related stigma was associated with female sex, non-completion of college, GCS score, APACHE II score, and 3-month mRS score (all p < 0.05). On multivariate analysis, disease-related stigma was associated with female sex (OR = 3.72, 95 % CI = 1.23-11.25, p = 0.02) and 3-month Barthel Index <100 (OR = 3.46, 95 % CI = 1.13-10.64, p = 0.03) on one model, and female sex (OR = 3.75, 95 % CI = 1.21-11.58, p = 0.02) and 3-month mRS score 3-5 (OR = 4.23, 95 % CI = 1.21-14.75, p = 0.02) on a second model. CONCLUSION Functional outcome and female sex are associated with disease-related stigma 3-months after hemorrhagic stroke. Because stigma may negatively affect recovery, there is a need to understand the relationship between these factors to mitigate stroke-related stigma.
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Affiliation(s)
- Alyssa Pullano
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States
| | - Kara R Melmed
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States
| | - Aaron Lord
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States
| | - Anlys Olivera
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States; NYU Langone Medical Center, Department of Psychiatry, New York, NY 10016, United States
| | - Jennifer Frontera
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States
| | - Benjamin Brush
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States
| | - Koto Ishida
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States
| | - Jose Torres
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States
| | - Cen Zhang
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States
| | - Leah Dickstein
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States
| | - Ethan Kahn
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States
| | - Ting Zhou
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States
| | - Ariane Lewis
- NYU Langone Medical Center, Department of Neurology, New York, NY 10016, United States; NYU Langone Medical Center, Department of Neurosurgery, New York, NY 10016, United States.
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Ownsworth T, Mols H, O'Loghlen J, Xie Y, Kendall M, Nielsen M, Mitchell J, Jones R, Geraghty T. Stigma following acquired brain injury and spinal cord injury: relationship to psychological distress and community integration in the first-year post-discharge. Disabil Rehabil 2024; 46:1796-1806. [PMID: 37128900 DOI: 10.1080/09638288.2023.2205173] [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: 11/07/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE This study aimed to compare stigma levels after acquired brain injury (ABI) and spinal cord injury (SCI) during the first 12-months post-discharge and investigate relationships between stigma, psychological distress and community integration. METHODS 110 adults with ABI (55%) or SCI (45%) were recruited from brain and spinal cord injury inpatient rehabilitation units of a tertiary healthcare facility. They were administered Neuro-QOL Stigma subscale and Depression Anxiety and Stress Scales (DASS-21) at discharge, 3-months and 12-months post-discharge, and Community Integration Measure at 12-months post-discharge. RESULTS Stigma levels did not significantly differ between individuals with ABI and SCI. However, stigma significantly decreased between discharge and 12-months post-discharge for the total sample. Stigma was positively associated with psychological distress at discharge and 3-months post-discharge, but not at 12-months post-discharge. Lower functional status and power wheelchair use were associated with higher stigma at 12-months post-discharge. Stigma at 3-months post-discharge predicted community integration at 12-months post-discharge, controlling for psychological distress and functional status. CONCLUSION Experience of stigma in the first few months post-discharge may negatively impact individuals' community reintegration. The early post-discharge period may be a pivotal time for supporting individuals to explore disability and injury-related appraisals and enhance connection to their community.
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Affiliation(s)
- Tamara Ownsworth
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Helen Mols
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jessica O'Loghlen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Yanfei Xie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Melissa Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Mandy Nielsen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Jessie Mitchell
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Rachel Jones
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
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Kitamura S, Miyamoto R, Watanabe S, Yoshida T, Ishii Y. Development of the Japanese version of the stroke stigma scale: a validity and reliability assessment. Top Stroke Rehabil 2024:1-10. [PMID: 38373013 DOI: 10.1080/10749357.2024.2318097] [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: 06/22/2023] [Accepted: 02/04/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The stigma perceived by many post-stroke persons hinders their social lives. A scale to measure stigma is needed to identify social problems related to stigma, and to evaluate effectiveness of interventions. OBJECTIVES This study aimed to develop a Japanese version of the Stroke Stigma Scale (SSS-J), and confirm its utility by examining reliability and validity. METHODS Eighty community-dwelling post-stroke individuals were enrolled at six sites. After translating the scale into Japanese using back translation methods, psychometric properties of the rating scale, internal scale validity, and reliability were examined to fit the Rasch model. Criterion-related validity, construct validity, and test-retest reliability were examined using total scores transformed to logit. For test-retest reliability, 30 participants completed the SSS-J twice, one week apart. RESULTS Rasch analysis showed that the SSS-J had the best fit with 15 items on a 3-category rating scale. Item difficulty logits were -2.01 to 2.21, person ability logits were -4.69 to 0.62 (mean, -1.41), person reliability coefficient was 0.71 (separation index, 1.58), and item reliability coefficient was 0.96 (separation index, 5.04). For criterion validity, Spearman's rank correlation coefficient with the Center for Epidemiologic Studies Depression Scale was 0.51 (p < 0.001). For construct validity, Spearman's rank correlation coefficients with each subscale of the Stroke Impact Scale ranged from -0.36 to -0.16 (p = 0.002-0.126). For test-retest reliability, the intra-class correlation coefficient was 0.64 (p < 0.001). CONCLUSIONS The SSS-J adapted to the Rasch model was reliable and valid. This scale can be used to quantitatively measure stigma among community-dwelling post-stroke persons in Japan.
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Affiliation(s)
- Shin Kitamura
- Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Reiko Miyamoto
- Department of Occupational Therapy, School of Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Shota Watanabe
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Taiki Yoshida
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Yoshikazu Ishii
- Department of Occupational Therapy, Faculty of Rehabilitation, Gunma Paz University, Gunma, Japan
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Wisnesky UD, Olson J, Paul P, Dahlke S. Percepciones y experiencias de los adultos mayores con respecto a la actividad Sit-to-stand: Un estudio etnográfico de viabilidad previa. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6128.3812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Resumen Objetivo: el propósito de este estudio de viabilidad previa fue examinar percepciones y experiencias con respecto a la actividad Sit-to-stand entre los adultos mayores de Brasil que viven en sus hogares en comunidades urbanas. Método: el método de exploración se enfocó en la etnografía. Se utilizó muestreo intencional para reclutar 20 adultos mayores. Se emplearon cinco medios para generar datos, a saber: encuestas sociodemográficas, observaciones participantes, entrevistas informales, entrevistas formales semiestructuradas y notas de campo. Para el análisis de los datos se recurrió a análisis de contenido cualitativo. Resultados: la experiencia de los adultos mayores con problemas de movilidad en relación con la actividad Sit-to-stand dependió de sus expectativas en torno a la movilidad, las cuales implicaron muchos factores que actuaron en conjunto para influenciar sus creencias y actitudes con respecto a la actividad, al igual que preferencias, conductas y percepciones culturales. Aparentemente, a los participantes de este estudio la actividad les resultó amena; sin embargo, los inconvenientes más notorios para adoptar la actividad Sit-to-stand surgió en la forma de déficits en sus necesidades personales e intrapersonales. Conclusión: las recomendaciones resultantes de los hallazgos del estudio indican la necesidad de diseñar estrategias de implementación para la intervención Sit-to-stand a la medida de las necesidades de este grupo poblacional específico.
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Affiliation(s)
- Uirá Duarte Wisnesky
- University of Alberta, Canada; University of Alberta, Canada; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
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Wisnesky UD, Olson J, Paul P, Dahlke S. Percepções e experiências de idosos com a atividade Sit-to-stand: Um estudo etnográfico de pré-viabilidade. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6128.3814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Resumo Objetivo: o objetivo deste estudo de pré-viabilidade foi examinar percepções e experiências da atividade de Sit-to-stand com idosos brasileiros residentes em suas casas, no meio urbano. Método: o método exploratório foi etnografia focada. Foi utilizada a amostragem intencional para recrutar 20 idosos. Foram utilizados cinco meios de geração de dados: inquéritos sociodemográficos, observações participantes, entrevistas informais, entrevistas formais semiestruturadas e notas de campo. Os dados foram analisados mediante análise de conteúdo qualitativo. Resultados: a experiência dos idosos com problemas de mobilidade na realização da atividade Sit-to-stand dependia de suas expectativas de mobilidade envolvendo muitos fatores coordenados que, de forma conjunta, influenciaram suas crenças e atitudes em relação à atividade, suas preferências, seus comportamentos e percepções culturais. Os participantes deste estudo pareciam considerar a atividade aprazível; no entanto, as deficiências mais perceptíveis para o engajamento dos participantes na atividade Sit-to-stand surgiram de falhas em suas necessidades pessoais e intrapessoais. Conclusão: as recomendações geradas a partir dos achados do estudo convocam a concepção de estratégias de implementação da intervenção Sit-to-stand adaptadas às necessidades dessa população em particular.
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Affiliation(s)
- Uirá Duarte Wisnesky
- University of Alberta, Canada; University of Alberta, Canada; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
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Mohamad NBZ, Koh NZM, Yeo JPT, Ng MG, Turpin M, Asano M. A qualitative study of Singaporean perspectives on returning to work after stroke. Work 2023:WOR211170. [PMID: 36641709 DOI: 10.3233/wor-211170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Post-stroke return-to-work (RTW) rates reported in Singapore ranged between 38% and 55%, indicating challenges in the RTW process among individuals with stroke. OBJECTIVE We sought to understand the lived experience of returning to work among individuals with stroke in Singapore. METHODS This was a qualitative study using a phenomenological approach. We recruited individuals with stroke who were citizens or permanent residents of Singapore. We conducted semi-structured interviews to collect data on their lived experience of returning to work and analyzed the interview data inductively. RESULTS Twenty-seven participants completed the interviews. Their median age was 61 years (interquartile range = 54 - 64). They were mostly male (n = 19, 70.4%) and married (n = 21, 78%). Twenty participants (74%) returned to work after their stroke. Three major themes emerged from the interviews that underpinned the participants' RTW experience. They were i) direct impact of stroke, ii) realignment of life priorities, and iii) engagement with support and resources. CONCLUSION RTW after stroke is complex and influenced by personal and environmental factors. Our findings suggest that individuals with stroke need continuing support to overcome stigma and discrimination, to manage expectations of their recovery process, and to better navigate resources during their RTW process in Singapore. We recommend future studies to design and test the feasibility of appropriate interventions based on our proposed strategies to better support individuals with stroke to return to work.
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Affiliation(s)
| | - Nicklaus Zhi Ming Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Joanna Peck Tiang Yeo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Min Geng Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Merrill Turpin
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Miho Asano
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Wisnesky UD, Olson J, Paul P, Dahlke S. Older people's perceptions and experiences of older people with the Sit-to-stand activity: An ethnographic pre-feasibility study. Rev Lat Am Enfermagem 2023; 31:e3813. [PMID: 36722635 PMCID: PMC9886074 DOI: 10.1590/1518-8345.6128.3813] [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: 03/22/2022] [Accepted: 08/18/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE the purpose of this pre-feasibility study was to examine perceptions and experiences of a Sit-to-stand activity with urban Brazilian community-dwelling older people in their homes. METHOD the exploration method was focused ethnography. Purposive sampling was used to recruit 20 older people. Five means of data generation were used, namely: socio-demographic surveys, participant observations, informal interviews, formal semi-structured interviews, and field notes. Data analysis was qualitative content analysis. RESULTS the experience of mobility-challenged older people with the Sit-to-stand activity was dependent on their mobility expectations involving many factors that worked together to influence their beliefs and attitudes towards the activity, preferences, behaviors, and cultural perceptions. The participants of this study seemed to find the activity enjoyable; however, the most noticeable shortcomings for their engagement in the Sit-to-stand activity emerged as gaps in their personal and intrapersonal needs. CONCLUSION the recommendations generated from the study findings call for the design of implementation strategies for the Sit-to-stand intervention that are tailored to this particular population's needs.
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Affiliation(s)
- Uirá Duarte Wisnesky
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada., University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada., Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil, Uirá Duarte Wisnesky E-mail:
| | - Joanne Olson
- University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada
| | - Pauline Paul
- University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada
| | - Sherry Dahlke
- University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada
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Zhu R, Zhang L, Zheng YH, Zhang ZH, Zhang LM, Yang HL, Yue Y, Xiong X. Association between Stigma and Pain in Patients with Temporomandibular Disorders. Int J Clin Pract 2022; 2022:2803540. [PMID: 36212051 PMCID: PMC9519306 DOI: 10.1155/2022/2803540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aims to explore the association between stigma and pain in patients with temporomandibular disorders (TMDs). METHODS Two hundred and twenty-five patients with TMDs were recruited, and they completed the questionnaires including the Visual Analogue Scale of Pain (VAS), Generalized Anxiety Disorder 7-Item (GAD-7), the Patient Health Questionnaire 9-item (PHQ-9), Jaw Functional Limitation Scale 8-item (JFLS-8), the Stigma Scale for Chronic Illness 8-item (SSCI-8), and other demographic and disease-related information. The total score of SSCI-8 indicated overall stigma, which could be classified into 2 subdomains, felt stigma and enacted stigma, according to their representative items, respectively. Then, the patients were divided into 2 groups in each subdomain of stigma according to their scores: stigma group (score ≥ 1) and no stigma group (score = 0). RESULTS Patients with overall stigma and enacted stigma presented significantly higher scores in VAS, GAD-7, PHQ-9, and JFLS-8 than those without overall stigma and those without enacted stigma, respectively. Significant differences between patients with and without felt stigma were only observed in GAD-7, PHQ-9, and JFLS-8. Patients with overall stigma and enacted stigma mainly suffered from pain-related TMDs (PTs) and combined TMDs (CTs). Overall stigma and enacted stigma rather than felt stigma were significantly associated with both PTs and CTs. Stigma, including overall stigma, enacted stigma, and felt stigma, was more associated with anxiety and depression and less related to jaw functional limitation of the patients with TMDs. CONCLUSION Stigma, specifically enacted stigma, was correlated to pain in patients with TMDs. Stigma was more related to psychological problems than jaw functional limitation.
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Affiliation(s)
- Rui Zhu
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Li Zhang
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yun-Hao Zheng
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Zi-Han Zhang
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Li-Ming Zhang
- Rehabilitation Medicine Center, Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao-Lun Yang
- Rehabilitation Medicine Center, Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Yue
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Xin Xiong
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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