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Han K, Liu G, Liu N, Li J, Li J, Cui L, Cheng M, Long J, Liao X, Tang Z, Liu Y, Liu J, Chen J, Lu H, Zhang H. Effects of Mobile Intelligent Cognitive Training for Patients with Post-Stroke Cognitive Impairment: A 12-Week, Multicenter, Randomized Controlled Study. J Alzheimers Dis 2024; 100:999-1015. [PMID: 38968051 DOI: 10.3233/jad-240356] [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: 07/07/2024]
Abstract
Background The current application effects of computerized cognitive intervention are inconsistent and limited to hospital rehabilitation settings. Objective To investigate the effect of mobile intelligent cognitive training (MICT) on patients with post-stroke cognitive impairment (PSCI). Methods This study was a multicenter, prospective, open-label, blinded endpoint, cluster-randomized controlled trial (RCT). 518 PSCI patients were stratified and assigned to four rehabilitation settings, and then patients were randomized into experimental and control groups in each rehabilitation setting through cluster randomization. All patients received comprehensive management for PSCI, while the experimental group additionally received MICT intervention. Treatment was 30 minutes daily, 5 days per week, for 12 weeks. Cognitive function, activities of daily living (ADL), and quality of life (QOL) were assessed before the treatment, at weeks 6 and 12 post-treatment, and a 16-week follow-up. Results Linear Mixed Effects Models showed patients with PSCI were better off than pre-treatment patients on each outcome measure (p < 0.05). Additionally, the improvement of these outcomes in the experimental group was significantly better than in the control group at week 6 post-treatment and 16-week follow-up (p < 0.05). The rehabilitation setting also affected the cognitive efficacy of MICT intervention in improving PSCI patients, and the degree of improvement in each outcome was found to be highest in hospital, followed by community, nursing home, and home settings. Conclusions Long-term MICT intervention can improve cognition, ADL, and QOL in patients with PSCI, with sustained effects for at least one month. Notably, different rehabilitation settings affect the cognitive intervention efficacy of MICT on PSCI patients. However, this still needs to be further determined in future studies.
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Affiliation(s)
- Kaiyue Han
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | | | - Nan Liu
- Beijing Puren Hospital, Beijing, China
| | - Jiangyi Li
- Beijing Dongcheng District Kangfu One Two Three Health Training Center, Beijing, China
| | - Jianfeng Li
- Beijing Yangfangdian Hospital, Beijing, China
| | - Lihua Cui
- Beijing Fengtai District Jiaxiang Nursing-Home for the Elderly, Beijing, China
- Beijing Fengtai You Anmen Hospital, Beijing, China
| | - Ming Cheng
- Beijing Haidian District Guolilai Elderly Care Center, Beijing, China
| | - Junzi Long
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
- Changping Laboratory, Beijing, China
| | - Xingxing Liao
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
- Changping Laboratory, Beijing, China
| | - Zhiqing Tang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Ying Liu
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Jiajie Liu
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Jiarou Chen
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Haitao Lu
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Hao Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
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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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Alvarenga MTM, Ada L, Preston E, Caetano LCG, Teixeira-Salmela LF, Scianni AA. Home-based self-management for sedentary individuals with mild walking disability after stroke: protocol for a randomised pilot study. BMC Neurol 2023; 23:412. [PMID: 37986149 PMCID: PMC10659041 DOI: 10.1186/s12883-023-03461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND A Phase I study showed that it is feasible to implement a home-based self-management program aimed at increasing physical activity in individuals after stroke with mild walking disability in Brazil. The next step is to test this program against a control group in order to provide a power analysis for a fully-powered Phase III clinical trial. METHODS A Phase II pilot randomised clinical trial with concealed allocation, blinded measurement, and intention-to-treat analyses will be carried out. The inclusion criteria will be individuals diagnosed with stroke, in the acute or subacute phase, with mild walking disability, sedentary, and no significant language impairment. The participants will be randomly allocated to the experimental or control group. The experimental group will receive six sessions of a home-based self-management program based on behaviour change techniques through the Social-Cognitive Theory and Control Theory over 11 weeks. The control group will receive one session of education about stroke (regarding the importance of practising physical activity after a stroke) and usual care. A total of 24 participants will be recruited. The primary outcome will be physical activity, measured through steps taken per day by an activity monitor (Actigraph wGT3X-BT, Pensacola, FL, USA). The mean of daily steps will be analysed to compare groups after intervention. Secondary outcomes will be cardiovascular risk (body mass index, waist circumference, and blood pressure), depressive symptoms (Geriatric Depression Scale), walking ability (6-Minute Walk Test and 10-Meter Walk Test), exercise self-efficacy (Self-Efficacy for Exercise scale), social participation (Stroke Impact Scale) and quality of life (EuroQual-5D). Two-way analyses of variance will be implemented for all parametric outcomes, and the Kruskal-Wallis test for non-parametric outcomes will be used to determine the statistical significance of the between-group differences and reported as mean differences between groups (95% CI). All analyses will be conducted intention-to-treat. All outcomes will be measured at baseline (Week 0), post-intervention (Week 12), and follow-up (Week 24). This pilot clinical trial was registered online at Clinical Trials under number NCT05461976 on 4th April 2022. DISCUSSION If beneficial, this Phase II pilot randomised trial will provide data to plan a fully powered future Phase III clinical trial aimed at verifying the efficacy of this program to promote physical activity after stroke. TRIAL REGISTRATION Clinical Trials NCT05461976 on 4th April 2022.
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Affiliation(s)
- Maria Tereza Mota Alvarenga
- Department of Physiotherapy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos 6627- Pampulha, Belo Horizonte, 31270-901, Brazil
| | - Louise Ada
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Elisabeth Preston
- School of Rehabilitation and Exercise Science, University of Canberra, Canberra, Australia
| | - Lívia Cristina Guimarães Caetano
- Department of Physiotherapy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos 6627- Pampulha, Belo Horizonte, 31270-901, Brazil
| | - Luci Fuscaldi Teixeira-Salmela
- Department of Physiotherapy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos 6627- Pampulha, Belo Horizonte, 31270-901, Brazil
| | - Aline A Scianni
- Department of Physiotherapy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos 6627- Pampulha, Belo Horizonte, 31270-901, Brazil.
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Almeida LRS, Valenca GT, Canning CG, Carvalho K, Silva AC, Oliveira-Filho J, Pinto EB. Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral (FaB-Brazil) Scale. Disabil Rehabil 2023; 45:3922-3929. [PMID: 36373004 DOI: 10.1080/09638288.2022.2141356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To develop and cross-culturally adapt a Brazilian-Portuguese version of the Falls Behavioral Scale (FaB-Brazil) and to verify its psychometric properties. MATERIAL AND METHODS The translation and cross-cultural adaptation process of the scale followed standard guidelines. The FaB-Brazil scale was applied to 93 community-dwelling older people. Cronbach's alpha was calculated to evaluate internal consistency and the intraclass correlation coefficient (ICC) to evaluate interrater and test-retest reliability. The standard error of measurement (SEM), minimal detectable change (MDC), ceiling and floor effects, convergent and discriminative validity were evaluated. A significance level of .05 was set for statistical analyses. RESULTS Internal consistency was moderate (α = 0.73). An excellent inter-rater (ICC = 0.93; p < 0.001) and a good test-retest (ICC = 0.79; p < 0.001) reliability were found. The SEM was 0.27 and MDC was 0.53. Neither ceiling nor floor effects were found. Convergent validity was established by the positive correlations between the FaB-Brazil scale, age, and functional mobility, and by the negative correlations between the FaB-Brazil scale and balance confidence, community mobility and EuroQol-5D (p < 0.05). No significant differences were found between males and females and between non-fallers and fallers. CONCLUSIONS Our results offer evidence for the reliability and validity of the FaB-Brazil scale for community-dwelling older people.Implications for RehabilitationFall-related behaviors should be part of the fall risk assessment of community-dwelling older people.The Brazilian-Portuguese version of the Falls Behavioral Scale (FaB-Brazil) is reliable and valid for assessing fall-related behaviors in community-dwelling older people.The FaB-Brazil scale may be used to raise awareness about potential fall hazards and to guide fall prevention programs.
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Affiliation(s)
- Lorena Rosa S Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Brazil
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Brazil
| | - Guilherme T Valenca
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Brazil
- Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kárin Carvalho
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Brazil
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil
| | - Adriana Campos Silva
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Brazil
- Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Jamary Oliveira-Filho
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil
| | - Elen Beatriz Pinto
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Brazil
- Department of Life Sciences (DCV), Bahia State University, Salvador, Brazil
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Oliveira-Kumakura ARDS, Batista LMOS, Spagnol GS, Valler L. Functionality and quality of life in Brazilian patients 6 months post-stroke. Front Neurol 2023; 14:1020587. [PMID: 37153670 PMCID: PMC10157197 DOI: 10.3389/fneur.2023.1020587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/14/2023] [Indexed: 05/10/2023] Open
Abstract
Background Surviving a stroke poses a social and economic impact that requires the care system to be reformulated and the patient to be addressed in a comprehensive approach. Purpose This study aims to investigate if there is a relationship between functional activities performed before the stroke, patients' clinical and hospitalization data, and functionality and quality of life measures in the first 6 months after the stroke. Methods This study used a prospective cohort of 92 patients. We investigated sociodemographic and clinical data, the modified Rankin Scale (mRS), and the Frenchay Activities Index (FAI) during hospitalization. The Barthel Index (BI) and EuroQol-5D (EQ-5D) were applied at the following time points: 30 days (T1), 90 days (T2), and 180 days (T3) following postictal state. Statistical analysis was conducted using Spearman's coefficient, Friedman's non-parametric test, and multiple linear regression models. Results No correlation was found between FAI, BI, and EQ-5D average scores. Severe patients, patients with comorbidities, and patients with extended hospital stays showed lower BI and EQ-5D scores □in the follow-up. BI and EQ-5D scores increased. Conclusion This research found no relationship between activities performed before the stroke and functionalities and quality of life after the stroke, but comorbidities and extended hospital stay were associated with worse outcomes.
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Affiliation(s)
- Ana Railka de Souza Oliveira-Kumakura
- School of Nursing, University of Campinas, Campinas, Brazil
- Nursing Sciences Research Chair, Laboratory Education and Health Promotion, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Gabriela Salim Spagnol
- Nursing School, Anhanguera University, Sumaré, Brazil
- Knowledge Management and Education Solutions, Cogna Education, Valinhos, Brazil
| | - Lenise Valler
- Clinical Hospital, University of Campinas, Campinas, Brazil
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Self-management to promote physical activity after discharge from in-patient stroke rehabilitation: a feasibility study. Top Stroke Rehabil 2023; 30:32-42. [PMID: 34581249 DOI: 10.1080/10749357.2021.1978630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To investigate the feasibility of a self-management program aimed at increasing physical activity in community-dwelling ambulators after stroke in a middle-income country with high income inequality. METHODS A Phase 1, pre-post intervention study was conducted with 20 sub-acute stroke participants. The self-management program was delivered in six home-based sessions over 3 months. Feasibility of recruitment, intervention, and measurement was determined. Physical activity, cardiovascular risk, depression, walking speed, self-efficacy for exercise, participation, and quality of life were measured at baseline, 3, and 6 months. RESULTS 16% of eligible participants were recruited. 90% completed the program and were measured at 3 months, and 65% at 6 months. The most common reasons for withdrawal were return to work, lack of interest/motivation and surgery. 92% of the sessions were delivered for 59 (SD 23) minutes per session. Participants did not increase physical activity at 3 months (MD 364 steps/day, 95% CI -282 to 1010) or 6 months (MD 312 steps/day, 95% CI -881 to 1504). Post-hoc analysis showed that sedentary participants increased their step count at 3 months by 1,300 (95% CI 152 to 2447) and at 6 months by 1,701 (95% CI -556 to 3959) more steps than non-sedentary participants. CONCLUSIONS A Phase 2 study of the self-management program appears to be feasible in a middle-income country with high income inequality and has the potential to increase physical activity levels in sedentary individuals with mild disability after stroke. TRIAL REGISTRATION RBR-6bdmsk.
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Bazan R, Fonseca BHDS, Miranda JMDA, Nunes HRDC, Bazan SGZ, Luvizutto GJ. Effect of Robot-Assisted Training on Unilateral Spatial Neglect After Stroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Neurorehabil Neural Repair 2022; 36:545-556. [PMID: 35880666 DOI: 10.1177/15459683221110894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several studies have shown that robotic devices can effectively improve motor function in stroke patients through limb activation. However, the effects of robot-assisted therapy on perceptual deficits after stroke is unclear. OBJECTIVE This review aimed to evaluate the effectiveness of robotic limb activation in patients with unilateral spatial neglect (USN) after stroke. METHODS In this systematic review, a literature search was performed using MEDLINE, EMBASE, CENTRAL, CINAHL, and LILACS databases without language restrictions. Randomized controlled trials (RCTs) and quasi-RCTs of robot-assisted therapy for USN after stroke were selected. Two reviewers independently assessed the risk of bias and certainty of the evidence of the included studies. RESULTS A total of 630 studies were identified, including five studies for qualitative synthesis and four meta-analyses. The results of RCTs comparing robotic limb activation with a control group suggested an improvement in the degree of USN measured by the line bisection test (standardized mean difference [SMD], -0.64; 95% confidence interval [CI], -1.13 to -0.15; P = .01). There were no differences between the groups in the motor-free visual perception test 3rd edition (SMD, 0.27; 95% CI, -0.25-0.79; P = .31), star cancellation test (SMD, 0.26; 95% CI, -0.42-0.94; P = .54), Albert's test (SMD, -0.67; 95% CI, -2.01-0.66; P = .32), and Catherine Bergego Scale (SMD, -0.81; 95% CI, -2.07-0.45; P = .21). CONCLUSION The study demonstrated that limb activation through robotic therapy can improve midline perception. However, there was no impact on tasks assessing visual scanning, functionality, or activities of daily living.
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Affiliation(s)
- Rodrigo Bazan
- Department of Neurology, Psychology, and Psychiatry at Botucatu Medical School (UNESP), Botucatu, São Paulo, Brazil
| | | | | | | | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy-Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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da Silva TR, de Carvalho Nunes HR, Martins LG, da Costa RDM, de Souza JT, Winckler FC, Sartor LCA, Modolo GP, Ferreira NC, da Silva Rodrigues JC, Kanda R, Fogarolli MO, Borges GF, Rizzatti GRS, Ribeiro PW, Favoretto DB, Aguiar L, Zanati Bazan SG, Betting LEG, de Oliveira Antunes LC, Mendes Pereira V, Santos TEG, Pontes-Neto O, Conforto AB, Bazan R, Luvizutto GJ. Brain stimulation can reduce unilateral spatial neglect after stroke: ELETRON trial. Ann Neurol 2022; 92:400-410. [PMID: 35688801 DOI: 10.1002/ana.26430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rehabilitation top-down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal direct current stimulation (A-tDCS and C-tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke. METHODS This double-blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to Behavior Inattention Test Conventional (BIT-C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 min of tDCS. The primary outcome was the USN degree evaluated by the BIT-C. Secondary outcomes were the difference in CBS score, stroke severity [National Institutes of Health Stroke Scale (NIHSS)], disability [modified Rankin Scale (mRS)], autonomy [Barthel Index (BI), functional independence measure (FIM)], and quality of life (EQ-5D). Outcomes were analyzed using ANCOVA model corrected by age, baseline NIHSS and baseline BIT-C. Pairwise posthoc comparisons were performed using Bonferroni correction. RESULTS In the primary outcomes, A-tDCS led to greater improvement in BIT-C after intervention (MD: 18.4; 95%CI: 3.9-32.8; p=0.008) compared to sham. However, no significant differences were observed between A-tDCS and C-tDCS (MD: 13.9; 95%CI: -0.3-28.1; p=0.057), or C-tDCS and sham (MD: 4.5; 95%CI: -9.7-18.8; p=0.99). There were no significant differences between groups in terms of secondary outcomes. CONCLUSIONS A-tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase III trial. REGISTRATION URL: https://ensaiosclinicos.gov.br/; Unique Identifier RBR-78jvzx This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Rafael Kanda
- Department of Neurology, Psychology and Psychiatry at Botucatu Medical School (UNESP)
| | | | | | | | | | - Diandra B Favoretto
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Luan Aguiar
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | | | - Taiza E Grespan Santos
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Octávio Pontes-Neto
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Adriana Bastos Conforto
- Hospital das Clínicas São Paulo University and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry at Botucatu Medical School (UNESP)
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
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Adding Physical Activity Coaching and an Activity Monitor Was No More Effective Than Adding an Attention Control Intervention to Group Exercise for Patients With Chronic Nonspecific Low Back Pain (PAyBACK Trial): A Randomized Trial. J Orthop Sports Phys Ther 2022; 52:287-299. [PMID: 35536245 DOI: 10.2519/jospt.2022.10874] [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: 02/07/2023]
Abstract
OBJECTIVE To investigate whether adding physical activity coaching and an activity monitor enhanced the effects of a group exercise program on pain intensity and disability for people with chronic nonspecific low back pain. DESIGN Randomized controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors. METHODS One hundred sixty participants with chronic nonspecific low back pain who were aged between 18 and 60 years and seeking care at an outpatient physiotherapy clinic participated. Both groups received supervised group exercise therapy. The intervention group also received physical activity coaching sessions aimed at improving physical activity, and physical activity electronic feedback delivered by an activity monitor. The attention control group received modified approaches of coaching sessions and an activity monitor. Disability was measured using the Roland Morris Disability Questionnaire (0-24), and pain intensity was measured using the 11-point Numerical Rating Scale (0-10). Linear mixed models were performed to test for differences between groups. RESULTS There were no differences between groups for reductions in disability (mean difference [MD] = -0.5 out of 24 points; 95% confidence interval [CI]: -2.2, 1.1) and pain intensity (MD = -0.4 out of 10 points; 95% CI: -1.3, 0.5) at 3-month follow-up. There were no between-groups differences at 6- and 12-month follow-up assessments. CONCLUSION Adding targeted physical activity coaching and an activity monitor did not reduce pain intensity or disability more than an attention control approach in participants with chronic low back pain who were undertaking a group exercise program. J Orthop Sports Phys Ther 2022;52(5):287-299. doi:10.2519/jospt.2022.10874.
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Individualized Home-based rehabilitation after stroke in France: a pragmatic study of a Community Stroke Rehabilitation Team. Neurol Sci 2022; 50:405-410. [PMID: 35477586 DOI: 10.1017/cjn.2022.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Community stroke rehabilitation teams (CSRT) provide an individualized home-based rehabilitation service to patients recovering from stroke. OBJECTIVE To examine whether there is an improvement in the social participation of patients who received a rehabilitation program provided by CSRT. The secondary objectives were to show if there is an improvement in the patients' quality of life and a reduction in the caregiver burden. METHODS Retrospective cohort study, pragmatic in real-care conditions. The rehabilitation program delivered by the CSRT was adapted to the needs of the patients and caregivers. The outcome questionnaires included: the Frenchay Activity Index (FAI), the Minizarit, the EuroQol EQ5D, and the Barthel Index. The primary outcome measure was the FAI. RESULTS We included 206 patients followed by the CSRT over the 2018-2020 study period, for whom the primary endpoint was present. The mean age was 66.3 ± 12.7 years, the post-stroke delay was 16.4 ± 32.7 months, and the Barthel index was 66.42 ± 12.6. The duration of the rehabilitation program was on average 162 ± 109 days. We observed a significant improvement in the FAI, from 12.9 ± 10.4 to 17.85 ± 12.4 (p < 0.00001); in the EuroQol, from 57.51 ± 19.96 to 66.36 ± 18.87 (p < 0.00001); in the mini-Zarit, from 2.49 ± 1.75 to 2.06 ± 1.67 (p = 0.0002); and in the Barthel index, from 66.42 ± 12.67 to 84.81 ± 23.70 (p < 0.001). CONCLUSION Patients who received a rehabilitation program by the CSRT have an improvement in their social participation, and their informal caregivers have a reduction in their burden.
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Healthcare, Clinical Factors and Rehabilitation Predicting Quality of Life in First-time Stroke Patients: A 12-month Longitudinal Study. J Stroke Cerebrovasc Dis 2022; 31:106300. [DOI: 10.1016/j.jstrokecerebrovasdis.2021.106300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
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12
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Fernández-Sanchis D, Brandín-de la Cruz N, Jiménez-Sánchez C, Gil-Calvo M, Herrero P, Calvo S. Cost-Effectiveness of Upper Extremity Dry Needling in Chronic Stroke. Healthcare (Basel) 2022; 10:healthcare10010160. [PMID: 35052323 PMCID: PMC8775940 DOI: 10.3390/healthcare10010160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions. Objective: The aim of this study was to evaluate the cost-effectiveness of a single dry needling session in patients with chronic stroke. Methods: A cost-effectiveness analysis was performed based on a randomized controlled clinical trial. The results obtained from the values of the EuroQol-5D questionnaire and the Modified Modified Ashworth Scale were processed in order to obtain the percentage of treatment responders and the quality-adjusted life years (QALYs) for each alternative. The cost analysis was that of the hospital, clinic, or health center, including the equipment and physiotherapist. The cost per respondent and the incremental cost-effectiveness ratio of each alternative were assessed. Results: Twenty-three patients with stroke were selected. The cost of DN treatment was EUR 14.96, and the data analysis showed a favorable cost-effectiveness ratio of both EUR/QALY and EUR/responder for IG, although the sensitivity analysis using limit values did not confirm the dominance (higher effectiveness with less cost) of the dry needling over the sham dry needling. Conclusions: Dry needling is an affordable alternative with good results in the cost-effectiveness analysis—both immediately, and after two weeks of treatment—compared to sham dry needling in persons with chronic stroke.
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Affiliation(s)
- Daniel Fernández-Sanchis
- Faculty of Health Sciences, Universidad San Jorge, Autovía A-23 Zaragoza-Huesca Km.299, Villanueva de Gállego, 50830 Zaragoza, Spain; (D.F.-S.); (N.B.-d.l.C.); (C.J.-S.)
| | - Natalia Brandín-de la Cruz
- Faculty of Health Sciences, Universidad San Jorge, Autovía A-23 Zaragoza-Huesca Km.299, Villanueva de Gállego, 50830 Zaragoza, Spain; (D.F.-S.); (N.B.-d.l.C.); (C.J.-S.)
| | - Carolina Jiménez-Sánchez
- Faculty of Health Sciences, Universidad San Jorge, Autovía A-23 Zaragoza-Huesca Km.299, Villanueva de Gállego, 50830 Zaragoza, Spain; (D.F.-S.); (N.B.-d.l.C.); (C.J.-S.)
| | - Marina Gil-Calvo
- IIS Aragon, University of Zaragoza, Avda. San Juan Bosco, 13, 50009 Zaragoza, Spain; (M.G.-C.); (S.C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n., 50009 Zaragoza, Spain
| | - Pablo Herrero
- IIS Aragon, University of Zaragoza, Avda. San Juan Bosco, 13, 50009 Zaragoza, Spain; (M.G.-C.); (S.C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n., 50009 Zaragoza, Spain
- Correspondence:
| | - Sandra Calvo
- IIS Aragon, University of Zaragoza, Avda. San Juan Bosco, 13, 50009 Zaragoza, Spain; (M.G.-C.); (S.C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n., 50009 Zaragoza, Spain
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13
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Del Brutto VJ, Rundek T, Sacco RL. Prognosis After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Calvo S, Brandín-de la Cruz N, Jiménez-Sánchez C, Bravo-Esteban E, Herrero P. Effects of dry needling on function, hypertonia and quality of life in chronic stroke: a randomized clinical trial. Acupunct Med 2021; 40:312-321. [PMID: 34894776 DOI: 10.1177/09645284211056347] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persons with stroke commonly have impairments associated with a reduction in functionality. Motor impairments are the most prevalent, causing an impact on activities of daily life. OBJECTIVE The aim of this study was to evaluate the effect of a session of dry needling (DN) applied to the upper extremity muscles on the sensorimotor function, hypertonia, and quality of life of persons with chronic stroke. METHODS A randomized, sham-controlled clinical trial was performed. Participants were randomly assigned into an intervention group that received a single session DN in the biceps brachii, brachialis, flexor digitorum superficialis and profundus, extensor digitorum, adductor pollicis and triceps brachii muscles, or into a control group that received the same treatment but with a sham DN intervention. Treatment outcomes included the Fugl-Meyer Assessment Scale for the upper extremity, the Modified Modified Ashworth Scale, and the EuroQol-5D questionnaire. Measurements were carried out before, immediately after, and 14 days after intervention. RESULTS Twenty-three persons participated in the study. Significant differences between groups were observed after the intervention in the total wrist-hand motor score (p = 0.023) and sensorimotor score (p = 0.022), for hypertonia in the elbow extensors both after treatment (p = 0.002) and at follow-up (p = 0.018), and in quality of life at follow-up (p = 0.030). CONCLUSIONS A single session of DN improved total wrist-hand motor function and total sensorimotor function in persons with chronic stroke immediately after treatment, as well as quality of life 2 weeks after treatment. TRIAL REGISTRATION NUMBER NCT03546517 (ClinicalTrials.gov).
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Affiliation(s)
- Sandra Calvo
- IIS Aragon, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | | | - Elisabeth Bravo-Esteban
- Faculty of Health Sciences, Universidad San Jorge, Zaragoza, Spain.,Toledo Physiotherapy Research Group (GIFTO), E.U.E. Fisioterapia de Toledo, Universidad Castilla La Mancha, Toledo, Spain
| | - Pablo Herrero
- IIS Aragon, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
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15
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Kainz A, Meisinger C, Linseisen J, Kirchberger I, Zickler P, Naumann M, Ertl M. Changes of Health-Related Quality of Life Within the 1st Year After Stroke-Results From a Prospective Stroke Cohort Study. Front Neurol 2021; 12:715313. [PMID: 34671308 PMCID: PMC8520951 DOI: 10.3389/fneur.2021.715313] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: As prospective data on long-term patient-reported outcome measures (PROMs) to assess Health related Quality of Life (HRQoL) after stroke are still scarce, this study examined the long-term course of PROMs and investigated influential factors such as recanalization therapies. Materials and Methods: A total of 945 (mean age 69 years; 56% male) stroke patients were enrolled with a personal interview and chart review performed at index event. One hundred forty (15%) patients received thrombolysis (IVT) and 53 (5%) patients received endovascular therapy (ET) or both treatments as bridging therapy (BT). After 3 and 12 months, a follow-up was conducted using a postal questionnaire including subjective quality of life EQ-5D-5L (European Quality of Life 5 Dimensions). At all time-points, Modified Rankin Scale (mRS) was additionally used to quantify functional stroke severity. Differences between therapy groups were identified using post-hoc-tests. Linear and logistic regression analyses were used to identify predictors of outcomes. Results: Recanalization therapies were associated with significant improvements of NIHSS (National Institutes of Health Stroke Scale [regression coefficient IVT 1.21 (p = 0.01) and ET/BT 7.6; p = 0.001] and mRS (modified Rankin Scale) [regression coefficient IVT 0.83; p = 0.001 and ET/BT 2.0; p = 0.001] between admission and discharge compared to patients with stroke unit therapy only, with a trend toward improvement of EQ-5D after 12 months [regression coefficient 4.67 (p = 0.17)] with IVT. HRQoL was considerably impaired by stroke and increased steadily in 3- and 12-months follow-up in patients with (mean EQ-5D from 56 to 68) and without recanalization therapy (mean EQ-5D from 62 to 68). In severe strokes a major and significant improvement was only detected during period of 3 to 12 months (p = 0.03 in patients with and p = 0.005 in patients without recanalization therapy). Conclusions: Despite significant and continuous improvements after stroke the HRQoL after 12 months remained below the age-matched general population, but was still unexpectedly high in view of the accumulation of permanent disabilities in up to 30% of the patients. Especially in severe strokes, it is important to evaluate HRQoL beyond a 3-months follow-up as improvements became significant only between 3 months and 1 year.
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Affiliation(s)
- Anabelle Kainz
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, University Augsburg, University Hospital Augsburg, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, University Augsburg, University Hospital Augsburg, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Inge Kirchberger
- Chair of Epidemiology, University Augsburg, University Hospital Augsburg, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Philipp Zickler
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Markus Naumann
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Michael Ertl
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
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16
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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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17
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Chagas TDJ, Cravo ISDS, Bazan R, de Souza LAPS, Luvizutto GJ. Effects of transcranial direct current stimulation on balance after ischemic stroke (SANDE trial): Study protocol for a multicentric randomized controlled trial. Contemp Clin Trials 2021; 105:106396. [PMID: 33831502 DOI: 10.1016/j.cct.2021.106396] [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: 02/17/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Among the tools used for motor rehabilitation after stroke, transcranial direct current electrical stimulation (tDCS) aims to modify cortical excitability and improve motor function. Despite promising results, the effects of tDCS on balance after stroke have not yet been assessed using specific protocols. Therefore, this study will aim to evaluate the effects of tDCS and rehabilitation on balance after stroke. METHODS Eighty-two ischemic stroke patients across two inpatient rehabilitation sites in Brazil will be randomized into one of two treatment programs (anodic tDCS and sham tDCS), both associated with balance training, each 2 days/week, for six weeks and monitored for exertion, repetition and quality of movements. The primary outcome measure is the balance. Secondary outcomes will include clinical and functional measures. Outcome data will be assessed at two time points. DISCUSSION This trial will contribute to clarify if anodal tDCS is effective when associated with balance training to stroke recovery.
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Affiliation(s)
- Tatiane de Jesus Chagas
- Physical Therapy Department, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | | | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), Botucatu, São Paulo, Brazil
| | | | - Gustavo José Luvizutto
- Physical Therapy Department, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.
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18
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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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19
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Cuenca Zaldívar JN, Calvo S, Bravo-Esteban E, Oliva Ruiz P, Santi-Cano MJ, Herrero P. Effectiveness of dry needling for upper extremity spasticity, quality of life and function in subacute phase stroke patients. Acupunct Med 2020; 39:299-308. [PMID: 32815384 DOI: 10.1177/0964528420947426] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Stroke is the fourth leading cause of death in Europe, represents one of the most common causes of disability in adult patients, and involves considerable short- and long-term social and healthcare costs. The effectiveness of deep dry needling (DDN) on affected arm functionality was assessed throughout 8 weeks of treatment in patients with stroke in the subacute phase. METHODS Eighty patients were included in this two-group non-randomised study after a propensity score analysis was carried out. Both groups received standard physiotherapy treatment on the affected arm. The needling group also received six sessions of DDN during the 8-week period. Patients were evaluated before and after each session using the Fugl-Meyer upper extremity (FM UE) scale, the modified modified Ashworth scale (MMAS), the resistance to passive movement scale (REPAS) and a 10-point numeric pain rating scale (NPRS 10). The Brunnstrom recovery stage was recorded at the beginning and at the end of the study, and the EuroQoL quality of life survey was completed at the beginning of the study, after the first month of treatment and at the end of the study. RESULTS Patients treated with DDN showed a reduction in spasticity measured using the REPAS (p < 0.001) and the MMAS (p < 0.05). There was also an improvement in the Brunnstrom recovery stages (p < 0.05). CONCLUSION The addition of a specific DDN treatment to a standard physiotherapy treatment appeared to lead to a higher reduction in spasticity in the affected arm; however, it did not provide additional changes in functionality, pain and quality of life. Further studies with a randomised controlled trial design are required to confirm our findings.
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Affiliation(s)
- Juan Nicolás Cuenca Zaldívar
- Rehabilitation Service, Guadarrama Hospital, Guadarrama, Spain.,School of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - Sandra Calvo
- School of Health Sciences, San Jorge University, Zaragoza, Spain
| | | | - Petronila Oliva Ruiz
- School of Health Sciences, Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cádiz, Cádiz, Spain
| | - Maria José Santi-Cano
- School of Health Sciences, Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cádiz, Cádiz, Spain
| | - Pablo Herrero
- School of Health Sciences, San Jorge University, Zaragoza, Spain
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Cunha CM, da Cunha DCPT, Manzato RDO, Nepomuceno E, da Silva D, Dantas RAS. Validation of the Brazilian Version of the Patient Activation Measure 13. J Nurs Meas 2020; 27:97-113. [PMID: 31068494 DOI: 10.1891/1061-3749.27.1.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE To assess the psychometric properties of the PAM13 Brazilian-Portuguese (PAM13-B) among outpatients with chronic diseases. METHODS 513 adults participated, diagnosed with a chronic disease for more than 6 months, under outpatient monitoring. Reliability was tested using internal consistency and test-retest reliability. Construct validity was verified through different techniques (correlation between activation and self-esteem measures, anxiety, depression and health status), known-groups validity and dimensionality by means of confirmatory factor analysis. Significance was set at 0.05. RESULTS The PAM13-B presented appropriate results for internal consistency (α = 0.83) and test-retest reliability (intraclass correlation coefficient [ICC] = 0.81). A moderate correlation was found between activation and self-esteem only (r = 0.43, p < 0.001). The one-dimensional structure was not confirmed in the sample analyzed. CONCLUSIONS In the study sample, the version PAM13-B demonstrated its reliability and validity, but with a two-factor structure.
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Affiliation(s)
| | | | | | - Eliane Nepomuceno
- University of São Paulo at Ribeirão Preto College of Nursing-São Paulo State, Brazil
| | - Dirceu da Silva
- University of Campinas, Faculty of Education, Campinas-São Paulo State, Brazil
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21
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Martins LG, Molle da Costa RD, Alvarez Sartor LC, Thomaz de Souza J, Winckler FC, Regina da Silva T, Modolo GP, Nunes HRDC, Bazan SGZ, Martin LC, Luvizutto GJ, Bazan R. Clinical factors associated with trunk control after stroke: A prospective study. Top Stroke Rehabil 2020; 28:181-189. [PMID: 32772828 DOI: 10.1080/10749357.2020.1805244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Poor trunk control after stroke can impact recovery of global functional abilities. Therefore, the aim of this study was to evaluate whether clinical and functional data from stroke participants can be used to predict trunk control at 90 days. METHODS This is a prospective study of 37 participants with stroke. The variables evaluated at hospital discharge were stroke severity (National Institute of Health Stroke Scale - NIHSS); functional capacity (modified Rankin scale - mRS); handgrip; and cognitive function. At 90 days, the variables evaluated were autonomy (Functional Independence Measure - FIM, Barthel Index); gait mobility (Tinetti mobility test -TMT); quality of life (European Quality of Life Scale - EuroQol-5D) and trunk control (trunk impairment scale - TIS). The participants were considered to have satisfactory (TIS³14) or non-satisfactory trunk control (TIS≤13), and the differences between them were assessed by chi-square test (categorical variables) and Mann-Whitney/unpaired t-test (continuous variables). A ROC curve was used to show cut-off value of clinical variables to predict trunk control. RESULTS The unsatisfactory trunk control group presented ahigher NIHSS at discharge (p=0.01), higher mRS at discharge (p=0.00), lower Barthel Index at 90 days (p=0.03), lower FIM at 90 days (p=0.01) and lower TMT at 90 days (p=0.00) than the satisfactory trunk control group. The best cut-off points for the NIHSS and mRS scores at discharge for predicting unsatisfactory trunk control are ≥6 and ≥3, respectively. CONCLUSION Greater NIHSS and mRS scores at hospital discharge increase the chance of unsatisfactory trunk control at 90 days after stroke.
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Affiliation(s)
| | | | | | - Juli Thomaz de Souza
- Doctorate student in Physiopathology in Internal Medicine, Botucatu Medical School, Botucatu, Brazil
| | | | - Taís Regina da Silva
- Rehabilitation Department, Botucatu Medical School, Botucatu, Brazil.,Doctorate student in Physiopathology in Internal Medicine, Botucatu Medical School, Botucatu, Brazil
| | | | | | | | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Botucatu, Brazil
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22
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Abedini MR, Bijari B, Miri Z, Shakhs Emampour F, Abbasi A. The quality of life of the patients with diabetes type 2 using EQ-5D-5 L in Birjand. Health Qual Life Outcomes 2020; 18:18. [PMID: 32000785 PMCID: PMC6990543 DOI: 10.1186/s12955-020-1277-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to high prevalence of diabetes and its complications, evaluating of the patients' quality of life is critical. EQ-5D-5 L is a valid tool for assessing the quality of life in chronic diseases including diabetes. The present study conducted to illustrate the quality of life for the patients who referred to the Diabetes clinic and determine its relationship with their demographic and clinical characteristics in Birjand in 2017. METHODS In this cross-sectional study, 300 patients with type 2 diabetes were selected through a systematic sampling in 2017. Data were collected using a checklist including patients' demographic, clinical and laboratory information and the EQ-5D-5 L. Data were entered the SPSS (22) software, analyzed by independent sample T-test, ANOVA, Chi-Square and logistic regression tests. Statistical significance was inferred at α = 0.05. RESULTS Mean age for the participants was 58.1 ± 9.6 years. The mean score for the quality of life based on the EQ-5D-5 L and VAS scale were 0.89 ± 0.13 and 65.22 ± 9.32, respectively. Moderate and severe problems were found in the anxiety/depression dimensions in 12% of the patients, while these numbers for the presence of pain/discomfort and mobility were slightly higher (13.7 and 13.6%, respectively). The mean scores for quality of life and VAS were significantly higher in the men, employed and patients < 50 years age. CONCLUSION The quality of life for the type 2 diabetes patients is affected by numerous factors including sex, occupation, duration of the disease and the presence of complications such as neuropathy and nephropathy.
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Affiliation(s)
- Mohammad Reza Abedini
- Cellular and Molecular Research Center, Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Bita Bijari
- Cardiovascular Diseases Research Center, Community Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Zahra Miri
- Birjand University of Medical Sciences, Birjand, Iran
| | - Fatemeh Shakhs Emampour
- Anesthesiology, Department of Anesthesia, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Abbasi
- Medical education, Birjand University of Medical Sciences, Birjand, Iran
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23
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Godlwana L, Stewart A, Musenge E. The effect of a home exercise intervention on persons with lower limb amputations: a randomized controlled trial. Clin Rehabil 2019; 34:99-110. [PMID: 31617395 DOI: 10.1177/0269215519880295] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To establish if a home-based exercise and education programme is more effective than usual treatment in improving function, mobility and quality of life in people with lower limb amputation due to peripheral vascular disease. METHOD A blocked randomized single-blinded controlled trial (RCT) with 154 participants (54 female; mean age 58) compared a home-based exercise and education programme (n = 77) with usual care (control) (n = 77). Participants were measured at baseline, immediately post intervention at three months, and after a further three months without any intervention. The outcome measures were the Barthel Index, Participation Scale, EuroQuol 5D, Modified Locomotor Capability Index and Timed Up and Go Test. Changes over time were established using generalized estimating equations and analysis of covariance, (P < 0.05). RESULTS The Participation Scale (18.73 ± 14.91 against 26.67 ± 19.14; P = 0.011), the EuroQuol5D visual analogue scale (69.10 ± 20.31 against 55.37 ± 27.67; P = 0.003), EuroQuol5D utility index (0.672 ± 0.300 against 0.532 ± 0.358; P = 0.25) and the Modified Capability Index (21.03 ± 15.79 against 15.91 ± 13.67; P = 0.034) improved in the intervention group compared with the control group at three months. At six months, there was no difference between the groups in any of the measures except for the EuroQuol5D visual analogue scale (74.52 ± 16.14 against 66.34 ± 22.91; P = 0.033). Although there were no differences between the Timed Up and Go test at 3 (35.39 ± 32.48 against 45.08 ± 41.52; P = 0.192) and six months (28.22 ± 20.96 against 36.08 ± 36.19; P = 0.189) between the groups the intervention group was more mobile. CONCLUSION This intervention improved function, mobility and quality of life in persons following lower limb amputation in the first three months post amputation.
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Affiliation(s)
- Lonwabo Godlwana
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aimee Stewart
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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de Paula GV, da Silva TR, de Souza JT, Luvizutto GJ, Bazan SGZ, Modolo GP, Winckler FC, de Oliveira Antunes LC, Martin LC, da Costa RDM, Bazan R. Effect of ankle-foot orthosis on functional mobility and dynamic balance of patients after stroke: Study protocol for a randomized controlled clinical trial. Medicine (Baltimore) 2019; 98:e17317. [PMID: 31574862 PMCID: PMC6775434 DOI: 10.1097/md.0000000000017317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Stroke is the principal cause of impairment in the motor function and gait of adults. One of the resources used in rehabilitation to optimize gait is a prescription of ankle-foot orthosis (AFO), and the most prescribed AFOs are Fixed AFO and Articulated AFO; however, it is not known which of these options is more effective for these individuals. The aim of this study is to evaluate the impact of different types of ankle-foot orthosis functional mobility and dynamic balance in stroke patients. METHODS Prospective randomized controlled clinical trial with 2 parallel groups will be conducted, and the aim is to recruit 50 patients with stroke diagnosis within 1 year, who indicated that they use both types of orthotics, who had a previous Rankin score less than or equal to 3, and who obtained AFO orthosis through the Hospital Clinics at the Botucatu Medical School (HCBMS) São Paulo, Brazil. After a specific evaluation by a physiotherapist, the patient will receive 1 of the AFO types via randomization. After 30 days, the patient will be reevaluated. The primary outcomes will be balance and mobility, which will be evaluated by the Time Up Go Test (TUG) and Tinetti's Scale of Mobility and Balance (TSMB). The secondary outcomes will be quality of life and the levels of anxiety and depression, which will be evaluated with the European (5D) Quality of Life Scale (Euroqol) and Hospital Anxiety and Depression Scale (HADS). Group allocation will be not concealed because the blinding of participants and of therapists that provide intervention is not possible, and all analyses will be based on an intention-to-treat principle. This study was approved by the Human Research Ethics Committee of the São Paulo State University UNESP, number 2.367.953. The results will be published in relevant journal. DISCUSSION The results of this study will contribute to clinical practice by identifying the type of AFO orthosis that is more suitable for this condition, helping to standardize prescription of these orthoses by professionals, and guiding future research studies on this subject, which is still incompletely defined in the literature. TRIAL REGISTRATION RBR-6SF2VV (March 5, 2018).
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Affiliation(s)
| | | | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy. Federal University of Triângulo Mineiro (UFTM), Uberaba, MG-BRA
| | | | - Gabriel Pinheiro Modolo
- Department of Neurology, Psychology and Psychiatry. Sao Paulo State University (UNESP). Botucatu Medical School, Botucatu, SP-BRA, Brazil
| | | | | | | | | | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry. Sao Paulo State University (UNESP). Botucatu Medical School, Botucatu, SP-BRA, Brazil
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25
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Broussy S, Saillour-Glenisson F, García-Lorenzo B, Rouanet F, Lesaine E, Maugeais M, Aly F, Glize B, Salamon R, Sibon I. Sequelae and Quality of Life in Patients Living at Home 1 Year After a Stroke Managed in Stroke Units. Front Neurol 2019; 10:907. [PMID: 31496987 PMCID: PMC6712081 DOI: 10.3389/fneur.2019.00907] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: Knowledge about residual deficiencies and their consequences on daily life activities among stroke patients living at home 1-year after the initial event managed in stroke units is poor. This multi-dimensional study assessed the types of deficiencies, their frequency and the consequences that the specific stroke had upon the daily life of patients. Methods: A cross-sectional survey, assessing, using standardized scales, 1 year post-stroke disabilities, limitations of activities, participation and quality of life, was carried out by telephone interview and by mail in a sample of stroke patients who returned home after having been initially managed in a stroke unit. Results: A total of 161 patients were included (142 able to answer the interview on their own; 19 needing a care-giver). Amongst a sub-group of the patients interviewed, 55.4% (95% Confidence Interval [47.1–63.7]) complained about pain and 60.0% (95% CI [51.4–68.6]) complained of fatigue; about 25% presented neuropsychological or neuropsychiatric disability. Whilst 87.3% (95% CI [81.7–92.9]) were independent for daily life activities, participation in every domains and quality of life scores, mainly in daily activity, pain, and anxiety subscales, were low. Conclusion: Despite a good 1-year post-stroke functional outcome, non-motor disabling symptoms are frequent amongst patients returned home and able to be interviewed, contributing to a low level of participation and a poor quality of life. Rehabilitation strategies focused on participation should be developed to break the vicious circle of social isolation and improve quality of life.
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Affiliation(s)
- Sophie Broussy
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Florence Saillour-Glenisson
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France.,CHU de Bordeaux, Pôle de Santé publique, Service d'Information Médicale, Bordeaux, France
| | - B García-Lorenzo
- Health Technology Assessment Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francois Rouanet
- Pôle des Neurosciences Cliniques, CHU Bordeaux, Bordeaux, France
| | - Emilie Lesaine
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Melanie Maugeais
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Florence Aly
- Physical and Rehabilitation Medicine Unit, EA4136, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Bertrand Glize
- Physical and Rehabilitation Medicine Unit, EA4136, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Roger Salamon
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Igor Sibon
- Pôle des Neurosciences Cliniques, CHU Bordeaux, Bordeaux, France
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26
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Molle Da Costa RD, Luvizutto GJ, Martins LG, Thomaz De Souza J, Regina Da Silva T, Alvarez Sartor LC, Winckler FC, Modolo GP, Molle ERDSD, Dos Anjos SM, Bazan SGZ, Cuadrado LM, Bazan R. Clinical factors associated with the development of nonuse learned after stroke: a prospective study. Top Stroke Rehabil 2019; 26:511-517. [PMID: 31230583 DOI: 10.1080/10749357.2019.1631605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Upper extremity impairment is present in most of people with stroke. The use of the affected upper extremity can be impacted not only by physical impairment but also by abehavioral phenomenon called learned nonuse. Objective: The aim of this study was to evaluate which clinical factors in the acute phase are associated with the development of learned nonuse in the upper extremity after stroke. Methods: This cohort study included 38 patients with ischemic stroke. Hospital discharge data were collected for clinical aspects, scales of severity, incapacity and autonomy, as well as for neuromuscular and sensory evaluations. At 90 days after hospital discharge, the score on the Motor Activity Log scale for detecting learned nonuse was obtained, and life quality was evaluated by the EuroQol. The individuals with and without learned nonuse were compared by attest for univariate analysis, and ageneralized linear model was employed to find possible predictors, which were considered significant p <0.05. Results: In the statistical model, age (p= .006), severity at discharge (p= .036), handgrip strength (p= .000), altered sensitivity (p= .011), incapacity at discharge (p= .009) and autonomy at discharge (p= .011) were found to be associated with learned nonuse. In relation to quality of life, mobility, personal care, usual activities, anxiety, depression and perception had lower mean values in the learned nonuse group. Conclusion: Age, severity of stroke, incapacity and neuromuscular and sensory compromises are associated with upper extremity learned nonuse in stroke patients.
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Affiliation(s)
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro , Uberaba , Brazil
| | | | | | - Taís Regina Da Silva
- Department of rehabilitation Center, Botucatu Medical School , Botucatu , Brazil
| | | | | | - Gabriel Pinheiro Modolo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School , Botucatu , Brazil
| | | | - Sarah M Dos Anjos
- Department of Medicine, University of Alabama , Birmingham , AL , USA
| | | | | | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School , Botucatu , Brazil
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27
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da Silva Rodrigues JC, Luvizutto GJ, da Costa RDM, Prudente RA, da Silva TR, de Souza JT, da Silveira CFDSMP, Rossi DAA, Winckler FC, Modolo GP, Valadão TFC, de Oliveira Antunes LC, Martin LC, Bazan R, Bazan SGZ. Influence of an exercise program on cardiac remodeling and functional capacity in patients with stroke (CRONuS trial): study protocol for a randomized controlled trial. Trials 2019; 20:298. [PMID: 31138281 PMCID: PMC6540544 DOI: 10.1186/s13063-019-3328-1] [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: 12/07/2018] [Accepted: 03/25/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiovascular rehabilitation is one of the treatment options for post-stroke individuals in order to improve functional independence in activities of daily life and reduce energy expenditure. The aim of this trial is to evaluate the effect of an exercise program on the echocardiographic variables, functional capacity, inflammatory response, neurological status, nutritional status, cardiologic evaluation, and quality of life of patients after stroke. METHODS/DESIGN This is a randomized controlled trial including patients with ischemic stroke in the chronic phase. The patients will be evaluated at the beginning of the study and after 16 weeks. This will include clinical and physical evaluation, 6-min walk test, neurological assessment, nutritional assessment, ambulatory blood pressure monitoring, transthoracic echocardiography, and assessment of the quality of life. The sample size has been determined as 40 patients, who will be divided into two groups: control group (CG; n = 20) and intervention group (IG; n = 20). The CG will undergo conventional physiotherapy for 45 min, three times a week, up to 16 weeks, while the IG will be put on a cardiovascular rehabilitation program consisting of heating, aerobic exercise, and muscle strengthening for 45 min, three times a week, for 16 weeks. The primary endpoint will be functional capacity following a 6-min walk test (delta maxVO2) and morphofunctional echocardiographic variables (indexed left ventricular mass) before and after the intervention. DISCUSSION We expect to observe an improvement in cardiac structural and functional abnormalities in the IG, on echocardiography and biochemical examination, and that the improvement of these parameters after cardiovascular rehabilitation will have a favorable impact on the functional capacity and quality of life of patients after stroke. TRIAL REGISTRATION REBEC, RBR-4wk4b3. Registered on 19 September 2016.
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Affiliation(s)
| | - Gustavo José Luvizutto
- Department of Applied Physiotherapy, Triangulo Mineiro Federal University, Uberaba, Brazil
| | - Rafael Dalle Molle da Costa
- Department of Rehabilitation, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Robson Aparecido Prudente
- Department of Rehabilitation, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Taís Regina da Silva
- Department of Rehabilitation, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Juli Thomaz de Souza
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | | | - Daniele Andreza Antonelli Rossi
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | - Fernanda Cristina Winckler
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Gabriel Pinheiro Modolo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Tainá Fabri Carneiro Valadão
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | | | - Luis Cuadrado Martin
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil.
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28
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Yeoh YS, Koh GCH, Tan CS, Tu TM, Singh R, Chang HM, De Silva DA, Ng YS, Ang YH, Yap P, Chew E, Merchant RA, Yeo TT, Chou N, Venketasubramanian N, Lee KE, Young SH, Hoenig H, Matchar DB, Luo N. Health-related quality of life loss associated with first-time stroke. PLoS One 2019; 14:e0211493. [PMID: 30689666 PMCID: PMC6349359 DOI: 10.1371/journal.pone.0211493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/15/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study aimed to quantify health-related quality of life (HRQoL) loss associated with first episode of stroke by comparing patient-reported HRQoL before and after stroke onset. The impact of stroke in local population was also evaluated by comparing the pre- and post-stroke HRQoL with that of the general population. METHODS The HRQoL of stroke survivors was assessed with the EQ-5D-3L index score at recruitment, for recalled pre-stroke HRQoL, and at 3 and 12 month post-stroke. Change in HRQoL from pre-stroke to 3 and 12 month was self-reported by 285 and 238 patients, respectively. Mean EQ index score at each time point (baseline: 464 patients; 3 month post-stroke: 306 patients; 12 month post-stroke: 258 patients) was compared with published population norms for EQ-5D-3L. RESULTS There was a significant decrease in HRQoL at 3 (0.25) and 12 month (0.09) post-stroke when compared to the retrospectively recalled patients' mean pre-stroke HRQoL level (0.87). The reduction at 3 month was associated with the reduction in all EQ-5D-3L health dimensions; reductions remaining at 12 month were limited to dimensions of mobility, self-care, usual activities, and anxiety/depression. Stroke patients had a lower mean EQ index than the general population by 0.07 points pre-stroke (0.87 vs. 0.94), 0.33 points at 3 month (0.61 vs. 0.94) and 0.18 points at 12 month (0.76 vs. 0.94) post-stroke. CONCLUSIONS Stroke has a substantial impact on HRQoL in Singapore, especially in the first three months post-stroke. Compared to the general population, stroke survivors have lower HRQoL even before stroke onset. This pre-stroke deficit in HRQoL should be taken into account when quantifying health burden of stroke or setting goals for stroke rehabilitation.
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Affiliation(s)
- Yen Shing Yeoh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Hui Meng Chang
- Department of Neurology, Singapore General Hospital campus, National Neuroscience Institute, Singapore, Singapore
| | - Deidre A. De Silva
- Department of Neurology, Singapore General Hospital campus, National Neuroscience Institute, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yan Hoon Ang
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore, Singapore
| | - Reshma A. Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Ning Chou
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | | | - Kim En Lee
- Farrer Park Medical Centre, Farrer Park Hospital, Singapore, Singapore
| | - Sherry H. Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine & Rehabilitation Service, Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - David Bruce Matchar
- Health Services & Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
- Center for Clinical Health Policy Research, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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29
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Souza CS, de Castro CCS, Carneiro FRO, Pinto JMN, Fabricio LHZ, Azulay‐Abulafia L, Romiti R, Cestari TF, Suzuki CE, Biegun PM, Guedes LS, Oyafuso LKM. Metabolic syndrome and psoriatic arthritis among patients with psoriasis vulgaris: Quality of life and prevalence. J Dermatol 2019; 46:3-10. [PMID: 30474868 PMCID: PMC6587528 DOI: 10.1111/1346-8138.14706] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/13/2018] [Indexed: 12/13/2022]
Abstract
Interest has increased in comorbidities associated with psoriasis and their effects on health-related quality of life (HRQoL). This study aimed to evaluate the prevalence of metabolic syndrome (MetS) and psoriatic arthritis (PsA) and to investigate HRQoL and the prevalence of hypertension, type 2 diabetes mellitus (T2DM), obesity and dyslipidemia. In a cross-sectional design, patients diagnosed with plaque psoriasis answered an interview and standardized questionnaires (Dermatology Life Quality Index questionnaire [DLQI], 36-Item Short Form Health Survey [SF-36] and EuroQol Five-Dimension Questionnaire Three-Level version [EQ-5D-3L]). Physical examination and several tests to assess desired outcomes were performed by a dermatologist and a rheumatologist during three visits. The prevalence of MetS and PsA was 50.0% and 41.8%, respectively. Dyslipidemia was the most prevalent (74.5%) secondary comorbidity, followed by hypertension (61.8%), obesity (52.5%) and T2DM (30.9%). The mean (standard deviation) DLQI score was 6.5 (6.9), and mean physical and mental SF-36 measures were 45.2 (10.4) and 45.5 (12.3), respectively, and for EQ-5D-3L, mean utility index and EQ-VAS scores were 0.68 (0.27) and 72.7 (19.7), respectively. PsA and MetS are important comorbidities; a reduced HRQoL is noted among plaque psoriasis patients with these comorbidities, emphasizing the relevance of diagnosis and treatment beyond the care of skin lesions.
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Affiliation(s)
- Cacilda S. Souza
- Faculty of Medicine of Ribeirao Preto/University of Sao PauloSao PauloBrazil
| | - Caio C. S. de Castro
- Hospital of Santa Casa of Curitiba/Pontifical Catholic University of ParanaCuritibaBrazil
| | | | | | | | | | - Ricardo Romiti
- Department of Dermatology, Hospital das ClinicasUniversity of Sao PauloSao PauloBrazil
| | - Tania F. Cestari
- Hospital de Clinicas of Porto Alegre/Federal University of Rio Grande do SulPorto AlegreBrazil
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30
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Yeoh YS, Koh GCH, Tan CS, Lee KE, Tu TM, Singh R, Chang HM, De Silva DA, Ng YS, Ang YH, Yap P, Chew E, Merchant RA, Yeo TT, Chou N, Venketasubramanian N, Young SH, Hoenig H, Matchar DB, Luo N. Can acute clinical outcomes predict health-related quality of life after stroke: a one-year prospective study of stroke survivors. Health Qual Life Outcomes 2018; 16:221. [PMID: 30463574 PMCID: PMC6249770 DOI: 10.1186/s12955-018-1043-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is a key metric to understand the impact of stroke from patients' perspective. Yet HRQoL is not readily measured in clinical practice. This study aims to investigate the extent to which clinical outcomes during admission predict HRQoL at 3 months and 1 year post-stroke. METHODS Stroke patients admitted to five tertiary hospitals in Singapore were assessed with Shah-modified Barthel Index (Shah-mBI), National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Mini-Mental State Examination (MMSE), and Frontal Assessment Battery (FAB) before discharge, and the EQ-5D questionnaire at 3 months and 12 months post-stroke. Association of clinical measures with the EQ index at both time points was examined using multiple linear regression models. Forward stepwise selection was applied and consistently significant clinical measures were analyzed for their association with individual dimensions of EQ-5D in multiple logistic regressions. RESULTS All five clinical measures at baseline were significant predictors of the EQ index at 3 months and 12 months, except that MMSE was not significantly associated with the EQ index at 12 months. NIHSS (3-month standardized β = - 0.111; 12-month standardized β = - 0.109) and mRS (3-month standardized β = - 0.122; 12-month standardized β = - 0.080) were shown to have a larger effect size than other measures. The contribution of NIHSS and mRS as significant predictors of HRQoL was mostly explained by their association with the mobility, self-care, and usual activities dimensions of EQ-5D. CONCLUSIONS HRQoL at 3 months and 12 months post-stroke can be predicted by clinical outcomes in the acute phase. NIHSS and mRS are better predictors than BI, MMSE, and FAB.
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Affiliation(s)
- Yen Shing Yeoh
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Kim En Lee
- Farrer Park Hospital, 1 Farrer Park Station Road, #10-08 Connexion, Singapore, Singapore
| | - Tian Ming Tu
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, Singapore
| | - Rajinder Singh
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, Singapore
| | - Deidre A De Silva
- Department of Neurology, Singapore General Hospital campus, National Neuroscience Institute, 20 College Road, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, 20 College Road, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
| | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, Singapore
| | - Reshma Aziz Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, Singapore
| | - Ning Chou
- Department of Neurosurgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, Singapore
| | - N Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, 585 North Bridge Road, Singapore, Singapore
| | - Sherry H Young
- Department of Rehabilitation Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, Singapore
| | - Helen Hoenig
- Veterans Affairs Medical Center, 508 Fulton St, Durham, NC, USA.,Duke University Medical Center, Duke Box, Durham, NC, 3003, USA
| | - David Bruce Matchar
- Duke-NUS Medical School, 8 College Road, Singapore, Singapore.,Center for Clinical Health Policy Research, Duke University Medical Center, First Union Tower, 2200 W Main St, Suite, Durham, NC, 230, USA
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549, Singapore.
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Stein LA, Goldmann E, Zamzam A, Luciano JM, Messé SR, Cucchiara BL, Kasner SE, Mullen MT. Association Between Anxiety, Depression, and Post-traumatic Stress Disorder and Outcomes After Ischemic Stroke. Front Neurol 2018; 9:890. [PMID: 30450075 PMCID: PMC6224432 DOI: 10.3389/fneur.2018.00890] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Stroke patients are known to be at risk of developing anxiety, depression, and post-traumatic stress disorder (PTSD). Objective: To determine the overlap between anxiety, depression, and PTSD in patients after stroke and to determine the association between these disorders and quality of life, functional status, healthcare utilization, and return to work. Methods: A cross-sectional telephone survey was conducted to assess for depression, anxiety, PTSD, and health-related outcomes 6-12 months after first ischemic stroke in patients without prior psychiatric disease at a single stroke center. Results: Of 352 eligible subjects, 55 (16%) completed surveys. Seven subjects (13%) met criteria for probable anxiety, 6 (11%) for PTSD, and 11 for depression (20%). Of the 13 subjects (24%) who met criteria for any of these disorders, 6 (46%) met criteria for more than one, and 5 (39%) met criteria for all three. There were no significant differences in baseline characteristics, including stroke severity or neurologic symptoms, between those with or without any of these disorders. Those who had any of these disorders were less likely to be independent in their activities of daily living (ADLs) (54 vs. 95%, p < 0.001) and reported significantly worse quality of life (score of 0-100, median score of 50 vs. 80, p < 0.001) compared to those with none of these disorders. Conclusions: Anxiety, depression, and PTSD are common after stroke, have a high degree of co-occurrence, and are associated with worse outcomes, including quality of life and functional status.
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Affiliation(s)
- Laura A. Stein
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Emily Goldmann
- College of Global Public Health, New York University, New York, NY, United States
| | - Ahmad Zamzam
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Jean M. Luciano
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Steven R. Messé
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Brett L. Cucchiara
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Scott E. Kasner
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Michael T. Mullen
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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Klein SK, Fofonka A, Hirdes A, Jacob MHVM. Quality of life and levels of physical activity of residents living in therapeutic residential care facilities in Southern Brazil. CIENCIA & SAUDE COLETIVA 2018; 23:1521-1530. [PMID: 29768606 DOI: 10.1590/1413-81232018235.13432016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 07/24/2016] [Indexed: 12/23/2022] Open
Abstract
Interest in the quality of life of people with mental disorders living in therapeutic residential care facilities is an important indicator for the evaluation of therapeutic interventions in the area of health. Physical activity can contribute to a good quality of life. This study evaluated the quality of life and levels of physical activity of people living in therapeutic residential care facilities in the metropolitan area of Porto Alegre. This case series study (n = 68) used SF-36, EuroQol and IPAQ and social-demographic questions. The SF-36 results showed that the domain of general health received the lowest scores (57.47 ± 14.27). The highest scores were in terms of social aspects (77.39 ± 20.21) and physical aspects (77.57 ± 39.71). When using EuroQol, at least one problem (mild or extreme) in at least one dimension was evident among 82% of the residents. The physical activity levels showed that most of the participants were insufficiently active (48.5%) and 14.7% were sedentary. The domains of pain and mobility suggested that the residents were not being encouraged enough to perform physical activities. Knowledge about the perceptions of those living in therapeutic residential care facilities is critical in order to establish effective public policies.
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Affiliation(s)
- Simone Karine Klein
- Universidade Luterana do Brasil Gravataí. Av. Itacolomi 3.600, São Vicente. 94155-052 Gravataí RS Brasil.
| | - Aline Fofonka
- Universidade Luterana do Brasil Gravataí. Av. Itacolomi 3.600, São Vicente. 94155-052 Gravataí RS Brasil.
| | - Alice Hirdes
- Universidade Luterana do Brasil Gravataí. Av. Itacolomi 3.600, São Vicente. 94155-052 Gravataí RS Brasil.
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Behrendt F, Schuster-Amft C. Using an interactive virtual environment to integrate a digital Action Research Arm Test, motor imagery and action observation to assess and improve upper limb motor function in patients with neuromuscular impairments: a usability and feasibility study protocol. BMJ Open 2018; 8:e019646. [PMID: 30012780 PMCID: PMC6082472 DOI: 10.1136/bmjopen-2017-019646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/24/2018] [Accepted: 05/15/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In the recent past, training systems using an interactive virtual environment have been introduced to neurorehabilitation. Such systems can be applied to encourage purposeful limb movements and will increasingly be used at home by the individual patient. Therefore, an integrated valid and reliable assessment tool on the basis of such a system to monitor the recovery process would be an essential asset. OBJECTIVES The aim of the study is to evaluate usability, feasibility and validity of the digital version of the Action Research Arm Test using the Bi-Manu-Trainer system as a platform. Additionally, the feasibility and usability of the implementation of action observation and motor imagery tasks into the Bi-Manu-Trainer software will be evaluated. PATIENTS AND METHODS This observational study is planned as a single-arm trial for testing the new assessment and the action observation and motor imagery training module. Therefore, 75 patients with Parkinson's disease, multiple sclerosis, stroke, traumatic brain injury or Guillain-Barré syndrome will be included. 30 out of the 75 patients will additionally take part in a 4-week training on the enhanced Bi-Manu-Trainer system. Primary outcomes will be the score on the System Usability Scale and the correlation between the conventional and digital Action Research Arm Test scores. Secondary outcomes will be hand dexterity, upper limb activities of daily living and quality of life. HYPOTHESIS We hypothesise that the digital Action Research Arm Test assessment is a valid and essential tool and that it is feasible to incorporate action observation and motor imagery into Bi-Manu-Trainer practice. The results are expected to give recommendations for necessary modifications and might also contribute knowledge concerning the application of action observation and motor imagery tasks using a training system such as the Bi-Manu-Trainer. TRIAL REGISTRATION NUMBER NCT03268304; Pre-results.
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Affiliation(s)
- Frank Behrendt
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- University Children’s Hospital Basel, Basel, Switzerland
| | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Candeias da Silva C, Bichuetti DB, Azevedo Silva SMCD, Ferraz HB, Oliveira EMLD, Borges V. Movement disorders in multiple sclerosis and neuromyelitis optica: A clinical marker of neurological disability. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Oliveira CB, Franco MR, Maher CG, Tiedemann A, Silva FG, Damato TM, Nicholas MK, Christofaro DGD, Pinto RZ. The efficacy of a multimodal physical activity intervention with supervised exercises, health coaching and an activity monitor on physical activity levels of patients with chronic, nonspecific low back pain (Physical Activity for Back Pain (PAyBACK) trial): study protocol for a randomised controlled trial. Trials 2018; 19:40. [PMID: 29334992 PMCID: PMC5769445 DOI: 10.1186/s13063-017-2436-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/29/2017] [Indexed: 12/15/2022] Open
Abstract
Background Physical activity plays an important role in the management of chronic low back pain (LBP). Engaging in an active lifestyle is associated with a better prognosis. Nevertheless, there is evidence to suggest that patients with chronic LBP are less likely to meet recommended physical activity levels. Furthermore, while exercise therapy has been endorsed by recent clinical practice guidelines, evidence from systematic reviews suggests that its effect on pain and disability are at best moderate and not sustained over time. A limitation of current exercises programmes for chronic LBP is that these programmes are not designed to change patients’ behaviour toward an active lifestyle. Therefore, we will investigate the short- and long-term efficacy of a multimodal intervention, consisting of supervised exercises, health coaching and use of an activity monitor (i.e. Fitbit Flex) compared to supervised exercises plus sham coaching and a sham activity monitor on physical activity levels, pain intensity and disability, in patients with chronic, nonspecific LBP. Methods This study will be a two-group, single-blind, randomised controlled trial. One hundred and sixty adults with chronic, nonspecific LBP will be recruited. Participants allocated to both groups will receive a group exercise programme. In addition, the intervention group will receive health coaching sessions (i.e. assisting the participants to achieve their physical activity goals) and an activity monitor (i.e. Fitbit Flex). The participants allocated to the control group will receive sham health coaching (i.e. encouraged to talk about their LBP or other problems, but without any therapeutic advice from the physiotherapist) and a sham activity monitor. Outcome measures will be assessed at baseline and at 3, 6 and 12 months post randomisation. The primary outcomes will be physical activity, measured objectively with an accelerometer, as well as pain intensity and disability at 3 months post randomisation. Secondary outcomes will be physical activity, pain intensity and disability at 6 and 12 months post randomisation as well as other self-report measures of physical activity and sedentary behaviour, depression, quality of life, pain self-efficacy and weight-related outcomes at 3, 6, and 12 months post randomisation. Discussion This study is significant as it will be the first study to investigate whether a multimodal intervention designed to increase physical activity levels reduces pain and disability, and increases physical activity levels compared to a control intervention in patients with chronic LBP. Trial registration ClinicalTrials.gov, ID: NCT03200509. Registered on 28 June 2017. Electronic supplementary material The online version of this article 10.1186/s13063-017-2436-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Crystian B Oliveira
- Department of Physical Therapy, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Márcia R Franco
- Department of Physical Therapy, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Chris G Maher
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Anne Tiedemann
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Fernanda G Silva
- Department of Physical Therapy, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Tatiana M Damato
- Department of Physical Therapy, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Michael K Nicholas
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia
| | - Diego G D Christofaro
- Departament of Physical Education, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Rafael Z Pinto
- Department of Physical Therapy, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil. .,Departament of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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Shams T, Auchus AP, Oparil S, Wright CB, Wright J, Furlan AJ, Sila CA, Davis BR, Pressel S, Yamal JM, Einhorn PT, Lerner AJ. Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). Stroke 2017; 48:3078-3085. [PMID: 28954920 DOI: 10.1161/strokeaha.117.016062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The visual analogue scale is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) and evaluate determinants of poststroke change in QoL. In the ALLHAT study, among the 33 357 patients randomized to treatment arms, 1525 experienced strokes; 1202 (79%) strokes were nonfatal. This study cohort includes 32 318 (97%) subjects who completed the baseline visual analogue scale QoL estimate. METHODS QoL was measured on a visual analogue scale and adjusted using a Torrance transformation (transformed QoL [TQoL]). Kaplan-Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0-1) and by quartiles (≤0.81, >0.81≤0.89, >0.89≤0.95, >0.95). We analyzed the change from baseline to first poststroke TQoL using adjusted linear regression. RESULTS After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% confidence interval, 0.89-0.98) per 0.1 U increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (hazard ratio=1.20 [95% confidence interval, 1.00-1.44]) compared with the reference highest quartile TQoL. Poststroke TQoL change was significant within all treatment groups (P≤0.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of poststroke TQoL with similar results for the untransformed QoL. CONCLUSIONS The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted poststroke change in TQoL. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.
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Affiliation(s)
- Tanzila Shams
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.).
| | - Alexander P Auchus
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Suzanne Oparil
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Clinton B Wright
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Jackson Wright
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Anthony J Furlan
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Cathy A Sila
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Barry R Davis
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Sara Pressel
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Jose-Miguel Yamal
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Paula T Einhorn
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Alan J Lerner
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
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von Dach E, Morel CM, Murthy A, Pagani L, Macedo-Vinas M, Olearo F, Harbarth S. Comparing the cost-effectiveness of linezolid to trimethoprim/sulfamethoxazole plus rifampicin for the treatment of methicillin-resistant Staphylococcus aureus infection: a healthcare system perspective. Clin Microbiol Infect 2017; 23:659-666. [PMID: 28232163 DOI: 10.1016/j.cmi.2017.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Few industry-independent studies have been conducted to compare the relative costs and benefits of drugs to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. We performed a stochastic cost-effectiveness analysis comparing two treatment strategies-linezolid versus trimethoprim-sulfamethoxazole plus rifampicin-for the treatment of MRSA infection. METHODS We used cost and effectiveness data from a previously conducted clinical trial, complementing with other data from published literature, to compare the two regimens from a healthcare system perspective. Effectiveness was expressed in terms of quality-adjusted life-years (QALYs). Several sensitivity analyses were performed using Monte Carlo simulation, to measure the effect of potential parameter changes on the base-case model results, including potential differences related to type of infection and drug toxicity. RESULTS Treatment of MRSA infection with trimethoprim-sulfamethoxazole plus rifampicin and linezolid were found to cost on average €146 and €2536, and lead to a gain of 0.916 and 0.881 QALYs, respectively. Treatment with trimethoprim-sulfamethoxazole plus rifampicin was found to be more cost-effective than linezolid in the base case and remained dominant over linezolid in most alternative scenarios, including different types of MRSA infection and potential disadvantages in terms of toxicity. With a willingness-to-pay threshold of €0, €50 000 and €200 000 per QALY gained, trimethoprim-sulfamethoxazole plus rifampicin was dominant in 100%, 96% and 85% of model iterations. A 95% discount on the current purchasing price of linezolid would be needed when it goes off-patent for it to represent better value for money compared with trimethoprim-sulfamethoxazole plus rifampicin. CONCLUSIONS Combined treatment of trimethoprim-sulfamethoxazole plus rifampicin is more cost-effective than linezolid in the treatment of MRSA infection.
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Affiliation(s)
- E von Dach
- Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - C M Morel
- Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland; London School of Economics, London, UK
| | - A Murthy
- Incyte Corporation, Epalinges, Switzerland
| | - L Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy; Antimicrobial Stewardship Programme, Annecy-Genevois Hospital Centre, Annecy, France
| | - M Macedo-Vinas
- Dpto de Laboratorio de Patología Clínica, Facultad de Medicina, Udelar, Uruguay
| | - F Olearo
- Division of Infectious Diseases, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - S Harbarth
- Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Medical School, Geneva, Switzerland.
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Hong I, Yoo EY, Kazley AS, Lee D, Li CY, Reistetter TA. Development and Validation of the Activities of Daily Living Short Form for Community-Dwelling Korean Stroke Survivors. Eval Health Prof 2017; 41:44-66. [PMID: 29179561 DOI: 10.1177/0163278717695863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study developed and validated a short form (SF) using activities of daily living (ADL) outcome measures from the Korea National Health and Nutrition Examination Survey (KNHANES) that can minimize survey administration burden for clinicians. This study utilized secondary data from the 2005 KNHANES with 422 community-dwelling stroke survivors. The KNHANES data were collected from April to June 2005 in South Korea. We created a 7-item SF from the 17 ADL questions in the survey using item response theory (IRT) methodologies. The precision and validity of the SF were compared to the full questionnaire of ADL items and the EuroQol-5D total score. Among the 17 ADL questions, 14 questions demonstrated unidimensional construct validity. Using IRT methodologies, a set of 7 items were selected from the full bank. The 7-item SF demonstrated good psychometric properties: high correlation with the full bank ( r = .975, p < .001), good internal consistency (Cronbach's α = .93), and a high correlation with the EuroQol-5D total score ( r = .678, p < .001). These findings indicate that a well-developed SF can precisely measure ADL performance capacity for stroke survivors compared to the full item bank, which is expected to reduce the administration burden of the KNHANES.
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Affiliation(s)
- Ickpyo Hong
- 1 Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Eun-Young Yoo
- 2 Department of Occupational Therapy, Yonsei University, Wonju, South Korea
| | - Abby Swanson Kazley
- 3 Department of Healthcare Leadership & Management, Medical University of South Carolina, Charleston, SC, USA
| | - Danbi Lee
- 4 Center for Education in Health Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chih-Ying Li
- 1 Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Timothy A Reistetter
- 5 Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX, USA
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Luvizutto GJ, Rizzati GRS, Fogaroli MO, Rodrigues RT, Ribeiro PW, de Carvalho Nunes HR, Braga GP, da Costa RDM, Bazan SGZ, de Lima Resende LA, Conforto AB, Bazan R. Treatment of unilateral spatial neglect after stroke using transcranial direct current stimulation (ELETRON trial): study protocol for a randomized controlled trial. Trials 2016; 17:479. [PMID: 27716442 PMCID: PMC5048673 DOI: 10.1186/s13063-016-1598-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background Unilateral spatial neglect (USN) is characterized by the inability to report or respond to people or objects that are presented in the spatial hemisphere that is contralateral to the lesioned hemisphere of the brain. USN has been associated with poor functional outcomes and long stays in hospitals and rehabilitation centers. Noninvasive brain stimulation, such as transcranial direct current stimulation (tDCS), has been used in people who have been affected by USN after stroke. The effects of such treatment could provide new insights for health professionals and policy-makers. The aim of this study will be to evaluate the effectiveness and safety of tDCS for USN after stroke. Methods A prospective randomized controlled trial with two parallel groups will be conducted, which will aim to recruit 60 patients with USN after ischemic or hemorrhagic stroke. Participants will be randomly placed into the following four treatment groups: (1) anodal tDCS over the right parietal lobe (n = 15), (2) cathodal tDCS over the left parietal lobe (n = 15), (3) a sham group of anodal tDCS over the right parietal lobe (n = 15), and (4) a sham group of cathodal tDCS over the left parietal lobe (n = 15). Blinded assessors will conduct two baseline assessments and one post-intervention assessment. The primary outcome measure will be the level of USN as assessed by the conventional Behavioral Inattention Tasks and the Catherine Bergego Scale. Secondary measures will include neurological capacity (based on the Scandinavian Stroke Scale), functional capacity (based on the Functional Independence Measure and Modified Rankin Scale), autonomy (based on the Barthel Index), and quality of life (based on the EuroQol-5D). Group allocation will be concealed, and all analyses will be based on an intention-to-treat principle. Discussion This study will explore the effects of more than 15 sessions of tDCS on the level of USN, functional capacity, autonomy, and quality of life in patients with USN after stroke. This proposed study has the potential to identify a new, evidence-based intervention that can enhance perception and independent living in patients with USN after stroke. Trial registration REBEC - RBR-78jvzx, registered on 13 March 2016.
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Affiliation(s)
- Gustavo José Luvizutto
- Rehabilitation Department, Botucatu Medical School, Professor Montenegro Ave., Botucatu, Brazil. .,Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, District of Rubião Junior, Botucatu, SP, 18618-970, Brazil.
| | | | | | | | - Priscila Watson Ribeiro
- Rehabilitation Department, Botucatu Medical School, Professor Montenegro Ave., Botucatu, Brazil
| | | | - Gabriel Pereira Braga
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Professor Montenegro Ave., Botucatu, Brazil
| | | | | | - Luiz Antônio de Lima Resende
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Professor Montenegro Ave., Botucatu, Brazil
| | | | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Professor Montenegro Ave., Botucatu, Brazil
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Sandberg K, Kleist M, Falk L, Enthoven P. Effects of Twice-Weekly Intense Aerobic Exercise in Early Subacute Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2016; 97:1244-53. [DOI: 10.1016/j.apmr.2016.01.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 01/14/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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Pinto EB, Nascimento C, Monteiro M, Castro M, Maso I, Campos A, Marinho C, Barreto-Neto NJ, Lopes AA, Jesus PAP, Oliveira-Filho J. Proposal for a New Predictive Scale for Recurrent Risk of Fall in a Cohort of Community-Dwelling Patients with Stroke. J Stroke Cerebrovasc Dis 2016; 25:2619-2626. [PMID: 27475520 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/19/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES This study aimed to determine risk factors related to the occurrence of falls in stroke patients and to propose a new predictive scale for falls. METHODS Demographic and clinical data were collected and the following scales were applied: Barthel Index, Timed Up and Go Test (TUG), and National Institutes of Health Stroke Scale (NIHSS). Subjects were followed prospectively for 2 years for the occurrence of recurrent (≥2) falls. Kaplan-Meier curves were constructed and univariable associations were tested using log-rank test. Two separate multivariable models were then used: the first used Cox proportional hazards regression and the second used Poisson regression. In each model, significant associations were considered present with a P value less than .05. RESULTS We evaluated 150 individuals and the final analysis included 131 patients; the average age of the patients was 55.8 ± 13 years, 52% were women, and the median NIHSS score was 2 (interquartile range = 1-5). Falls occurred in 17% of patients, with a median of 23 months of follow-up (interquartile range = 16-26 months). In the multivariable Cox regression model, only TUG quartile, female gender, and posterior circulation territory involvement remained significant predictors of recurrent falls. We used the predictors from the Cox regression model to propose a new recurrent fall risk scale. The area under the receiver operating characteristic curve was 73%, 95% confidence interval = 62%-83%, P = .001, with 81.3% sensitivity and 41.8% specificity. CONCLUSIONS The new predictive scale for recurrent risk (including TUG, posterior circulation territory involvement, and female gender) is presented as an instrument for monitoring the risk of recurrent falls.
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Affiliation(s)
- Elen Beatriz Pinto
- Stroke Clinic of the Federal University of Bahia, Brazil; Department of Physical Therapy, Bahia School of Medicine and Public Health, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil.
| | - Carla Nascimento
- Stroke Clinic of the Federal University of Bahia, Brazil; Department of Physical Therapy, Bahia School of Medicine and Public Health, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil
| | - Maiana Monteiro
- Stroke Clinic of the Federal University of Bahia, Brazil; Department of Physical Therapy, Bahia School of Medicine and Public Health, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil
| | - Mayra Castro
- Stroke Clinic of the Federal University of Bahia, Brazil; Department of Physical Therapy, Bahia School of Medicine and Public Health, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil
| | - Iara Maso
- Stroke Clinic of the Federal University of Bahia, Brazil; Department of Physical Therapy, Bahia School of Medicine and Public Health, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil
| | - Adriana Campos
- Stroke Clinic of the Federal University of Bahia, Brazil; Department of Physical Therapy, Bahia School of Medicine and Public Health, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil
| | - Camila Marinho
- Stroke Clinic of the Federal University of Bahia, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil
| | - Nestor J Barreto-Neto
- Stroke Clinic of the Federal University of Bahia, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil
| | - Antônio A Lopes
- Department of Internal Medicine and Diagnosis, Federal University of Bahia, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil
| | - Pedro A P Jesus
- Stroke Clinic of the Federal University of Bahia, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil
| | - Jamary Oliveira-Filho
- Stroke Clinic of the Federal University of Bahia, Brazil; Ambulatório de Doenças Cerebrovasculares, Hospital Universitário Prof. Edgard Santos-HUPES, Salvador, Brazil
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de Araújo AA, Ribeiro SB, Dos Santos ACS, Lemos TMAM, Medeiros CAX, Guerra GCB, de Araújo Júnior RF, Serrano-Blanco A, Rubio-Valera M. Quality of Life and Hormonal, Biochemical, and Anthropometric Profile Between Olanzapine and Risperidone Users. Psychiatr Q 2016. [PMID: 26220635 DOI: 10.1007/s11126-015-9385-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This cross-sectional study compared quality of life and side effects in 108 users of olanzapine or risperidone suffering schizophrenia and being attended at psychiatric ambulatory services in Rio Grande do Norte, Brazil. Economic, socio-demographic, anthropometric, biochemical, and hormonal variables were compared. The EuroQoL Five-Dimension Scale (EQ-5D) was used to evaluate quality of life, and side effects were assessed using the Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale and the Simpson-Angus Scale. Data were analysed using the χ(2) test and Student's t test, with a significance level of 5 %.The household incomes of approximately 80 % of patients were <2.0 minimum wages ($678). Anthropometric variables (waist circumference, hip circumference, weight, waist-to-hip ratio) and systolic and diastolic blood pressure were noted among male olanzapine users (all p < 0.05). EQ-5D scores showed that olanzapine use significantly impacted self-help ability (p < 0.001). Risperidone users had a mean quality-adjusted life year value of 1. Mean total Simpson-Angus Scale scores was 0.38 for olanzapine users and 0.11 for risperidone users (p < 0.02). Significant differences in UKU were observed for the following items: asthenia/lassitude/fatigue (higher among olanzapine users, p = 0.02), dystonia (higher among olanzapine users, p = 0.01), tremors (higher among olanzapine users, p = 0.03), gynecomastia (higher among risperidone users, p < 0.02), and ejaculatory dysfunction (higher among risperidone users, p < 0.02). Olanzapine users had impaired quality of life, which can be explained in part by adverse motor, biochemical, and hormonal effects characteristic of metabolic syndrome.
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Affiliation(s)
- Aurigena Antunes de Araújo
- Postgraduate Programs in Public Health and Pharmaceutical Science, Department of Biophysics and Pharmacology, Federal University of Rio Grande Norte (UFRN), Natal, RN, Brazil.
| | | | | | - Telma Maria Araújo Moura Lemos
- Postgraduate Programs in Health Science and Pharmaceutical Science, Department of Clinical Analyses and Toxicological, Federal University of Rio Grande Norte (UFRN), Natal, RN, Brazil
| | - Caroline Addison Xavier Medeiros
- Postgraduate Program in Health and Society, Department of Biophysics and Pharmacology, State University of Rio Grande Norte (UERN), Natal, RN, Brazil
- Postgraduate Programs in Biological Science, Federal University of Rio Grande Norte (UFRN), Natal, RN, Brazil
| | | | | | - Antoni Serrano-Blanco
- Acute Inpatient Unit of Psychiatry, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Maria Rubio-Valera
- Research and Innovation Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
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Richardson M, Campbell N, Allen L, Meyer M, Teasell R. The stroke impact scale: performance as a quality of life measure in a community-based stroke rehabilitation setting. Disabil Rehabil 2015; 38:1425-30. [DOI: 10.3109/09638288.2015.1102337] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Laura Allen
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Matthew Meyer
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Robert Teasell
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- St. Joseph’s Health Care London, London, Ontario, Canada
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Jiménez-Monreal AM, Murcia MA, Gómez-Murcia V, Bibiloni MDM, Pons A, Tur JA, Martínez-Tomé M. Anthropometric and Quality-of-Life Parameters in Acute Intermittent Porphyria Patients. Medicine (Baltimore) 2015; 94:e1023. [PMID: 26222840 PMCID: PMC4554130 DOI: 10.1097/md.0000000000001023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/08/2015] [Accepted: 05/26/2015] [Indexed: 11/26/2022] Open
Abstract
The porphyrias are a group of rare metabolic disorders. The incidence and prevalence are low because the acute intermittent porphyria (AIP) is rare. Our aim was to assess the use of anthropometric and quality-of-life parameters in porphyric patients in order to identify predictor factors that might help in characterizing AIP patients.Sixteen AIP patients from Murcia (Spain) were recruited from local health centers in 2008 and 2009. A control group of 16 healthy people was established. Body composition was assessed by bioelectrical impedance analysis (BIA) and anthropometric measurements: body weight; height; knee-heel height; waist, hip, upper arm and calf circumferences (CCs); biacromion and biiliac diameters; bicondylar and biepicondylar width; and triceps, subscapular, supraspinale, and calf skinfold thickness. Anthropometric indicators were obtained from anthropometric measurements. A quality-of-life evaluation was carried out using the EuroQol-5D (EQ-5D) questionnaire and Barthel and Katz indexes. Significant differences in means were tested by unpaired Student t test. Group differences in anthropometric measurements were tested with a 2-way analysis of variance (group × condition: age group, overweight, and adiposity degree). Relative frequencies were obtained for noncontinuous variables. Significant differences in prevalence were calculated by means of χ.AIP patients showed statistically significant differences in terms of knee-heel height, biiliac diameter, CC, triceps skinfold thickness, BIA, ponderal index, endomorphy, and ectomorphy. Only 1 quality-of-life indicator, visual analog scale, in the EQ-5D questionnaire showed significant differences between porphyric and control groups.Some anthropometric parameters and the EQ-5D questionnaire could be used to appreciate the presence or follow the evolution of the disease in AIP patients.
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Affiliation(s)
- Antonia M Jiménez-Monreal
- From the Department of Food Science (AMJ-M, AM, VG-M, MM-T), Regional Campus of International Excellence "Campus Mare Nostrum," University of Murcia, Murcia; CIBEROBN (Fisiopatología de la Obesidad y la Nutrición CB12/03/30038) (AMJ-M, AM, MMB, AP, JAT, MM-T), Instituto de Salud Carlos III, Madrid; and Research Group on Community Nutrition and Oxidative Stress (MMB, AP, JAT), University of the Balearic Islands, Palma de Mallorca, Spain
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de Oliveira Junior HA, dos Santos JB, Acurcio FA, Almeida AM, Kakehasi AM, Alvares J, de Carvalho LFD, Cherchiglia ML. Poorer functionality is related to better quality of life response following the use of biological drugs: 6-month outcomes in a prospective cohort from the Public Health System (Sistema Único de Saúde), Minas Gerais, Brazil. Expert Rev Pharmacoecon Outcomes Res 2015; 15:403-12. [PMID: 25603696 DOI: 10.1586/14737167.2015.1003367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We aim to analyze factors associated with the quality of life (QOL) response of individuals with rheumatic diseases treated by the Public Health System (Sistema Único de Saúde) with biological disease-modifying antirheumatic drugs (bDMARDs). Data from 428 patients using bDMARDs were collected using a standardized form at baseline and 6 months after the onset of treatment. The average reduction of the scores on EuroQol-five dimension was 0.11 ± 0.18 6 months after the onset of treatment with bDMARDs, denoting significant improvement of the participants' QOL. All the investigated types of disease exhibited significant improvement at the 6-month assessment, without any difference among them (p = 0.965). The participants with baseline poorest functionality and best QOL exhibited the best QOL outcomes after 6 months of treatment. Our study showed that the use of biological drugs induced considerable improvement in the participants' QOL.
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Affiliation(s)
- Haliton Alves de Oliveira Junior
- Departamento de Farmácia Social, Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Campus Pampulha, bloco 2, 1° andar, sala 1023. Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
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Felício JS, de Souza ACCB, Koury CC, Neto JFA, Miléo KB, Santos FM, Motta ARB, Silva DD, Arbage TP, Carvalho CT, de Rider Brito HA, Yamada ES, Cobas RA, Matheus A, Tannus L, Palma CCS, Japiassu L, Carneiro JRI, Rodacki M, Zajdenverg L, de Araújo NBC, de Menezes Cordeiro M, Luescher JL, Berardo RS, Nery M, Cani C, do Carmo Arruda Marques M, Calliari LE, de Noronha RM, Manna TD, Savoldelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Negrato CA, de Fatima Guedes M, Dib SA, Dualib P, da Silva SC, Sepúlveda J, Sampaio E, Rea RR, de Almeida Faria ACR, Tschiedel B, Lavigne S, Cardozo GA, Azevedo M, Canani LH, Zucatti AT, Coral MHC, Pereira DA, de Araujo LA, Pedrosa HC, Tolentino M, Prado FA, Rassi N, de Araujo LB, Fonseca RMC, Guedes AD, de Mattos OS, Faria M, Azulay R, e Forti AC, Façanha CFS, Junior RM, Montenegro AP, Melo NH, Rezende KF, Ramos A, Jezini DL, Gomes MB. Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group. Diabetol Metab Syndr 2015; 7:87. [PMID: 26448787 PMCID: PMC4596564 DOI: 10.1186/s13098-015-0081-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. METHODS This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. RESULTS We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. CONCLUSIONS Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.
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Affiliation(s)
- João Soares Felício
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Carolina Contente Braga de Souza
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Camila Cavalcante Koury
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - João Felício Abrahão Neto
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Karem Barbosa Miléo
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Flávia Marques Santos
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Regina Bastos Motta
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Denisson Dias Silva
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Thaís Pontes Arbage
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Carolina Tavares Carvalho
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Hana Andrade de Rider Brito
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Elizabeth Sumi Yamada
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Roberta Arnoldi Cobas
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Alessandra Matheus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lucianne Tannus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Catia Cristina Sousa Palma
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Leticia Japiassu
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - João Regis Ivar Carneiro
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Melanie Rodacki
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lenita Zajdenverg
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | | | | | - Jorge Luiz Luescher
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Renata Szundy Berardo
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Marcia Nery
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | - Catarina Cani
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | | | | | | | - Thais Della Manna
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Roberta Savoldelli
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Fernanda Garcia Penha
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Milton Cesar Foss
- />Ribeirão Preto Medical School of São Paulo University, Ribeirão Preto, Brazil
| | | | - Antonio Carlos Pires
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | - Fernando Cesar Robles
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | | | | | - Sergio Atala Dib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | - Patricia Dualib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | | | - Janice Sepúlveda
- />Endocrinology Unit, Hospital of Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais Brazil
| | - Emerson Sampaio
- />Diabetes Unit, State University Hospital of Londrina, Paraná, Brazil
| | | | | | - Balduino Tschiedel
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | - Suzana Lavigne
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | | | - Mirela Azevedo
- />Clinical Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Manuel Faria
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | - Rossana Azulay
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | | | | | | | | | | | | | - Alberto Ramos
- />Federal University Hospital of Campina Grande, Campina Grande, Paraíba Brazil
| | - Deborah Laredo Jezini
- />Getúlio Vargas University Hospital of Amazonas, Adriano Jorge Hospital, Manaus, Amazonas Brazil
| | - Marilia Brito Gomes
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
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Rhoda AJ. Health-related quality of life of patients six months poststroke living in the Western Cape, South Africa. Afr J Disabil 2014; 3:126. [PMID: 28730004 PMCID: PMC5443046 DOI: 10.4102/ajod.v3i1.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/04/2014] [Indexed: 11/24/2022] Open
Abstract
Background The majority of individuals report a decline in health-related quality of life following a stroke. Quality of life and factors predicting quality of life could differ in individuals from lower income countries. The aim of this study was therefore to determine the quality of life and factors influencing quality of life of community-dwelling stroke patients living in low-income, peri-urban areas in the Western Cape, South Africa. Method An observational, longitudinal study was used to collect data from a conveniently selected sample of first-ever stroke patients. The Rivermead Motor Assessment Scale and the Barthel Index were used to determine functional outcome and the EQ-5D was used to collect information relating to quality of life at two months and six months poststroke. Descriptive and inferential statistics were used to analyse the data. Results The total sample of 100 participants consisted of 50% men and 50% women with a mean age of 61 and a standard deviation of 10.55 years. Six-month quality of life data was analysed for 73 of the 100 participants. Of the 27 who were lost to follow-up, nine participants died, four withdrew from the study after baseline data was collected and eleven could not be followed up as they had either moved or no follow-up telephone numbers were available. A further three participants were excluded from the analysis of the EQ-5D as they were aphasic. Of these, approximately 35% had problems with mobility and self-care, whilst 42% had severe problems with everyday activities and 37.8% expressed having anxiety and depression. Quality of life at two months (p = 0.010) and urinary incontinence (p = 0.002) were significant predictors of quality of life at six months. Conclusion Health-related quality of life was decreased in the South African stroke sample. Functional ability and urinary incontinence were the factors affecting quality of life in the sample. These factors should be considered in the rehabilitation of stroke patients in these settings.
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Affiliation(s)
- Anthea J Rhoda
- Department of Physiotherapy, University of the Western Cape, South Africa
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Golicki D, Niewada M, Buczek J, Karlińska A, Kobayashi A, Janssen MF, Pickard AS. Validity of EQ-5D-5L in stroke. Qual Life Res 2014; 24:845-50. [PMID: 25347978 PMCID: PMC4366565 DOI: 10.1007/s11136-014-0834-1] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/30/2022]
Abstract
Purpose To assess EQ-5D-5L (5L) validity in patients with acute stroke, in comparison with EQ-5D-3L (3L). Methods Cross-sectional study of 408 patients during index hospitalization. We compared 5L and 3L in terms of feasibility, frequency of unique health states, ceiling effect and discriminatory power (informativity). We assessed construct validity in terms of known-groups validity and convergent validity of 5L dimensions with other stroke outcome measures. Results The overall proportion of patients with acute stroke reporting ‘no problems’ with 3L—6.1 % was further reduced to 5.6 % with 5L (relative reduction of 8.2 %). The highest improvement in relative discriminatory power, when moving from 3L to 5L, was noticed in pain/discomfort and anxiety/depression dimensions (Shannon Evenness Index 0.91 for both 5L dimensions; relative increase 34.4 and 29.1 %, respectively). Known-groups validity tests confirmed prior hypotheses: Health state utilities were lower in following subpopulations—females, patients with high modified Rankin Scale (mRS) score, low Barthel Index (BI) or VAS score, patients with subarachnoid hemorrhage or intracerebral hemorrhage, and when proxy respondent was used. Convergence of EQ-5D-5L dimensions with mRS, BI and EQ VAS was improved or at least the same as for 3L dimensions. Conclusions Results support the validity of the EQ-5D-5L descriptive system as a generic health outcome measure in patients with acute stroke, demonstrating some psychometric advantages in comparison with EQ-5D-3L.
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Affiliation(s)
- Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Banacha 1b St, 02-097, Warsaw, Poland,
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de Araújo AA, de Araújo Dantas D, do Nascimento GG, Ribeiro SB, Chaves KM, de Lima Silva V, de Araújo RF, de Souza DLB, de Medeiros CACX. Quality of life in patients with schizophrenia: the impact of socio-economic factors and adverse effects of atypical antipsychotics drugs. Psychiatr Q 2014; 85:357-67. [PMID: 24789610 DOI: 10.1007/s11126-014-9290-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This cross-sectional study compared the effects of treatment with atypical antipsychotic drugs on quality of life (QoL) and side effects in 218 patients with schizophrenia attending the ambulatory services of psychiatric in Rio Grande do Norte, Brazil. Socio-economic variables were compared. The five-dimension EuroQoL (EQ-5D) was used to evaluate QoL, and side effects were assessed using the Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale and the Simpson-Angus Scale. Data were analysed using the χ (2) test and Student's t test, with a significance level of 5 %. Average monthly household incomes in the medication groups were 1.1-2.1 minimum wages ($339-$678). UKU Scale scores showed significant differences in side effects, mainly, clozapine, quetiapine and ziprasidone (p < 0.05). EQ-5D scores showed that all drugs except olanzapine significantly impacted mobility (p < 0.05), and proportions of individuals reporting problems in other dimensions were high: 63.6 % of clozapine users reported mobility problems, 63.7 and 56.3 % of clozapine and ziprasidone users, respectively, had difficulties with usual activities, 68.8 and 54.5 % of ziprasidone and clozapine users, respectively, experienced pain and/or discomfort, and 72.8 % of clozapine users reported anxiety and/or depression. Psychiatric, neurological, and autonomous adverse effects, as well as other side effects, were prevalent in users of atypical antipsychotic drugs, especially clozapine and ziprasidone. Olanzapine had the least side effects. QoL was impacted by side effects and economic conditions in all groups. Thus, the effects of these antipsychotic agents appear to have been masked by aggravating social and economic situations.
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Affiliation(s)
- Aurigena Antunes de Araújo
- Department of Biophysical and Pharmacology, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil,
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Ali M, Fulton R, Quinn T, Brady M. How well do standard stroke outcome measures reflect quality of life? A retrospective analysis of clinical trial data. Stroke 2013; 44:3161-5. [PMID: 24052510 DOI: 10.1161/strokeaha.113.001126] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Quality of life (QoL) is important to stroke survivors yet is often recorded as a secondary measure in acute stroke randomized controlled trials. We examined whether commonly used stroke outcome measures captured aspects of QoL. METHODS We examined primary outcomes by National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and modified Rankin Scale (mRS), and QoL by Stroke Impact Scale (SIS) and European Quality of Life Scale (EQ-5D) from the Virtual International Stroke Trials Archive (VISTA). Using Spearman correlations and logistic regression, we described the relationships between QoL mRS, NIHSS, and BI at 3 months, stratified by respondent (patient or proxy). Using χ2 analyses, we examined the mismatch between good primary outcome (mRS ≤1, NIHSS ≤5, or BI ≥95) but poor QoL, and poor primary outcome (mRS ≥3, NIHSS ≥20, or BI ≤60) but good QoL. RESULTS Patient-assessed QoL had a stronger association with mRS (EQ-5D weighted score n=2987, P<0.0001, r=-0.7, r2=0.53; SIS recovery n=2970, P<0.0001, r=-0.71, r2=0.52). Proxy responses had a stronger association with BI (EQ-5D weighted score n=837, P<0.0001, r=0.78, r2=0.63; SIS recovery n=867, P<0.0001, r=0.68, r2=0.48). mRS explained more of the variation in QoL (EQ-5D weighted score=53%, recovery by SIS v3.0=52%) than NIHSS or BI and resulted in fewer mismatches between good primary outcome and poor QoL (P<0.0001, EQ-5D weighted score=8.5%; SIS recovery=10%; SIS-16=4.4%). CONCLUSIONS The mRS seemed to align closely with stroke survivors' interests, capturing more information on QoL than either NIHSS or BI. This further supports its recommendation as a primary outcome measure in acute stroke randomized controlled trials.
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Affiliation(s)
- Myzoon Ali
- From the Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (M.A., M.B.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Western Infirmary, United Kingdom (M.A., R.F., T.Q.)
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