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Helbach J, Hoffmann F, Hecht N, Heesen C, Thomalla G, Wilfling D, Rahn AC. Information needs of people who have suffered a stroke or TIA and their preferred approaches of receiving health information: A scoping review. Eur Stroke J 2024:23969873241272744. [PMID: 39188106 DOI: 10.1177/23969873241272744] [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: 08/28/2024] Open
Abstract
PURPOSE We aimed to synthesize the information needs of people with stroke (PwS) in recurrent stroke prevention. METHODS In this scoping review we searched Medline (via PubMed), CINAHL, and PsycINFO from inception to June 5, 2023, to identify all studies describing the information needs of people 18 years and older who have suffered a stroke or transient ischemic attack within the past 5 years. We included qualitative and quantitative studies from developed countries published in German or English. Data analysis was performed following Arksey and O'Malley's methodological framework for scoping reviews. FINDINGS We screened 5822 records for eligibility and included 36 articles published between 1993 and 2023. None of the included studies used a comprehensive framework or defined information needs. Based on statements from PwS and their caregivers, PwS needed information on treatment, etiology, effects of stroke, prognosis, rehabilitation, discharge, life changes, care role, support options, information sources, and hospital procedures. The most frequently expressed needs were information on the treatment (77.8%) and stroke etiology (63.9%). The primary information source was healthcare professionals (85.7%), followed by written information (71.4%), family and friends (42.6%), and the internet (35.7%), with information provided directly by healthcare professionals being preferred. The timing of information transfer is often described as too early. CONCLUSION PwS are primarily interested in clinical information about stroke, for example, treatment and etiology, and less often in information about daily life, for example, rehabilitation, the role of care, or lifestyle changes. PwS prefer to receive information directly from healthcare professionals. Developing a shared understanding of PwS's information needs is crucial to implement suitable strategies and programs for dealing with these needs in clinical practice.
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Affiliation(s)
- Jasmin Helbach
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Nina Hecht
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Denise Wilfling
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Germany
| | - Anne Christin Rahn
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Germany
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Chehri S, Henriksen OM, Marner L, Christensen M, Muhic A, Poulsen HS, Law I. A prospective clinical study of the influence of oral protein intake on [ 18F]FET-PET uptake and test-retest repeatability in glioma. EJNMMI Res 2024; 14:58. [PMID: 38922458 PMCID: PMC11208353 DOI: 10.1186/s13550-024-01119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND O-(2-[18F]fluoroethyl)-L-tyrosine positron emission tomography ([18F]FET PET) scanning is used in routine clinical management and evaluation of gliomas with a recommended 4 h prior fasting. Knowledge of test-retest variation of [18F]FET PET imaging uptake metrics and the impact of accidental protein intake can be critical for interpretation. The aim of this study was to investigate the repeatability of [18F]FET-PET metrics and to assess the impact of protein-intake prior to [18F]FET PET scanning of gliomas. RESULTS Test-retest variability in the non-protein group was good with absolute (and relative) upper and lower limits of agreement of + 0.15 and - 0.13 (+ 9.7% and - 9.0%) for mean tumour-to-background ratio (TBRmean), + 0.43 and - 0.28 (+ 19.6% and - 11.8%) for maximal tumour-to-background ratio (TBRmax), and + 2.14 cm3 and - 1.53 ml (+ 219.8% and - 57.3%) for biological tumour volume (BTV). Variation was lower for uptake ratios than for BTV. Protein intake was associated with a 27% increase in the total sum of plasma concentration of the L-type amino acid transporter 1 (LAT1) relevant amino acids and with decreased standardized uptake value (SUV) in both healthy appearing background brain tissue (mean SUV - 25%) and in tumour (maximal SUV - 14%). Oral intake of 24 g of protein 1 h prior to injection of tracer tended to increase variability, but the effects on derived tumour metrics TBRmean and TBRmax were only borderline significant, and changes generally within the variability observed in the group with no protein intake. CONCLUSION The test-retest repeatability was found to be good, and better for TBRmax and TBRmean than BTV, with the methodological limitation that tumour growth may have influenced results. Oral intake of 24 g of protein one hour before a [18F]FET PET scan decreases uptake of [18F]FET in both tumour and in healthy appearing brain, with no clinically significant difference on the most commonly used tumour metrics.
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Affiliation(s)
- Sarah Chehri
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Radiation Biology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Otto Mølby Henriksen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Christensen
- Department of Clinical Genetics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Aida Muhic
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Hans Skovgaard Poulsen
- Department of Radiation Biology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Assessing the level of perceived social support among community-dwelling stroke survivors using the Multidimensional Scale of Perceived Social Support. Sci Rep 2022; 12:19318. [PMID: 36369351 PMCID: PMC9652448 DOI: 10.1038/s41598-022-23840-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
Social support has an important role in stroke rehabilitation. The Multidimensional Scale of Perceived Social Support (MSPSS) is an instrument examining the adequacy of perceived social support. However, the psychometric properties of the Chinese version of MSPSS (MSPSS-C) have not been examined in Chinese people with stroke. This study aimed at investigating the psychometric properties of the MSPSS-C, identifying the correlations between MSPSS-C scores and health-related measures of these people; and examining the differences in the levels of perceived social support between people with and without stroke in Hong Kong using a cohort of 57 community-dwelling people with stroke and 50 age-matched healthy controls. We found that the MSPSS-C subscales demonstrated excellent internal consistency, and a ceiling effect was observed for the family subscale of the MSPSS-C. The total MSPSS-C score had significant weak to moderate correlations with the scores of the concerned variables of interests. Exploratory factor analysis revealed a two-factor structure for the MSPSS-C. People with stroke had lower levels of perceived social support from friends and their significant other than those without stroke. The MSPSS-C is a valid tool for assessing perceived social support among chronic stroke survivors with moderate to very severe motor impairment.
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Fan Q, Doshi K, Narasimhalu K, Shankari G, Wong PS, Tan IF, Ng SC, Goh SY, Woon FP, De Silva DA. Impact of beliefs about medication on the relationship between trust in physician with medication adherence after stroke. PATIENT EDUCATION AND COUNSELING 2022; 105:1025-1029. [PMID: 34281721 DOI: 10.1016/j.pec.2021.07.016] [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: 01/09/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the relationship between medication adherence, trust in physician and beliefs about medication among stroke survivors. To determine whether beliefs about medication would mediate the relationship between trust in physician and medication adherence. METHODS A sample of 200 patients with a diagnosis of ischemic stroke or transient ischemic attack (TIA) completed a one-time survey, including the shortened Medication Adherence Report Scale (MARS-5), Beliefs about Medicines Questionnaire (BMQ), and Trust in Physician Scale (TIPS). RESULTS Our study found that medication adherence was associated with trust in physician (p = 0.019) and four factors of beliefs about medication (BMQ1-Necessity: p < 0.001; BMQ2-Concerns: p = 0.024; BMQ3-Overuse: p = 0.016; BMQ4-Harm: p < 0.001). Furthermore, we found monthly income of survivors moderated the relationship between trust in physician and medication adherence (p = 0.007, CI(95%): [-0.822, -0.132]). CONCLUSIONS The beliefs about medication mediating the relationship between trust in physician and medication adherence were different based on the stroke survivors' income bracket. PRACTICE IMPLICATIONS Interventions being developed to improve medication adherence may benefit from improving stroke survivors' trust in physician and addressing their beliefs about medication. In addition, healthcare providers are advised to take monthly income into consideration to effectively address stroke survivors' concerns regarding prescribed medications to mitigate stroke recurrence.
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Affiliation(s)
- Qianqian Fan
- Zhengzhou University, School of Education, Zhengzhou, China; Singapore General Hospital, Department of Psychology, Singapore
| | - Kinjal Doshi
- Singapore General Hospital, Department of Psychology, Singapore
| | - Kaavya Narasimhalu
- National Neuroscience Institute (Singapore General Hospital Campus), Department of Neurology, Singapore
| | | | - Pei Shieen Wong
- Singapore General Hospital, Department of Pharmacy, Singapore
| | - Il Fan Tan
- National Neuroscience Institute, Nursing Division, Singapore
| | - Szu Chyi Ng
- Singapore General Hospital, Department of Neurology, Singapore
| | - Si Ying Goh
- National Neuroscience Institute (Singapore General Hospital Campus), Department of Neurology, Singapore
| | - Fung Peng Woon
- Singapore General Hospital, Department of Neurology, Singapore
| | - Deidre Anne De Silva
- National Neuroscience Institute (Singapore General Hospital Campus), Department of Neurology, Singapore.
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Sui W, Wan LH. Association Between Patient Activation and Medication Adherence in Patients With Stroke: A Cross-Sectional Study. Front Neurol 2021; 12:722711. [PMID: 34659088 PMCID: PMC8516066 DOI: 10.3389/fneur.2021.722711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/19/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Medication adherence is key to secondary prevention in patients with stroke. Poor medication adherence can lead to recurrence, disability, or even death in stroke survivors. Patient activation is associated with increased healthy behaviors and improved clinical outcomes in many chronic diseases. However, the association between patient activation and medication adherence in patients with stroke remains unclear. Objective: The study aimed to explore the influence of patient activation on the medication adherence of patients with stroke and to analyze the reasons for medication nonadherence. Materials and Methods: A cross-sectional design with convenience sampling was used in this study. A total of 119 patients with stroke were recruited from a tertiary hospital in Guangzhou. A social-demographic and clinical data form, a self-developed medication adherence questionnaire, and the 13-item Patient Activation Measure (PAM-13) were used. Univariate analysis and multiple linear regression analysis with dummy variables were conducted to investigate the associations between medication adherence and patient activation. Data were analyzed with IBM® SPSS® version 25.0. Results: The mean PAM-13 score in patients with stroke was 51.56 ± 12.58. A low level of patient activation was reported by up to 66.4% of the patients. The self-reported medication adherence questionnaire score was 5.59 ± 1.52. A low level of medication adherence was reported by up to 59.7% of the patients, while a moderate level was reported by 34.4%, and a high level was reported by only 5.9%. In the multiple stepwise regression analysis, patient activation was found to be an independent influencing factor of medication adherence in patients with stroke (p < 0.05). Conclusion: Medication adherence was poor in patients in Guangzhou, China, following an ischemic stroke. Patient activation as the independent influencing factor identified in this study will support healthcare givers to develop the tailored intervention to improve medication adherence among patients with stroke in China.
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Affiliation(s)
- Weijing Sui
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Hong Wan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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Srithumsuk W, Chaleoykitti S, Jaipong S, Pattayakorn P, Podimuang K. Association between depression and medication adherence in stroke survivor older adults. Jpn J Nurs Sci 2021; 18:e12434. [PMID: 34137175 DOI: 10.1111/jjns.12434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/29/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to investigate the association between depression score and medication adherence in stroke survivor older adults. METHODS The participants were 102 stroke survivor older adults. The outcome was medication adherence during a 6-month follow-up. The independent variable was the depression score which was assessed by the Patient Health Questionnaire-9 (PHQ-9). The confounding factors included sociodemographic data, clinical characteristics, number of comorbidities, and number of medications. We analyzed the association between depression and medication adherence using multiple linear regression analyses. RESULTS The PHQ-9 score of stroke survivor older adults at the baseline was 1.11±2.03, and at the 6-month follow-up was increased to 5.06±3.91. The medication adherence mean score at the outcome was 4.15±1.83. After full adjustment, the PHQ-9 scores at baseline and 6-month follow-up were significantly associated with medication adherence (β = -.315, 95% CI = -.483 to -.086, p = 0.006 and β = -.270, 95% CI = -.238 to -.020, p = 0.021, respectively). Other variables that affect medication adherence during a 6-month follow-up included living with others and a lower number of medications. CONCLUSION This study revealed that lower depression scores were associated with high medication adherence in post-stroke older adults. Additionally, living with others and a lower number of medications were associated with medication adherence. Therefore, stroke survivor older adults should be assessed for depression and given medication, and education should be used to improve mediation adherence, especially for the ones who live alone and have polypharmacy to prevent recurrent stroke.
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Affiliation(s)
- Werayuth Srithumsuk
- Faculty of Nursing Science and Allied Health, Phetchaburi Rajabhat University, Phetchaburi, Thailand
| | | | - Saitip Jaipong
- Stroke Unit, Phrachomklao Hospital, Phetchaburi, Thailand
| | - Pinthusorn Pattayakorn
- Department of Nursing, College of Natural Science, California State University San Bernardino, San Bernardino, California, USA.,Stroke Unit, Eisenhower Health, Rancho Mirage, California, USA
| | - Kattiya Podimuang
- Annenberg 3 South Telemetry Unit, Eisenhower Medical Center, Rancho Mirage, California, USA
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Pishkhani MK, Dalvandi A, Ebadi A, Hosseini MA. Adherence to a Rehabilitation Regimen in Stroke Patients: A Concept Analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:139-145. [PMID: 32195160 PMCID: PMC7055185 DOI: 10.4103/ijnmr.ijnmr_170_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/07/2019] [Accepted: 12/23/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Adherence to rehabilitation regimens is a major issue in the treatment of stroke. Despite the agreement on the importance of adherence, there is still no clear definition of this concept in rehabilitation. The aim of this study was the concept analysis of the concept of adherence to rehabilitation regimens in stroke patients. MATERIALS AND METHODS This qualitative concept analysis was performed using Walker and Avant's method. English and Persian articles were searched using keywords such as "adherence", "compliance", "rehabilitation", "stroke", and other related keywords among articles published from 1997 to 2018 in PubMed, Scopus, Web of Science, Google Scholar, Iranmedex, Magiran, and Scientific Information Database (SID). Related textbooks were also searched and all articles containing definitions, attributes, antecedents, and consequences of the concept were included in the study. RESULTS The attributes of the concept included complex, multidimensional, and dynamic behavior in the treatment process, personal experience, and adaptive behavior in patients, changeable, situational, voluntary, and collaborative behavior, and active communication between the patient and the healthcare provider. Common antecedents of the concept of adherence to the rehabilitation regimen were classified into patient-related and environmental-related categories and the consequences were classified into the three categories of patient-related, healthcare professional-related, and healthcare system-related. CONCLUSIONS This concept analysis can be useful in eliminating any ambiguity of the concept of adherence to rehabilitation regimens. It helps clarify the vague concepts used in nursing rehabilitation instead of adherence. The results of this study can be helpful for researchers for further studies in this context.
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Affiliation(s)
- Maryam Khoshbakht Pishkhani
- Department of Nursing, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Asghar Dalvandi
- School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- School of Nursing and Midwifery, Islamic Azad University of Tehran, Central Branch, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Hosseini
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Salis C, Murray L, Vonk JMJ. Systematic review of subjective memory measures to inform assessing memory limitations after stroke and stroke-related aphasia. Disabil Rehabil 2019; 43:1488-1506. [PMID: 31559870 DOI: 10.1080/09638288.2019.1668485] [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: 10/25/2022]
Abstract
AIM Primary aims of this systematic review were to: (1) identify the range of subjective memory measures used in the stroke and stroke-related aphasia literature and (2) critically appraise their psychometric properties as well as (3) the methodological qualities of studies that included them, (4) investigate whether such measures provide an accurate reflection of memory impairments (i.e., in comparison to norms from age-matched, neurotypical participants), (5) document the representation of individuals with stroke-related aphasia, and (6) examine the extent to which subjective memory measures correlate with objective memory measures. METHODS Systematic review of the literature from 1970 to June 2019 using a comprehensive range of relevant search terms in EMBASE, Medline, PsychINFO, SCOPUS, and Web of Science. Eligibility criteria were for studies to include adults who had suffered of clinical stroke, to report a subjective memory measure that was completed by the stroke survivors, to be reported in a peer-reviewed journal, and to be published in English or Dutch. Quality appraisal was carried out for the included studies as well as the subjective memory measures they employed. RESULTS A total of 7,077 titles or abstracts were screened, with 41 studies included in the quantitative and qualitative synthesis. Twenty-six subjective memory measures were used in the included studies. The critical appraisal of their psychometric properties and the methodological quality of the included studies revealed significant shortcomings; for example, neurotypical participants were included in only 14 of the 41 studies. When statistical comparisons were made, different outcomes arose. Only eight studies statistically compared subjective with objective memory measures. CONCLUSIONS This literature domain currently provides an unclear picture as to how memory limitations affect participation in stroke and stroke-related aphasia.IMPLICATIONS FOR REHABILITATIONA broad range of subjective memory measures have been used to determine stroke survivors' perceptions of their everyday memory issues.Because of psychometric weaknesses such as inadequate reliability and cross-cultural validity among subjective memory measures, there remains a need to carefully review a given measure's properties to determine if it is appropriate for use with a given stroke survivor.Stroke survivors with aphasia have been infrequently included or inadequately described in studies of subjective memory measures, and thus how these individuals perceive their everyday memory abilities requires further investigation.Although the relationship between subjective and objective memory measures has been infrequently investigated by stroke researchers, both types of measures should be considered as they likely offer complementary rather than redundant information about stroke survivors' memory abilities.
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Affiliation(s)
- Christos Salis
- Speech and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Murray
- Communication Sciences and Disorders, Western University, London, ON Canada
| | - Jet M J Vonk
- Department of Neurology, Columbia University, New York, NY, USA
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Cheiloudaki E, Alexopoulos EC. Adherence to Treatment in Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020196. [PMID: 30641978 PMCID: PMC6351941 DOI: 10.3390/ijerph16020196] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/30/2018] [Accepted: 01/10/2019] [Indexed: 11/16/2022]
Abstract
Background: Compliance with medication in patients who have suffered stroke is usually not-optimal. This study aims to measure the level of compliance with the treatment and to identify socio-demographic, clinical, and subjective factors related to the long-term compliance of stroke patients with their treatment. Methods: 140 patients (66.4% males) suffered an ischemic stroke at least six months old, participated in the survey. Compliance was measured using the Medication Adherence Report Scale and the quality of life by the Stroke Specific Quality of Life questionnaire. Furthermore, the Beliefs about Medicines Questionnaire and the Brief Illness Perception Questionnaire on perceptions about the disease were assessed. The doctor–patient relationship was assessed by the Common-Sense Model of Self-Regulation questionnaire and the family support was assessed by the FSS scale. Univariate and multivariate analysis was employed to identify the significant factors affecting compliance in these stroke patients. Results: In 68.6% of patients the compliance was classified as optimal, in 25.7% as partial and as poor in 5.7%; the last two categories were treated as sub-optimal compliance in multivariate analysis. The high compliance was related to patient’s mental state (OR:3.94 95% CI: 1.84–4.46), the perception medication necessity (OR:1.26 95% CI: 1.01–1.56), and the doctor–patient communication (OR:1.76 95% CI: 1.15–2.70). Men showed a lower compliance than women, as well as increased concerns about taking medication (OR: 0.83, 95% CI: 0.69–0.99). Paradoxically, the work /productivity related quality of life was inversely associated with compliance (OR (95% CI): 0.44 (0.23 to 0.82)). Conclusions: The perception of medication necessity and the doctor–patient communication are manageable factors associated with compliance in treating patients who have suffered stroke. In addition, rehabilitation and return to work programs should consider these factors when providing support to those persons.
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Affiliation(s)
| | - Evangelos C Alexopoulos
- School of Social Sciences, Hellenic Open University, 26335 Patra, Greece.
- Occupational Health Department, Metropolitan General Hospital, 15562 Athens, Greece.
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Lombard-Vance R, O'Keeffe F, Desmond D, Coen R, Ryall N, Gallagher P. Comprehensive Neuropsychological Assessment of Cognitive Functioning of Adults With Lower Limb Amputation in Rehabilitation. Arch Phys Med Rehabil 2018; 100:278-288.e2. [PMID: 30172643 DOI: 10.1016/j.apmr.2018.07.436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To establish a comprehensive profile of cognitive functioning in people engaged in lower limb amputation (LLA) rehabilitation. DESIGN Cross-sectional study as part of a longitudinal prospective cohort. SETTING A national tertiary rehabilitation hospital. PARTICIPANTS Adult volunteer participants (N=87) referred for comprehensive rehabilitation for major LLA were sampled from 207 consecutive admissions. Participants with both vascular (n=69) and nonvascular (n=18) LLA etiologies were included. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographic and health information and a battery of standardized neuropsychological assessments. RESULTS Compared to normative data, impairment was evident in overall cognitive functioning (P≤.003). Impairment was also evident in particular areas, including reasoning, psychomotor function, information processing, attention, memory, language/naming, visuospatial functions, and executive functions (all P≤.003 Holm-corrected). There were also higher frequencies of impaired functions across most aspects of functioning in this group compared with expected frequencies in normative data (P≤.003 Holm-corrected). There were no significant differences in cognitive functioning between participants of vascular and nonvascular LLA etiology. CONCLUSIONS Findings support the need for cognitive screening at rehabilitation admission regardless of etiology. Administration of comprehensive neuropsychological assessment with a battery sensitive to vascular cognitive impairment is recommended in some cases to generate an accurate and precise understanding of relative strengths and weaknesses in cognitive functioning. Cognitive functioning is a potential intervention point for improvement of rehabilitation outcomes for those with LLA, and further research is warranted in this area.
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Affiliation(s)
- Richard Lombard-Vance
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland; Dublin Psychoprosthetics Group, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- Department of Psychology, National Rehabilitation Hospital, Dún Laoghaire, Ireland
| | - Deirdre Desmond
- Dublin Psychoprosthetics Group, Dublin, Ireland; Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Robert Coen
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Nicola Ryall
- Department of Rehabilitation Medicine, National Rehabilitation Hospital, Dún Laoghaire, Ireland
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland; Dublin Psychoprosthetics Group, Dublin, Ireland.
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Crayton E, Fahey M, Ashworth M, Besser SJ, Weinman J, Wright AJ. Psychological Determinants of Medication Adherence in Stroke Survivors: a Systematic Review of Observational Studies. Ann Behav Med 2018; 51:833-845. [PMID: 28421453 PMCID: PMC5636868 DOI: 10.1007/s12160-017-9906-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Medications targeting stroke risk factors have shown good efficacy, yet adherence is suboptimal. To improve adherence, its determinants must be understood. To date, no systematic review has mapped identified determinants into the Theoretical Domains Framework (TDF) in order to establish a more complete understanding of medication adherence. PURPOSE The aim of this study was to identify psychological determinants that most influence stroke survivors' medication adherence. METHODS In line with the prospectively registered protocol (PROSPERO CRD42015016222), five electronic databases were searched (1953-2015). Hand searches of included full text references were undertaken. Two reviewers conducted screening, data extraction and quality assessment. Determinants were mapped into the TDF. RESULTS Of 32,825 articles, 12 fulfilled selection criteria (N = 43,984 stroke survivors). Tested determinants mapped into 8/14 TDF domains. Studies were too heterogeneous for meta-analysis. Three TDF domains appeared most influential. Negative emotions ('Emotions' domain) such as anxiety and concerns about medications ('Beliefs about Consequences' domain) were associated with reduced adherence. Increased adherence was associated with better knowledge of medications ('Knowledge' domain) and stronger beliefs about medication necessity ('Beliefs about Consequences' domain). Study quality varied, often lacking information on sample size calculations. CONCLUSIONS This review provides foundations for evidence-based intervention design by establishing psychological determinants most influential in stroke survivors' medication adherence. Six TDF domains do not appear to have been tested, possibly representing gaps in research design. Future research should standardise and clearly report determinant and medication adherence measurement to facilitate meta-analysis. The range of determinants explored should be broadened to enable more complete understanding of stroke survivors' medication adherence.
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Affiliation(s)
- Elise Crayton
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Marion Fahey
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Sarah Jane Besser
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - John Weinman
- King's College London, Institute of Pharmaceutical Sciences, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
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Rohde D, Merriman NA, Doyle F, Bennett K, Williams D, Hickey A. Does cognitive impairment impact adherence? A systematic review and meta-analysis of the association between cognitive impairment and medication non-adherence in stroke. PLoS One 2017; 12:e0189339. [PMID: 29220386 PMCID: PMC5722379 DOI: 10.1371/journal.pone.0189339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/22/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND While medication adherence is essential for the secondary prevention of stroke, it is often sub-optimal, and can be compromised by cognitive impairment. This study aimed to systematically review and meta-analyse the association between cognitive impairment and medication non-adherence in stroke. METHODS A systematic literature search of longitudinal and cross-sectional studies of adults with any stroke type, which reported on the association between any measure of non-adherence and cognitive impairment, was carried out according to PRISMA guidelines. Odds ratios and 95% confidence intervals were the primary measure of effect. Risk of bias was assessed using the Cochrane Bias Methods Group's Tool to Assess Risk of Bias in Cohort Studies, with evidence quality assessed according to the GRADE approach. We conducted sensitivity analyses according to measure of cognitive impairment, measure of medication adherence, population, risk of bias and adjustment for covariates. The protocol was registered with PROSPERO. RESULTS From 1,760 titles and abstracts, we identified 9 studies for inclusion. Measures of cognitive impairment varied from dementia diagnosis to standardised cognitive assessments. Medication adherence was assessed through self-report or administrative databases. The majority of studies were of medium risk of bias (n = 6); two studies had low risk of bias. Findings were mixed; when all studies were pooled, there was no evidence of an association between cognitive impairment and medication non-adherence post-stroke [OR (95% CI): 0.85 (0.66, 1.03)]. However, heterogeneity was substantial [I2 = 90.9%, p < .001], and the overall evidence quality was low. CONCLUSIONS Few studies have explored associations between cognitive impairment and medication adherence post-stroke, with substantial heterogeneity in study populations, and definitions and assessments of non-adherence and cognitive impairment. Further research using clear, standardised and objective assessments is needed to clarify the association between cognitive impairment and medication non-adherence in stroke.
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Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A. Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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13
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Al AlShaikh S, Quinn T, Dunn W, Walters M, Dawson J. Predictive factors of non-adherence to secondary preventative medication after stroke or transient ischaemic attack: A systematic review and meta-analyses. Eur Stroke J 2016; 1:65-75. [PMID: 29900404 PMCID: PMC5992740 DOI: 10.1177/2396987316647187] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/06/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose Non-adherence to secondary preventative medications after stroke is
relatively common and associated with poorer outcomes. Non-adherence can be
due to a number of patient, disease, medication or institutional factors.
The aim of this review was to identify factors associated with non-adherence
after stroke. Method We performed a systematic review and meta-analysis of studies reporting
factors associated with medication adherence after stroke. We searched
MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL and Web of Knowledge. We followed
PRISMA guidance. We assessed risk of bias of included studies using a
pre-specified tool based on Cochrane guidance and the Newcastle–Ottawa
scales. Where data allowed, we evaluated summary prevalence of non-adherence
and association of factors commonly reported with medication adherence in
included studies using random-effects model meta-analysis. Findings From 12,237 titles, we included 29 studies in our review. These included
69,137 patients. The majority of included studies (27/29) were considered to
be at high risk of bias mainly due to performance bias. Non-adherence rate
to secondary preventative medication reported by included studies was 30.9%
(95% CI 26.8%–35.3%). Although many factors were reported as related to
adherence in individual studies, on meta-analysis, absent history of atrial
fibrillation (OR 1.02, 95% CI 0.72–1.5), disability (OR 1.27, 95% CI
0.93–1.72), polypharmacy (OR 1.29, 95% CI 0.9–1.9) and age (OR 1.04, 95% CI
0.96–1.14) were not associated with adherence. Discussion This review identified many factors related to adherence to preventative
medications after stroke of which many are modifiable. Commonly reported
factors included concerns about treatment, lack of support with medication
intake, polypharmacy, increased disability and having more severe
stroke. Conclusion Understanding factors associated with medication taking could inform
strategies to improve adherence. Further research should assess whether
interventions to promote adherence also improve outcomes.
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Affiliation(s)
- Sukainah Al AlShaikh
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Terry Quinn
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - William Dunn
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Matthew Walters
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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14
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Validation and Cross-Cultural Adaptation of a Chinese Version of the Emotional and Social Dysfunction Questionnaire in Stroke Patients. Clin Nurs Res 2016; 26:763-782. [DOI: 10.1177/1054773816638823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study were to develop a cross-cultural Chinese version of the Emotional and Social Dysfunction Questionnaire (ESDQ-C) and test its validity and reliability among Chinese-speaking stroke patients. Various methods were used to develop the ESDQ-C. A cross-sectional study was used to examine the validity and reliability of the developed questionnaire, which consists of 28 items belonging to six factors, anger, helplessness, emotional dyscontrol, indifference, inertia and fatigue, and euphoria. Satisfactory convergence and known-group validities were confirmed by significant correlations of the ESDQ-C with the Profile of Mood States–Short Form ( p < .05) and with the Hospital Anxiety and Depression Scale ( p < .05). The internal consistency was represented by Cronbach’s alpha, which was .96 and .79 to .92 for the entire scale and subscales, respectively. Appropriate application of the ESDQ-C will be helpful to identify critical adjustment-related types of distress and patients who experience difficulty coping with such distress.
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Coffey L, O’Keeffe F, Gallagher P, Desmond D, Lombard-Vance R. Cognitive functioning in persons with lower limb amputations: a review. Disabil Rehabil 2012; 34:1950-64. [DOI: 10.3109/09638288.2012.667190] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Goff I, Coady D, Wright D, Mooney J, Poland F, Spalding N, Scott DGI, Watts R, Aquilina D, Walker D, Margham T, Bracewell C, Vila J, Burridge D, Coady D, Morris H, Ryan C, Lauchlan D, Field M, Lutalo PM, Davies U, Nandagudi A, Bruce J, Dabrera MG, Fleming CA, O'Connor MB, Bond U, Swan J, Phelan MJ, Hughes M, Amin R, Watson P, Pocock J, Gaffney K, Rao VK, Bhaskar S, Tosounidou S, Chaudhuri K, Nicolaou M, Amstrong R, Hassell AB, Walker D, Birrell F. Education research: 33. Evaluation of the First BSR Ultrasound Anatomy Training Course. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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