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Braga MAF, Faria-Fortini I, de Menezes KKP, Santos JM, Rodrigues NAG, de Moura Silva EA, de Morais Faria CDC. General and Specific Quality of Life Course of Individuals with Different Levels of Stroke Severity: A One-Year Prospective Longitudinal Study. Clin Gerontol 2024:1-13. [PMID: 38872328 DOI: 10.1080/07317115.2024.2366833] [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] [Indexed: 06/15/2024]
Abstract
OBJECTIVES To compare the course of generic and specific health-related quality of life (HRQOL) of individuals with stroke, and its physical, mental, and social domains, at three, six, and 12 months after hospital discharge, considering the levels of stroke severity. METHODS This is a longitudinal study, in stroke individuals, assessed during hospital admission by the National Institutes of Health Stroke Scale (NIHSS), and divided into mild (NIHSS ≤3) or moderate/severe (NIHSS ≥4) disease. At three, six, and 12 months after hospital discharge, the individuals were assessed for generic (Short Form Health Survey-36: total score and physical and mental domains) and specific (Stroke Specific Quality of Life Scale: total score and social domain) HRQOL. A 2 × 2 repeated measures analysis of variance (ANOVA) with post-hoc was applied. RESULTS 146, 122, and 103 individuals were assessed at three, six and 12 months, respectively HRQOL courses showed different behaviors according to stroke severity (3.37≤F ≤ 4.62; 0.010≤p ≤ .036). Individuals with mild stroke showed significant changes in the physical domain, with a reduction between three and six months, and an increase between six and 12. Moderate/severe individuals showed a significant increase in all HRQOL variables between three and six months, and a maintenance of values for almost all variables, except for physical domain, which improved significantly between three and six months, and got significantly worse between six and 12. CONCLUSIONS HRQOL during the first year after stroke showed distinct trajectories, being stroke severity an important factor in identifying stroke subjects at risk of HRQOL decline. CLINICAL IMPLICATIONS These results demonstrate the importance of considering not only the phase of the stroke, the severity, and the general and specific HRQOL, but also the physical, social, and mainly the mental domain, which has long been neglected, when assessing this population.
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Affiliation(s)
- Marcela Aline Fernandes Braga
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Iza Faria-Fortini
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Jéssica Melo Santos
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Edvânia Andrade de Moura Silva
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Christina Danielli Coelho de Morais Faria
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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de Geus EQJ, Milders MV, van Horn JE, Jonker FA, Fassaert T, Hutten JC, Kuipers F, Grimbergen C, Noordermeer SDS. A literature review of outcome and treatment options after acquired brain injury: Suggestions for adult offenders using knowledge from the general population. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:311-338. [PMID: 38527155 DOI: 10.1002/cbm.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Acquired brain injury (ABI) is a major health problem, often with negative effects on behaviour and mental health as well as cognition. Prevalence of ABI is exceptionally high among offenders and increases their re-offending risk. Information on risk factors for ABI and its outcomes among offenders that could guide effective treatment for them is, nevertheless, scarce and dispersed. However, there is a more substantial literature about the general population that could inform work with brain-injured offenders, especially when selecting for samples or subgroups with similar relevant characteristics, such as lower socio-economic status (SES), pre-injury lower tested intelligence score (<85) and pre-injury mental health problems. AIMS To explore brain injury data from non-offender samples of otherwise similar socio-economic and mental health and ability characteristics to offenders then, first, to describe their untreated outcomes and, secondly, outcomes after frequently used interventions in these circumstances, noting factors associated with their effectiveness. METHOD Three databases were systematically searched for the years 2010-2022; first, using terms for brain injury or damage and cognitive (dys)function, mental health or quality of life. Second, in a separate search, we used these terms and terms for interventions and rehabilitation. In the second review, studies were selected for clear, distinguishable data on age, sex, SES and lifestyle factors to facilitate inferences for offenders. A narrative analytical approach was adopted for both reviews. RESULTS Samples with characteristics that are typical in offender groups, including lower SES, lower pre-injury intelligence quotient (<85), prior cognitive impairments and prior mental health problems, had poorer cognitive and behavioural outcomes following ABI than those without such additional problems, together with lower treatment adherence. With respect to treatment, adequate motivation and self-awareness were associated with better cognitive and behavioural outcomes than when these were low or absent, regardless of the outcome measured. CONCLUSIONS More complex pre-injury mental health problems and social disadvantages typical of offenders are associated with poorer post-brain injury recovery. This paper adds to practical knowledge by bringing together work that follows specific outcome trajectories. Overall, succesful ABI-interventions in the general population that aim at pre-injury difficulties comparable to those seen among offenders, show that personalising injury-specific treatments and taking account of these difficulties, maximised positive outcomes.
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Affiliation(s)
- Esther Q J de Geus
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maarten V Milders
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Frank A Jonker
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Altrecht, Vesalius, Amsterdam, The Netherlands
| | | | | | | | | | - Siri D S Noordermeer
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Braga MAF, Faria-Fortini I, Soares CLDA, Rodrigues NAG, Sant Anna RV, Faria CDCDM. Acute clinical outcomes predict both generic and specific health-related quality of life six and 12 months after stroke: A one-year prospective study developed in a middle-income country. J Stroke Cerebrovasc Dis 2024; 33:107777. [PMID: 38795794 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107777] [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: 10/20/2023] [Revised: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVE To identify acute predictors of generic and specific health-related quality of life (HRQoL) six and 12 months after stroke in individuals from a middle-income country. MATERIAL AND METHODS This was a prospective study. The dependent outcomes assessed during six and 12 months after stroke included both generic and specific HRQoL (Short Form Health Survey-36 [SF-36] and stroke-specific quality of life [SSQOL]). The predictors were age, sex, education level, length of hospital stay, current living arrangement, stroke severity, functional independence, and motor impairment. RESULTS 122 (59.9±14 years) and 103 (59.8±14.71 years) individuals were evaluated six and 12 months after stroke, respectively. Functional independence and sex were significant acute predictors of both generic and specific HRQoL. Functional independence was the strongest predictor (0.149≤R2≤0.262; 20.01≤F≤43.96, p<0.001), except for generic HRQoL at 12 months, where sex was the strongest predictor (R2=0.14; F=17.97, p<0.001). CONCLUSION Generic and specific HRQoL in chronic individuals six and 12 months after stroke, from a middle-income country, can be predicted based on functional independence, the strongest predictor, assessed in the acute phase, except for generic HRQoL at 12 months. Functional independence can be modified by rehabilitation strategies and thus should be considered for HRQoL prognoses at chronic phase.
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Affiliation(s)
- Marcela Aline Fernandes Braga
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil
| | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Graduate Program in Occupation Studies of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, (MG), Brazil
| | - Carolina Luísa de Almeida Soares
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Physiotherapy graduation in Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil
| | | | - Romeu Vale Sant Anna
- Neurologist, coordinator of the stroke unit at the public hospital Risoleta Tolentino Neves, Belo Horizonte, (MG), Brazil
| | - Christina Danielli Coelho de Morais Faria
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Department of Physical Therapy, Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil.
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Reinholdsson M, Palstam A, Jood K, S Sunnerhagen K. Associations between pre-stroke physical activity levels and health-related quality of life 3 months after stroke: A registry-based study (part of PAPSIGOT). Int J Stroke 2023; 18:1178-1185. [PMID: 37306491 DOI: 10.1177/17474930231184367] [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: 06/13/2023]
Abstract
BACKGROUND Whether pre-stroke physical activity is associated with health-related quality of life after stroke has been sparsely investigated. AIMS To explore associations between pre-stroke physical activity and health-related quality of life 3 months after stroke onset. METHODS A consecutively collected cohort study with data from registries. Included were adult patients with first stroke in the period 2014-2018 who were hospitalized at any one of the three stroke units in Gothenburg, Sweden. Pre-stroke physical activity was assessed with the Saltin-Grimby Physical Activity Level Scale (SGPALS) after hospital admission for acute stroke. Health-related quality of life was assessed with the EuroQoL 5 Dimensions 5 Level Version (EQ-5D-5L) 3 months after stroke. Data were analyzed with the Kruskal-Wallis test and binary logistic regression. RESULTS Data were included from 2044 patients; 91% had ischemic stroke, 46% were female, and mean age was 73 years, with mild stroke severity median National Institute of Health Stroke Scale (NIHSS) of 2. Patients who were pre-stroke physically active reported better overall health-related quality of life by the EQ-5D-5L index value, all the domains in EQ-5D-5L, and the EuroQoL-Visual Analogue Scale (EQ-VAS) compared with pre-stroke physically inactive patients (all p < 0.001). Better health-related quality of life 3 months after stroke was associated with pre-stroke light and moderate physical activity: adjusted odds ratio (95% confidence interval), 1.9 (1.5-2.3) and 2.3 (1.5-3.4), respectively. CONCLUSION Pre-stroke physical activity is associated with better health-related quality of life 3 months after stroke. For the domains of mobility, self-care, and pain/discomfort, physical activity with higher intensity is even more beneficial.
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Affiliation(s)
- Malin Reinholdsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annie Palstam
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Dunne S, Williams GP, Bradbury C, Keyes T, Lane AR, Yang K, Ellison A. Uncovering the social determinants of brain injury rehabilitation. J Health Psychol 2023; 28:956-969. [PMID: 37026570 PMCID: PMC10466963 DOI: 10.1177/13591053231166263] [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: 04/08/2023] Open
Abstract
Social determinants of health (SDH), such as social isolation and loneliness, are often more frequently experienced in brain injury survivors. The paper explores the personal experiences of loneliness among brain injury survivors during lockdown to negate health inequalities and improve rehabilitation for this population in the future. Twenty-four brain injury survivors participated in semi-structured interviews and questionnaires relating to loneliness, resilience and wellbeing. Three themes (the experience of loneliness, loneliness during the pandemic and loneliness after the pandemic) explored survivors' experiences of loneliness generally post-brain injury, but also chronicle how these feelings developed in lockdown and survivors' feelings regarding society returning to 'normal'. Future interventions should focus on reframing survivors' beliefs regarding societal expectations and minimise the pressure they experience to keep up with their peers physically and emotionally. Additionally, we recommend creating accessible peer support options for all brain injury survivors as an important step for alleviating loneliness.
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Affiliation(s)
- Stephen Dunne
- Northumbria University, UK
- NIHR Applied Research Collaboration North-East and North Cumbria, UK
| | | | | | | | | | | | - Amanda Ellison
- NIHR Applied Research Collaboration North-East and North Cumbria, UK
- Durham University, UK
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Bonini-Rocha AC, de Andrade ALS, Santos Pereira RD, de Moraes AM, Matheus LBG, da Fonseca ST, Ribeiro ALDA, Martins WR. Biofeedback interventions for short term upper limb function following stroke: A systematic review with meta-analysis. J Hand Ther 2023; 36:693-705. [PMID: 35817688 DOI: 10.1016/j.jht.2022.05.001] [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: 03/25/2021] [Revised: 02/20/2022] [Accepted: 05/23/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Biofeedback has been used by rehabilitation professionals in the treatment of poststroke function impairments. PURPOSE Investigate the efficacy of any type of biofeedback intervention for the treatment of upper limb function in individuals following stroke. STUDY DESIGN Systematic review of literature with meta-analysis. METHODS Literature searches were conducted using MESH terms and text words in PubMed, Lilacs, Scielo, Scopus, PEDro, and Web of Science databases. The main outcome was improvement in upper limb's motor function and motor function in activities of daily living. We calculated the Mean Difference and Standardized Mean Difference for the assessment scales reported as primary outcome. The methodological quality of included studies was assessed using PEDro scale. The overall quality of the evidence was assessed using GRADE system. RESULTS From 1360 articles identified, 16 were included in the review (09 in the meta-analysis). Three forest plots of hemiparesis and one of hemiplegia showed that biofeedback therapy associated with conventional therapy has a greater improvement in participants upper limb motor function when compared to isolated conventional therapy. Two forest plots of hemiparesis and one of hemiplegia showed no superiority in participants improvement for biofeedback associated with conventional therapy when compared to isolated conventional therapy. CONCLUSION Biofeedback therapy associated with conventional therapy showed a small clinical effect when associated to conventional therapy and very low quality of evidence. Although further research with higher quality evidence is needed.
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Affiliation(s)
| | | | | | | | | | - Sérgio Teixeira da Fonseca
- Federal University of Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Belo Horizonte, MG, Brazil
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Almhdawi KA, Jaber H, Alghwiri A, Arabiat A, Alazrai A, Tariah HA, Obeidat D, Alrabbaie H. Health-related quality of life and its correlates among individuals with stroke during the COVID-19 pandemic. Neuropsychol Rehabil 2023; 33:69-84. [PMID: 34663187 DOI: 10.1080/09602011.2021.1984256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Strict safety procedures including lockdowns were adopted during the Corona virus (COVID-19) pandemic worldwide which might have influenced mental and physical health in affected communities. This study aimed to investigate the level of Health-related quality of life (HRQoL) and its correlates among individuals with stroke in Jordan during the COVID-19 pandemic. This was a cross-sectional study with a self-administered questionnaire, which included demographics, 12-item Short Form (SF-12) health survey, Depression Anxiety Stress Scale (DASS 21), and The Stroke Impact Scale 16 (SIS-16). Descriptive analyses were used to summarize study data. Factors significantly correlated with HRQoL were determined using Pearson correlation. A total of 97 individuals successfully completed the study with a mean age of 57.9 years (±57.9). The level of HRQoL (measured by SF-12) was significantly and negatively associated with mental health symptoms (depression, anxiety, and stress) and the stroke recovery subscale of the SIS-16. Furthermore, participants' HRQoL level was significantly and positively associated with participants' age, stroke chronicity, receiving rehabilitation, and amount of help asked from caregivers. Jordanians with stroke demonstrated a relatively low level of HRQoL and high levels of mental health symptoms during the COVID-19 pandemic. Healthcare administrators should carefully consider individuals with stroke HRQoL and its correlates while planning for future crises.
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Affiliation(s)
- Khader A Almhdawi
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid - Jordan
| | - Hanan Jaber
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid - Jordan
| | - Alia Alghwiri
- Department of Physical Therapy, The University of Jordan, Amman, Jordan
| | - Alaa Arabiat
- Department of Family Medicine, The Jordanian Ministry of Health, Amman, Jordan
| | - Alza Alazrai
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid - Jordan
| | - Hashem Abu Tariah
- Department of Occupational Therapy, The Hashemite University, Zarqa, Jordan
| | - Donia Obeidat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid - Jordan
| | - Hassan Alrabbaie
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid - Jordan
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Dos Santos HM, de Oliveira LC, Bonifácio SR, Brandão TCP, Silva WP, Pereira GS, Silva SM. Use of the International Classification of Functioning, Disability and Health (ICF) to expand and standardize the assessment of quality-of-life following a stroke: proposal for the use of codes and qualifiers. Disabil Rehabil 2022; 44:7449-7454. [PMID: 34752176 DOI: 10.1080/09638288.2021.1995055] [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] [Indexed: 01/18/2023]
Abstract
PURPOSE Propose a way of coding and qualifying HRQoL following a stroke using the codes and qualifiers of the International Classification of Functioning, Disability and Health (ICF). METHODS An observational, cross-sectional study was conducted involving 51 individuals with hemiparesis resulting from a stroke. ICF codes related to the Stroke Specific Quality of Life (SS-QOL) scale were listed and subsequently classified using the generic ICF qualifiers, which range from .0 - no impairment to .4 - complete impairment. A simple mathematic calculation was proposed to convert the SS-QOL scores into ICF qualifiers. RESULTS The use of the ICF qualifiers revealed that the individuals exhibited a moderate level (.2) of quality of life, with mild impairment (.1) regarding upper limb function, language, self-care, and vision as well as severe impairment (.3) regarding social relations. CONCLUSIONS The proposal presented in this study allowed qualifying 43 ICF codes related to quality of life after a stroke in a simple, standardized manner, enabling the identification of different levels of impairment on each of the domains of the SS-QOL scale. This coding standardizes the evaluation, facilitates communication between healthcare providers, and systematizes the collection of data and information on health.Implications for rehabilitationProposal for qualifying concepts related to body functions, activity & participation, and environmental factors in a simple, standardized manner.The proposed mathematic calculation is simple and easy to understand, which minimizes the occurrence of errors.Possibility to identify different levels of impairment in each of the domains of the Stroke Specific Quality of Life scale, facilitating the establishment of individualized, longitudinal care.The ICF codes standardize the evaluation, facilitate communication between healthcare providers, and systematize the collection of data and information on health and functioning.
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Affiliation(s)
| | - Leia Cordeiro de Oliveira
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Sandra Regina Bonifácio
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | | | - Wallace Pereira Silva
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Gabriela Santos Pereira
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | - Soraia Micaela Silva
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
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Adherence to Post-Stroke Pharmacotherapy: Scale Validation and Correlates among a Sample of Stroke Survivors. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081109. [PMID: 36013576 PMCID: PMC9413934 DOI: 10.3390/medicina58081109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Adherence to post-stroke pharmacotherapy has been less studied compared with other cardiovascular diseases, and previous research in this context utilized generic tools without cross-validating for stroke specific factors and patient characteristics. This study aimed to validate the Lebanese Medication Adherence Scale (LMAS-14) among stroke survivors to assess adherence to post-stroke pharmacotherapy. It also aimed to determine the socioeconomic, clinical characteristics, and health related quality of life correlates of medication adherence among stroke survivors. Materials and Methods: This was a cross-sectional study that included stroke survivors from districts throughout Lebanon. A well-structured questionnaire consisting of three parts was developed and utilized to collect data. The first part included questions about the sociodemographic and socioeconomic characteristics. The second part included questions about medical history, current clinical characteristics of the patients, and use of medications. The third part included validated scales to assess stroke outcomes, daily performance and activities, and quality of life. Results: A total of 172 stroke survivors were included. The LMAS-14 structure was validated over a solution of three factors, with a Kaiser−Meyer−Olkin (KMO) measure of sampling adequacy = 0.836 and a significant Bartlett’s test of sphericity (p < 0.001). Severe difficulty in obtaining medications within the current Lebanese economic crisis was significantly associated with lower medication adherence (Beta = −8.473, p = 0.001). Lower medication adherence was also associated with poor stroke prognosis (Beta = −3.264, p = 0.027), higher number of used medications (Beta = −0.610, p = 0.034), and longer duration of stroke diagnosis (Beta = −4.292, p = 0.002). Conclusions: The LMAS−14 is a valid and reliable tool to assess medication adherence in stroke practice and research. Severe difficulty in obtaining medications due to unpredictable availability and shortage of supplies is associated with lower medication adherence, and thus places stroke survivors at higher risk of complications and morality. Additional measures and urgent action by stroke care providers and public health stakeholders are necessary to ensure adequate post-stroke management and outcomes.
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Okonkwo UP, Agbo CF, Ibeneme SC, Igwe ES, Akosile CO, Onwuakagba IU, Emmanuel OC, Maduagwu SM, Ezenwankwo EF, Ekechukwu EN. The Burden and Quality of life of Caregivers of Stroke Survivors with Cognitive Impairment in Selected Healthcare Facilities in Anambra State, Nigeria. Gerontol Geriatr Med 2022; 8:23337214221126329. [PMID: 36189374 PMCID: PMC9520178 DOI: 10.1177/23337214221126329] [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: 05/24/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the burden and quality of life of caregivers of stroke survivors with cognitive impairment in selected healthcare facilities in Anambra State, Nigeria. Methods: This was a cross-sectional survey using the World Health Organization QOL-BREF and Caregiver Strain Index (CSI) as instruments. Descriptive statistics of frequency, percentage counts, mean and standard deviation were used to summarize the socio-demographics. Spearman’s ranked order correlation; Mann–Whitney U test assessed the correlation and gender and age difference in QoL and caregiver’s burden. Alpha level was set at 0.05. Results: Physical health domain of QOL was slightly moderate (53.29 ± 15.19), psychological health was low (46.33 ± 16.96), social relationship was slightly moderate (51.16 ± 0.31), environmental health was slightly moderate (51.22 ± 15.88), the burden of caregivers was high (6.35 ± 1.29). Conclusion: The quality of life of the caregivers of stroke survivors with cognitive impairment was moderate, and the caregivers’ stress was high in the sample of the population studied.
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Adams HP. Clinical Scales to Assess Patients With Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Soto-Vidal C, Calvo-Fuente V, Muriel-García A, Gallego-Izquierdo T, González-Alted C, Pacheco-da-Costa S. Responsiveness of the Spanish Version of Newcastle Stroke-Specific Quality of Life Measure (NEWSQOL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10034. [PMID: 34639337 PMCID: PMC8507955 DOI: 10.3390/ijerph181910034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the responsiveness of the Spanish version of the Newcastle Stroke-specific Quality of Life measure (NEWSQOL) to assess quality of life in Spanish people after suffering a stroke. DESIGN A prospective observational study was conducted to assess the responsiveness of the Spanish version of NEWSQOL. The sample contained 128 patients who filled in the questionnaires before and after a physical therapy intervention. The responsiveness was assessed with p-values using the effect size (ES) and the standardized response means (SRMs) of the change. Besides, two other external criteria were used to distinguish patients who improved with the treatment from those who remained stable. This classification was based on one functional independence measure (the Barthel Index) and one disability measure (the modified Rankin Scale). RESULTS There was a statistically significant correlation (Spearman's coefficient = p < 0.01) between the domains of the Spanish version of NEWSQOL in relation to the Barthel Index and the modified Rankin Scale. All domains showed between marked-to-mild change responsiveness except sleep and relationships; mobility (ES 0.66 and SRM 0.92) and activities of daily living (ES 0.75 and SRM 0.87) were markedly responsive; communication (ES 0.38 and SRM 0.61) was moderately responsive; and pain, vision, cognition, feelings, emotions and fatigue were mildly responsive (ES 0.21-0.41 and SRM 0.23-0.44). CONCLUSION The Spanish version of NEWSQOL shows between marked and mild responsiveness to measure the perception of QoL in post-stroke patients. Therefore, its use can be suitable for evaluation studies, clinical trials and clinical practice.
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Affiliation(s)
- Concepción Soto-Vidal
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Victoria Calvo-Fuente
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Alfonso Muriel-García
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Tomás Gallego-Izquierdo
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | | | - Soraya Pacheco-da-Costa
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
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13
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Wong HJ, Lua PL, Harith S, Ibrahim KA. Health-related quality of life profiles and their dimension-specific associated factors among Malaysian stroke survivors: a cross sectional study. Health Qual Life Outcomes 2021; 19:210. [PMID: 34461920 PMCID: PMC8406972 DOI: 10.1186/s12955-021-01847-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/20/2021] [Indexed: 12/14/2022] Open
Abstract
Background Apart from maximizing functional abilities and independence after stroke, improving overall health-related quality of life (HRQoL) should also become part of the stroke treatment and rehabilitation process goals. This study aimed to assess the HRQoL profiles and explore the dimension-specific associated factors of HRQoL among stroke survivors. Methods This was a cross-sectional study of stroke survivors attending post-stroke care clinics in three public hospitals in the states of Pahang and Terengganu, Malaysia. The HRQoL was assessed by EuroQol-5 dimension-5 levels. Data on socio-demographic, clinical profiles, malnutrition risk, and physical activity level were collected through an interviewer-administered survey. Descriptive analyses for HRQoL profiles and multiple logistic regression analyses for its associated factors were performed. Crude and adjusted odds ratios were reported. Results A total of 366 stroke survivors were recruited with a mean age of 59 ± 11 years. The most -commonly reported health problems were mobility (85%), followed by usual activities (82%), pain/discomfort (63%), anxiety/depression (51%) and self-care (41%). The mean of the EQ visual analogue scale and the median of the EQ5D summary index was reported at 60.3 ± 14.2 and 0.67 ± 0.37, respectively. Malnutrition risk (mobility, usual activities, and self-care), wheelchair users (self-care and usual activities), speech impairment (usual activities and pain/discomfort), number of stroke episodes (self-care and pain/discomfort), body mass index, physical activity level and types of strokes (usual activities), age and use of a proxy (anxiety/depression), working and smoking status (mobility), were factors associated with either single or multiple dimensions of HRQoL. Conclusion Routine malnutrition screening, tailored program for speech therapy, prevention of recurrent stroke, and physical activity promotion should be addressed and further reinforced in current rehabilitation interventions to improve the HRQoL among stroke survivors in Malaysia.
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Affiliation(s)
- Hui Jie Wong
- School of Nutrition and Dietetics, Faculty of Health Sciences, Gong Badak Campus, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Pei Lin Lua
- Faculty Pharmacy, Tembila Campus, Universiti Sultan Zainal Abidin, 22200, Besut, Terengganu, Malaysia.
| | - Sakinah Harith
- School of Nutrition and Dietetics, Faculty of Health Sciences, Gong Badak Campus, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Khairul Azmi Ibrahim
- Department of Medicine, Neurology Unit, Hospital Sultanah Nur Zahirah, Ministry of Health, Terengganu, Malaysia
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Self-reported quality of life following stroke: a systematic review of instruments with a focus on their psychometric properties. Qual Life Res 2021; 31:329-342. [PMID: 34247327 DOI: 10.1007/s11136-021-02944-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the psychometric properties of common health-related quality-of-life instruments used post stroke and provide recommendations for research and clinical use with this diagnostic group. METHODS A systematic review of the psychometric properties of the five most commonly used quality-of-life measurement tools (EQ-5D, SF-36, SF-6D, AQoL, SS-QOL) was conducted. Electronic searches were performed in MEDLINE, CINAHL, and EMBASE on November 27th 2019. Two authors screened papers against the inclusion criteria and where consensus was not reached, a third author was consulted. Included papers were appraised using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist and findings synthesized to make recommendations. RESULTS A total of n = 50,908 papers were screened and n = 45 papers reporting on 40 separate evaluations of psychometric properties met inclusion criteria (EQ-5D = 19, SF-36 = 16, SF-6D = 4, AQoL = 2, SS-QOL = 4). Studies reported varied psychometric quality of instruments, and results show that psychometric properties of quality-of-life instruments for the stroke population have not been well established. The strongest evidence was identified for the use of the EQ-5D as a quality-of-life assessment for adult stroke survivors. CONCLUSIONS This systematic evaluation of the psychometric properties of self-reported quality-of-life instruments used with adults after stroke suggests that validity across tools should not be assumed. Clinicians and researchers alike may use findings to help identify the most valid and reliable measurement instrument for understanding the impact of stroke on patient-reported quality of life.
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15
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Unveiling the importance of hidden personal resources in cerebrovascular diseases. Int Psychogeriatr 2021; 33:535-538. [PMID: 34173355 DOI: 10.1017/s104161022000099x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Yoon S, Kim HY, Kim SR. A prediction model of health-related quality of life in young adult patients with stroke. J Clin Nurs 2021; 30:2023-2035. [PMID: 33756032 DOI: 10.1111/jocn.15755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/05/2020] [Accepted: 03/01/2021] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to establish and test a predictive model for explaining the health-related quality of life of young adult patients with stroke. BACKGROUND Individual characteristics, biological and physiological variables, social support, emotional and cognitive symptoms, physical function disability and general health perception may be interrelated and may directly or indirectly affect the health-related quality of life of young adult patients with stroke. DESIGN A cross-sectional study. METHODS 237 young outpatients with stroke were recruited and surveyed. Data collection used a structured questionnaire from July-November 2018. The collected data were analysed using SPSS version 25.0® and AMOS 23.0. This study is based on STROBE guidelines. RESULTS The hypothetical model's fit indices were adequate. Stroke severity, social support, fear of stroke recurrence, physical function disability and general health perceptions directly affected the health-related quality of life. Additionally, stroke severity, depression and fear of stroke recurrence also indirectly affected it. These variables explained 60.3% of the variance in this quality. CONCLUSIONS Variables such as severity of stroke, depression, fear of stroke recurrence, social support, physical function disability and general health perception were found to be related to the HRQoL of young adult patients with stroke. RELEVANCE TO CLINICAL PRACTICE A variety of physical, psychological, functional and social factors related to health-related quality of life should be systematically monitored. Furthermore, nurses need to develop and apply detailed nursing interventions that take into account all these variables.
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Affiliation(s)
- Susie Yoon
- School of Nursing, Cheju Halla University, Jeju, South Korea
| | - Hye Young Kim
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, South Korea
| | - Sung Reul Kim
- College of Nursing, Korea University, Seoul, South Korea
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17
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Health-Related Quality of Life and Psychological Features in Post-Stroke Patients with Chronic Pain: A Cross-Sectional Study in the Neuro-Rehabilitation Context of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063089. [PMID: 33802829 PMCID: PMC8002692 DOI: 10.3390/ijerph18063089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
This study aims at exploring disability, health-related quality of life (HrQoL), psychological distress, and psychological features in post-stroke patients with chronic pain. An observational cross-sectional study involving 50 post-stroke patients (25 with chronic pain and 25 without pain) was conducted. The primary outcome was the self-reported level of disability and HrQoL which were both assessed through the Stroke Impact Scale 3.0. Both psychological distress and specific psychological features (i.e., self-efficacy, coping strategies, psychological flexibility, perceived social support) were examined. Post-stroke patients with chronic pain reported statistically significant higher levels of disability and worse HrQoL, higher psychological distress and inflexibility, as well as a lower level of self-efficacy and problem-oriented coping strategies than patients without pain (p < 0.001). Finally, correlation analysis in the group of stroke survivors with pain showed that higher levels of disability were significantly related to higher psychological distress. This study confirms the negative influence of chronic pain on disability and HrQoL in post-stroke patients and presents preliminary insights on the association between chronic pain, disability, HrQoL, psychosocial distress, and the patient’s approach in dealing with personal difficulties and emotions. These findings carry further implications for multidisciplinary management of post-stroke patients with chronic pain.
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18
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Harris Walker G, Gonzalez-Guarda R, Yang Q, Shah S, Prvu Bettger J. Socio-ecological perspective on factors influencing acute recovery of younger stroke survivors: A mixed methods study. J Adv Nurs 2021; 77:2860-2874. [PMID: 33650219 DOI: 10.1111/jan.14778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022]
Abstract
AIMS Stroke is affecting an increasing number of young and middle-aged adults. Given the substantial diversion from anticipated life trajectories that younger stroke survivors experience as a result of their stroke deficits, their health-related quality of life (HRQOL) is likely to be negatively impacted during the immediate post-acute recovery period. The aim of this study was to generate a comprehensive understanding of the influences on HRQOL and acute recovery during the first three months following stroke for younger adults using a socio-ecological perspective. DESIGN Longitudinal, convergent mixed methods design. METHODS HRQOL survey data, assessed using the Patient Generated Index (N = 31), and qualitative interview data about survivors' recovery experiences (N = 20) were collected. Simple linear regression and effect size results were integrated with themes and sub-themes identified from conventional content analysis using joint data displays. RESULTS Depression and fatigue negatively affected recovery at the individual level. At the family and societal level, family functioning, social support including being married, having insurance, working, adequate income and being unemployed post-stroke all positively impacted recovery. Qualitative findings revealed determination, coping, and accessing healthcare to positively affect recovery though a meta-inference could not be drawn as no quantitative data addressed these concepts. CONCLUSION A variety of factors intersecting across socio-ecological levels were perceived by young stroke survivors to influence acute recovery experiences and outcomes. IMPACT This study identified individual-, family- and societal-level factors in younger adults' environments that may affect the acute stroke recovery experience. Findings underscore the need for research and clinical approaches that consider environmental factors at multiple levels of influence when supporting stroke recovery for younger adults.
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Affiliation(s)
| | | | - Qing Yang
- Duke University School of Nursing, Durham, NC, USA
| | | | - Janet Prvu Bettger
- Duke University School of Nursing, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
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Lens C, Demeestere J, Vanhaecht K, Lemmens R. Patient Reported Outcomes Measurements Information System in Stroke Patients in Full and Shortened Format. Front Neurol 2021; 11:630850. [PMID: 33551985 PMCID: PMC7864084 DOI: 10.3389/fneur.2020.630850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/29/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction: The modified Rankin Scale (mRS) after 90 days documents outcome in stroke patients, but focusses only on activities of daily living. Here we studied stroke outcome beyond these activities by the Dutch-Flemish version of the Patient Reported Outcomes Measurement Information System (PROMIS) questionnaire. Patients and Methods: We documented the mRS at day 90 in stroke patients who filled out a questionnaire on pain intensity and seven PROMIS domains: physical function, ability to participate in social roles, anxiety, fatigue, depression, sleep disturbance, pain interference. In a subgroup of patients this questionnaire was reduced to one overall question per PROMIS domain. We correlated these findings with the mRS. Results: We received 102 questionnaires and identified physical function as the most affected PROMIS domain. The strongest correlation with mRS was found for the health domains of physical function (ρs = 0.70, p < 0.001) and ability to participate in social roles (ρs = 0.61, p < 0.001). The other domains with substantial proportions of patients with worse scores compared to the general population (19-44%) correlated weakly with the mRS. We identified a strong correlation between the single question per health domain and the overall score per PROMIS domain. Discussion and Conclusion: PROMIS better reflects the overall health status of stroke patients beyond functional outcome as measured by the mRS. Simplification of the questionnaire with a single question per PROMIS domain could potentially replace the full questionnaire, but needs further validation.
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Affiliation(s)
- Charlotte Lens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven – University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jelle Demeestere
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven – University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven – University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
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20
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Larsen LP, Johnsen SP, Andersen G, Hjollund NH. Determinants of Health Status After Stroke: A Cohort Study with Repeated Measurements. Clin Epidemiol 2020; 12:1269-1279. [PMID: 33235507 PMCID: PMC7678700 DOI: 10.2147/clep.s270249] [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: 07/27/2020] [Accepted: 10/08/2020] [Indexed: 01/13/2023] Open
Abstract
Background Knowledge about the long-term course of health following stroke is sparse and relies mainly on studies with short follow-up or few measurements per patient. We aimed to describe the course and analyze the determinants of the course of physical and mental health status after stroke with repeated measurements in a large population-based cohort of first time Danish stroke patients. Methods We followed 2,414 first time stroke patients admitted to any hospital in the Central Denmark Region, Denmark, between October 1, 2008 and January 1, 2012, with five questionnaires over a 2 years period. Self-rated health was assessed by the SF-12 instrument. Information on possible clinical and patient-related determinants of self-rated health was obtained from questionnaires and national registers. The scores were analyzed at five selected fixed time-points and as well as longitudinally with mixed models. Results The SF-12 mental component summary score (MCS) increased with 0.89 points/year (95% CI=0.6–1.2), while the increase in the physically component summary score (PCS) did not reach statistical significance (0.13/year; 95% CI=−0.2–0.5). The most pronounced changes were seen in the Vitality and Role Physical SF-12 subscales, which both increased by 2.1 points/year. No statistically significant changes over time were found in the Physical Functioning and Bodily Pain subscales. Variables associated with increasing self-rated mental health (MCS) were no comorbidity, older age, male gender, and mild stroke severity. Variables associated with increasing ratings of physical health (PCS) were mild stroke severity, no comorbidity, higher educational level, and younger age. The negative impact of age increased significantly with time during the follow-up period for physical as well as mental health, while the effects of the other variables were stable over time. The results were similar in the two analytical approaches. Conclusion In a large, geographically well-defined population of first time stroke patients, the majority of SF-12 sub-scales and the mental component score improved slightly over time. Small improvements in self-rated mental health may be observed during the first 2 years after the stroke. Stroke is a disease with long-term consequences on a wide range of health aspects. Level as well as course differ between sub-groups, and treatment of comorbidity may be an important target with respect to rehabilitation.
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Affiliation(s)
- Louise Pape Larsen
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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21
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Deb-Chatterji M, Konnopka A, Flottmann F, Leischner H, Fiehler J, Gerloff C, Thomalla G. Patient-reported, health-related, quality of life after stroke thrombectomy in clinical practice. Neurology 2020; 95:e1724-e1732. [PMID: 32680947 DOI: 10.1212/wnl.0000000000010356] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine patient-reported health-related quality of life (HRQOL) after stroke thrombectomy in clinical practice and to identify predictors of better HRQOL by analyzing data of 504 consecutive patients treated in a large university stroke center. METHODS All patients with stroke treated by thrombectomy (June 2015-October 2018) were prospectively enrolled in this observational study. At 90 days, functional outcome was assessed by the modified Rankin Scale (mRS) and patient-reported HRQOL was assessed by the EuroQol Group 5-Dimension (EQ-5D) self-report questionnaire, consisting of 5 health domains. The EQ-5D utility index (EQ-5D-I) score (-0.594 to 1.00, with higher values indicating better HRQOL) was calculated. Linear regression analysis was applied to identify predictors of better HRQOL (higher EQ-5D-I score). RESULTS Of 504 patients (median age 76 years, 51.8% female), the mean EQ-5D-I score was 0.39 (SD 0.44). The proportion of stroke survivors who reported complaints in the different domains decreased from 66% in Usual Activities to 57% in Mobility, 50.4% in Self-Care, 41.7% in Pain/Discomfort, and 40.8% Anxiety/Depression. Lower age, lower prestroke mRS score, lower baseline NIH Stroke Scale score, higher Alberta Stroke Program Early CT Score, concomitant thrombolysis therapy, and a successful recanalization were independent predictors of better HRQOL. CONCLUSIONS Patient-reported HRQOL provides a more comprehensive assessment of stroke outcome than the mRS score. Health domains involving motor function most frequently showed complaints in HRQOL after stroke thrombectomy, while a large proportion of patients did not report any complaints across the different health domains. Predictors of better HRQOL closely match the predictors of better functional outcome measured by the mRS in other thrombectomy studies.
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Affiliation(s)
- Milani Deb-Chatterji
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Alexander Konnopka
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Leischner
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Uchida H, Hiragaki Y, Nishi Y, Nakahara S, Koumoto J, Onmyoji Y, Fujimoto N, Kawakami K, Ishii M, Hirao K. An iPad application-based intervention for improving post-stroke depression symptoms in a convalescent rehabilitation ward: A pilot randomized controlled clinical trial protocol. Internet Interv 2020; 21:100340. [PMID: 32944505 PMCID: PMC7481559 DOI: 10.1016/j.invent.2020.100340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is a neuropsychiatric sequela that causes serious adverse effects on the prognosis of stroke patients. Our developed iPad application is a very innovative approach designed to improve participants' depressive symptoms by presenting positive words stimuli in a video. Although this application has fewer side effects than existing pharmacological and non-pharmacological interventions and is likely less burdensome for patients and caregivers, its efficacy for PSD has not been investigated. Here we present a pilot randomized controlled trial (RCT) protocol to investigate the therapeutic potential of this application intervention for PSD patients. METHODS This study is designed as a 5-week, single-center, open-label, parallel-group, pilot RCT. Thirty-two patients with PSD will be randomly assigned to a combination of the iPad application and usual rehabilitation or usual rehabilitation alone (1:1 allocation ratio). The iPad application intervention lasts 3 min a day, and the usual rehabilitation lasts 3 h a day. The primary outcome is the change from baseline in The Center for Epidemiologic Studies Depression Scale score at the end of the 5-week intervention. DISCUSSION This pilot RCT is the first study to investigate the potential of iPad application interventions to reduce depressive symptoms in PSD patients. This pilot RCT determines whether this is a viable and effective intervention and informs the design for a full-scale trial. If our hypothesis is correct, this trial can provide evidence to augment the standard practice of iPad application interventions to improve depressive symptoms in patients with PSD.
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Key Words
- API, Application Programming Interface
- CBT, Cognitive Behavioral Therapy
- CRW, Convalescent Rehabilitation Ward
- Depression
- Mobile applications
- OT, Occupational Therapists
- PSD, Post-stroke Depression
- PT, Physical Therapists
- RCT, Randomized Controlled Trial
- Rehabilitation
- SPSRS, Subliminal Priming with Supraliminal Reward Stimulation
- ST, Speech Therapists
- Stroke
- rTMS, Repetitive Transcranial Magnetic Stimulation
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Affiliation(s)
- Hiroyuki Uchida
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Yoshiya Hiragaki
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Yuta Nishi
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Shiori Nakahara
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Junki Koumoto
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Yusuke Onmyoji
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Norimasa Fujimoto
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kazuho Kawakami
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Masato Ishii
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kazuki Hirao
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
- Corresponding author at: Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma 371-8514, Japan.
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Fatone S, Jerousek S, Slater BCS, Deutsch A, LaVela SL, Peterson M, Soltys NT, McPherson V, Heinemann AW. Identifying Instruments to Assess Care Quality for Individuals With Custom Ankle Foot Orthoses: A Scoping Review. Arch Phys Med Rehabil 2020; 102:709-734. [PMID: 32791070 DOI: 10.1016/j.apmr.2020.06.029] [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: 11/28/2019] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We conducted 2 complementary scoping reviews to identify instruments that assess the experience and outcomes of custom ankle-foot orthosis (AFO) care in individuals with neurologic and traumatic conditions and to determine to what extent they might be psychometrically sound for AFO users. A stakeholder advisory committee considered to what extent the identified and psychometrically sound instruments might be feasible for use in developing quality measures for custom AFO users. DATA SOURCES Both scoping reviews were conducted using PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, and Cochrane Systematic Reviews. The following were used for the first scoping review only: Cochrane Central Register of Controlled Trials and the Physiotherapy Evidence Database. STUDY SELECTION The initial scoping review yielded 79 articles with 82 instruments, 16 of which were used in 4 or more studies. The second scoping review yielded 57 articles reporting psychometric properties. DATA EXTRACTION Psychometric properties for populations who use AFOs were summarized for 15 of the 16 instruments. The advisory committee eliminated 2 insrtruments, noted overlap between 4 instruments in terms of the constructs measured, and suggested 6 potential contemporary substitutes. DATA SYNTHESIS Most instruments assessed activity (specifically mobility) and pertained to the National Quality Forum domain of "Health-Related Quality of Life." The 10-meter walk test, 6-minute walk test, Berg Balance Scale, Timed Up and Go, and Rivermead Mobility Index were reported to have adequate reliability and validity, and were considered feasible for administration in a clinical setting. CONCLUSIONS Complementary scoping reviews demonstrated that some instruments with reasonable psychometric properties are available that are feasible to use in developing quality measures for custom AFO care. However, experience of care instruments suitable for this population were not identified but are needed for a comprehensive evaluation of care quality for AFO users.
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Affiliation(s)
- Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Sara Jerousek
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | | | - Anne Deutsch
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; The Shirley Ryan Ability Lab, Chicago, IL; RTI International, Chicago, IL
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL
| | | | | | | | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; The Shirley Ryan Ability Lab, Chicago, IL
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Soto-Vidal C, Pacheco-da-Costa S, Calvo-Fuente V, Fernández-Guinea S, González-Alted C, Gallego-Izquierdo T. Validation of the Spanish Version of Newcastle Stroke-Specific Quality of Life Measure (NEWSQOL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4237. [PMID: 32545844 PMCID: PMC7345147 DOI: 10.3390/ijerph17124237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Stroke causes a wide variety of clinical manifestations that may have a negative impact on quality of life. Therefore, it is very important to use specific instruments for measuring quality of life in individuals who suffered a stroke. The aim of this study was to develop a psychometrically validated Spanish version of the Newcastle stroke-specific quality of life measure (NEWSQOL). METHODS A psychometric validation of the Spanish version of the NEWSQOL questionnaire was carried out in 159 patients. The reliability (intraclass correlation coefficient and Cronbach's alpha coefficient), validity (factorial analysis and Spearman's coefficient), feasibility (response rate), and the ceiling and floor effects were calculated. RESULTS Internal consistency showed that Cronbach's alpha coefficient was 0.93. The test-retest reliability was high or excellent for all domains (range 0.71-0.97 p < 0.001). The response rate of the questionnaire was 100% and the average administration time was 20.5 (±7.2) min. No ceiling effect was detected and two domains (pain and vision) may have a significant potential for floor effect. Construct validity showed that all the variables are important enough to keep them all in the questionnaire. Concerning convergent construct validity, a high correlation was found with the Nottingham Health Profile, the Barthel Index, and the Modified Rankin Scale. CONCLUSION The Spanish version of the NEWSQOL questionnaire is reliable, valid, and feasible to evaluate quality of life in the Spanish population.
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Affiliation(s)
- Concepción Soto-Vidal
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
| | - Soraya Pacheco-da-Costa
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
| | - Victoria Calvo-Fuente
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
| | - Sara Fernández-Guinea
- Department of Experimental Psychology, Complutense University of Madrid, 28040 Madrid, Spain;
| | | | - Tomás Gallego-Izquierdo
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
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Pedersen SG, Friborg O, Heiberg GA, Arntzen C, Stabel HH, Thrane G, Nielsen JF, Anke A. Stroke-Specific Quality of Life one-year post-stroke in two Scandinavian country-regions with different organisation of rehabilitation services: a prospective study. Disabil Rehabil 2020; 43:3810-3820. [PMID: 32356473 DOI: 10.1080/09638288.2020.1753830] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose: To compare stroke-specific health related quality of life in two country-regions with organisational differences in subacute rehabilitation services, and to reveal whether organisational factors or individual factors impact outcome.Materials and methods: A prospective multicentre study with one-year follow-up of 369 first-ever stroke survivors with ischaemic or haemorrhagic stroke, recruited from stroke units in North Norway (n = 208) and Central Denmark (n = 161). The 12-domain Stroke-Specific Quality of Life scale was the primary outcome-measure.Results: The Norwegian participants were older than the Danish (Mage= 69.8 vs. 66.7 years, respectively), had higher initial stroke severity, and longer stroke unit stays. Both cohorts reported more problems with cognitive, social, and emotional functioning compared to physical functioning. Two scale components were revealed. Between-country differences in the cognitive-social-mental component showed slightly better function in the Norwegian participants. Depression, anxiety, pre-stroke dependency, initial stroke severity, and older age were substantially associated to scale scores.Conclusions: Successful improvements in one-year functioning in both country-regions may result from optimising long-term rehabilitation services to address cognitive, emotional, and social functioning. Stroke-Specific Quality of Life one-year post-stroke could be explained by individual factors, such as pre-stroke dependency and mental health, rather than differences in the organisation of subacute rehabilitation services.IMPLICATIONS FOR REHABILITATIONThe stroke-specific health related quality of life (SS-QOL) assessment tool captures multidimensional effects of a stroke from the perspective of the patient, which is clinically important information for the rehabilitation services.The cognitive-social-mental component and the physical health component, indicate specific functional problems which may vary across and within countries and regions with different organisation of rehabilitation services.For persons with mild to moderate stroke, longer-term functional improvements may be better optimised if the rehabilitation services particularly address cognitive, emotional, and social functioning.
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Affiliation(s)
- Synne Garder Pedersen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Department of Health and Care Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Oddgeir Friborg
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Guri Anita Heiberg
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Cathrine Arntzen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Department of Health and Care Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Henriette Holm Stabel
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Denmark, Denmark
| | - Gyrd Thrane
- Department of Health and Care Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Denmark, Denmark
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Research Centre for Habilitation and Rehabilitation Model and Services (CHARM), University of Oslo, Oslo, Norway
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Deems NP, Leuner B. Pregnancy, postpartum and parity: Resilience and vulnerability in brain health and disease. Front Neuroendocrinol 2020; 57:100820. [PMID: 31987814 PMCID: PMC7225072 DOI: 10.1016/j.yfrne.2020.100820] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/25/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
Risk and resilience in brain health and disease can be influenced by a variety of factors. While there is a growing appreciation to consider sex as one of these factors, far less attention has been paid to sex-specific variables that may differentially impact females such as pregnancy and reproductive history. In this review, we focus on nervous system disorders which show a female bias and for which there is data from basic research and clinical studies pointing to modification in disease risk and progression during pregnancy, postpartum and/or as a result of parity: multiple sclerosis (MS), depression, stroke, and Alzheimer's disease (AD). In doing so, we join others (Shors, 2016; Galea et al., 2018a) in aiming to illustrate the importance of looking beyond sex in neuroscience research.
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Affiliation(s)
- Nicholas P Deems
- The Ohio State University, Department of Psychology, Columbus, OH, USA
| | - Benedetta Leuner
- The Ohio State University, Department of Psychology, Columbus, OH, USA.
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Lee Y, Kim JS, Hong BY, Park JG, Yoo JW, Lee KB, Kim TW, Lim SH. Determinant of Quality of Life in Patients with Chronic Cerebral Infarct. BRAIN & NEUROREHABILITATION 2019; 13:e4. [PMID: 36744274 PMCID: PMC9879529 DOI: 10.12786/bn.2020.13.e4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/19/2019] [Accepted: 09/23/2019] [Indexed: 11/08/2022] Open
Abstract
This study investigated how physical and cognitive function and psychological factors affected the health-related quality of life (HRQoL, hereafter HQ) of stroke patients in South Korea. The study enrolled 32 right-handed subjects with chronic cerebral infarction with disability and preserved cognitive function (Mini-Mental State Examination ≥ 20). Physical disability was assessed using the modified Rankin Scale (mRS) and Korean modified Barthel Index (KMBI). Quality of life was measured using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF, hereafter WB) and the 36-Item Short-form Health Survey (SF-36) in face-to-face interviews. Psychological distress was investigated using the Beck Depression Inventory Scale-II. The associations of each domain of WB and SF-36 were investigated using Pearson correlation analyses. Physical disability was negatively correlated with HQ in the SF-36. The physical function and bodily pain scales of the SF-36 were negatively correlated with physical disability. The general health domain of the SF-36 was negatively correlated with psychological scores. Emotional status was associated with physical health, social relationships, and general health in HQ. In summary, the severity of physical disability was associated with the patient's general and physical health and body pain. These findings suggest the importance of psychological, cognitive, and physiological interventions for improving the quality of life of patients after cerebral infarction.
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Affiliation(s)
- Yujin Lee
- Bloomberg school of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joon Sung Kim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Geun Park
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Wan Yoo
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Bo Lee
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Grau-Pellicer M, Chamarro-Lusar A, Medina-Casanovas J, Serdà Ferrer BC. Walking speed as a predictor of community mobility and quality of life after stroke. Top Stroke Rehabil 2019; 26:349-358. [PMID: 31063439 DOI: 10.1080/10749357.2019.1605751] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background: Community mobility (CM) is considered a part of community reintegration that enhances Quality of Life (QoL). Achieving an appropriate gait speed is essential in attaining an independent outdoor ambulation and satisfactory CM. Objective: The aim of this study was to identify whether gait speed is a predictor of CM and QoL in patients with stroke following a multimodal rehabilitation program (MRP). Methods: This was a baseline control trial with 6-months follow-up in an outpatient rehabilitation setting at a university hospital. Twenty-six stroke survivors completed the MRP (24 sessions, 2 days/wk, 1 hr/session). The MRP consisted of aerobic exercise, task-oriented exercises, balance exercises and stretching. Participants also performed an ambulation program at home. Outcome variables were: walking speed (10-m walking test) and QoL (physical and psychosocial domains of Euroquol and Sickness Impact Profile). Results: At the end of the intervention, comfortable and fast walking speed increased by an average of 0.16 (SD 0.21) (*p < .05) and 0.40 (SD 0.51) (**p < .001) m/s, respectively. After the intervention, all participants achieved independent outdoor ambulation with an increase of 34.14 of walking minutes/day in the community and a decrease of sitting time of 95.45 minutes/day. Regarding QoL there were increased mean scores on the physical and psychosocial dimensions of Euroquol and the Sickness Impact Profile, respectively (**p < .001). Conclusions: The results suggest that improved walking speed after the MRP is associated with CM and higher scores in QoL. These findings support the need to implement rehabilitation programs to promote increased speed.
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Affiliation(s)
- Montserrat Grau-Pellicer
- a Rehabilitation Unit , Hospital-Consorci Sanitari de Terrassa , Barcelona , Spain.,b Physical Therapy Department , Autonomous University of Barcelona , Barcelona , Spain
| | - Andrés Chamarro-Lusar
- c Basic, Evolutionary, and Educational Psychology Department , Autonomous University of Barcelona , Barcelona , Spain
| | - Josep Medina-Casanovas
- b Physical Therapy Department , Autonomous University of Barcelona , Barcelona , Spain.,d Functional Rehabilitation Department, Private Foundation Institut Guttmann Neurorehabilitation Hospital, Badalona, Barcelona, Spain. Physical Therapy Department , Autonomous University of Barcelona , Barcelona , Spain
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29
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Heiberg G, Pedersen SG, Friborg O, Nielsen JF, Holm HS, Steinbüchel von N, Arntzen C, Anke A. Can the health related quality of life measure QOLIBRI- overall scale (OS) be of use after stroke? A validation study. BMC Neurol 2018; 18:98. [PMID: 30021558 PMCID: PMC6052666 DOI: 10.1186/s12883-018-1101-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 07/09/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Brief measures of health-related quality of life (HRQOL) that assess both patient-reported functioning and well-being after stroke are scarce. The objective of this study was to examine reliability and validity of one of these measures, the patient-reported Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS), in patients after stroke. METHODS Stroke survivors were examined prospectively using survey methods. Core survey data (n = 125) and retest data (n = 36) were obtained at 3 and 12 months, respectively. Item properties (distribution, floor and ceiling effects), psychometric properties (reliability and model fit), and validity (correlations with established measures of anxiety, depression and HRQOL) of the QOLIBRI-OS were examined. RESULTS Missing responses on the questionnaire were low (0.5%). All items were positively skewed. No floor effects were present, whereas five out of six items showed ceiling effects. The summary QOLIBRI-OS score exhibited no floor or ceiling effects, and had excellent internal consistency (Cronbach's α =0.93). All item-total correlations were high (0.73-0.88). The test-retest reliability of single items varied from 0.74 to 0.91 and was 0.93 for the overall score. The confirmatory factor analysis yielded an excellent fit for a five-item version and provided tentative support for the original six-item version. The convergent validity correlations were in the hypothesized directions, thus supporting the construct validity. CONCLUSIONS The brief QOLIBRI-OS is a valid and reliable brief health-related outcome measure that is appropriate for screening HRQOL in patients after stroke.
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Affiliation(s)
- Guri Heiberg
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Rehabilitation, University Hospital of North Norway- Harstad, 9480 Harstad, Norway
| | - Synne Garder Pedersen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø The Artic University of Norway, Tromsø, Norway
| | - Oddgeir Friborg
- Department of Psychology, Faculty of Health Sciences, University of Tromsø, the Artic University of Norway, Tromsø, Norway
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Henriette Stabel Holm
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | | | - Cathrine Arntzen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø The Artic University of Norway, Tromsø, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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30
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Katzan IL, Thompson NR, Uchino K, Lapin B. The most affected health domains after ischemic stroke. Neurology 2018; 90:e1364-e1371. [PMID: 29592886 DOI: 10.1212/wnl.0000000000005327] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES (1) Examine 8 patient-reported domains of health across levels of disability compared to the US general population; and (2) identify factors associated with domain scores in patients with ischemic stroke. METHODS Observational cohort study of 1,195 patients in a cerebrovascular clinic from February 17, 2015, to January 27, 2017, who completed Neuro-QoL (Quality of Life in Neurological Disorders) executive function or the following PROMIS (Patient-Reported Outcomes Measurement Information System) scales as part of routine care: physical function, satisfaction with social roles, fatigue, anxiety, depression, pain interference, and sleep disturbance. RESULTS Mean age was 62 (±15) years, and 81% were white. Median modified Rankin Scale (mRS) score at the clinic visit was 1 (interquartile range 0-2). Percentage of patients with scores meaningfully worse than the general population ranged from 28% (sleep disturbance) to 63% (physical function). Scores were worse in patients with higher mRS levels, although correlation between scores and mRS level varied (sleep disturbance r = 0.16 to physical function r = 0.52). Most affected domains were physical function (T score = 58.8), satisfaction with social roles (T score = 55.4), and executive function (T score = 53.4). Disability, lower income, and female sex were associated with worse scores in multiple domains. Age was associated with worse physical function but lower anxiety, depression, and sleep disturbance. CONCLUSIONS Patients with ischemic stroke reported symptoms in multiple domains that increase to variable degrees at higher levels of disability. Physical function, satisfaction with social roles, and executive function were most affected. This information improves our understanding of the well-being of patients with ischemic stroke and brings attention to the importance of social roles and executive function for stroke survivors.
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Affiliation(s)
- Irene L Katzan
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., N.R.T., B.L.), and Cerebrovascular Center (I.L.K., K.U.), Cleveland Clinic, OH.
| | - Nicolas R Thompson
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., N.R.T., B.L.), and Cerebrovascular Center (I.L.K., K.U.), Cleveland Clinic, OH
| | - Ken Uchino
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., N.R.T., B.L.), and Cerebrovascular Center (I.L.K., K.U.), Cleveland Clinic, OH
| | - Brittany Lapin
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., N.R.T., B.L.), and Cerebrovascular Center (I.L.K., K.U.), Cleveland Clinic, OH
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Pellicer MG, Lusar AC, Casanovas JM, Ferrer BCS. Effectiveness of a multimodal exercise rehabilitation program on walking capacity and functionality after a stroke. J Exerc Rehabil 2017; 13:666-675. [PMID: 29326899 PMCID: PMC5747202 DOI: 10.12965/jer.1735056.528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/05/2017] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine the effectiveness of a 12-week multimodal exercise rehabilitation program on walking speed, walking ability and activities of daily living (ADLs) among people who had suffered a stroke. Thirty-one stroke survivors who had completed a conventional rehabilitation program voluntarily participated in the study. Twenty-six participants completed the multimodal exercise rehabilitation program (2 days/wk, 1 hr/session). Physical outcome measures were: walking speed (10-m walking test), walking ability (6-min walking test and functional ambulation classification) and ADLs (Barthel Index). The program consisted on: aerobic exercise; task oriented exercises; balance and postural tonic activities; and stretching. Participants also followed a program of progressive ambulation at home. They were evaluated at baseline, postintervention and at the end of a 6-month follow-up period. After the intervention there were significant improvements in all outcomes measures that were maintained 6 months later. Comfortable and fast walking speed increased an average of 0.16 and 0.40 m/sec, respectively. The walking distance in the 6-min walking test increased an average of 59.8 m. At the end of the intervention, participants had achieved independent ambulation both indoors and outdoors. In ADLs, 40% were independent at baseline vs. 64% at the end of the intervention. Our study demonstrates that a multimodal exercise rehabilitation program adapted to stroke survivors has benefits on walking speed, walking ability and independence in ADLs.
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Affiliation(s)
| | - Andrés Chamarro Lusar
- Basic, Evolutionary, and Educational Psychology Department, Autonomous University of Barcelona, Barcelona,
Spain
| | - Josep Medina Casanovas
- Functional Rehabilitation Department, Private Foundation Institut Guttmann Neurorehabilitation Hospital, Badalona, Barcelona,
Spain
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Mahesh PKB, Gunathunga MW, Jayasinghe S, Arnold SM, Liyanage SN. Factors influencing pre-stroke and post-stroke quality of life among stroke survivors in a lower middle-income country. Neurol Sci 2017; 39:287-295. [PMID: 29103178 DOI: 10.1007/s10072-017-3172-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/25/2017] [Indexed: 11/25/2022]
Abstract
Quality of life (QOL) reflects the individual's perception of the position within living contexts. This study was done to describe pre- and post-stroke QOLs of stroke survivors. A prospective longitudinal study was done among stroke survivors admitted to 13 hospitals in the western province of Sri Lanka. The calculated sample size was 260. The pre-stroke and post-discharge one-month QOL was gathered using short form-36 (SF-36) QOL tool. SF-36 includes questions on eight domains: general health, physical functioning, pain, role limitation due to physical problems, social functioning, vitality, role limitations due to emotional problems, and mental health. Univariate analysis was followed by determining the independent risk factors through multivariate analysis. The response rate was 81%. The disability was measured by the modified Rankin scale which ranges from 0 (no symptoms) to 6 (fatal outcome). The median (IQR) disability score was 4 (3 to 5). The post-discharge QOL scores were significantly lower than pre-stroke values (p < 0.05). With a higher pre-stroke QOL, younger age was significantly associated in six domains and higher income and better health infrastructure in two domains (p < 0.05). Six factors were determined to be independent risk factors for lower post-discharge QOL scores of SF-36: younger age (for general health and role limitation-physical domains), female gender (for physical functioning and pain domains), lower health infrastructure (for general health, vitality, and mental health domains), lower education (for pain domain), higher disability (for general health, physical functioning, vitality, social functioning, and mental health domains), and hypercholesterolemia (for role limitation-emotional domain). Stroke survivors have not regained their pre-stroke QOL at 1 month following the hospital discharge irrespective of income level and pre-stroke QOL. Higher pre- and post-stroke QOLs are associated with better statuses of social determinants of health.
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Affiliation(s)
- P K B Mahesh
- Office of Regional Director of Health Services (RDHS), Colombo, Sri Lanka.
| | - M W Gunathunga
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - S Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - S M Arnold
- Office of Regional Director of Health Services (RDHS), Colombo, Sri Lanka
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Abel H, Kephart G, Packer T, Warner G. Discordance in Utility Measurement in Persons with Neurological Conditions: A Comparison of the SF-6D and the HUI3. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1157-1165. [PMID: 28964449 DOI: 10.1016/j.jval.2017.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 03/10/2017] [Accepted: 04/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To examine the extent of disagreement in estimated utility between the six-dimensional health state short form (SF-6D) and the Health Utilities Index-Mark 3 (HUI3) in Canadians with neurological conditions and how discordance varied by participant and neurological condition attributes. METHODS The study analyzed cross-sectional survey data from the Living with and Managing the Impact of a Neurological Condition Study. Self-reported data were collected on the burden and impact of neurological conditions on participants' everyday lives. Disagreement was examined by comparing utility distributions, paired t tests of the means, Spearman ρ correlations, intraclass correlations, and Bland-Altman plots. Associations between participant and neurological condition attributes and utility differences were assessed using multiple regression models. RESULTS Disagreement between the SF-6D and the HUI3 was substantial, with a mean utility difference of 0.15 (95% confidence interval 0.13-0.17). An intraclass correlation coefficient of 0.41 suggests only marginal agreement. The Bland-Altman plot and regression analysis showed systematic variation in utility difference associated with level of utility. Depending on the level of utility, utility differences between the SF-6D and the HUI3 shift in magnitude and direction. The pattern of disagreement did not vary substantially by participant or neurological condition characteristics. CONCLUSIONS The SF-6D and the HUI3 provide inconsistent evaluations of utility in persons with neurological conditions. The magnitude and direction of differences in estimated utility are strongly associated with level of utility. Depending on the health status of the sample, the SF-6D and the HUI3 could provide widely contradictory utility estimates. A concern is that utility scores, and hence potential evaluations and health care decisions, may vary simply according to the choice of instrument.
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Affiliation(s)
- Hannah Abel
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tanya Packer
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
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Effects of Home-Based Supportive Care on Improvements in Physical Function and Depressive Symptoms in Patients With Stroke: A Meta-Analysis. Arch Phys Med Rehabil 2017; 98:1666-1677.e1. [DOI: 10.1016/j.apmr.2017.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/04/2017] [Accepted: 03/16/2017] [Indexed: 12/29/2022]
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Tse T, Binte Yusoff SZ, Churilov L, Ma H, Davis S, Donnan GA, Carey LM. Increased work and social engagement is associated with increased stroke specific quality of life in stroke survivors at 3 months and 12 months post-stroke: a longitudinal study of an Australian stroke cohort. Top Stroke Rehabil 2017; 24:405-414. [PMID: 28438076 DOI: 10.1080/10749357.2017.1318339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a relative lack of longitudinal studies investigating stroke-specific outcomes and quality of life (QOL). This study aimed to identify which factors (level of disability, cognitive functioning, depressive symptoms, physical activity, and work and social engagement) were independently associated with each stroke-specific domain of QOL, adjusting for age and gender, at 3 months and 12 months post-stroke in an Australian cohort. METHOD Survivors of ischemic stroke were recruited from 18 sites of the STroke imAging pRevention and Treatment (START) longitudinal cohort study. Survivors were assessed at 3 months (n = 185) and 12 months (n = 170) post-stroke using the Stroke Impact Scale (SIS), modified Rankin Scale (mRS), Montreal Cognitive Assessment (MoCA), Montgomery-Asberg Depression Rating Scale, Rapid Assessment of Physical Activity, and Work and Social Adjustment Scale (WSAS). RESULTS WSAS was independently associated with the SIS domains of: Physical Composite function; Participation; and Perceived Recovery at 3 months and 12 months and SIS domain of Emotion at 12 months post-stroke. The presence of depressive symptoms was independently associated with the SIS domains of: Memory and Thinking; and Emotion at 3 months. At 12 months post-stroke, mRS was independently associated with SIS domain of Physical Composite function and MoCA with SIS domain of Communication. CONCLUSION Engaging in work and social activities is an important factor associated with stroke-specific domains of QOL over time. It is recommended that services focus on improving work and social engagement given their importance related to QOL in the first year of recovery post-stroke. Identifying and treating those with depressive symptoms may enhance QOL in the early months post-stroke. TRIAL REGISTRATION START-PrePARE Australian New Zealand Clinical Trials, www.anzctr.org.au , Registry number: ACTRN12610000987066. EXTEND ClinicalTrial.gov identifier: NCT00887328.
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Affiliation(s)
- Tamara Tse
- a Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health , La Trobe University , Melbourne , Australia.,b Neurorehabilitation and Recovery, Stroke Division , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia
| | - Siti Zubaidah Binte Yusoff
- a Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health , La Trobe University , Melbourne , Australia.,c Ang Mo Kio - Thye Hua Kwan Hospital , Ang Mo Kio , Singapore
| | - Leonid Churilov
- d Statistics and Decision Analysis Academic Platform , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia.,e School of Mathematical and Geospatial Sciences , RMIT University , Melbourne , Australia
| | - Henry Ma
- f Department of Medicine, Stroke Unit, Monash Health , Monash University , Clayton , Australia.,g The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia
| | - Stephen Davis
- h Department of Medicine, Melbourne Brain Centre , Royal Melbourne Hospital, University of Melbourne , Parkville , Australia
| | - Geoffrey Alan Donnan
- g The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia.,i Florey Department of Neuroscience and Mental Health , The University of Melbourne , Parkville , Australia
| | - Leeanne M Carey
- a Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health , La Trobe University , Melbourne , Australia.,b Neurorehabilitation and Recovery, Stroke Division , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia
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Pai HC, Wu MH, Chang MY. Determinants of Health-Related Quality of Life in Taiwanese Middle-Aged Women Stroke Survivors. Rehabil Nurs 2017; 42:80-89. [DOI: 10.1002/rnj.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Health-related quality of life in stroke patients questionnaire, short version (HRQOLISP-40): validation for its use in Colombia. BMC Neurol 2016; 16:246. [PMID: 27894282 PMCID: PMC5127092 DOI: 10.1186/s12883-016-0770-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 11/21/2016] [Indexed: 01/22/2023] Open
Abstract
Background The health-related quality of life in stroke patients (HRQOLISP-40, short version) survey was developed in Nigeria and constitutes a 40-item, multidimensional, self-administrated questionnaire. We assessed the validity and reliability of the HRQOLISP-40 Spanish version for stroke patients in Colombia. Methods The analysis included factor analysis, confirmatory factor analysis, Rasch analysis, convergent validity, internal consistency (261 stroke patients), test-retest reliability (73 patients assessed at two different times) and sensitivity to change (46 patients assessed before and after a rehabilitation intervention). Results We found an 8-domain structure. None of the items had a significant impact on the global alpha value in order to be removed. Lin’s concordance correlation coefficient indicated test-retest reliability (Rho IC: 0.76 to 0.95), suggesting an adequate stability of the instrument. Regarding sensitivity to change differences, they were only significant in the psychological and eco-social domains (p <0.05). When comparing SF-36 with HRQOLISP-40, all the correlation coefficients values were significantly different from zero, except those related to vitality. The highest scores were found in the physical and physical functioning domains, with a value of 0.722. Conclusions The HRQOLISP-40 scale is valid and reliable for assessing patients’ quality of life after a stroke. Validating quality of life assessment instruments is necessary in order to improve the effectiveness of rehabilitation programs for Colombian stroke patients. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0770-5) contains supplementary material, which is available to authorized users.
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Ponte AS, Fedosse E. Lesão Encefálica Adquirida: impacto na atividade laboral de sujeitos em idade produtiva e de seus familiares. CIENCIA & SAUDE COLETIVA 2016; 21:3171-3182. [DOI: 10.1590/1413-812320152110.19162016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/14/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo correlacionou o impacto da Lesão Encefálica Adquirida (LEA) na atividade laboral de sujeitos em idade produtiva à sua Qualidade de Vida (QV) e de seus familiares/cuidadores. Pesquisa quali-quantitativa. Para a análise dos dados qualitativos realizou-se Análise de Conteúdo e os quantitativos foram analisados descritivamente. Foram entrevistados 48 sujeitos com LEA e 27 familiares/cuidadores. A correlação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde - WHOQOL-BREF (52,1% homens; média de idade 48,7 anos, no momento da lesão; nível escolar baixo; 18,7% doméstica) revelou que as Funções Mentais comprometidas pela LEA interferiram nos quatro domínios da QV; Funções do Coração e Pressão Sanguínea acometeram o domínio Social; a lesão Cerebral interferiu nos domínios Psicológico e Ambiental. Quanto aos familiares/cuidadores (77,7% mulheres; 96,3% informais; média de idade 52,6 anos; e nível escolar baixo), observaram-se alterações na rotina de trabalho e na estrutura familiar (85,2%). O surgimento de uma LEA desorganiza o sujeito lesionado e sua família, afetando a QV em todos os seus domínios, especialmente nos físicos, psicológicos e ambientais do primeiro e os domínios físicos e ambientais de familiares/cuidadores.
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Determinants of Self-Rated Health Three Months after Stroke. J Stroke Cerebrovasc Dis 2016; 25:1027-1034. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/09/2015] [Indexed: 11/21/2022] Open
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Lagogianni C, Thomas S, Lincoln N. Examining the relationship between fatigue and cognition after stroke: A systematic review. Neuropsychol Rehabil 2016; 28:57-116. [PMID: 26787096 DOI: 10.1080/09602011.2015.1127820] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Many stroke survivors experience fatigue, which is associated with a variety of factors including cognitive impairment. A few studies have examined the relationship between fatigue and cognition and have obtained conflicting results. The aim of the current study was to review the literature on the relationship between fatigue and cognition post-stroke. The following databases were searched: EMBASE (1980-February, 2014), PsycInfo (1806-February, 2014), CINAHL (1937-February, 2014), MEDLINE (1946-February, 2014), Ethos (1600-February, 2014) and DART (1999-February, 2014). Reference lists of relevant papers were screened and the citation indices of the included papers were searched using Web of Science. Studies were considered if they were on adult stroke patients and assessed the following: fatigue with quantitative measurements (≥ 3 response categories), cognition using objective measurements, and the relationship between fatigue and cognition. Overall, 413 papers were identified, of which 11 were included. Four studies found significant correlations between fatigue and memory, attention, speed of information processing and reading speed (r = -.36 to .46) whereas seven studies did not. Most studies had limitations; quality scores ranged from 9 to 14 on the Critical Appraisal Skills Programme Checklists. There was insufficient evidence to support or refute a relationship between fatigue and cognition post-stroke. More robust studies are needed.
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Affiliation(s)
- Christodouli Lagogianni
- a Division of Rehabilitation & Ageing, Medical School , University of Nottingham , Nottingham , UK.,b Queens Medical Centre , Nottingham , UK
| | - Shirley Thomas
- a Division of Rehabilitation & Ageing, Medical School , University of Nottingham , Nottingham , UK.,b Queens Medical Centre , Nottingham , UK
| | - Nadina Lincoln
- a Division of Rehabilitation & Ageing, Medical School , University of Nottingham , Nottingham , UK.,b Queens Medical Centre , Nottingham , UK
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Quality of Life Predictors in Chronic Stable Post-Stroke Patients and Prognostic Value of SF-36 Score as a Mortality Surrogate. Transl Stroke Res 2015; 6:375-83. [DOI: 10.1007/s12975-015-0418-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 01/20/2023]
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Wu MH, Lee S, Su HY, Pai HC. The effect of cognitive appraisal in middle-aged women stroke survivors and the psychological health of their caregivers: a follow-up study. J Clin Nurs 2015; 24:3155-64. [PMID: 26265435 DOI: 10.1111/jocn.12926] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This study identified the factors that affect health-related quality of life at one and six months post-stroke in women who have undergone a mild stroke and that affect their informal caregivers' psychological health status. BACKGROUND Middle-aged women perform the main care roles in a family. When they suffer a stroke, it upsets the equilibrium of their family life. DESIGN This is a longitudinal design. METHODS This prospective follow-up study recruited 41 middle-aged women stroke survivors (mean age = 54.95, SD = 9.63) and their informal caregivers (mean age = 41.56, SD = 15.93). The Short-Form Health Survey (SF-36) was used to assess stroke survivor's health-related quality of life, and the Chinese Health Questionnaire was used to measure the level of depression of the stroke survivor's informal caregiver. Data were analysed through descriptive statistics, Wilcoxon signed-rank tests and the generalised estimating equation approach for modelling repeatedly measures. RESULTS All stroke survivors showed significant improvement in the physical component summary of the health-related quality of life at one and six months after stroke, but there was no significant difference in the mental component summary. In addition, there was no significant difference in the health of the informal caregivers of the women over time. Generalised estimating equation analysis showed that the most important determinant of mental component summary of health-related quality of life among women stroke survivors was cognitive appraisal. The informal caregivers' most important determinants of health status, as measured by level of depression, were their sense of coherence, burden and patients' mental component summary of the health-related quality of life. CONCLUSION This study highlights the impact of cognitive appraisal in determining health-related quality of life of women stroke survivors and how it affects their caregivers' mental health. RELEVANCE TO CLINICAL PRACTICE The findings of this study may contribute to home care nurses' understanding the importance of the psychosocial impact of the stroke for the survivor and their ability to help the surviving women to promote the confidence needed for self-care, which will contribute to their quality of life and affect their caregivers' health.
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Affiliation(s)
- Ming-Hsiu Wu
- Division of Neurology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Sheuan Lee
- School of Nursing, Chung-Shan Medical University, Taichung City, Taiwan.,National Defense Medical Center, Taipei City, Taiwan
| | - Hui-Yi Su
- Department of Nursing, Tainan Sin-Lau Hospital, Tainan City, Taiwan
| | - Hsiang-Chu Pai
- School of Nursing, Chung-Shan Medical University, Taichung City, Taiwan
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Beinotti F, Christofoletti G, Correia N, Borges G. Effects of Horseback Riding Therapy on Quality of Life in Patients Post Stroke. Top Stroke Rehabil 2015; 20:226-32. [DOI: 10.1310/tsr2003-226] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Savini S, Buck HG, Dickson VV, Simeone S, Pucciarelli G, Fida R, Matarese M, Alvaro R, Vellone E. Quality of life in stroke survivor-caregiver dyads: a new conceptual framework and longitudinal study protocol. J Adv Nurs 2014; 71:676-87. [PMID: 25186274 DOI: 10.1111/jan.12524] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2014] [Indexed: 11/30/2022]
Abstract
AIM To describe a new conceptual framework and the research protocol of a study designed to examine the quality of life in stroke survivor-caregiver dyads. BACKGROUND Stroke has a significant impact on the patient-caregiver dyad. Few studies have been guided by a specific conceptual framework which considers the interactions among pre-existing situations prior to stroke, the new situation caused by the stroke and the moderating effects of environmental and caregiver-related variables. DESIGN Longitudinal study. METHODS A sample of stroke survivor-caregiver dyads will be enrolled at patient discharge from rehabilitation hospitals and will be surveyed every 3 months for 1-year. Hypotheses generated from the conceptual framework will test predictors, mediators and moderators of stroke survivor and caregiver quality of life from the pre-existing situation prior to the stroke, the new situation mediation poststroke and situation moderators. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, December 2013. DISCUSSION This study seeks to identify variables in the pre-existing situation prior to the stroke (e.g. living condition), the new situation mediation poststroke (e.g. type of stroke and caregiver burden) as well as situation moderators (e.g. social support) that influence stroke survivor-caregiver dyad's quality of life across the stroke trajectory. Also, the study will inform clinical practice and research by identifying variables that are potentially modifiable and therefore amenable to intervention. The proposed framework will also be helpful for future research focused on stroke survivor-caregiver dyads.
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Rymer MM, Anderson CS, Harada M, Jarosz J, Ma N, Rowley HA, Summers D, Tastula K, Williams O, Bornstein NM. Stroke service: how can we improve and measure outcomes? Consensus summary from a global stroke forum. Acta Neurol Scand 2014; 130:73-80. [PMID: 24796345 DOI: 10.1111/ane.12256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2014] [Indexed: 11/27/2022]
Abstract
The success of acute stroke treatment is first and foremost time-dependent, and the need for improvement in acute stroke management is demonstrated by the fact that only a minority of patients gain access to treatment - in particular, intravenous recombinant tissue plasminogen activator (IV tPA) - within the necessary time window. Standards of acute stroke care vary widely both regionally and nationally; consequently, various healthcare organizations have undertaken initiatives to measure and improve quality of care. To date, most quality measures have been process-based, focusing primarily on metrics of patient care in the acute hospital-based setting (e.g., time to recombinant tPA administration). Therefore, there remains a need for metrics designed to assess how improvements in process translate into patient outcomes. A global forum was convened to share best practice and provide consensus recommendations on core metrics for measuring improvements in access to care and patient outcomes. Recommendations for core metrics of patient outcomes include hospital-based outcomes (e.g., neurological status at 24 h, ambulatory status at discharge) and post-discharge outcomes (e.g., modified Rankin Scale score at 30 and/or 90 days). Recommendations for best practice relating to aspects of people, process, and technology involved in the stroke treatment pathway that may help provide improvements in these core outcome measures are also outlined.
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Affiliation(s)
- M. M. Rymer
- The University of Kansas Hospital; Kansas City KS USA
| | - C. S. Anderson
- The George Institute for Global Health; Royal Prince Alfred Hospital; University of Sydney; Sydney NSW Australia
| | - M. Harada
- University of Tokushima; Tokushima Japan
| | | | - N. Ma
- Beijing Tiantan Hospital; Beijing China
| | - H. A. Rowley
- School of Medicine and Public Health; University of Wisconsin; Madison WI USA
| | - D. Summers
- St Luke's Neuroscience Institute; Kansas City MO USA
| | - K. Tastula
- Royal Prince Alfred Hospital; Sydney NSW Australia
| | | | - N. M. Bornstein
- Tel-Aviv Medical Center; Tel-Aviv University; Tel-Aviv Israel
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Jaracz K, Grabowska-Fudala B, Górna K, Kozubski W. Consequences of stroke in the light of objective and subjective indices: A review of recent literature. Neurol Neurochir Pol 2014; 48:280-6. [DOI: 10.1016/j.pjnns.2014.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
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Predictors of poststroke health-related quality of life in Nigerian stroke survivors: a 1-year follow-up study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:350281. [PMID: 24982864 PMCID: PMC4058476 DOI: 10.1155/2014/350281] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 11/20/2022]
Abstract
This study aims to identify the predictors in the different aspects of the health-related quality of life (HRQoL) and to measure the changes of functional status over time in a cohort of Nigerian stroke survivors. A prospective observational study was conducted in three hospitals of Kano state of Nigeria where stroke survivors receive rehabilitation. The linguistic-validated Hausa versions of the stroke impact scale 3.0, modified Rankin scale, Barthel index and Beck depression inventory scales were used. Paired samples t-test was used to calculate the amount of changes that occur over time and the forward stepwise linear regression model was used to identify the predictors. A total of 233 stroke survivors were surveyed at 6 months, and 93% (217/233) were followed at 1 year after stroke. Functional disabilities were significantly reduced during the recovery phase. Motor impairment, disability, and level of depression were independent predictors of HRQoL in the multivariate regression analysis. The involvement of family members as caregivers is the key factor for those survivors with improved functional status. Thus, to enhance the quality of poststroke life, it is proposed that a holistic stroke rehabilitation service and an active involvement of family members are established at every possible level.
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Jenkinson C, Fitzpatrick R, Crocker H, Peters M. The Stroke Impact Scale: validation in a UK setting and development of a SIS short form and SIS index. Stroke 2013; 44:2532-5. [PMID: 23868278 DOI: 10.1161/strokeaha.113.001847] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The Stroke Impact Scale (SIS) covers 8 dimensions and a composite disability score. This study evaluates the SIS in the UK context, and develops a single index and an 8-item short form. METHODS Patients with a diagnosis of stroke were recruited through general practices in London and the North-West of England. Patients completed the SIS and the EQ-5D. RESULTS Internal consistency of the SIS dimensions and the disability score ranged from α 0.86 to 0.95. Complete data were available on 73 questionnaires (48.34%). Factor analysis suggested the 8 domains could be aggregated into a single index. A short-form SIS (SF-SIS) index was created by summing 1 item per dimension. Selected items were those that most highly correlated with their respective domain score (ρ ranged from 0.77-0.94, P<0.001). The SF-SIS index scores were highly correlated with those gained from the parent form (ρ=0.98; P<0.001). The correlation of the SIS index and SF-SIS index with the EQ-5D was identical (ρ=0.83; P<0.001). The disability score, whether scored from the dimensions of the SIS, or relevant items on the SF-SIS, were highly correlated (ρ=0.97; P<0.001). CONCLUSIONS The SIS covers aspects of health, which are of importance to stroke patients, and the dimensions were found to have high levels of internal consistency in the UK context. The amount of incomplete data suggests that the length of the questionnaire may present a substantial patient burden. In comparison to the parent form the SF-SIS can accurately provide the disability score and overall index score with considerable brevity.
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Affiliation(s)
- Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Chen CY, Huang YB, Tzu-Chi Lee C. Epidemiology and disease burden of ischemic stroke in Taiwan. Int J Neurosci 2013; 123:724-31. [PMID: 23594118 DOI: 10.3109/00207454.2013.796552] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The incidence and prevalence of ischemic stroke (IS) are increasing in Asian countries. We conducted this retrospective database research to investigate epidemiology and disease burden of IS in Taiwan. METHODS We identified cases from the National Health Insurance Research Database during period from 2000 to 2005 to calculate prevalence and mortality. We analyzed the relationship between disease burden and gender in Taiwan during the period from 2000 to 2005 using Dismod II. RESULTS From study period, stroke mortality increased from 50 to 2300 per 100 000 among individuals aged 50-90 years, with a higher prevalence among females than males. The highest prevalence was observed among men aged 80-84 years, but prevalence among women was highest in patients aged >85 years. The burden of stroke during the period per 1000 population was estimated as follows: the sum of the years of life lost as a result of premature mortality of 55-80 years, years lost as a result of disability of 11-19 years, and disability-adjusted life years (DALYs) of 70-80 years. Most of the DALYs of stroke occurred among those aged 65-69 years. The DALY value was higher among women than among men before 2005; there was no clear trend in 2005. CONCLUSIONS Stroke is a significant health concern in Taiwan. The associated disease burden was found to increase each year, especially among individuals aged 65-69 years. Overall, the DALY value increased from 2000 to 2005, which suggests that the associated disease burden will continue to increase over time.
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Affiliation(s)
- Chung-Yu Chen
- 1School of Pharmacy, Kaohsiung Medical University , Kaohsiung , Taiwan
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