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Jin L, Zhao Y, Ye T, He Y, Yao L. Cognitive and emotional impairment in stroke survivors: insights from a multi-center study on inpatient rehabilitation therapy. Brain Inj 2024; 38:630-636. [PMID: 38528739 DOI: 10.1080/02699052.2024.2333398] [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: 04/24/2023] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Individuals recovering from stroke often experience cognitive and emotional impairments, but rehab programs tend to focus on motor skills. The aim of this investigation is to systematically assess the change of magnitude of cognitive and emotional function subsequent to a conventional rehabilitative protocol administered to stroke survivors within a defined locale in China. METHODS This is a multicenter study; a total of 1884 stroke survivors who received in-hospital rehabilitation therapy were assessed on admission (T0) and discharge (T1). The tool of InterRAI was used to assess cognitive, emotional, and behavioral abnormality. RESULTS The patients aged >60 years, with a history of hypertension, and long stroke onset duration were more exposed to functional impairment (all p < 0.05). Both cognitive and emotional sections were significantly improved at T1 compared to T0 (p < 0.001). Initially, 64.97% and 46.55% of patients had cognitive or emotional impairment at T0, respectively; this percentage was 58.55% and 37.15% at T1. CONCLUSION Many stroke survivors have ongoing cognitive and emotional problems that require attention. It is essential to focus on rehabilitating these areas during the hospital stay, especially for older patients, those with a longer recovery, and those with hypertension history.
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Affiliation(s)
- Lihua Jin
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ying Zhao
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ting Ye
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ying He
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Liqing Yao
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Ladwig S, Werheid K, Südmeyer M, Volz M. Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies. Front Psychiatry 2023; 14:1093918. [PMID: 36860505 PMCID: PMC9969555 DOI: 10.3389/fpsyt.2023.1093918] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Cerebral insults lead in many cases not only to cognitive impairment but also to disturbed emotionality. After stroke, one in three survivors develops a depression which impacts quality of life and rehabilitation. Meta-analyses have identified five main predictors of post-stroke depression (PSD): history of mental disorder, stroke severity, physical disability, cognitive impairment, and social support. However, these five established variables have never been conjointly investigated in a sample of stroke survivors. Therefore, their independent predictive values remain unclear. Moreover, predictors are most often used as time-invariant factors (status scores), neglecting the intraindividual dynamics after stroke. METHODS Our study analyses the data of two prospective longitudinal studies, investigating stroke survivors from two rehabilitation hospitals (N 1 = 273) and one acute care hospital (N 2 = 226). Baseline assessments included the five established predictors and depressive symptoms. After 6 months, depressive symptoms were reassessed in both studies (n 1 = 176, n 2 = 183), and physical disability and social support were reassessed in study 2. The predictivity of the five predictors and the additional predictivity of intraindividual dynamics for PSD were examined in multiple linear regression analyses. RESULTS History of mental disorder was a risk factor for depressive symptoms after stroke at all measurement times (B = 3.32 to 3.97; p < 0.01). Physical disability was a risk factor at all measurement times (B = -0.09 to -0.03; p < 0.05) except 6 months after rehabilitation. Social support was a protective factor (B = -2.69 to -1.91; p < 0.01) outside the acute phase (R 2 = 0.15-0.39). Intraindividual changes in physical disability and perceived social support were independent predictors of PSD 6 months after the acute phase (B = -0.08/-0.14; p < 0.01), in addition to status scores on established variables (ΔR 2 = 0.08, p < 0.001). DISCUSSION History of mental disorder, physical disability, and social support are independent predictors of depressive symptoms in the first year post-stroke, also when considered conjointly. Future studies should control for these variables when investigating new predictors of PSD. In addition, intraindividual changes in known predictors after stroke play a relevant role in the pathogenesis of PSD and should be considered in clinical practice and future research.
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Affiliation(s)
- Simon Ladwig
- Clinical Neuropsychology and Psychotherapy, Department of Psychology, Faculty of Psychology and Sport Science, Universität Bielefeld, Bielefeld, Germany
| | - Katja Werheid
- Clinical Neuropsychology and Psychotherapy, Department of Psychology, Faculty of Psychology and Sport Science, Universität Bielefeld, Bielefeld, Germany
| | - Martin Südmeyer
- Department of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany.,Department of Neurology, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Matthias Volz
- Clinical Psychology I, Department of Psychology, Faculty of Human Sciences, Universität Kassel, Kassel, Germany
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Lindsay M, Decker VB. Improving Depression Screening in Primary Care. J Dr Nurs Pract 2022; 15:84-90. [DOI: 10.1891/jdnp-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundDepression is a serious problem in the United States. It not only impacts chronic illness and healthcare utilization, but it can also result in death, intentional or unintentional. Despite the seriousness associated with depression, it continues to be underdiagnosed and undertreated. The primary care setting provides an ideal location to screen and initiate treatment for depression in individuals who would otherwise not be screened.ObjectiveThe objective of this evidence-based practice project was to improve the diagnosis and treatment of depression in an adult primary care office.MethodAn intervention consisting of a HealthWatcher reminder for depression screening, the administration of the PHQ-9 instrument, and a treatment algorithm was incorporated into the office workflow. The charts of a pre-intervention random sample were compared to a post-intervention random sample to test for significant differences in depression screening and treatment rates.ResultsUsing the chi-squared test, the post-intervention sample screening rate was significantly higher than pre-intervention sample rate (90% vs 23.3%; χ2 = 54.3, df = 1, P < .000).Conclusion/ImplicationsIt is feasible to improve the diagnosis and treatment of depression for adult primary care patients by modifying office protocols and using the PHQ-9 screening instrument and a treatment algorithm.
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Almohammed OA, Alsalem AA, Almangour AA, Alotaibi LH, Al Yami MS, Lai L. Antidepressants and health-related quality of life (HRQoL) for patients with depression: Analysis of the medical expenditure panel survey from the United States. PLoS One 2022; 17:e0265928. [PMID: 35442954 PMCID: PMC9020683 DOI: 10.1371/journal.pone.0265928] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/10/2022] [Indexed: 12/25/2022] Open
Abstract
Background Despite the empirical literature demonstrating the efficacy of antidepressant medications for treatment of depression disorder, these medications’ effect on patients’ overall well-being and health-related quality of life (HRQoL) remains controversial. This study investigates the effect of antidepressant medication use on patient-reported HRQoL for patients who have depression. Methods A comparative cohort, secondary database analysis was conducted using data from the United States’ Medical Expenditures Panel Survey for patients who had depression. HRQoL was measured using the SF-12 and reported as physical and mental component summaries (PCS and MCS). A cohort of patients that used antidepressant medications were compared to a cohort of patients that did not. Univariate and multivariate difference-in-differences (D-I-D) analyses were used to assess the significance of the mean difference of change on the PCS and MCS from baseline to follow-up. Results On average, 17.5 million adults were diagnosed with depression disorder each year during the period 2005–2016. The majority were female (67.9%), a larger proportion of whom received antidepressant medications (60.5% vs. 51.5% of males). Although use of antidepressants was associated with some improvement on the MCS, D-I-D univariate analysis revealed no significant difference between the two cohorts in PCS (–0.35 vs. –0.34, p = 0.9595) or MCS (1.28 vs. 1.13, p = 0.6405). The multivariate D-I-D analyses ensured the robustness of these results. Conclusion The real-world effect of using antidepressant medications does not continue to improve patients’ HRQoL over time. Future studies should not only focus on the short-term effect of pharmacotherapy, it should rather investigate the long-term impact of pharmacological and non-pharmacological interventions on these patients’ HRQoL.
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Affiliation(s)
- Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- * E-mail:
| | - Abdulaziz A. Alsalem
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A. Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lama H. Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Majed S. Al Yami
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Leanne Lai
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, Davie, Florida, United States of America
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Burdea G, Kim N, Polistico K, Kadaru A, Grampurohit N, Hundal J, Pollack S. Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports. JMIR Rehabil Assist Technol 2022; 9:e26990. [PMID: 35416787 PMCID: PMC9047881 DOI: 10.2196/26990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/16/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND BrightArm Compact is a new rehabilitation system for the upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with cognitively challenging serious games. OBJECTIVE The aim of this study is to design and test a robotic rehabilitation table-based virtual rehabilitation system for functional impact of the integrative training in the early poststroke phase. METHODS A new robotic rehabilitation table, controllers, and adaptive games were developed. The 2 participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity function (primary outcome), depression, and cognition were administered before and after the intervention. Nonstandardized measures included game variables and subjective evaluations. RESULTS The 2 case study participants attained high total arm repetitions per session (504 and 957) and achieved high grasp and finger-extension counts. Training intensity contributed to marked improvements in affected shoulder strength (225% and 100% increase), grasp strength (27% and 16% increase), and pinch strength (31% and 15% increase). The shoulder flexion range increased by 17% and 18% and elbow supination range by 75% and 58%. Improvements in motor function were at or above minimal clinically important difference for the Fugl-Meyer Assessment (11 and 10 points), Chedoke Arm and Hand Activity Inventory (11 and 14 points), and Upper Extremity Functional Index (19 and 23 points). Cognitive and emotive outcomes were mixed. Subjective rating by participants and training therapists were positive (average 4, SD 0.22, on a 5-point Likert scale). CONCLUSIONS The design of the robotic rehabilitation table was tested on 2 participants in the early poststroke phase, and results are encouraging for upper extremity functional gains and technology acceptance. TRIAL REGISTRATION ClinicalTrials.gov NCT04252170; https://clinicaltrials.gov/ct2/show/NCT04252170.
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Affiliation(s)
- Grigore Burdea
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
- Electrical and Computer Engineering Department, Rutgers-The State University of New Jersey, Piscataway, NJ, United States
| | - Nam Kim
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
| | - Kevin Polistico
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
| | - Ashwin Kadaru
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
| | - Namrata Grampurohit
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jasdeep Hundal
- Hundal Neuropsychology Group, Hillsborough, NJ, United States
- Robert Wood Johnson Medical School, Rutgers-The State University of New Jersey, Department of Neurology, New Brunswick, NJ, United States
| | - Simcha Pollack
- Computer Information Systems and Decision Sciences, St John's University, New York City, NY, United States
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Ladwig S, Werheid K. Determinants of Antidepressant Treatment and Outpatient Rehabilitation Within the First Year After Stroke. J Geriatr Psychiatry Neurol 2022; 35:135-144. [PMID: 33233997 DOI: 10.1177/0891988720973749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims to identify individual determinants of antidepressant treatment and outpatient rehabilitation after stroke. People with ischemic stroke (N = 303) recruited at 2 inpatient rehabilitation clinics were included into a prospective longitudinal study with follow-up telephone interviews 6 and 12 months later. Participants reported on their use of antidepressant medication and psychotherapy as well as physical, occupational, speech, and neuropsychological therapy. The use of antidepressants at discharge (n = 65, 23.8%) was predicted by the severity of depressive symptoms, severity of stroke, history of depression, and use of antidepressants at admission (all p < .05, R2= .55). The number of outpatient rehabilitation services used at follow-ups was predicted by higher functional and cognitive impairment, higher education, younger age, severity of depressive symptoms, and lower self-efficacy (all p < .05; R26M = .24, R212M = .49). The relevance of identified determinants for the improvement of treatment rates after stroke is discussed.
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Affiliation(s)
- Simon Ladwig
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Clinic of Neurology, Hospital Ernst von Bergmann, Potsdam, Germany
| | - Katja Werheid
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Clinic of Neurology, Hospital Ernst von Bergmann, Potsdam, Germany
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Burdea G, Kim N, Polistico K, Kadaru A, Roll D, Grampurohit N. Novel integrative rehabilitation system for the upper extremity: Design and usability evaluation. J Rehabil Assist Technol Eng 2021; 8:20556683211012885. [PMID: 34422282 PMCID: PMC8373277 DOI: 10.1177/20556683211012885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/08/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Design and test the usability of a novel virtual rehabilitation system for bimanual training of gravity supported arms, pronation/supination, grasp strengthening, and finger extension. METHODS A robotic rehabilitation table, therapeutic game controllers, and adaptive rehabilitation games were developed. The rehabilitation table lifted/lowered and tilted up/down to modulate gravity loading. Arms movement was measured simultaneously, allowing bilateral training. Therapeutic games adapted through a baseline process. Four healthy adults performed four usability evaluation sessions each, and provided feedback using the USE questionnaire and custom questions. Participant's game play performance was sampled and analyzed, and system modifications made between sessions. RESULTS Participants played four sessions of about 50 minutes each, with training difficulty gradually increasing. Participants averaged a total of 6,300 arm repetitions, 2,200 grasp counts, and 2,100 finger extensions when adding counts for each upper extremity. USE questionnaire data averaged 5.1/7 rating, indicative of usefulness, ease of use, ease of learning, and satisfaction with the system. Subjective feedback on the custom evaluation form was 84% favorable. CONCLUSIONS The novel system was well-accepted, induced high repetition counts, and the usability study helped optimize it and achieve satisfaction. Future studies include examining effectiveness of the novel system when training patients acute post-stroke.
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Affiliation(s)
- Grigore Burdea
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
- Department of Electrical and Computer Engineering, Rutgers – The
State University of New Jersey, Piscataway, NJ, USA
| | - Nam Kim
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Kevin Polistico
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Ashwin Kadaru
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Doru Roll
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Namrata Grampurohit
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
- Department of Occupational Therapy, Jefferson University,
Philadelphia, PA, USA
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Improvements and deficits progression among ischemic stroke patients with pre-stroke depression and thrombolytic therapy. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.npbr.2020.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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