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Bazoukis G, Letsas KP, Liu T, Tse G, Alsheikh-Ali A. Association of Late Potentials With Fatal Arrhythmic Events in Patients With Brugada Syndrome-A Meta-analysis. Cardiol Rev 2024; 32:334-337. [PMID: 37811999 DOI: 10.1097/crd.0000000000000511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Risk stratification of patients with Brugada syndrome (BrS) remains challenging. Signal-averaged electrocardiogram (SAECG) is a noninvasive tool that can be used to identify the electrophysiologic substrate potentially underlying fatal ventricular arrhythmias. The aim of this meta-analysis is to summarize the existing evidence about the role of late potentials (LP) as a predictor for arrhythmic events in patients with BrS. A systematic search in the MedLine database through to June 2022 without any limitations was performed. Ten studies were included in the quantitative synthesis (1431 patients with BrS, mean age 47.4 years, males 86%). Of these, 1220 patients underwent SAECG evaluation (53.2% had positive LP, and 20.6% had a fatal arrhythmic event). There was a nonsignificant association between positive LPs and fatal arrhythmic events [RR: 2.06 (0.98-4.36), P = 0.06, I 2 = 82%]. By including only studies with patients without a history of fatal arrhythmia, the association between LP with arrhythmic events remained nonsignificant [RR: 1.29 (0.67-2.48), P = 0.44, I 2 = 54%]. In conclusion, there is a possible association between LP and fatal arrhythmic events in patients with BrS, but the literature remains inconclusive. Large cohort studies using a multiparametric approach for risk stratification purposes are needed to improve the risk stratification of BrS and to optimize the selection of BrS patients that should be referred for implantable cardioverter-defibrillator.
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Affiliation(s)
- George Bazoukis
- From the Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Konstantinos P Letsas
- Arrhythmia Unit, Laboratory of Cardiac Pacing and Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Kent and Medway Medical School, Canterbury, Kent, United Kingdom
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-United Kingdom Collaboration, Hong Kong, China
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Harayama E, Ano N, Yamauchi K, Arakawa S. Difficulty resuming driving in acute acquired brain injury: Retrospective observational study using discriminant analysis. J Stroke Cerebrovasc Dis 2024; 33:107808. [PMID: 38848977 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107808] [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: 11/16/2023] [Revised: 04/06/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVES We hypothesized that neuropsychological testing and history of falls would be associated with difficulty resume driving after acute acquired brain injury (ABI). This study aimed to analyze ABI facing difficulties in resuming driving in the acute phase. METHODS We retrospectively analyzed 63 patients receiving assistance in driving-resumption after ABI. Patients were categorized into two groups: driving-resumption-possible and driving-resumption-difficult. Discriminant analysis delineated characteristics of patients experiencing driving-resumption difficulty. Additionally, significant predictors were analyzed using ROC curves. RESULTS 42 patients were able to resume driving, and 21 experienced difficulties in driving resumption. Factors predicting difficulty returning to driving were age, history of falls, TMT Part B, and ROCF. Furthermore, cut-off values for each were 72 years, 148 seconds for TMT Part B, and 29.5 points for ROCF. CONCLUSIONS Patients with advanced age, history of falls, delayed TMT Part B, and poor ROCF outcomes may face challenges in resuming driving after ABI. These factors may serve as a valuable metric to assess driving resumption difficulties after ABI.
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Affiliation(s)
- Eisei Harayama
- Research Institute, Department of Rehabilitation, Social Medical Corporation Steel Memorial Yawata Hospital, Kitakyushu, Japan, Harunomachi1-1-1, Yawatahigasi-ward, Kitakyushu, Fukuoka, 805-0050, Japan.
| | - Nanami Ano
- Research Institute, Department of Rehabilitation, Social Medical Corporation Steel Memorial Yawata Hospital, Kitakyushu, Japan, Harunomachi1-1-1, Yawatahigasi-ward, Kitakyushu, Fukuoka, 805-0050, Japan
| | - Kouta Yamauchi
- Research Institute, Department of Rehabilitation, Social Medical Corporation Steel Memorial Yawata Hospital, Kitakyushu, Japan, Harunomachi1-1-1, Yawatahigasi-ward, Kitakyushu, Fukuoka, 805-0050, Japan
| | - Shuji Arakawa
- Department of Stroke and Neurological Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan, Harunomachi1-1-1, Yawatahigasi-ward, Kitakyushu, Fukuoka, 805-0050, Japan
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Wallace HE, Gullo HL, Copland DA, Rotherham A, Wallace SJ. Does aphasia impact on return to driving after stroke? A scoping review. Disabil Rehabil 2024:1-24. [PMID: 38415619 DOI: 10.1080/09638288.2024.2317989] [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: 09/25/2022] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Stroke can affect driving, an important activity of daily living. Little is known about whether aphasia (language impairment) impacts driving post-stroke. This scoping review explores impacts and perceived impacts of aphasia on driving performance, and the process of returning to driving post-stroke. MATERIALS AND METHODS Scoping review using Arksey and O'Malley's framework, reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Bibliographic databases were searched and international clinical practice guidelines were sourced online. Full-text articles were independently assessed by two reviewers. Results were tabulated and summarised using narrative synthesis. RESULTS Forty-three literature sources and 17 clinical practice guidelines were identified. Six studies investigated return to driving with aphasia post-stroke; 37 sources from the broader literature contributed to objectives. It remains unclear whether aphasia impacts fitness-to-drive; however, people with aphasia face barriers in returning to driving due to: (1) uncertainty regarding the role of language in driving; (2) poor awareness and knowledge of aphasia, and (3) communication demands in the patient-journey and assessment. CONCLUSIONS The current evidence base is limited, inconsistent, and lacking in quality and recency and there is a lack of guidelines to support clinical practice. People with aphasia face barriers in returning to driving; however, it is unclear if aphasia affects fitness-to-drive post-stroke. Implications for rehabilitationPeople with aphasia, their caregivers and clinicians have identified return to driving as a top 10 research priority.We do not know if aphasia affects fitness-to-drive post-stroke, but communication difficulties can make the process of returning to driving more difficult.Speech pathologists have an important role in ensuring that driving is discussed with people with aphasia post-stroke.Speech pathologists should support the multidisciplinary team to understand and meet the communication needs of people with aphasia throughout the driving evaluation process.
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Affiliation(s)
- Helen E Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - Hannah L Gullo
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Metro North Health, Brisbane, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Annette Rotherham
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
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Gårdinger MB, Johansson R, Lidestam B, Selander H. Validation of a computerized driving simulator test of cognitive abilities for fitness-to-drive assessments. Front Psychol 2024; 14:1294965. [PMID: 38259535 PMCID: PMC10800903 DOI: 10.3389/fpsyg.2023.1294965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Background Driving requires a series of cognitive abilities, many of which are affected by age and medical conditions. The psychosocial importance of continued driving ushers the need for valid measurements in fitness-to-drive assessments. A driving simulator test could prove useful in these assessments, having greater face validity than other off-road tests and being more cost-effective and safer than ordinary on-road testing. The aim of this study was to validate a driving simulator test for assessment of cognitive ability in fitness-to-drive assessments. Methods The study included 67 healthy participants. Internal consistency of the simulator subtests was estimated. A correlation analysis between results on the simulator and the cognitive tests Trail Making Test (TMT) A and B and the Useful field of View test (UFOV) and multiple regression analysis were conducted. Finally, a comparison of results between age groups (>65 years) and (<65 years) was done. Results Results showed good internal consistency. Significant and moderate correlations were found for all reaction time in the simulator's subtests and UFOV 3, and all but two with TMT A. Lane positioning in the simulator showed significant and low to moderate correlations with UFOV 3 in all subtests. Reaction time and Double reaction time on subtest 3 were significantly correlated with UFOV 2 and UFOV 3 and TMT A, respectively. Test on Centerline (position) in subtest 3 as dependent variable was significantly correlated with UFOV 3. Significant means differences and large effect sizes between the age groups were found for all reaction time and lane positioning tests. Conclusion The findings of concurrent validity, especially with TMT A and UFOV 3 and its sensitivity for age-related differences, indicate potential for the simulator to be used as a complement in fitness-to-drive assessments. However, a clinical study is necessary to further examine its usefulness for patients with cognitive deficits.
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Affiliation(s)
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Björn Lidestam
- Swedish National Transport Research Institute, Linköping, Sweden
| | - Helena Selander
- Swedish National Transport Research Institute, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Chanmas G, Taveekitworachai P, Paliyawan P, Thawonmas R, Thawonmas R, Nukoolkit C, Dajpratham P. Driving scenarios and environmental settings in simulator-based driving assessment systems for stroke: a systematic review. Top Stroke Rehabil 2023; 30:872-880. [PMID: 36617424 DOI: 10.1080/10749357.2023.2165273] [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: 09/11/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND Driving simulators are effective tools to evaluate the driving abilities of patients with stroke. They can introduce various driving scenarios which will greatly benefit both the assessors and drivers. However, there is still no guidelines by which driving scenarios should be introduced in the driving assessment. OBJECTIVES We conducted a systematic review to examine the utilization of driving scenarios and environments in the simulator-based driving assessment for patients with stroke. METHODS A systematic review was conducted following PRISMA. We searched PubMed, Web of Science, ScienceDirect, ACM Digital Library, and IEEE Xplore Digital Library databases in January and June 2022 to identify eligible articles published since 2010. RESULTS Our searches identified 1,614 articles. We included 12 studies that applied driving simulators to assess the driving performance of patients with stroke. The driving scenarios were categorized into three categories - vehicle controls scenarios, hazard perception scenarios, and trajectory planning scenarios - based on a certain set of driving abilities. The most common driving scenarios are simple navigation (n = 8) and emergency stop (n = 8). The most frequently used driving area is urban (n = 9), and a variety of roads and traffic conditions were found in the included studies. Only 2 studies applied weather conditions, such as the clear and sunny condition or the windy condition. CONCLUSION It is recommended for future research to consider covering scenarios from the aforementioned three categories and further investigate the benefits of introducing complex weather conditions and localized traffic conditions in the driving assessment.
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Affiliation(s)
- Gunt Chanmas
- Graduate School of Information Science and Engineering, Ritsumeikan University, Shiga, Japan
| | | | - Pujana Paliyawan
- Ritsumeikan Center for Game Studies, Ritsumeikan University, Kyoto, Japan
| | - Ramita Thawonmas
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ruck Thawonmas
- College of Information Science and Engineering, Ritsumeikan University, Shiga, Japan
| | - Chakarida Nukoolkit
- School of Information Technology, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Piyapat Dajpratham
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Marnane K, Gustafsson L, Liddle J, Molineux M. Interventions for Driving Disruption in Community Rehabilitation: A Chart Audit. Disabil Rehabil 2023; 45:4424-4430. [PMID: 36448310 DOI: 10.1080/09638288.2022.2152501] [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: 03/15/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE After injury or illness, a person's ability to drive may be impacted and they may experience a period of "driving disruption," a period during which they cannot drive although they have not permanently ceased driving. They may require additional information and supports from treating rehabilitation services; however, this process is less understood than others related to driving. MATERIALS AND METHODS This study aimed to document the prevalence of driving-related issues and the current practices of a community rehabilitation service, regarding driving interventions. An audit of 80 medical records was conducted in a multidisciplinary community rehabilitation service in Brisbane, Australia. RESULTS In total, 61% of clients were "driving-disrupted" on admission and 35% remained driving-disrupted on discharge. Majority of driving-disrupted clients had an acquired brain injury (ABI). Driving-related interventions were not routinely provided, with 29% receiving no information or supports. Clients with ABI more frequently received information; provision of psychosocial support and community access training was infrequent. CONCLUSIONS This study highlights that return to driving is a common issue and goal for people undergoing community rehabilitation, with the period of driving disruption extending beyond rehabilitation discharge. It also highlights gaps in community rehabilitation practice, and opportunities to better support these clients.IMPLICATIONS FOR REHABILITATIONMany clients of community rehabilitation services experience driving disruption, often beyond discharge.Driving disruption should be recognised and documented by community rehabilitation services.Current practices may not adequately address the practical and psychological needs of clients experiencing driving disruption.
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Affiliation(s)
- Kerry Marnane
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Acquired Brain Injury Outreach Service, Princess Alexandra Hospital, Brisbane, Australia
| | - L Gustafsson
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - J Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - M Molineux
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
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7
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Ogawa T, Fujita K, Kawabata K, Hori H, Hayashi K, Suzuki A, Nakaya Y, Kobayashi Y. Is it safe to control the car pedal with the lower limb of the unaffected side in patients with stroke? TRAFFIC INJURY PREVENTION 2023; 25:27-35. [PMID: 37773056 DOI: 10.1080/15389588.2023.2260914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Few studies have examined motor function in determining the suitability of patients with stroke to resume driving a car. Patients with hemiplegia usually control car pedals with the unaffected lower limb. However, motor control on the unaffected side is also impaired in patients with stroke. This study aimed to clarify the neurophysiological characteristics of pedal switching control during emergency braking in patients with hemiplegia. METHODS The study participants consisted of 10 drivers with left hemiplegia and 10 age-matched healthy drivers. An experimental pedal was used to measure muscle activity and kinematic data during braking, triggered by the light from a light-emitting diode placed in front of the drivers. RESULTS The patient group took the same reaction time as the healthy group. However, from the visual stimulus to the release of the accelerator pedal, the patient group had higher muscle activity in the tibialis anterior and rectus femoris and had faster angular velocities of hip and knee flexion than the healthy group. In addition, the patient group had higher co-contraction activities between flexors and extensors. From the accelerator pedal release to brake contact, the patient group had slower angular velocities of hip adduction, internal rotation, ankle dorsiflexion, internal return, and internal rotation than the healthy group. CONCLUSIONS Patients with hemiplegia exhibited poor control of pedal switching using their unaffected side throughout the pedal-switching task. These results indicate that the safety related to car-pedal control should be carefully evaluated while deciding whether a patient can resume driving a car after a stroke.
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Affiliation(s)
- Tomoki Ogawa
- Department of Health Science, Graduate School of Health Science, Fukui Health Science University, Fukui, Japan
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui, Japan
| | - Kazuki Fujita
- Graduate School of Health Science, Fukui Health Science University, Fukui, Japan
| | - Kaori Kawabata
- Graduate School of Health Science, Fukui Health Science University, Fukui, Japan
| | - Hideaki Hori
- Graduate School of Health Science, Fukui Health Science University, Fukui, Japan
| | - Koji Hayashi
- Department of Rehabilitation Medicine, Fukui General Hospital, Fukui, Japan
| | - Asuka Suzuki
- Department of Rehabilitation Medicine, Fukui General Hospital, Fukui, Japan
| | - Yuka Nakaya
- Department of Rehabilitation Medicine, Fukui General Hospital, Fukui, Japan
| | - Yasutaka Kobayashi
- Graduate School of Health Science, Fukui Health Science University, Fukui, Japan
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8
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Sidiropoulos G, Antoniadis A, Saplaouras A, Bazoukis G, Letsas ΚP, Karamitsos TD, Giannopoulos G, Fragakis N. Impact of baseline right ventricular function on the response to cardiac resynchronization therapy - A meta-analysis. Hellenic J Cardiol 2023; 73:61-68. [PMID: 36914097 DOI: 10.1016/j.hjc.2023.03.002] [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: 12/19/2022] [Revised: 02/25/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
Baseline right ventricular (RV) function potentially determines the response to Cardiac Resynchronization Therapy (CRT) but is not included in the current selection criteria. In this meta-analysis, we examined the value of echocardiographic indices of RV function as potential predictors of CRT outcomes in patients with standard indications for CRT. Baseline tricuspid annular plane systolic excursion was consistently higher in CRT responders, and this association appears independent of age, sex, ischemic etiology of heart failure, and baseline left ventricular ejection fraction. This proof-of-concept meta-analysis of observational data may justify a more detailed assessment of RV function as an additional component in the selection process of CRT candidates.
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Affiliation(s)
- Georgios Sidiropoulos
- Department of Cardiology, Georgios Papanikolaou General Hospital, Leoforos Papanikolaou, Pylaia, Thessaloniki, PK 57010, Greece.
| | - Antonios Antoniadis
- 3(rd) Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, Κonstantinoupoleos 49, Thessaloniki, PK 54642, Greece.
| | - Athanasios Saplaouras
- Onassis Cardiac Surgery Center, Electrophysiology Department, Leoforos Andrea Syggrou 356, Athens, PK 17674, Greece.
| | - Georgios Bazoukis
- Department of Cardiology Larnaca General Hospital, Pandoras Street, Larnaca, PK 6301, Cyprus; Department of Basic and Clinical Sciences, University of Nicosia Medical School, 93 Agiou Nikolaou Street, Engomi, Nicosia, Cyprus.
| | - Κonstantinos P Letsas
- Onassis Cardiac Surgery Center, Electrophysiology Department, Leoforos Andrea Syggrou 356, PK 17674, Athens, Greece.
| | - Theodoros D Karamitsos
- 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University Medical School, Kiriakidi 1, Thessaloniki, PK 54636, Greece.
| | - Georgios Giannopoulos
- 3(rd) Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, Κonstantinoupoleos 49, Thessaloniki, PK 54642, Greece.
| | - Nikolaos Fragakis
- 2(nd) Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, Κonstantinoupoleos 49, Thessaloniki, PK 54642, Greece.
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Bazoukis G, Chung CT, Vassiliou VS, Sfairopoulos D, Lee S, Papadatos SS, Korantzopoulos P, Saplaouras A, Letsas KP, Liu T, Tse G. The Role of Electrophysiological Study in the Risk Stratification of Brugada Syndrome. Cardiol Rev 2023:00045415-990000000-00106. [PMID: 37126436 DOI: 10.1097/crd.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Brugada syndrome (BrS) is a complex arrhythmogenic disease associated with an increased risk of sudden cardiac death (SCD). The role of electrophysiological study (EPS) for risk stratification purposes of asymptomatic BrS patients remains still controversial. This study aims to summarize the existing data about the role of electrophysiological study for arrhythmic risk stratification of BrS patients without a prior history of aborted SCD or fatal arrhythmic event. Two independent investigators (G.B. and G.T.) performed a systematic search in the MedLine database and Cochrane library from their inception until April 2022 without any limitations. The reference lists of the relevant research studies as well as the relevant review studies and meta-analyses were manually searched. Nineteen studies were included in the final analysis. The included studies enrolled 6218 BrS patients (mean age: 46.9 years old, males: 76%) while 4265 (68.6%) patients underwent an EPS. The quantitative synthesis showed that a positive EPS study was significantly associated with arrhythmic events in BrS patients (RR, 1.74 [1.23-2.45]; P = 0.002; I2 = 63%]. By including the studies that provided data on the association of EPS with arrhythmic events during follow-up in patients without a prior history of aborted SCD or fatal arrhythmic event, the association between positive EPS study and future arrhythmic events remained significant (RR, 1.60 [1.08-2.36]; P = 0.02; I2 = 19%). In conclusion, EPS is a useful invasive tool for the risk stratification of BrS patients and can be used to identify the population of BrS patients who may be candidates for primary prevention of SCD with implantable cardioverter-defibrillator (ICD) implantation.
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Affiliation(s)
- George Bazoukis
- From the Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Cheuk To Chung
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Vassilios S Vassiliou
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK, Norfolk and Norwich University Hospital and University of East Anglia, Norwich, UK
| | - Dimitrios Sfairopoulos
- First Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Sharen Lee
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China
| | - Stamatis S Papadatos
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Panagiotis Korantzopoulos
- First Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Athanasios Saplaouras
- Arrhythmia Unit, Laboratory of Cardiac Pacing and Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Konstantinos P Letsas
- Arrhythmia Unit, Laboratory of Cardiac Pacing and Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Kent and Medway Medical School, Canterbury, Kent, United Kingdom; and
- School of Nursing and Health Studies, Metropolitan University, Hong Kong, China
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10
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Venketasubramanian N, Chan ML. Stroke Recurrence among Stroke Patients Referred for Driving Assessment and Rehabilitation: A Cohort Study. J Cardiovasc Dev Dis 2023; 10:jcdd10020083. [PMID: 36826579 PMCID: PMC9959833 DOI: 10.3390/jcdd10020083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Returning to driving is one of the priorities for stroke survivors. However, the fear of the risk of recurrent stroke has led to concern about allowing driving post-stroke. This study was performed to study the impact of various vascular risk factors on stroke recurrence among drivers referred to our national referral center for Driving Assessment and Rehabilitation Program (DARP). Medical records of subjects who were diagnosed to have a stroke and were referred to DARP were retrospectively reviewed. Data on demographics (age and gender) and vascular risk factors (hypertension-HT, diabetes mellitus-DM, hyperlipidemia-HL, cigarette smoking-SM, previous stroke-PS, and heart disease-HD) were collected. Subjects were contacted and records scrutinized for a report of recurrent stroke. A total of 133 subjects were recruited, median 54 years (range 20-77 years), 95.5% male, 59.4% had HT, 32.3% DM, 65.4% HL, 43.6% SM, 3.8% PS, and 8.3% HD. Over a median follow-up of 30 months (range 1-78 months), the recurrence rate of stroke was 11.3%, 3.69/100 patient-years. On uni-variable analysis, the risk of stroke recurrence rose with age (HR 1.08, 95%CI 1.02-1.15, p = 0.01) and heart disease (HR 5.77, 95%CI 1.46-22.83, p = 0.01). On multivariable analysis, only age remained significant (HR 1.07, 95%CI 1.00-1.13, p = 0.045). Among those aged > 60 years, the HR was 3.88 (95%CI 1.35-11.20, p = 0.012). The risk of stroke recurrence is higher among older drivers and is not influenced by other vascular factors.
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Affiliation(s)
| | - Mei Leng Chan
- Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore 308433, Singapore
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11
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Use of P wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol 2022; 65:827-840. [PMID: 35488962 DOI: 10.1007/s10840-022-01147-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND To investigate the changes of P wave indices in atrial fibrillation (AF) patients after catheter ablation and the association between P wave indices and AF recurrence. METHODS PubMed, Embase, and Cochrane Database were searched through September 15th 2021 for studies on the association between P wave indices and AF with catheter ablation. Heterogeneity was estimated using the I2 statistic, the random effects model was used to calculate the pooled results, and summary receiver operating characteristic curve (SROC) was used to evaluate the predictive value. RESULTS Among included fourteen studies with 1674 AF patients, we found significantly decreased P wave dispersion (Pdis) (mean difference [MD]: - 6.5 ms, 95% confidence interval [95% CI]: - 11.81 to - 1.18, P = 0.02) after cryoballoon ablation (CBA) or radiofrequency ablation (RFA), and maximum P wave (Pmax) (MD: - 8.57 ms, 95% CI: - 17.03 to - 0.10, P = 0.05) after RFA only, but increased minimum P wave (Pmin) (MD: 3.43 ms, 95% CI: 1.07 to 5.79, P < 0.01) after CBA only. Pdis measured before ablation was remarkably higher (MD: 5.79 ms, 95% CI: 2.23 to 9.36, P < 0.01) in patients with recurrence than without; meanwhile, Pmax was higher measured both before and after ablation (MD: 6.49 ms, 95% CI: 2.30 to 10.69, P < 0.01 and MD: 11.2 ms, 95% CI: 2.88 to 19.52, P < 0.01). Furthermore, SROC analysis showed acceptable predictive efficiencies of Pdis (AUC = 0.776) and Pmax (AUC = 0.759) for AF recurrence. CONCLUSION Pdis was significantly decreased after AF catheter ablation. Higher Pdis and Pmax may have predictive values for AF recurrence.
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12
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Bazoukis G, Garcia-Zamora S, Çinier G, Lee S, Elvin Gul E, Álvarez-García J, Miana G, Hayıroğlu Mİ, Tse G, Liu T, Baranchuk A. Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings. World J Cardiol 2022; 14:483-495. [PMID: 36187429 PMCID: PMC9523270 DOI: 10.4330/wjc.v14.i9.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is a unique tool for non-invasive tissue characterization, especially for identifying fibrosis.
AIM To present the existing data regarding the association of electrocardiographic (ECG) markers with myocardial fibrosis identified by CMR - late gadolinium enhancement (LGE).
METHODS A systematic search was performed for identifying the relevant studies in Medline and Cochrane databases through February 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com).
RESULTS A total of 32 studies were included. In hypertrophic cardiomyopathy (HCM), fragmented QRS (fQRS) is related to the presence and extent of myocardial fibrosis. fQRS and abnormal Q waves are associated with LGE in ischemic cardiomyopathy patients, while fQRS has also been related to fibrosis in myocarditis. Selvester score, abnormal Q waves, and notched QRS have also been associated with LGE. Repolarization abnormalities as reflected by increased Tp-Te, negative T-waves, and higher QT dispersion are related to myocardial fibrosis in HCM patients. In patients with Duchenne muscular dystrophy, a significant correlation between fQRS and the amount of myocardial fibrosis as assessed by LGE-CMR was observed. In atrial fibrillation patients, advanced inter-atrial block is defined as P-wave duration ≥ 120 ms, and biphasic morphology in inferior leads is related to left atrial fibrosis.
CONCLUSION Myocardial fibrosis, a reliable marker of prognosis in a broad spectrum of cardiovascular diseases, can be easily understood with an easily applicable ECG. However, more data is needed on a specific disease basis to study the association of ECG markers and myocardial fibrosis as depicted by CMR.
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Affiliation(s)
- George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca 6036, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia 2414, Cyprus
| | | | - Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul 34668, Turkey
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong 999077, China
| | - Enes Elvin Gul
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah 42351, Saudi Arabia
| | - Jesús Álvarez-García
- Department of Cardiology, Ramon y Cajal University Hospital, Madrid 28034, Spain
| | - Gabi Miana
- Telehealth Center of Hospital das Clínicas, Hong Kong 999077, China
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul 34668, Turkey
| | - Gary Tse
- Kent and Medway Medical School, Canterbury, Canterbury CT2 7FS, United Kingdom
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin, Tianjin Medical University, Tianjin 300211, China
| | - Tong Liu
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Adrian Baranchuk
- Department of Cardiology, Queen's University, Ontario K7L 3N6, Canada
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13
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Vander Veen A, Laliberte Rudman D. Rethinking Driving Against Medical Advice: The Situated Nature of Driving After Stroke. Can J Occup Ther 2022; 89:406-416. [PMID: 35854415 DOI: 10.1177/00084174221114670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: As stroke can result in functional impairments that impact driving ability, many jurisdictions mandate a 30-day period of driving restriction post-stroke. However, between 26% and 38% of clients drive against medical advice during this period. Purpose: Informed by critical reflexivity of the literature and the first author's practice, this critical analysis paper (1) explicates and critiques how adherence to guidelines regarding driving after stroke in the first 30 days is conceptualized in individualistic, biomedically centred research and (2) argues for expanded understandings of driving based on a transactional occupational perspective. Key Issues: Individualistic, biomedical perspectives view driving against medical advice as an individually located phenomenon, generating partial understandings and individually focused solutions. Re-conceptualizing driving after stroke as a transactional occupational choice provides a productive basis for understanding and addressing driving within practice and research. Implications: Concepts from occupational science can generate new insights for research and client-centred practice regarding driving following stroke.
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14
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Bazoukis G, Tyrovolas K, Letsas KP, Vlachos K, Radford D, Chung CT, Liu T, Efremidis M, Tse G, Baranchuk A. Predictors of fatal arrhythmic events in patients with non-compaction cardiomyopathy: a systematic review. Heart Fail Rev 2022; 27:2067-2076. [PMID: 35776368 DOI: 10.1007/s10741-022-10257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 12/01/2022]
Abstract
Left ventricular non-compaction cardiomyopathy (LVNC) is a congenital heart disease with autosomal dominant inheritance. This review aims to summarize the existing data about the predictors of fatal arrhythmias in patients with LVNC. Medline and Cochrane library databases were searched from inception to November 2021 for articles on LVNC. The reference lists of the relevant research studies as well as the relevant review studies and meta-analyses were also searched. Clinical symptoms and electrocardiogram findings such as left bundle branch block are significantly associated with ventricular arrhythmias. Other non-invasive tools such as Holter monitoring, echocardiography, and cardiac magnetic resonance (CMR) can provide additional value for risk stratification. CMR-derived left and right ventricular ejection fraction, left ventricular end-diastolic diameter, late gadolinium enhancement, and non-compacted to compacted myocardium ratio are predictive of ventricular arrhythmias. An electrophysiological study can provide additional prognostic data in patients with LVNC who are at moderate risk of ventricular arrhythmias. Risk stratification of LVNC patients with no prior history of a fatal arrhythmic event remains challenging. Symptoms assessment, electrocardiogram, Holter monitoring, and cardiac imaging should be performed on every patient, while an electrophysiological study should be performed for moderate-risk patients. Large cohort studies are needed for the construction of score models for arrhythmic risk stratification purposes.
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Affiliation(s)
- George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus. .,Department of Basic and Clinical Sciences, University of Nicosia Medical School, 2414, Nicosia, Cyprus.
| | | | | | | | - Danny Radford
- Kent and Medway Medical School, Canterbury, Kent, UK
| | | | - Tong Liu
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Collaboration, Hong Kong, China-UK, China.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Michael Efremidis
- Department of Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Gary Tse
- Kent and Medway Medical School, Canterbury, Kent, UK.,Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Collaboration, Hong Kong, China-UK, China
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, ON, Canada
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15
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Hirano D, Kimura N, Yano H, Enoki M, Aikawa M, Goto Y, Taniguchi T. Different brain activation patterns in the prefrontal area between self-paced and high-speed driving tasks. JOURNAL OF BIOPHOTONICS 2022; 15:e202100295. [PMID: 35103406 DOI: 10.1002/jbio.202100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this study was to investigate the effects on prefrontal cortex brain activity when participants attempted to stop a car accurately at a stop line when driving at different speeds using functional near-infrared spectroscopy (fNIRS). Twenty healthy subjects with driving experience drove their own cars for a distance of 60 m five times each at their own pace or as fast as possible. The variation in the distance between the stop line and the car was not significantly different between the self-paced and high-speed tasks. However, oxygenated hemoglobin concentration in the prefrontal cortex was significantly higher in the high-speed task than in the self-paced task. These findings suggest that driving at high speed requires more divided attention than driving at self-paced speed, even though the participants were able to stop the car at the same distance from the target. This study shows the advantages and usefulness of fNIRS .
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Affiliation(s)
- Daisuke Hirano
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Naotoshi Kimura
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Rehabilitation, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Chiba, Japan
| | - Hana Yano
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Miku Enoki
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Rehabilitation, International University of Health and Welfare Shioya Hospital, Yaita, Tochigi, Japan
| | - Maya Aikawa
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Rehabilitation, International University of Health and Welfare Shioya Hospital, Yaita, Tochigi, Japan
| | - Yoshinobu Goto
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Faculty of Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
- Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Okawa, Fukuoka, Japan
| | - Takamichi Taniguchi
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
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16
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Development of a Web-Based Mini-Driving Scene Screening Test (MDSST) for Clinical Practice in Driving Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063582. [PMID: 35329268 PMCID: PMC8954781 DOI: 10.3390/ijerph19063582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: For the elderly and disabled, self-driving is very important for social participation. An understanding of changing driving conditions is essential in order to drive safely. This study aimed to develop a web-based Korean Mini-Driving Scene Screening Test (MDSST) and to verify its reliability and validity for clinical application. (2) Methods: We developed a web-based MDSST, and its content validity was verified by an expert group. The tests were conducted with 102 elderly drivers to verify the internal consistency and reliability of items, and the validity of convergence with the existing Korean-Safe Driving Behavior Measure (K-SDBM) and the Korean-Adelaide Driving Self-Efficacy Scale (K-ADSES) driving tests was also verified. The test–retest reliability was verified using 54 individuals who participated in the initial test. (3) Results: The average content validity index of MDSST was 0.90, and the average internal consistency of all items was 0.822, indicating high content validity and internal consistency. The exploratory factor analysis for construct validity, the KOM value of the data, was 0.658, and Bartlett’s sphericity test also showed a strongly significant result. The four factors were road traffic and signal perception, situation understanding, risk factor recognition, and situation prediction. The explanatory power was reliable at 61.27%. For the convergence validation, MDSST and K-SDBM showed r = 0.435 and K-ADSES showed r = 0.346, showing a moderate correlation. In the evaluation–reevaluation reliability verification, the reliability increased to r = 0.952. (4) Conclusions: The web-based MDSST test developed in this study is a useful tool for detecting and understanding real-world driving situations faced by elderly drivers. It is hoped that the MDSST test can be applied more widely as a driving ability test that can be used in the clinical field of driving rehabilitation.
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17
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Samuelsson K, Wressle E. Usability of Norm Values on Results from a Simulator Device and Cognitive Tests in Traffic Medicine. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:59-70. [PMID: 35299782 PMCID: PMC8922450 DOI: 10.2147/mder.s346226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Driving is an essential everyday task for most adults, and fitness to continue car-driving after a brain injury/disease is a common issue in rehabilitation settings. There is no consensus on how this assessment should be performed and thus further research and development are of great value. The aim was to study the usability of cut-off values, based on recently developed norm values for a driving simulator device (CyberSiM), as well as cognitive tests, for patients already considered fit-to-drive after a standardized traffic medical investigation. Methods The study had a retrospective case-control design. Norm results (n = 129) were compared with patient results (n = 126) divided into two age groups (≤59 years and ≥60 years). Results from Useful Field of View, Trail Making Test, Nordic Stroke Driver Screening Assessment as well as a simulator device (CyberSiM) were compared. Results The group of patients considered fit-to-drive after a traffic medicine assessment had worse results on all cognitive tests compared with norms. Results on CyberSiM subtests II and III did not differ from norms. The proportion of patients within suggested cut-off limits (mean±2SD norm) and considered fit to drive (mean±2SD norm) were highest (75–95%) for all three subtests of CyberSiM and for Useful Field of View in both age groups. Conclusion Availability of norm values in decision on continued driving is of value when interpreting the results of cognitive assessments sensitive to age, but it must be handled with care because many factors are important for individuals’ ability to drive.
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Affiliation(s)
- Kersti Samuelsson
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Correspondence: Kersti Samuelsson, Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden, Email
| | - Ewa Wressle
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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18
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Samuelsson K, Lundqvist A, Selander H, Wressle E. Fitness to drive after acquired brain injury: Results from patient cognitive screening and on-road assessment compared to age-adjusted norm values. Scand J Psychol 2021; 63:55-63. [PMID: 34558073 DOI: 10.1111/sjop.12774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/16/2021] [Accepted: 08/10/2021] [Indexed: 01/13/2023]
Abstract
Fitness to drive after acquired brain injury or disease is a common question in rehabilitation settings. The aim of the study was to compare age-matched norms with patient cognitive test results used to predict fitness to drive. A second aim was to analyze the contribution from an on-road assessment to a final decision on resumption of driving after an acquired brain injury. Retrospective cognitive test results from four traffic medicine units (n = 333) were compared with results from a healthy norm population (n = 410) in Sweden. Patients were dichotomized according to the final decision as fit or unfit to drive made by the traffic medicine team. The norm group had significantly better results in all age groups for all cognitive tests compared with the patients considered unfit to drive and fit to drive. A binary regression analysis for the patient group showed an explained value for fit to drive/unfit to drive of 88%, including results for the Nordic Stroke Driver Screening Assessment total score, Useful Field of View total score and the final outcome from an on-road assessment. Results from the present study illustrate the importance of using several tests, methods and contexts for the final decision regarding fitness to drive.
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Affiliation(s)
- Kersti Samuelsson
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Lundqvist
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Helena Selander
- Department of Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Swedish National Transport Research Institute, Stockholm, Sweden
| | - Ewa Wressle
- Department of Geriatric Medicine and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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19
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Perna R, Pundlik J, Arenivas A. Return-to-driving following acquired brain injury: A neuropsychological perspective. NeuroRehabilitation 2021; 49:279-292. [PMID: 34420988 DOI: 10.3233/nre-218026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Return to driving after an acquired brain injury (ABI) has been positively associated with return to employment, maintenance of social relationships, and engagement in recreational and other community activities. Safe driving involves multiple cognitive abilities in a dynamic environment, and cognitive dysfunction resulting from ABI can negatively impact driving performance. OBJECTIVE This manuscript examines the post-injury return-to-driving process, including performances on the in-office and on-road assessments, and the role of a rehabilitation neuropsychologist in helping patients resume driving. METHOD In this study, 39 of 200 individuals (approximately 20%) treated at an outpatient neurorehabilitation facility, who performed satisfactorily on a pre-driving cognitive screening, completed a behind-the-wheel driving test. RESULTS Of the 200 individuals, 34 (87%) passed the road test. Among the remaining five individuals who did not pass the road test, primary reasons for their failure included inability to follow or retain examiner directions primarily about lane position, speed, and vehicle control. The errors were attributable to cognitive difficulties with information processing, memory, attention regulation, and dual tasking.CONCLUSIONThe rehabilitation neuropsychologist contributed to the process by assessing cognition, facilitating self-awareness and error minimization, providing education about driving regulations and safety standards, and preparing for the road test and its outcomes.
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Affiliation(s)
| | | | - Ana Arenivas
- The Institute of Rehabilitation Research (TIRR), Memorial Hermann, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
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20
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Bazoukis G, Naka KK, Alsheikh-Ali A, Tse G, Letsas KP, Korantzopoulos P, Liu T, Yeung C, Efremidis M, Tsioufis K, Baranchuk A, Stavrakis S. Association of QRS narrowing with response to cardiac resynchronization therapy-a systematic review and meta-analysis of observational studies. Heart Fail Rev 2021; 25:745-756. [PMID: 31392534 DOI: 10.1007/s10741-019-09839-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Prolonged QRS duration, which reflects a higher degree of mechanical dysynchrony, is a predictor of response to CRT. However, the association of QRS narrowing after biventricular pacing with CRT response rates is not clear. Our aim was to conduct a systematic review and meta-analysis on the association between QRS narrowing after cardiac resynchronization therapy (CRT) and clinical and echocardiographic response to CRT in patients with heart failure. Two independent investigators searched MedLine and EMBASE databases through July 2018 without any limitations. Studies providing estimates (continuous data) on the association of QRS shortening with either clinical (defined as New York Heart Association (NYHA) reduction ≥ 1) or echocardiographic (defined as left ventricular end-systolic volume (LVESV) reduction ≥ 15%) response to CRT were finally included in the quantitative synthesis. We included 32 studies (14 studies (1274 patients mean age 64 years old, males 79.3%) using clinical CRT response and 18 studies (1270 patients, mean age 64 years old, males 69.1%) using echocardiographic CRT response). A significant association between QRS narrowing and shorter attained QRS duration with clinical and echocardiographic CRT response was observed. The observed association was independent of the timing of QRS width measurement after CRT implantation. Acute and late improvement of electrical dysynchrony as depicted by QRS narrowing following biventricular pacing is associated with clinical and echocardiographic response to CRT. However, large prospective studies are needed to further examine our findings.
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Affiliation(s)
- George Bazoukis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece. .,The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Katerina K Naka
- Second Department of Cardiology, University of Ioannina, GR 45110, Ioannina, Greece
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Konstantinos P Letsas
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | | | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Cynthia Yeung
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Michael Efremidis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Stavros Stavrakis
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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21
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Sawada T, Tomori K, Sakaue K, Higashikawa Y, Ohno K, Okita Y, Seike Y, Fujita Y, Umeda M. Evaluating the Content Validity of a New On-Road Driving Test. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2021.1873476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Tatsunori Sawada
- School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Kounosuke Tomori
- School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | | | | | - Kanta Ohno
- School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Yuho Okita
- Soaring Health Sports, Wellness & Community Centre, Melbourne, Australia
| | - Yousuke Seike
- School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Yoshio Fujita
- Department of Rehabilitation, Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Masaru Umeda
- School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
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22
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Bazoukis G, Thomopoulos C, Tse G, Vassiliou VS, Liu T, Dimitriadis K, Tatakis F, Konstantinou K, Doumas M, Tsioufis K. Impact of renal sympathetic denervation on cardiac magnetic resonance-derived cardiac indices in hypertensive patients - A meta-analysis. J Cardiol 2021; 78:314-321. [PMID: 34088560 DOI: 10.1016/j.jjcc.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/20/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal sympathetic denervation (RDN) is a safe device-based option for the treatment of hypertension although current guidelines do not recommend its use in routine clinical practice. In this meta-analysis, we investigated the effects of RDN in cardiac magnetic resonance (CMR)-derived cardiac indices. METHODS This meta-analysis was performed in accordance with the PRISMA statement. A comprehensive systematic search of MEDLINE database and Cochrane library through to January 2021 was performed. The inclusion criteria were studies that enrolled patients undergoing RDN in whom CMR data were provided for left ventricular end-diastolic volume indexed to body surface area (BSA) (LVEDVI), left ventricular end-systolic volume indexed (LVESVI), left ventricular mass indexed (LVMI), and left ventricular ejection fraction (LVEF) pre and post RDN. A random effects model was used for the analyses. RESULTS Our search strategy revealed 9 studies that were finally included in the meta-analysis (n=300 patients, mean age: 60 years old, males: 59%). Compared to control group, RDN patients showed significantly lower values in the attained volumes (LVEDVI: -6.70 ml/m2, p=0.01; LVESVI: -3.63 ml/m2, p=0.006). Moreover, RDN group achieved a statistically significant higher attained LVEF (3.49%, p=0.01). A non-significant difference was found in the attained LVMI between RDN and control groups (-2.59 g/m2, p=0.39). Compared to pre-RDN values, RDN reduces significantly the LVMI, the LVEDVI, and the LVESVI while a non-significant change of LVEF was found. CONCLUSIONS In conclusion, the current study demonstrates the potential beneficial role of RDN in CMR-derived cardiac indices that reflect adverse remodeling. However, large, randomized studies are needed to elucidate the role of RDN in cardiac remodeling in hypertension, heart failure, and other clinical settings.
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Affiliation(s)
- George Bazoukis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
| | | | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Vassilios S Vassiliou
- Norfolk and Norwich University Hospital, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Kyriakos Dimitriadis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Fotios Tatakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Konstantinou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Sakamaki K, Nishizawa S, Katsuki M, Kawamura S, Koh A. On-Road Driving Assessment in a Driving School Course and the Results of a Cognitive Function Test After Stroke in a Depopulated Rural Area in Japan: Case Series of Eight Patients. Cureus 2021; 13:e15293. [PMID: 34211804 PMCID: PMC8236213 DOI: 10.7759/cureus.15293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Returning to driving after a stroke is a step toward independence and improving quality of life. Cognitive function after stroke is one of the essential factors that affect driving ability, and on-road driving assessment in driving school courses is beginning to spread in Japan. We started on-road driving assessment in 2018, and we herein report eight patients who underwent on-road driving assessment in the last three years, presenting both off-road cognitive function tests and on-road driving assessment results. Methods Of the 320 consecutive stroke patients from 2018 to 2020, we retrospectively investigated the eight patients’ characteristics who underwent on-road driving assessment. We performed cognitive function tests, including behavioral inattention test (BIT), trail-making test, Wechsler Adult Intelligence Scale-III, and behavioral assessment of the dysexecutive syndrome. Patients who meet BIT > 35, at least three other subitem criteria, and no unevaluable subitems can undergo on-road driving assessment by a driving instructor. With the recommendation of the driving instructors, we comprehensively decided the permission to drive. Results All eight patients could return to driving after on-road driving assessment. Two patients could return to driving after nearly a year. Conclusion The patients did not meet all the cut-offs of the cognitive function test, but they were judged to return to driving by driving instructors. We finally permitted all eight patients to drive. On-road driving assessment in the driving school course might be helpful for determining the permission to return to driving.
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Affiliation(s)
- Keita Sakamaki
- Department of Rehabilitation Medicine, Itoigawa General Hospital, Itoigawa, JPN
| | - Shin Nishizawa
- Department of Rehabilitation Medicine, Itoigawa General Hospital, Itoigawa, JPN
| | - Masahito Katsuki
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
| | - Shin Kawamura
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
| | - Akihito Koh
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
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24
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Chiang LLW, Li C, Hong KL, Hui WS, Beh SY, Gong M, Liu T, Li G, Xia Y, Ho J, Roever L, Duong S, Huang G, Tse G, Baranchuk A, Glover BM. The use of minimal fluoroscopy for cardiac electrophysiology procedures: A meta-analysis and review of the literature. Clin Cardiol 2021; 44:814-823. [PMID: 33998690 PMCID: PMC8207968 DOI: 10.1002/clc.23609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/13/2021] [Accepted: 03/31/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Conventional catheter ablation involves prolonged exposure to ionizing radiation, potentially leading to detrimental health effects. Minimal fluoroscopy (MF) represents a safer alternative, which should be explored. Data on the safety and efficacy of this technique are limited. HYPOTHESIS Our hypothesis is that MF is of equal efficacy and safety to conventional catheter ablation with the use of fluoroscopy by performing a meta-analysis of both randomized controlled trials (RCTs) and real-world registry studies. METHODS Pubmed and Embase were searched from their inception to July 2020 for RCTs, cohort and observational studies that assessed the outcomes of catheter ablation using a MF technique versus the conventional approach. RESULTS Fifteen studies involving 3795 patients were included in this meta-analysis. There was a significant reduction in fluoroscopy and procedural time with no difference in acute success (odds ratio [OR]:0.74, 95% CI: 0.50-1.10, p = .14), long-term success (OR:0.92, 95% CI: 0.65-1.31, p = .38), arrhythmia recurrence (OR:1.24, 95% CI: 0.75-2.06, p = .97) or rate of complications. (OR:0.83, 95% CI: 0.46-1.48, p = .65). Additionally sub-group analysis for those undergoing catheter ablation for atrial fibrillation (AF) did not demonstrate a difference in success or complication rates (OR:0.86, 95% CI: 0.30-2.42, p = .77). Multivariate meta-regression did not identify the presence of moderator variables. CONCLUSION This updated meta-analysis demonstrated an overall reduction in procedural and fluoroscopy time for those undergoing a minimal fluoroscopic approach. There was no significant difference in either acute or chronic success rates or complications between a MF approach and conventional approach for the management of all arrhythmias including those undergoing catheter ablation for AF.
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Affiliation(s)
| | - Christien Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Kathryn L Hong
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Winsy Sin Hui
- Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Sze Yi Beh
- Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jeffery Ho
- Department of Anaesthesia and Intensive care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Leonardo Roever
- Federal University of Uberlândia, Department of Clinical Research, Uberlândia, Minas Gerais, Brazil
| | - Sophia Duong
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Grace Huang
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Benedict M Glover
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
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25
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Dimech-Betancourt B, Ponsford JL, Charlton JL, Ross PE, Gooden JR, Stolwyk RJ. Investigating feasibility and preliminary efficacy of a simulator-based driving intervention for people with acquired brain injury: A randomised controlled pilot study. Clin Rehabil 2021; 35:1277-1289. [PMID: 33810776 DOI: 10.1177/02692155211002455] [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: 11/17/2022]
Abstract
OBJECTIVE To investigate the feasibility and preliminary efficacy of a driving simulator intervention on driving outcomes following acquired brain injury. DESIGN Pilot randomised controlled trial. SETTING Occupational therapy driver assessment and rehabilitation service. SUBJECTS Individuals post-acquired brain injury aiming to return to driving. INTERVENTION Eight sessions of simulated driver training over four weeks, in addition to usual care. Control: Usual care only. MAIN MEASURES Feasibility outcomes: Participant recruitment and retention; data completeness; therapy attendance and fidelity; adverse events. Performance outcomes: on-road driving performance; Simulator Sickness Questionnaire; Brain Injury Driving Self-Awareness Measure and Driving Comfort Scale - Daytime, assessed at baseline and five weeks post-randomisation. RESULTS Out of 523 individuals screened, 22 (4%) were recruited and randomised, with 20 completing their allocated group (n = 12 Simulator, n = 8 Usual Care). For those who completed training, session attendance was 100% with simulator sickness rated, on average, as mild. Six individuals (50%) in the Simulator group failed the on-road assessment, versus two (25%) in the Usual Care group (P = 0.373). On average, the Simulator group reported a positive change in confidence ratings (M = 5.77, SD = 13.96) compared to the Usual Care group, who reported a negative change (M = -6.97, SD = 8.47), P = 0.034. The Simulator group (M = 0.67, SD = 3.34) demonstrated no significant change in self-awareness relative to the Usual Care group (M = -0.83, SD = 1.83, P = 0.325). CONCLUSIONS With adjustments to inclusion criteria and recruitment strategies, it may be feasible to deliver the intervention and conduct a larger trial. There is potential benefit of simulator training for improving driver confidence after acquired brain injury.
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Affiliation(s)
- Bleydy Dimech-Betancourt
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia.,Epworth Rehabilitation, Melbourne, VIC, Australia
| | - Judith L Charlton
- Monash University Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - Pamela E Ross
- Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia.,Epworth Rehabilitation, Melbourne, VIC, Australia
| | - James R Gooden
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia
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26
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Bazoukis G, Thomopoulos C, Tse G, Tsioufis K, Nihoyannopoulos P. Global longitudinal strain predicts responders after cardiac resynchronization therapy-a systematic review and meta-analysis. Heart Fail Rev 2021; 27:827-836. [PMID: 33782788 DOI: 10.1007/s10741-021-10094-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
To evaluate the association between baseline global longitudinal strain (GLS) and ΔGLS (difference of baseline GLS and follow-up) and cardiac resynchronization therapy (CRT) response defined either with clinical or with echocardiographic characteristics. This meta-analysis was performed in accordance to both the Meta-Analysis of Observational Studies in Epidemiology and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Two independent investigators performed a comprehensive systematic search in MedLine, EMBASE and Cochrane databases through September 2019 without limitations. Data analysis was performed by using the Review Manager software (RevMan), version 5.3, and Stata 13 software. A p value of less than 0.05 (two-tailed) was considered statistically significant. Twelve studies (1004 patients, mean age 63.8 years old, males 69.4%) provided data on the association of baseline GLS with the response to CRT therapy. We found that CRT responders had significantly better resting GLS values compared with non-responders [GLS mean difference -2.13 (-3.03, -1.23), p < 0.001, I2 78%]. Furthermore, CRT responders had significantly greater improvement of GLS at follow-up compared with non-responders [ΔGLS mean difference -3.20 (-4.95, -1.45), p < 0.001, I2 66%]. These associations remained significant in a subgroup analysis including only studies with similar CRT response definition. In this meta-analysis, we found that CRT responders had a baseline and ΔGLS significantly higher than the non-responders strengthening the central role of GLS as a tool for selecting candidates for CRT. Furthermore, improved GLS values after CRT may be used to better define CRT responders.
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Affiliation(s)
- George Bazoukis
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | | | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, 300211, Tianjin, P. R. China
| | - Konstantinos Tsioufis
- First Cardiology Clinic, Hippokration Hospital, University of Athens, Athens, Greece
| | - Petros Nihoyannopoulos
- Imperial College London, NHLI, National Heart & Lung Institute, London, UK. .,Imperial College London, NHLI, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK.
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Lodha N, Patel P, Shad JM, Casamento-Moran A, Christou EA. Cognitive and motor deficits contribute to longer braking time in stroke. J Neuroeng Rehabil 2021; 18:7. [PMID: 33436005 PMCID: PMC7805062 DOI: 10.1186/s12984-020-00802-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/20/2020] [Indexed: 01/13/2023] Open
Abstract
Background Braking is a critical determinant of safe driving that depends on the integrity of cognitive and motor processes. Following stroke, both cognitive and motor capabilities are impaired to varying degrees. The current study examines the combined impact of cognitive and motor impairments on braking time in chronic stroke. Methods Twenty stroke survivors and 20 aged-matched healthy controls performed cognitive, motor, and simulator driving assessments. Cognitive abilities were assessed with processing speed, divided attention, and selective attention. Motor abilities were assessed with maximum voluntary contraction (MVC) and motor accuracy of the paretic ankle. Driving performance was examined with the braking time in a driving simulator and self-reported driving behavior. Results Braking time was 16% longer in the stroke group compared with the control group. The self-reported driving behavior in stroke group was correlated with braking time (r = − 0.53, p = 0.02). The stroke group required significantly longer time for divided and selective attention tasks and showed significant decrease in motor accuracy. Together, selective attention time and motor accuracy contributed to braking time (R2 = 0.40, p = 0.01) in stroke survivors. Conclusions This study provides novel evidence that decline in selective attention and motor accuracy together contribute to slowed braking in stroke survivors. Driving rehabilitation after stroke may benefit from the assessment and training of attentional and motor skills to improve braking during driving.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Movement Neuroscience and Rehabilitation Laboratory, Colorado State University, Fort Collins, CA, 80523, USA.
| | - Prakruti Patel
- Department of Health and Exercise Science, Movement Neuroscience and Rehabilitation Laboratory, Colorado State University, Fort Collins, CA, 80523, USA
| | - Joanna M Shad
- Department of Health and Exercise Science, Movement Neuroscience and Rehabilitation Laboratory, Colorado State University, Fort Collins, CA, 80523, USA
| | | | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
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28
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Noh S, Na E, Park SJ, Kim SH, Evins AE, Roh S. Effects of various antipsychotics on driving-related cognitive performance in adults with schizophrenia. J Psychiatr Res 2020; 131:152-159. [PMID: 32971359 DOI: 10.1016/j.jpsychires.2020.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 01/13/2023]
Abstract
The aim of this study was to determine whether the driving-related cognitive performance differs among adults with schizophrenia taking different types of antipsychotics. Neurocognitive performance was assessed using the Cognitive Perceptual Assessment for Driving (CPAD), a computerized battery of tests of visual perception, attention, working memory, reaction time, and inhibitory control for driving ability. One hundred and two adults with schizophrenia who were on antipsychotic monotherapy participated in the study. Of these, 15 were on haloperidol, 28 on risperidone, 14 on olanzapine, 28 on aripiprazole, and 17 on paliperidone. Sixty-four (63%) of the 102 subjects were regarded as competent to drive. Of the subjects taking haloperidol, 33% passed the CPAD, while the passing rates of subjects taking risperidone, olanzapine, aripiprazole, and paliperidone were 57%, 57%, 75%, and 82%, respectively, with a significant difference between the haloperidol and aripiprazole groups (p = 0.005) and between the haloperidol and paliperidone groups (p = 0.001). Additionally, scores on CPAD depth perception (number of correct responses), divided attention, digit span test, and trail-making test B subtests were significantly better for the aripiprazole and paliperidone groups than for the haloperidol and risperidone groups. In this cross-sectional design study, adults with schizophrenia treated with aripiprazole or paliperidone antipsychotic monotherapy demonstrated superior driving-related cognitive performance than those treated with haloperidol or risperidone antipsychotic monotherapy.
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Affiliation(s)
- Seokmin Noh
- Department of Psychiatry, Hanyang University Hospital, Seoul, Republic of Korea
| | - Euihyeon Na
- Department of Neuropsychiatry, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Se Jin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - A Eden Evins
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sungwon Roh
- Department of Psychiatry, Hanyang University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea; Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Samuelsson K, Wressle E. Decisions on driving after brain injury/disease: Feasibility and construct validity of a new simulator assessment tool. Br J Occup Ther 2020. [DOI: 10.1177/0308022620950986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction Driving is a complex activity involving a high level of cognitive abilities and thus might be affected after a brain injury/disease. The aim of this research was to evaluate the feasibility and construct validity of a driving simulator tool as a complement to existing driving assessments of patients with cognitive dysfunctions after a brain injury/disease. Method A descriptive and prospective research design was achieved. For construct validation, decisions were based on results from the Useful Field of View, Nordic Stroke Driver Screening Assessment, Trail Making Test and, when necessary for the decision, an on-road observation. Results from the simulator tool were not included in the clinical decision process. Results A total of 129 patients from four different rehabilitation services were included. The results showed a significant difference in test results between those who were considered medically fit versus unfit to drive. A factor analysis revealed four components, all including attention in combination with processing speed, visuospatial function, simultaneous capacity and executive function; these are all represented in the simulator tool. A correlation analysis showed that simulator subtest 3 (response/divergent response to stimuli) had the strongest correlation with most of the other tests included. Conclusions The simulator was found to be feasible and valid and found to include components other than those measured in the other tests.
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Affiliation(s)
- Kersti Samuelsson
- Department of Rehabilitation Medicine in Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ewa Wressle
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Acute Internal Medicine and Geriatrics in Linköping
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30
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Narad ME, Nalepka P, Miley AE, Beebe DW, Kurowski BG, Wade SL. Driving after pediatric traumatic brain injury: Impact of distraction and executive functioning. Rehabil Psychol 2020; 65:268-278. [PMID: 32525341 DOI: 10.1037/rep0000329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of the current study was to examine the driving performance of young drivers with a history of moderate to severe traumatic brain injury (TBI) compared with an uninjured control group. The impact of cell phone related distraction (conversation and texting) and executive functioning (EF) were also explored. METHOD Individuals aged 16-25 years with (n = 19) and without (n = 19) a history of TBI engaged in a simulated drive under 3 distraction conditions (no distraction, cell phone conversation, and texting). Mean speed, maximum speed, standard deviation of speed, standard deviation of lane position, and crash rates were used as outcomes. The Global Executive Composite (GEC) from the Behavior Rating Inventory of Executive Functioning (BRIEF) was used to measure EF. RESULTS Significant Injury × Distraction × GEC interaction effects were noted on max speed and speed variability, with a trending Distraction × GEC interaction noted for lane position variability. The effect of distraction was most notable among individuals with greater GEC scores, across both injury groups. CONCLUSIONS A history of pediatric TBI did not specifically impact driving performance independent of EF, with EF playing a central role in functioning across domains of driving performance. Consistent effect of EF suggests that deficits in driving performance may be associated with EF specifically, with individuals with EF difficulties following TBI at greater risk for poor driving performance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Megan E Narad
- Division of Behavioral Medicine and Clinical Psychology
| | | | | | - Dean W Beebe
- Division of Behavioral Medicine and Clinical Psychology
| | | | - Shari L Wade
- Division of Physical Medicine and Rehabilitation
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Feasibility and Validity of a Low-Cost Racing Simulator in Driving Assessment after Stroke. Geriatrics (Basel) 2020; 5:geriatrics5020035. [PMID: 32485824 PMCID: PMC7345038 DOI: 10.3390/geriatrics5020035] [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: 03/18/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022] Open
Abstract
There is a myriad of methodologies to assess driving performance after a stroke. These include psychometric tests, driving simulation, questionnaires, and/or road tests. Research-based driving simulators have emerged as a safe, convenient way to assess driving performance after a stroke. Such traditional research simulators are useful in recreating street traffic scenarios, but are often expensive, with limited physics models and graphics rendering. In contrast, racing simulators developed for motorsport professionals and enthusiasts offer high levels of realism, run on consumer-grade hardware, and can provide rich telemetric data. However, most offer limited simulation of traffic scenarios. This pilot study compares the feasibility of research simulation and racing simulation in a sample with minor stroke. We determine that the racing simulator is tolerated well in subjects with a minor stroke. There were correlations between research and racing simulator outcomes with psychometric tests associated with driving performance, such as the Trails Making Test Part A, Snellgrove Maze Task, and the Motricity Index. We found correlations between measures of driving speed on a complex research simulator scenario and racing simulator lap time and maximum tires off track. Finally, we present two models, using outcomes from either the research or racing simulator, predicting road test failure as linked to a previously published fitness-to-drive calculator that uses psychometric screening.
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A Systematic Review Examining Associations between Cardiovascular Conditions and Driving Outcomes among Older Drivers. Geriatrics (Basel) 2020; 5:geriatrics5020027. [PMID: 32353970 PMCID: PMC7345371 DOI: 10.3390/geriatrics5020027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 01/13/2023] Open
Abstract
There is a vast literature on stroke as a cardiovascular disease and driving outcomes, however little is known about other cardiovascular conditions and driving. The purpose of this review is to examine the literature for studies assessing the effect of non-stroke, vascular conditions on daily driving, reported crash risk and driving decline in older adult drivers as captured by naturalistic methodologies. A systematic review of Embase, Ovid and Scopus Plus examined articles on driving and vascular conditions among older adults. A search yielded 443 articles and, following two screenings, no articles remained that focused on non-stroke, vascular conditions and naturalistic driving. As a result, this review examined non-stroke, vascular conditions in nine driving studies of older adults that used road testing, driving simulators and self-report measures. These studies fell into three categories—heart failure, vascular dementia and white matter hyperintensities/leukoaraiosis. The combined findings of the studies suggest that heart failure, vascular dementia and white matter hyperintensities (WMH) negatively impact driving performance and contribute to driving cessation among older adults. Future research should examine cardiovascular risk factors like hypertension, hypercholesterolemia, myocardial infraction or atherosclerosis using naturalistic driving measurement, as well as traditional measures, in order to more fully characterize how these conditions impact older adult driving.
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33
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Ku FL, Chen WC, Chen MD, Tung SY, Chen TW, Tsai CC. The determinants of motorized mobility scooter driving ability after a stroke. Disabil Rehabil 2020; 43:3701-3710. [PMID: 32297816 DOI: 10.1080/09638288.2020.1748125] [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: 10/24/2022]
Abstract
Purpose: To investigate the determinants related to the ability to drive a motorized mobility scooter after a stroke.Method: The study was a cross-sectional study. The ability to drive a motorized mobility scooter was measured with the Power Mobility Clinical Driving Assessment. The independent variables included cognitive functions measured by the Color Trails Test and reaction time test, visual functions measured by a visual acuity test and visual field test, and motor functions measured with a dynamometer, the Box and Block Test, and the Functional Independence Measure.Results: The correlation analyses revealed that the Power Mobility Clinical Driving Assessment scores had significant correlations with reaction time (ρ = -.65, p < 0.01), binocular visual field (r = .64, p < 0.01), binocular visual acuity (r = .40, p = 0.03), and the grip strength of the unaffected hand (r = .47, p = 0.01). The multiple regression analysis indicated that reaction time, binocular visual field, and the grip strength of the unaffected hand were the most significant determinants of the ability to drive a motorized mobility scooter (R2 = .76).Conclusions: The reaction time, binocular visual field, and grip strength of the unaffected hand were the most significant determinants related to the ability to drive a motorized mobility scooter after a stroke. IMPLICATIONS FOR REHABILITATIONMotorized mobility scooter driving ability for stroke patients is correlated with demographics (age, mobility scooter driving experience, time since last drive) and cognitive, visual and motor functions (reaction time, binocular visual field, visual acuity, and the grip strength of unaffected hand).Primary determinants of motorized mobility scooter driving ability for stroke patients include reaction time, binocular visual field, and grip strength of the unaffected hand.Comprehensive assessments incorporating cognitive, visual and motor functions are needed to evaluate the ability to drive a motorized mobility scooter after a stroke.
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Affiliation(s)
- Fang-Ling Ku
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wei-Chung Chen
- Department of Traditional Chinese Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-De Chen
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Szu-Ya Tung
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Tien-Wen Chen
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Chiu-Chin Tsai
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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Sawant AC, Panchal H, Radadiya D, Pomakov A, Tse G, Liu T, Sridhara S, Rodriguez J, Prakash MPH, Kanwar N, Kumar A, Banerjee K, Wiesner P, Pershad A. Comparison of Rotational with Orbital Atherectomy During Percutaneous Coronary Intervention for Coronary Artery Calcification: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:501-507. [PMID: 31377129 DOI: 10.1016/j.carrev.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/29/2019] [Accepted: 07/17/2019] [Indexed: 01/13/2023]
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35
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Abstract
The on-road driving test is considered a ‘gold standard’ evaluation; however, its validity and reliability have not been sufficiently reviewed. This systematic review aimed to map out and synthesize literature regarding on-road driving tests using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Cochrane Library, PubMed, CINAHL, and Web of Science databases were searched from initiation through February 2018. All articles addressing reliability or validity of on-road driving tests involving adult rehabilitation patients were included. The search output identified 513 studies and 36 articles, which were included in the review. The Washington University Road Test/Rhode Island Road Test, performance analysis of driving ability, test ride for investigating practical fitness-to-drive, and K-score demonstrated high reliability and validity in regard to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The Washington University Road Test/Rhode Island Road Test and test ride for investigating practical fitness-to-drive were analyzed based on Classical Test Theory techniques, and performance analysis of driving ability and K-score were analyzed based on Item Response Theory techniques. The frequency of studies were Washington University Road Test/Rhode Island Road Test (n=9), Test Ride for Investigating Practical fitness-to-drive (n=8), performance analysis of driving ability (n=4), and K-score (n=1). From the viewpoint of accuracy and generalization, the Washington University Road Test/Rhode Island Road Test, test ride for investigating practical fitness-to-drive, and performance analysis of driving ability were identified as highly qualified concerning on-road driving tests. However, the ability to assess real-world driving depends on various environmental conditions.
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Lund P, Moir C, Kristalovich L, Ben Mortenson W. Evaluating the Measurement Properties of the ScanCourse, a Dual-Task Assessment of Visual Scanning. Am J Occup Ther 2020; 74:7401185040p1-7401185040p7. [PMID: 32078509 DOI: 10.5014/ajot.2019.032052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The ScanCourse is used by occupational therapists to evaluate visual scanning ability during locomotion. Its measurement properties have not been examined. OBJECTIVE To assess the interrater reliability, test-retest reliability, and construct validity of the ScanCourse. DESIGN This study involved data collection at two time points. To assess test-retest reliability, the ScanCourse was administered twice within a 2-week period. To assess interrater reliability, a second rater was present for one session. To assess level of agreement, a Bland-Altman plot was created. To assess absolute reliability, the standard error of measurement was calculated. To evaluate construct validity, the results of the ScanCourse were compared with results of the Bells Test and Trail Making Test A and B. SETTING Rehabilitation hospital. PARTICIPANTS Forty-one patients with neurological impairments. OUTCOMES AND MEASURES The ScanCourse (participants identify numbered cards placed on both sides of a hallway at various heights during locomotion). RESULTS The ScanCourse was found to have excellent interrater reliability (intraclass correlation coefficient [ICC] [1,1] = .998; 95% confidence interval [CI] [.996-.999]), test-retest reliability (ICC [1,1] = .912; 95% CI [.811-.959]), a high level of agreement, and a low standard error of measurement (.503), and it was found to be significantly correlated with Trails A (rs = -.436, p = .009) and B (rs = -.364, p = .029). CONCLUSIONS AND RELEVANCE The assessment was found to have strong measurement properties, and it is therefore an appropriate tool for assessing dual-task visual scanning among those with neurological impairments. WHAT THIS ARTICLE ADDS This research demonstrates that the ScanCourse is reliable between raters and over time and that scores on the measure vary as anticipated with scores on a related measure, which provides evidence of its validity. These findings support its use in practice.
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Affiliation(s)
- Paige Lund
- Paige Lund, BSc, MOT, is Occupational Therapist, Family Resource Association, Parksville, British Columbia, Canada
| | - Caitlyn Moir
- Caitlyn Moir, BA, MOT, is Occupational Therapist, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Lisa Kristalovich
- Lisa Kristalovich, BMR (OT), MRSc, is Clinical Faculty, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada, and Occupational Therapist, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - W Ben Mortenson
- W. Ben Mortenson, BScOT, MSc, PhD, is Associate Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Principal Investigator, Rehabilitation Research Program, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada; and Principal Investigator, International Collaboration on Repair Discoveries, VCHRI, Vancouver, British Columbia, Canada;
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Bazoukis G, Yeung C, Wui Hang Ho R, Varrias D, Papadatos S, Lee S, Ho Christien Li K, Sakellaropoulou A, Saplaouras A, Kitsoulis P, Vlachos K, Lampropoulos K, Thomopoulos C, Letsas KP, Liu T, Tse G. Association of QT dispersion with mortality and arrhythmic events-A meta-analysis of observational studies. J Arrhythm 2020; 36:105-115. [PMID: 32071628 PMCID: PMC7011802 DOI: 10.1002/joa3.12253] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/02/2019] [Accepted: 10/13/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The risk stratification of coronary heart disease (CHD) and/or heart failure (HF) patients with easily measured electrocardiographic markers is of clinical importance. The aim of this meta-analysis is to indicate whether increased QT dispersion (QTd) is associated with fatal and nonfatal outcomes in patients with CHD and/or HF. METHODS We systematically searched MEDLINE and Cochrane databases without restrictions until August 15, 2018 using the keyword "QT dispersion". Studies including data on the association between QTd and all-cause mortality, sudden cardiac death (SCD) or arrhythmic events in patients with HF and/or CHD were classified as eligible. RESULTS In the analysis including patients with CHD and/or HF, we found that QTd did not differ significantly in patients with SCD compared to no SCD patients while QTd was significantly greater in the group of all-cause mortality patients and in patients who experienced a sustained ventricular arrhythmia. Subgroup analysis showed that in myocardial infarction studies, QTd was significantly higher in patients with an arrhythmic event compared to arrhythmic event-free patients while a nonsignificant difference was found in QTd in patients who died from any cause compared to survivors. Similarly, in HF patients, the QTd was significantly greater in patients with an arrhythmic event while a nonsignificant difference was found regarding all-cause mortality and SCD outcomes. CONCLUSIONS QTd has a prognostic role for stratifying myocardial infarction or HF patients who are at higher risk of arrhythmic events. However, no prognostic role was found regarding all-cause mortality or SCD in this patient population.
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Affiliation(s)
- George Bazoukis
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | - Cynthia Yeung
- Department of MedicineQueen's UniversityKingstonONCanada
| | - Ryan Wui Hang Ho
- Li Ka Shing Faculty of MedicineUniversity of Hong KongHong KongP.R. China
| | | | - Stamatis Papadatos
- 3rd Department of Internal MedicineSotiria General HospitalNational and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Sharen Lee
- Laboratory of Cardiovascular PhysiologyLi Ka Shing Institute of Health SciencesHong Kong S.A.R.P.R. China
| | | | - Antigoni Sakellaropoulou
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | - Athanasios Saplaouras
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | - Panagiotis Kitsoulis
- Laboratory of Anatomy‐Histology‐Embryology School of MedicineUniversity of IoanninaIoanninaGreece
| | - Konstantinos Vlachos
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | - Konstantinos Lampropoulos
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | | | - Konstantinos P. Letsas
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Gary Tse
- Laboratory of Cardiovascular PhysiologyLi Ka Shing Institute of Health SciencesHong Kong S.A.R.P.R. China
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Tse G, Lee S, Gong M, Mililis P, Asvestas D, Bazoukis G, Roever L, Jeevaratnam K, Hothi SS, Li KHC, Liu T, Letsas KP. Restitution metrics in Brugada syndrome: a systematic review and meta-analysis. J Interv Card Electrophysiol 2019; 57:319-327. [PMID: 31836966 DOI: 10.1007/s10840-019-00675-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Brugada syndrome (BrS) is an ion channelopathy that predisposes affected subjects to ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death. Restitution analysis has been examined in BrS patients but not all studies have reported significant differences between BrS patients and controls. Therefore, we conducted a systematic review and meta-analysis to investigate the different restitution indices used in BrS. METHODS PubMed and Embase were searched until April 7, 2019, identifying 20 and 27 studies. RESULTS A total of ten studies involving 178 BrS (mean age 38 years old, 63% male) and 102 controls (mean age 31 years old, 42% male) were included in this systematic review. Pacing was carried out at the right ventricular outflow tract (RVOT)/right ventricular apex (RPA) (n = 4), RPA (n = 4), or right atrium (RA) (n = 1). Basic cycle lengths of 400 (n = 4), 500 (n = 2), 600 (n = 6) and 750 ms (n = 1) were used. Recording methods include electrograms (n = 4), monophasic action potentials (n = 5), and electrocardiograms (n = 1). Signals were obtained from the RVOT (n = 8), RVA (n = 3), RA (n = 1), or the body surface (n = 1). The maximum restitution slope for endocardial repolarization at the RVOT was 0.87 for BrS patients (n = 5; 95% confidence interval [CI] 0.68-1.07) compared with 0.74 in control subjects (n = 4; 95% CI 0.42-1.06), with a significant mean difference of 0.40 (n = 4; 95% CI 0.11-0.69; P = 0.007). CONCLUSIONS Steeper endocardial repolarization restitution slopes are found in BrS patients compared with controls at baseline. Restitution analysis can provide important information for risk stratification in BrS.
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Affiliation(s)
- Gary Tse
- Xiamen Cardiovascular Hospital Affiliated to Xiamen University, Xiamen, Fujian, People's Republic of China. .,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.
| | - Sharen Lee
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, SAR, People's Republic of China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Panagiotis Mililis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Dimitrios Asvestas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | | | - Sandeep S Hothi
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Ka Hou Christien Li
- Xiamen Cardiovascular Hospital Affiliated to Xiamen University, Xiamen, Fujian, People's Republic of China.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.,Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece.
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Ouellet MA, Rochette A, Miéville C, Poissant L. Portrait of driving practice following a mild stroke: a secondary analysis of a chart audit. Top Stroke Rehabil 2019; 27:181-189. [DOI: 10.1080/10749357.2019.1684049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Marie-Andrée Ouellet
- Occupational Therapy Program, School of Rehabilitation, University of Montreal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation in greater Montreal (CRIR), Montreal, Canada
| | - Annie Rochette
- Occupational Therapy Program, School of Rehabilitation, University of Montreal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation in greater Montreal (CRIR), Montreal, Canada
| | - Carole Miéville
- Quebec Rehabilitation Research Network (REPAR), Montreal, Canada
| | - Lise Poissant
- Occupational Therapy Program, School of Rehabilitation, University of Montreal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation in greater Montreal (CRIR), Montreal, Canada
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Dimech-Betancourt B, Ross PE, Ponsford JL, Charlton JL, Stolwyk RJ. The development of a simulator-based intervention to rehabilitate driving skills in people with acquired brain injury. Disabil Rehabil Assist Technol 2019; 16:289-300. [DOI: 10.1080/17483107.2019.1673835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Bleydy Dimech-Betancourt
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Richmond, Australia
| | - Pamela E. Ross
- Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Richmond, Australia
- Department of Occupational Therapy, Epworth Rehabilitation & Mental Health, Epworth HealthCare, Richmond, Australia
| | - Jennie L. Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Richmond, Australia
| | - Judith L. Charlton
- Monash University Accident Research Centre, Monash University, Clayton, Australia
| | - Renerus J. Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Richmond, Australia
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Lee S, Gong M, Lai RWC, Liu FZ, Lam MHS, Chang D, Xia Y, Liu T, Tse G, Li KHC. Electrographic indices in migraine patients: A systematic review and meta-analysis. J Electrocardiol 2019; 57:63-68. [PMID: 31514014 DOI: 10.1016/j.jelectrocard.2019.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/18/2019] [Accepted: 05/31/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Migraine patients can exhibit autonomic dysregulation, in turn leading to cardiac conduction and repolarization abnormalities. This systematic review and meta-analysis evaluated the electrocardiographic changes in migraineurs. METHOD PubMed and Embase databases were searched for human studies using the search terms 'migraine' and 'electrocardiogram' until 15th December 2018, identifying 108 and 131 studies. RESULTS Thirteen studies involving 667 migraineurs and 208 normal subjects included (mean age=30.7, total male percentage=19.8%) were included. A longer mean QTc interval (standard mean difference=7.89, 95% confidence interval=[3.29, 12.49], p=0.0008) and higher frequency of QTc prolongation (risk ratio [RR]=6.23, [2.86-13.58], p<0.00001), but no difference in PR-interval (SMD=4.33, [-3.90-12.56], p=0.30) were observed during migraine attacks compared to pain-free periods. P-wave dispersion was higher in migraine patients compared to controls (mean difference=3.62, [1.03-6.21], p=0.006). RR-interval were statistically indistinguishable between migraine patients and controls (SMD=0.08, [-0.65-0.81], p=0.83), or between migraineurs with and without aura (SMD=-0.03, [-0.44-0.38], p=0.89). Deep breathing ratio was significantly lower in migraineurs compared to controls (SMD=-0.27, 95% CI=[-0.46, -0.08], p=0.006) but similar between migraineurs with and without aura (SMD=-0.04, [-0.27-0.19], p=0.74). No significant difference in Valsalva ratio is found between migraineurs and controls (SMD=0.10, [-0.32-0.53], p=0.63) or between migraineurs with and without aura (SMD=-0.17, [-0.40-0.06], p=0.14). Root mean square of successive differences (RMSSD) (SMD=-0.07, [-1.10-0.95], p=0.89) and standard deviation of NN intervals (SDNN) (SMD=-0.10, [-0.61-0.41], p=0.71) did not significantly differ between migraine patients and controls. CONCLUSION Electrocardiographic alterations are observed in migraine patients compared to controls, especially during migraine attacks.
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Affiliation(s)
- Sharen Lee
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong S.A.R., P.R. China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Rachel W C Lai
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong S.A.R., P.R. China
| | - Fang Zhou Liu
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital Affiliated to South China University of Technology, Guangzhou, China
| | | | - Dong Chang
- Xiamen Cardiovascular Hospital Affiliated to Xiamen University, Xiamen, China
| | - Yunlong Xia
- Department of Cardiovascular Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Gary Tse
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong S.A.R., P.R. China; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.
| | - Ka Hou Christien Li
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong S.A.R., P.R. China; Faculty of Medicine, Newcastle University, United Kingdom.
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A Systematic Review and Meta-Analysis on the Association Between Driving Ability and Neuropsychological Test Performances after Moderate to Severe Traumatic Brain Injury. J Int Neuropsychol Soc 2019; 25:868-877. [PMID: 31084639 DOI: 10.1017/s1355617719000456] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Guidelines on return-to-driving after traumatic brain injury (TBI) are scarce. Since driving requires the coordination of multiple cognitive, perceptual, and psychomotor functions, neuropsychological testing may offer an estimate of driving ability. To examine this, a meta-analysis of the relationship between neuropsychological testing and driving ability after TBI was performed. METHODS Hedge's g and 95% confidence intervals were calculated using a random effects model. Analyses were performed on cognitive domains and individual tests. Meta-regressions examined the influence of study design, demographic, and clinical factors on effect sizes. RESULTS Eleven studies were included in the meta-analysis. Executive functions had the largest effect size (g = 0.60 [0.39-0.80]), followed by verbal memory (g = 0.49 [0.27-0.71]), processing speed/attention (g = 0.48 [0.29-0.67]), and visual memory (g = 0.43 [0.14-0.71]). Of the individual tests, Useful Field of Vision (UFOV) divided attention (g = 1.12 [0.52-1.72]), Trail Making Test B (g = 0.75 [0.42-1.08]), and UFOV selective attention (g = 0.67 [0.22-1.12]) had the largest effects. The effect sizes for Choice Reaction Time test and Trail Making Test A were g = 0.63 (0.09-1.16) and g = 0.58 (0.10-1.06), respectively. Years post injury (β = 0.11 [0.02-0.21] and age (β = 0.05 [0.009-0.09]) emerged as significant predictors of effect sizes (both p < .05). CONCLUSIONS These results provide preliminary evidence of associations between neuropsychological test performance and driving ability after moderate to severe TBI and highlight moderating effects of demographic and clinical factors.
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Park MO. Driving scene-based driving errors in brain injury patients and their relevance to cognitive-perceptual function and functional activity level: A cross-sectional study. Medicine (Baltimore) 2019; 98:e16315. [PMID: 31277175 PMCID: PMC6635235 DOI: 10.1097/md.0000000000016315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Driving is an essential activity for community engagement in patients with brain injury. However, brain injury patients have cognitive-perceptual deficits and low independence in daily activities. The aims of this study were to identify the driving errors of brain injury patients and determine their relevance to cognitive-perception function and daily activity level. This study was conducted at a single rehabilitation hospital. Thirty-one brain injury patients were included in the study. The patients underwent a driving-scene-based simulator evaluation in the rehabilitation clinic. Driving errors were checked using automatic software. Perceptual ability was measured using Motor-free Visual Perceptual Test (MVPT) and Cognitive-perceptual Assessment for Driving (CPAD). A linear relationship was found between the driving aptitude score, steering wheel and judgment, simultaneous operation items, total score of road course test, and cognitive-perceptual functions and daily activity levels of the participants (P <.05). The general factors that affected driving errors included driving experience, age, part of the hemispheric affected, and presence of vascular injury (P <.05). In addition, the Korean version of Mini-Mental State Examination (K-MMSE) score and the CPAD score correlated with driving errors (P <.05). The total error score of the participants correlated with the Korean version of the Modified Barthel Index (K-MBI) score (P <.05).These findings suggest that driving experience and age have more influence on driving error than perceptual level due to brain damage. In addition, it was found that the basic level of daily living influences overall operating errors.
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Effects of Telemonitoring and Hemodynamic Monitoring on Mortality in Heart Failure: a Systematic Review and Meta-analysis. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40138-019-00181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Selander H, Wressle E, Samuelsson K. Cognitive prerequisites for fitness to drive: Norm values for the TMT, UFOV and NorSDSA tests. Scand J Occup Ther 2019; 27:231-239. [PMID: 31088186 DOI: 10.1080/11038128.2019.1614214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Fitness-to-drive assessment is a growing area for occupational therapists. There are few off-road tests specially developed to assess fitness to drive, and several cognitive tests have no age-specific norms.Aims/objectives: The aim was to identify and describe age-related norm values for the Trail Making Test, Nordic Stroke Driver Screening Assessment and Useful Field of View test, and to study inter-correlation between test results.Materials and methods: The sample included 410 volunteers; 149 men and 261 women, mean age 52 ± 16.8 years. Commonly used off-road tests were used: TMT A and B, UFOV and NorSDSA.Results: Normative data for the specific subtests and total score for NorSDSA and UFOV are provided and presented in four age groups. Age correlated with the results for most of the subtests.Conclusions: Off-road cognitive test scores are necessary and valuable for occupational therapists in their contribution to the final decision on continued driving. In clinical practice, it can be difficult to interpret cognitive test results when working with driving assessments. Age-based norm values are suggested to be a way to provide clinicians with a benchmark against which scores can be compared.Significance: Age-based norms can guide occupational therapists working with fitness to drive.
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Affiliation(s)
- Helena Selander
- Swedish National Transport Research Institute, Gothenburg, Sweden.,Department or Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ewa Wressle
- Department of Geriatric Medicine and Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Kersti Samuelsson
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Impact of Implantable Cardioverter-Defibrillator Interventions on All-Cause Mortality in Heart Failure Patients. Cardiol Rev 2019; 27:160-166. [PMID: 30052536 DOI: 10.1097/crd.0000000000000226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Samuelsson K, Tropp M, Lundqvist A, Wressle E. Development, concurrent validity and internal consistency of a simulator tool for assessing continued car driving after a brain injury/disease. Br J Occup Ther 2019. [DOI: 10.1177/0308022619836935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Kersti Samuelsson
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Tropp
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Lundqvist
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ewa Wressle
- Department of Acute Internal Medicine and Geriatrics and Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
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Hutchinson C, Berndt A, Gilbert-Hunt S, George S, Ratcliffe J. Modified motor vehicles: the experiences of drivers with disabilities. Disabil Rehabil 2019; 42:3043-3051. [PMID: 30907156 DOI: 10.1080/09638288.2019.1583778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose: Driving is often a rehabilitation goal of people with acquired disability, and vehicle modifications are typically required to facilitate this outcome. Though there have been several survey studies on vehicle modifications for people with disability, there has been no qualitative work on understanding people with disabilities' experiences of being a modified vehicle driver.Method: An interpretative phenomenological approach was used to understand the lived experiences of drivers with disability. Semi-structured interviews were conducted (n = 8) with drivers who used a variety of vehicle modifications from simple to highly complex. Using NVivo, Stage 1 of the coding involved case by case analysis and Stage 2 cross case analysis to identify themes that best captured drivers' experiences.Results: Four core themes were identified: knowing vs. challenging limitations, making complex driving considerations, considering undesired alternative transportation options, and responding emotionally to temporary vehicle loss. The Person-Environment-Occupation model was used as an orientating framework to discuss findings.Conclusions: This explorative small scale study highlights that less than full utilisation of modified vehicles is not a result of driver choice, but rather a complex interface between drivers' physical and psychological limitations, and physical environments that do not support the needs of drivers with disability.Implications for RehabilitationThe development of resources that identify environmental factors in public spaces (e.g., number and location of parking for people with disability, steps, slopes, ticket machines and their height and location) could support the driving choices of people with disabilities.It is important to assess psychological limitations of driving as well as physical limitations.Driving goals and driving capacity across different locations requires periodic review post-rehabilitation.More advocacy for improving community accessibility is required.
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Affiliation(s)
- Claire Hutchinson
- School of Commerce, University of South Australia, Adelaide, SA, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Angela Berndt
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Susan Gilbert-Hunt
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Stacey George
- Rehabilitation and Aged Care, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Institute for Choice, University of South Australia, Adelaide, SA, Australia
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Farrell HJ, Andrews SC, Ryan NP, Davis MC, Gordon S, Stout JC, Fisher F. Cognitive Fitness to Drive in Huntington's Disease: Assessing the Clinical Utility of DriveSafe DriveAware. J Huntingtons Dis 2019; 8:87-95. [PMID: 30776017 DOI: 10.3233/jhd-180323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND DriveSafe DriveAware (DSDA) has been validated as an off-road screening tool for predicting on-road driving performance in clinical populations, but its utility in people with Huntington's disease (HD) is unknown. OBJECTIVE Our aim was to evaluate the utility of DSDA in people with HD by demonstrating sensitivity of DSDA scores to HD progression and exploring associations between DSDA performance and cognitive functions that are essential to driving and impaired in people with HD. METHODS We administered the iPad application version of DSDA to 26 pre-symptomatic and symptomatic participants with HD. Disease progression was assessed via measures of motor impairment, disease burden and functional capacity. Standardised neuropsychological tests were used to assess cognitive function across several domains including attention, processing speed, planning, and visuoperception. RESULTS Results underscore the sensitivity of DSDA to HD progression and cognitive impairment; that is, poorer DSDA performance was associated with greater HD severity and poorer cognitive ability across the domains of attention, processing speed, and planning. Nevertheless, we identified a proportion of participants with HD who were predicted to pass on-road testing based on DSDA, but scored in the impaired range on multiple cognitive tests. These participants tended to score closer to the cut-off score used by DSDA to categorise pass/fail outcomes. CONCLUSIONS Our findings demonstrate potential for use of DSDA in the HD population, however, significant variability in cognitive performance among those predicted to 'pass' on-road driving assessment suggests the screening tool requires further development for use with HD drivers.
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Affiliation(s)
- Hayden J Farrell
- School of Psychological Sciences, and, Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Sophie C Andrews
- School of Psychological Sciences, and, Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Nicholas P Ryan
- Calvary Health Care Bethlehem, Statewide Progressive Neurological Disease Service, Caulfield South, VIC, Australia.,Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Marie-Claire Davis
- Calvary Health Care Bethlehem, Statewide Progressive Neurological Disease Service, Caulfield South, VIC, Australia
| | - Stephanie Gordon
- School of Psychological Sciences, and, Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Julie C Stout
- School of Psychological Sciences, and, Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Fiona Fisher
- Calvary Health Care Bethlehem, Statewide Progressive Neurological Disease Service, Caulfield South, VIC, Australia
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