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Ju M, Zhang Z, Tao X, Lin Y, Gao L, Yu W. The impact of Pilates exercise for depression symptoms in female patients: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35419. [PMID: 37832060 PMCID: PMC10578749 DOI: 10.1097/md.0000000000035419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/06/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The Pilates exercise has recently become an increasingly popular way of exercise in female patients since it is an attractive and low-cost physical exercise modality. Pilates may be a beneficial method of exercise for female patients with depression and anxiety symptoms. However, to date, there has been no attempt to collate this literature. This review aims to systematically assess and meta-analyze the efficacy of Pilates exercise for female patients with depression and anxiety symptoms and inform evidence-based guidelines for exercise prescription. METHODS Five electronic databases (Scopus, MEDLINE/PubMed, Embase, Web of Science, and the Cochrane Library) were systematically searched up to January 2023 to examine randomized controlled trials (RCTs) focused on the effects of Pilates exercise for female patients with depressive disorders and individuals with elevated levels of depression were included. The primary outcomes were the severity of depression, and the secondary outcomes were anxiety. Statistical analyses were performed using Stata version 15.1 software with a 95% confidence interval (Registration number: CRD42023426522), and the PEDRO Scale was used to evaluate the risk of bias for RCT. RESULTS 18 RCTs with 827 female patients were included. The methodological quality of the RCTs was considered an A level in 4 studies, B level in 13, studies, and C level in 1 study investigation. The meta-analysis showed that there was moderate evidence for the Pilates exercise significantly improved the severity of depression symptoms (SMD = -0.73; 95% CI -0.86 to -0.59; P < .01) and anxiety symptoms (SMD = -0.62; 95% CI -0.79 to -0.46; P < .01). CONCLUSIONS Pilates exercise could reduce levels of depression and anxiety in female patients with depression and anxiety symptoms. Pilates exercise can be used as a potential ancillary program to improve depression and anxiety symptoms for female patients.
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Affiliation(s)
- Mingxiao Ju
- Department of Physical Education, Ping Du Second Experimental Primary School, Qingdao, China
| | - Zhennan Zhang
- Institute of Sports Science, Ocean University of China, Qingdao, China
| | - Xiaojie Tao
- Department of Neurology, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital), Qingdao, China
| | - Yong Lin
- Department of Physical Education, Ping Du Second Experimental Primary School, Qingdao, China
| | - Lili Gao
- Department of Neurology, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital), Qingdao, China
| | - Wenbing Yu
- Institute of Sports Science, Ocean University of China, Qingdao, China
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2
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Feely D, Slattery B, Walsh T, Galvin T, Donlon K, Hanlon M, Gormley D, Brown GM, Quinn S, Robinson S, Judge C, O’Donnell M, Sarma K, McGuire BE. Acute stress symptoms 1-2 weeks after stroke predict the subsequent development of post-traumatic stress symptoms: A prospective cohort study. PLoS One 2023; 18:e0286220. [PMID: 37792802 PMCID: PMC10550116 DOI: 10.1371/journal.pone.0286220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 05/10/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE To date no research has examined the potential influence of acute stress symptoms (ASD) on subsequent development of post-traumatic stress disorder (PTSD) symptoms in stroke survivors. Our objective was to examine whether acute stress symptoms measured 1-2 weeks post-stroke predicted the presence of post-traumatic stress symptoms measured 6-12 weeks later. DESIGN Prospective within-groups study. METHODS Fifty four participants who completed a measure of acute stress disorder at 1-2 weeks following stroke (time 1) and 31 of these participants completed a measure of posttraumatic stress disorder 6-12 weeks later (time 2). Participants also completed measures of stroke severity, functional impairment, cognitive impairment, depression, anxiety, pre-morbid intelligence and pain across both time points. RESULTS Some 22% met the criteria for ASD at baseline and of those, 62.5% went on to meet the criteria for PTSD at follow-up. Meanwhile two of the seven participants (28.6%) who met the criteria for PTSD at Time 2, did not meet the ASD criteria at Time 1 (so that PTSD developed subsequently). A hierarchical multiple regression analysis indicated that the presence of acute stress symptoms at baseline was predictive of post-traumatic stress symptoms at follow-up (R2 = .26, p < .01). Less severe stroke was correlated with higher levels of post-traumatic stress symptoms at Time 2 (rho = .42, p < .01). CONCLUSIONS The results highlight the importance of early assessment and identification of acute stress symptoms in stroke survivors as a risk factor for subsequent PTSD. Both ASD and PTSD were prevalent and the presence of both disorders should be assessed.
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Affiliation(s)
- David Feely
- School of Psychology, University of Galway, Galway, Ireland
| | - Brian Slattery
- School of Psychology, University of Galway, Galway, Ireland
| | - Thomas Walsh
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | - Trish Galvin
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | - Kate Donlon
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | | | - Darina Gormley
- School of Psychology, University of Galway, Galway, Ireland
| | | | - Sarah Quinn
- School of Psychology, University of Galway, Galway, Ireland
| | - Stephanie Robinson
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | - Conor Judge
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | - Martin O’Donnell
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | - Kiran Sarma
- School of Psychology, University of Galway, Galway, Ireland
| | - Brian E. McGuire
- School of Psychology, University of Galway, Galway, Ireland
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
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Zhang Q, Chen S, Zhang Y, Ni J, Huang J, Wu Y, Li M. Interventions targeting psychosocial adaptation in people with stroke: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 113:107751. [PMID: 37116222 DOI: 10.1016/j.pec.2023.107751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This scoping review aimed to describe and map interventions targeting psychosocial adaptation in people with stroke. METHODS A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines. We included original studies with interventions targeting psychosocial adaptation (concept) on people with stroke (population) in any setting (context). We searched five online electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Cochrane Central Registry of Controlled Trials). We described interventions in terms of design characteristics, theoretical basis, details of interventions, and quantitative outcomes indicated in psychosocial adaptation. RESULTS Forty-three studies were identified. Five intervention categories were identified to describe the interventions targeting psychosocial adaptation. Quantitative outcomes indicated psychosocial adaptation in our review were grouped into four domains: global adaptation, psychological adaptation, social adaptation, and others. CONCLUSIONS The mapping and description brought to light the large heterogeneity of interventions targeting psychosocial adaptation in people with stroke. PRACTICE IMPLICATIONS Deepening understanding of psychosocial adaptation can help health professionals further develop effective interventions aiming at promoting psychosocial adaptation and reducing negative health sequelae, such as risk of reduced psychosomatic recovery post stroke.
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Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Shanshan Chen
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Jieqing Ni
- School of Social Sciences in Applied Psychology, Lingnan University, Hong Kong, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing, China
| | - Yi Wu
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
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Nicklas L, Albiston M, Dunbar M, Gillies A, Hislop J, Moffat H, Thomson J. A systematic review of economic analyses of psychological interventions and therapies in health-related settings. BMC Health Serv Res 2022; 22:1131. [PMID: 36071425 PMCID: PMC9450839 DOI: 10.1186/s12913-022-08158-0] [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: 10/02/2021] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background This review aims to synthesise evidence on the economic impact of psychological interventions and therapies when applied to a broad range of physical health conditions. Methods The following bibliographic databases were searched for relevant articles: MEDLINE (Ovid), EMBASE (Ovid) and PsycINFO (Ebsco). As this review was intended to update an earlier review, the date range for the search was restricted to between January 2012 and September 2018. Reference lists from the review articles were also searched for relevant articles. Study quality was evaluated using the Scottish Intercollegiate Network Guidelines (SIGN) appraisal checklists for both economic studies and Randomised Controlled Trials (RCTs). When the economic analyses did not provide sufficient detail for quality evaluation, the original RCT papers were sought and these were also evaluated. Half of the papers were quality rated by a second author. Initial agreement was high and all disagreements were resolved by discussion. Results This yielded 1408 unique articles, reduced to 134 following screening of the title and abstract. The full texts of the remaining articles were reviewed by at least one team member and all exclusions were discussed and agreed by the team. This left 46 original research articles, alongside five systematic reviews. Fifty-seven per cent of the articles were deemed to be of high quality, with the remainder of acceptable quality. Fifteen different medical conditions were covered, with chronic pain (10 articles) and cancer (9 articles) being the two most investigated health conditions. Three quarters of the papers reviewed showed evidence for the cost-effectiveness of psychological interventions in physical health, with the clearest evidence being in the field of chronic pain and cancer. Conclusions This paper provides a comprehensive integration of the research on the cost-effectiveness of psychological therapies in physical health. Whilst the evidence for cost-effectiveness in chronic pain and cancer is encouraging, some health conditions require further study. Clearly, as the primary research is international, and was therefore conducted across varying health care systems, caution must be exercised when applying the results to counties outside of those covered. Despite this, the results are of potential relevance to service providers and funders. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08158-0.
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Affiliation(s)
- Leeanne Nicklas
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK.
| | - Mairi Albiston
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | - Martin Dunbar
- Stobhill Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Alan Gillies
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | | | - Helen Moffat
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Judy Thomson
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
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Allida S, Cox KL, Hsieh C, Lang H, House A, Hackett ML. Pharmacological, psychological, and non-invasive brain stimulation interventions for treating depression after stroke. Cochrane Database Syst Rev 2020; 1:CD003437. [PMID: 31989584 PMCID: PMC6999797 DOI: 10.1002/14651858.cd003437.pub4] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Depression is an important morbidity associated with stroke that impacts on recovery yet often undetected or inadequately treated. This is an update and expansion of a Cochrane Review first published in 2004 and updated in 2008. OBJECTIVES Primary objective • To determine whether pharmacological therapy, non-invasive brain stimulation, psychological therapy, or combinations of these interventions reduce the prevalence of diagnosable depression after stroke Secondary objectives • To determine whether pharmacological therapy, non-invasive brain stimulation, psychological therapy, or combinations of these interventions reduce levels of depressive symptoms, improve physical and neurological function and health-related quality of life, and reduce dependency after stroke • To assess the safety of and adherence to such treatments SEARCH METHODS: We searched the Specialised Registers of Cochrane Stroke and Cochrane Depression Anxiety and Neurosis (last searched August 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1), in the Cochrane Library, MEDLINE (1966 to August 2018), Embase (1980 to August 2018), the Cumulative Index to Nursing and Alllied Health Literature (CINAHL) (1982 to August 2018), PsycINFO (1967 to August 2018), and Web of Science (2002 to August 2018). We also searched reference lists, clinical trial registers (World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) to August 2018; ClinicalTrials.gov to August 2018), and conference proceedings, and we contacted study authors. SELECTION CRITERIA Randomised controlled trials comparing (1) pharmacological interventions with placebo; (2) one of various forms of non-invasive brain stimulation with sham stimulation or usual care; (3) one of various forms of psychological therapy with usual care and/or attention control; (4) pharmacological intervention and various forms of psychological therapy with pharmacological intervention and usual care and/or attention control; (5) non-invasive brain stimulation and pharmacological intervention with pharmacological intervention and sham stimulation or usual care; (6) pharmacological intervention and one of various forms of psychological therapy with placebo and psychological therapy; (7) pharmacological intervention and non-invasive brain stimulation with placebo plus non-invasive brain stimulation; (8) non-invasive brain stimulation and one of various forms of psychological therapy versus non-invasive brain stimulation plus usual care and/or attention control; and (9) non-invasive brain stimulation and one of various forms of psychological therapy versus sham brain stimulation or usual care plus psychological therapy, with the intention of treating depression after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I² statistic and certainty of the evidence according to GRADE. MAIN RESULTS We included 49 trials (56 comparisons) with 3342 participants. Data were available for: (1) pharmacological interventions with placebo (with 20 pharmacological comparisons); (2) one of various forms of non-invasive brain stimulation with sham stimulation or usual care (with eight non-invasive brain stimulation comparisons); (3) one of various forms of psychological therapy with usual care and/or attention control (with 16 psychological therapy comparisons); (4) pharmacological intervention and various forms of psychological therapy with pharmacological intervention and usual care and/or attention control (with two comparisons); and (5) non-invasive brain stimulation and pharmacological intervention with pharmacological intervention and sham stimulation or usual care (with 10 comparisons). We found no trials for the following comparisons: (6) pharmacological intervention and various forms of psychological therapy interventions versus placebo and psychological therapy; (7) pharmacological intervention and non-invasive brain stimulation versus placebo plus non-invasive brain stimulation; (8) non-invasive brain stimulation and one of various forms of psychological therapy versus non-invasive brain stimulation plus usual care and/or attention control; and (9) non-invasive brain stimulation and one of various forms of psychological therapy versus sham brain stimulation or usual care plus psychological therapy. Treatment effects observed: very low-certainty evidence from eight trials suggests that pharmacological interventions decreased the number of people meeting study criteria for depression (RR 0.70, 95% CI 0.55 to 0.88; 1025 participants) at end of treatment, and very low-certainty evidence from six trials suggests that pharmacological interventions decreased the number of people with less than 50% reduction in depression scale scores at end of treatment (RR 0.47, 95% CI 0.32 to 0.69; 511 participants) compared to placebo. No trials of non-invasive brain stimulation reported on meeting study criteria for depression at end of treatment. Only one trial of non-invasive brain stimulation reported on the outcome <50% reduction in depression scale scores; thus, we were unable to perform a meta-analysis for this outcome. Very low-certainty evidence from six trials suggests that psychological therapy decreased the number of people meeting the study criteria for depression at end of treatment (RR 0.77, 95% CI 0.62 to 0.95; 521 participants) compared to usual care/attention control. No trials of combination therapies reported on the number of people meeting the study criteria for depression at end of treatment. Only one trial of combination (non-invasive brain stimulation and pharmacological intervention) therapy reported <50% reduction in depression scale scores at end of treatment. Thus, we were unable to perform a meta-analysis for this outcome. Five trials reported adverse events related to the central nervous system (CNS) and noted significant harm in the pharmacological interventions group (RR 1.55, 95% CI 1.12 to 2.15; 488 participants; very low-certainty evidence). Four trials found significant gastrointestinal adverse events in the pharmacological interventions group (RR 1.62, 95% CI 1.19 to 2.19; 473 participants; very low-certainty evidence) compared to the placebo group. No significant deaths or adverse events were found in the psychological therapy group compared to the usual care/attention control group. Non-invasive brain stimulation interventions and combination therapies resulted in no deaths. AUTHORS' CONCLUSIONS Very low-certainty evidence suggests that pharmacological or psychological therapies can reduce the prevalence of depression. This very low-certainty evidence suggests that pharmacological therapy, psychological therapy, non-invasive brain stimulation, and combined interventions can reduce depressive symptoms. Pharmacological intervention was associated with adverse events related to the CNS and the gastrointestinal tract. More research is required before recommendations can be made about the routine use of such treatments.
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Affiliation(s)
- Sabine Allida
- The George Institute for Global Health, Faculty of Medicine, University of New South WalesMental HealthSydneyNSWAustralia2050
| | - Katherine Laura Cox
- The George Institute for Global Health, Faculty of Medicine, University of New South WalesMental HealthSydneyNSWAustralia2050
| | - Cheng‐Fang Hsieh
- Kaohsiung Medical UniversityDivision of Geriatrics and Gerontology, Department of Internal Medicine and Department of Neurology, Kaohsiung Medical University HospitalKaohsiungTaiwan
| | | | - Allan House
- Leeds Institute of Health Sciences, University of LeedsDivision of Psychological and Social MedicineRoom 1090c, Worsley BuildingClarendon WayLeedsUKLS2 9LJ
| | - Maree L Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South WalesMental HealthSydneyNSWAustralia2050
- University of Central LancashireFaculty of Health and WellbeingPreston, LancashireUK
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Kootker JA, van Heugten CM, Kral B, Rasquin SM, Geurts AC, Fasotti L. Caregivers' effects of augmented cognitive-behavioural therapy for post-stroke depressive symptoms in patients: secondary analyses to a randomized controlled trial. Clin Rehabil 2019; 33:1056-1065. [PMID: 30841744 DOI: 10.1177/0269215519833013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the concomitant effects of two patient-directed interventions for post-stroke depressive symptoms on caregivers' well-being. DESIGN Secondary analyses of the results of a randomized controlled trial. SUBJECTS Fifty caregivers of stroke patients receiving outpatient rehabilitation. INTERVENTIONS Stroke patients and their caregivers were randomly allocated to either cognitive-behavioural therapy augmented with movement or occupational therapy ( n = 23) or computerized cognitive training ( n = 27) to alleviate depressive symptoms in patients. MAIN MEASURES Emotional burden (Involvement Evaluation Questionnaire), practical burden (Caregiver Strain Index), mental health (General Health Questionnaire) and emotional complaints (Hospital Anxiety and Depression Scale). RESULTS Caregivers of patients who received cognitive-behavioural therapy reported significantly higher mental health levels (mean difference (MD) = 1.78, 95% confidence interval (CI) = 0.43-3.13, P = 0.01) and less worrying about patients' well-being (MD = 1.9, 95% CI = 0.56-3.24, P < 0.01). In addition, there were positive time effects on the Involvement Evaluation Questionnaire for Brain Injury, particularly the subscales Worrying, Supervision and Tension. CONCLUSION The results suggest that augmented cognitive-behavioural therapy aimed at improving patients' emotional, behavioural and social functioning positively affects some aspects of caregivers' well-being.
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Affiliation(s)
- Joyce A Kootker
- 1 Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Caroline M van Heugten
- 2 Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,3 Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Bart Kral
- 4 Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Sascha Mc Rasquin
- 5 Adelante Rehabilitation Center, Hoensbroek, The Netherlands.,6 Department of Rehabilitation Medicine, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alexander C Geurts
- 1 Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.,4 Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Luciano Fasotti
- 7 Klimmendaal, Rehabilitation Center, Arnhem, The Netherlands.,8 Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
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Wichowicz HM, Puchalska L, Rybak-Korneluk AM, Gąsecki D, Wiśniewska A. Application of Solution-Focused Brief Therapy (SFBT) in individuals after stroke. Brain Inj 2017; 31:1507-1512. [PMID: 28696135 DOI: 10.1080/02699052.2017.1341997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the effects of Solution Focused Brief Therapy (SFBT) in individuals after stroke on self-efficacy, symptoms of depression and anxiety. DESIGN Randomized controlled trial. SETTING Clinic of Adult Neurology of Medical University of Gdańsk and M. Copernicus Pomeranian Traumatology Centre in Gdańsk. SUBJECTS A total of 62 patients, aged 54.0 ± 9.6 years. INTERVENTIONS They were randomly assigned to one of the two groups: SFBT participating in 10 therapy sessions and control - not participating in any psychotherapy. MAIN MEASURES Symptoms of depression and anxiety according to Hospital Anxiety and Depression Scale, Mini-Mental Adjustment to Cancer (scale originally designed for cancer patients) and Self-efficacy Scale were examined at baseline of the study and later in the same time intervals in both groups. RESULTS The intensity of depression and anxiety complaints drops in the SFBT group (from 5.0 to 2.0 and 8.0 to 4.0 respectively; both p < .001 Friedman's ANOVA (analysis of variance)) whilst in the control group remains unchanged. In addition to the gradual reduction of destructive attitudes (from 34.5 to 17.0), the increase in the number of constructive attitudes (from 42.0 to 50.5) and increased self-efficacy (from 79.0 to 96.0) was observed after therapy but not in the control group. CONCLUSIONS The authors suggest SFBT as a simple, beneficial and inexpensive method to manage patients after stroke.
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Affiliation(s)
- Hubert M Wichowicz
- a Clinic of Adult Psychiatry , Medical University of Gdańsk , Poland.,b Institute of Health Sciences , Pomeranian University in Słupsk , Poland
| | | | | | - Dariusz Gąsecki
- d Clinic of Adult Neurology , Medical University of Gdańsk , Poland
| | - Anna Wiśniewska
- e Neurological Ward , M. Copernicus Pomeranian Traumatology Centre in Gdańsk , Poland
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8
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Kootker JA, Rasquin SM, Lem FC, van Heugten CM, Fasotti L, Geurts AC. Augmented Cognitive Behavioral Therapy for Poststroke Depressive Symptoms: A Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:687-694. [DOI: 10.1016/j.apmr.2016.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
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van Eeden M, Kootker JA, Evers SMAA, van Heugten CM, Geurts ACH, van Mastrigt GAPG. An economic evaluation of an augmented cognitive behavioural intervention vs. computerized cognitive training for post-stroke depressive symptoms. BMC Neurol 2015; 15:266. [PMID: 26715040 PMCID: PMC4696099 DOI: 10.1186/s12883-015-0522-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 12/11/2015] [Indexed: 11/22/2022] Open
Abstract
Background Stroke survivors encounter emotional problems in the chronic phase after stroke. Post-stroke depressive symptoms have major impact on health-related quality of life (HRQol) and lead to increased hospitalization and therefore substantial healthcare costs. We present a cost-effectiveness and cost-utility evaluation of a cognitive behavioural therapy augmented with occupational and movement therapy to support patients with a stroke with depressive symptoms in goal-setting and goal attainment (augmented CBT) in comparison with a computerized cognitive training program (CogniPlus) as a control intervention. Methods A trial-based economic evaluation was conducted from a societal perspective with a time horizon of 12 months. Stroke patients (aged 18+ years) with signs of depression (Hospital Anxiety and Depression Scale (HADS) – subscale depression > 7) were eligible to participate. Primary outcomes were the HADS and Quality Adjusted Life Years (QALYs) based on the three-level five-dimensional EuroQol (EQ-5D-3 L). Missing data were handled through mean imputation (costs) and multiple imputation (HADS and EuroQol), and costs were bootstrapped. Sensitivity analyses were performed to test robustness of baseline assumptions. Results Sixty-one patients were included. The average total societal costs were not significantly different between the control group (€9,998.3) and the augmented CBT group (€8,063.7), with a 95 % confidence interval (−5,284, 1,796). The augmented CBT intervention was less costly and less effective from a societal perspective on the HADS, and less costly and slightly more effective in QALYs, in comparison with the control treatment. The cost-effectiveness and cost-utility analyses provided greater effects and fewer costs for the augmented CBT group, and fewer effects and costs for the HADS. Based on a willingness to pay (WTP) level of €40,000 per QALY, the augmented CBT intervention had a 76 % chance of being cost-effective. Sensitivity analyses showed robustness of results. Conclusion The stroke-specific augmented CBT intervention did not show convincing cost-effectiveness results. In addition to other literature, this study provided new insights into the potential cost-effectiveness of an adjusted cognitive behavioural therapy intervention. However, as our study showed a 76 % chance of being cost-effective for one outcome measure (QALY) and did not provide convincing cost-effectiveness results on the HADS we recommend further research in a larger population.
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Affiliation(s)
- M van Eeden
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,MHeNS, School for Mental Health & Neuroscience; Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - J A Kootker
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - C M van Heugten
- MHeNS, School for Mental Health & Neuroscience; Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - A C H Geurts
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - G A P G van Mastrigt
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Abstract
Cerebrovascular diseases are associated with a high incidence of psychiatric disorders. Depressive illness after stroke has been extensively investigated during the last three decades. Post-stroke depression is estimated to occur in 30-35% of the patients during the first year after stroke. Numerous studies have given information on its prevalence, pathogenesis, clinical course, treatment and prevention. Despite the high level of comorbidity, depressive symptoms appear to remain frequently unrecognized and untreated. This has a negative effect on the rehabilitation, quality of live, cognitive function and mortality of stroke patients.
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Affiliation(s)
| | - Dániel Bereczki
- Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest Balassa u. 6. 1083
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Kootker JA, Rasquin SMC, Smits P, Geurts AC, van Heugten CM, Fasotti L. An augmented cognitive behavioural therapy for treating post-stroke depression: description of a treatment protocol. Clin Rehabil 2014; 29:833-43. [DOI: 10.1177/0269215514559987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/26/2014] [Indexed: 11/15/2022]
Abstract
Aim: Currently, no evidence-based treatment is available for mood problems after stroke. We present a new psychological intervention designed to reduce depressive complaints after stroke. Method of protocol development: This intervention was based on cognitive behavioural therapy principles and was shown feasible in a pilot study. In order to meet the specific needs of stroke patients (concerning both sensori-motor, cognitive, and behavioural problems), we incorporated motivational interviewing, grief resolution, and psycho-education. We emphasised for each session to take into account the cognitive deficits of the patients (i.e. be concrete, accessible, structured, specific, and repeat information). Moreover, we augmented the psychologist-administered therapy with the contribution of an occupational or movement therapist aimed at facilitating patients’ goal-setting and attainment. The intervention consisted of 12 one-hour sessions with a psychologist and three or four one-hour sessions with an occupational or movement therapist. Currently, the effectiveness of the intervention is evaluated in a randomised controlled trial. Discussion: The proposed psychological treatment protocol is innovative, as it applies cognitive behavioural therapy in a stroke-specific manner; moreover, it supports goal attainment by incorporating occupational or movement therapy sessions.
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Affiliation(s)
- Joyce A Kootker
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sascha MC Rasquin
- Adelante Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands
- CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter Smits
- Rehabilitation Centre, St. Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander C Geurts
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
- Rehabilitation Medical Centre Groot Klimmendaal, Siza Support and Rehabilitation, Arnhem, The Netherlands
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Ferré-Grau C, Casado MS, Cid-Buera D, LLeixà-Fortuño M, Monteso-Curto P, Berenguer-Poblet M. Caring for family caregivers: An analysis of a family-centered intervention. Rev Esc Enferm USP 2014; 48 Spec No:87-94. [DOI: 10.1590/s0080-623420140000600013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 08/08/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the effectiveness of Problem-Solving Therapy (PST) on family caregivers through the use of scales to measure anxiety, depression and emotional distress; and to explore facilitating factors and obstacles for its use based on the narrative of nurses. Method A clinical trial and an exploratory focus group with the use of mixed analysis methodology. The study was conducted in a primary health care center in Tarragona, Spain, and the sample consisted of 122 family caregivers who were included in the home care service, and 10 nurses who participated in the intervention group. Family caregivers with evident symptoms of anxiety, depression and emotional distress received PST in the intervention group. The intervention group also consisted of a discussion with eight nurses, which was transcribed and submitted to content analysis. Conclusion Problem-Solving Therapy proved to be effective in reducing perceived anxiety, depression and emotional distress. We identified its strong points and obstacles as described by nurses.
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Tielemans NS, Visser-Meily JMA, Schepers VPM, Post MWM, Wade DT, van Heugten CM. Study Protocol of the Restore4Stroke Self-Management Study: A Multicenter Randomized Controlled Trial in Stroke Patients and Their Partners. Int J Stroke 2013; 9:818-23. [DOI: 10.1111/ijs.12127] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rationale Many stroke patients and their partners report long-term negative consequences of stroke on their health-related quality of life. Adequate self-management abilities may help manage the consequences of the stroke, but it is unknown what specific intervention might be effective to enhance self-management abilities of stroke patients and their partners. Aim The study aims to investigate the effectiveness of a 10-week group self-management intervention addressing proactive coping strategies compared with a group education intervention in stroke patients and their partners. Design The study is a multicenter randomized controlled trial. A total of 106 stroke patients with, if applicable, their partners are randomly assigned to the self-management intervention or the education intervention within each of the 10 participating hospitals and rehabilitation centers. The main inclusion criteria are a symptomatic stroke at least six-weeks ago, living at home, and reporting at least two participation restrictions on the Utrecht Scale for Evaluation of Rehabilitation-Participation's restriction scale. Measurements are performed at baseline, immediately after intervention, three-months, and nine-months postintervention. Study outcomes Primary outcome measures are stroke patients' and partners' proactive coping competencies (Proactive Competence Inventory) and societal participation (Utrecht Scale for Evaluation of Rehabilitation-Participation's restriction scale). Discussion If effective, the results of this study will enable stroke patients and their partners to deal better with the lasting consequences of stroke. In the context of the growing number of people returning home after stroke, a large number of people may profit from this intervention.
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Affiliation(s)
- Nienke S. Tielemans
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M. A. Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Vera P. M. Schepers
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marcel W. M. Post
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Derick T. Wade
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Psychology and Neurosciences, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
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