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Slenders JPL, de Graaf JA, Post MWM, van Heugten CM, Van den Berg-Vos RM, Kwa VIH, Visser-Meily JMA. Participation in daily life activities at two months after stroke predicts long-term health-related quality of life. Top Stroke Rehabil 2024; 31:11-20. [PMID: 37056169 DOI: 10.1080/10749357.2023.2202017] [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: 01/03/2023] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND After stroke, many patients experience problems with participation in daily activities. Improving participation is the main goal in stroke rehabilitation. However, the longitudinal relationship between participation and health-related quality of life (HRQoL) remains unclear. OBJECTIVES This study aimed to examine (1) the predictive value of participation at two months on long-term HRQoL and (2) the longitudinal relationship between participation and HRQoL. METHODS In this multicenter, prospective cohort study, patients were assessed at two and 12 months after stroke. Participation was measured with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation - Participation. HRQoL was assessed with the three-level version of the EuroQoL five dimensions questionnaire index score. RESULTS This study included 291 patients. Mean age was 66.6 ± 12.4 years, 64.3% were male and mean National Institutes of Health Stroke Scale (NIHSS) was 2.5 ± 2.9. Multivariable linear regression, adjusted for demographic characteristics, stroke characteristics, physical and cognitive impairment, showed that a higher level of participation at two months correlated with a higher HRQoL at one year (B = .004; 95% CI =.002-.005). Patients whose participation improved had a greater increase in HRQoL, compared to patients without improvement (0.080 ± .21 versus -.054 ± .21; p < .001). CONCLUSIONS The level of participation at two months post-stroke predicts HRQoL at one year. Improvement in participation during the first year after stroke is associated with improvement in HRQoL. We recommend including the assessment of participation in daily activities at follow-up visits.
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Affiliation(s)
| | - Joris A de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Caroline M van Heugten
- School for Mental Health & Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, Netherlands
| | - Renske M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, Netherlands
- Department of Neurology, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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2
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Zhang X, Sha Z, Gao C, Yuan J, He L, Huang J, Jiang R. Factors influencing wait-and-watch management in mild primary chronic subdural hematoma: a retrospective case-control study. Acta Neurol Belg 2023; 123:2277-2286. [PMID: 37269419 DOI: 10.1007/s13760-023-02293-z] [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: 01/19/2023] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To identify prognostic factors in patients with primary chronic subdural hematoma (CSDH) undergoing wait-and-watch management. METHODS A case-control study was conducted in a single center from February 2019 to November 2021 to identify independent influencing factors of wait-and-watch management in mild CSDH patients using wait-and-watch as monotherapy. A total of 39 patients who responded to wait-and-watch management (cases) and 24 nonresponders (controls) matched for age, sex, height, weight, MGS-GCS (Markwalder grading scale and Glasgow Coma Scale), and bilateral hematoma were included. Demographics, blood cell counts, serum biochemical levels, imaging data, and relevant clinical features at baseline were collected. RESULTS Univariate analysis revealed significant differences between cases and controls in hematoma volume, ability to urinate, maximal thickness of the hematoma, and hypodensity of the hematoma. Hypodense hematoma and hematoma volume were independently associated with the outcome in multivariate analysis. Combining these independently influencing factors revealed an area under the receiver operator characteristic curve of 0.741 (95% CI 0.609-0.874, sensitivity = 0.783, specificity = 0.667). CONCLUSIONS The results of this study may aid in identifying patients with mild primary CSDH who could benefit from conservative management. While wait-and-watch management may be an option in some cases, clinicians need to suggest medical interventions, such as pharmacotherapy, when appropriate.
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Affiliation(s)
- Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhuang Sha
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China
| | - Lei He
- Department of Neurology, Chengde Central Hospital, Chengde, 067000, Hebei, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China.
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China.
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3
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Assefa YA, Demeke ZD, Wolde S, Guadie YG. Environmental determinants for participation among stroke survivors in Africa, a scoping review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1136742. [PMID: 37288455 PMCID: PMC10242103 DOI: 10.3389/fresc.2023.1136742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/25/2023] [Indexed: 06/09/2023]
Abstract
Purpose In this review, we aimed to determine the environmental factors that are influencing the participation of stroke survivors in Africa. Methods Four electronic databases were systematically searched from inception to August 2021, and identified articles were screened by the two authors of this review based on predetermined criteria. No date restrictions were imposed, and we included any type of paper, including gray literature. We followed the scoping review framework by Arksey and O'Malley, which was later revised by Levac et al. The whole finding is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR). Results A total of 584 articles were generated by the systematic search, and one article was added manually. After eliminating the duplicates, the titles and abstracts of 498 articles were screened. From the screening, 51 articles were selected for full article review, of which 13 met the criteria to be included. In total, 13 articles were reviewed and analyzed based on the international classification of functioning, disability, and health (ICF) framework of the environmental determinants. Products and technology; natural environment and human-made changes to environment; and services, systems, and policies were found to be barriers for stroke survivors to participate in their community. Conversely, stroke survivors are getting good support from their immediate family and health professionals. Conclusion This scoping review sought to identify the environmental barriers and the facilitators that are determining the participation of stroke survivors in Africa. The results of this study can serve as a valuable resource for policymakers, urban planners, health professionals, and other stakeholders involved in disability and rehabilitation. Nonetheless, additional research is necessary to validate the identified facilitators and barriers.
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Affiliation(s)
- Yohannes Awoke Assefa
- Occupational Therapy Department, School of Medicine, University of Gondar, Gondar, Ethiopia
| | | | - Sara Wolde
- Occupational Therapy Student, Queen's University, Kingston, ON, Canada
| | - Yisak Girma Guadie
- Physiotherapy Department, School of Medicine, University of Gondar, Gondar, Ethiopia
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4
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Della Vecchia C, Préau M, Haesebaert J, Viprey M, Rode G, Termoz A, Dima A, Schott AM. Factors associated with post-stroke social participation: A quantitative study based on the ICF framework. Ann Phys Rehabil Med 2022; 66:101686. [PMID: 35779831 DOI: 10.1016/j.rehab.2022.101686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Post-stroke social participation is a major determinant of quality of life and life satisfaction. However, few data relating to participation determinants are available, especially the influence of psychological factors and factors related to the living environment. OBJECTIVES This study investigated determinants of post-stroke social participation within the International Classification of Functioning, Disability and Health framework. METHODS We contacted people with stroke who had been hospitalized in the Rhône County, included in a previous cohort study, were aged ≥18 years and were not institutionalized. The primary outcome was social participation measured with the Stroke Impact Scale (SIS) 2.0. We performed multiple hierarchical linear regressions to test the following predictors: clinical factors (stroke-related variables, limitations in Activities of Daily Living [ADL]/Instrumental ADL), personal factors (sociodemographic factors, coping strategies) and environmental factors (satisfaction with social relationships and living environment). RESULTS Among the 352 participants, 63% were men, and mean age was 68.7(SD 14.5) years. In the last multivariate model, variables associated with higher levels of social participation were the use of the positive thinking coping strategy (B (SD)=1.17(0.52), p = 0.03), higher perceived satisfaction with the living environment (B (SD)=0.17(0.07), p = 0.03) and fewer perceived activity limitations (B (SD)=0.55 (0.06), p < 0.001). Conversely, the seeking social support coping style (B (SD)= -1.98 (0.60), p = 0.001), and a higher number of stroke-related sequelae (B (SD)= -1.93(0.53), p = 0.001) were associated with lower social participation. CONCLUSIONS The identification of potentially modifiable personal and environmental factors that influence social participation provides elements to strengthen existing rehabilitation programs and opens the way for possible psychosocial interventions.
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Affiliation(s)
- Claire Della Vecchia
- Pole of Social Psychology, Inserm U1296 Unit 'Radiation: Defense, Health Environment', Lyon 2 University, Lyon, France.
| | - Marie Préau
- Pole of Social Psychology, Inserm U1296 Unit 'Radiation: Defense, Health Environment', Lyon 2 University, Lyon, France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Pôle Santé Publique, F-69008 Lyon, France
| | - Marie Viprey
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Pôle Santé Publique, F-69008 Lyon, France
| | - Gilles Rode
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron, France; Service de Médecine Physique et Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Anne Termoz
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Pôle Santé Publique, F-69008 Lyon, France
| | - Alexandra Dima
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Anne-Marie Schott
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Pôle Santé Publique, F-69008 Lyon, France
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5
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Choi H, Lim A, Song Y. Adaptive behavior in stroke survivors: A concept analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:S1976-1317(22)00034-2. [PMID: 35963571 DOI: 10.1016/j.anr.2022.07.002] [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: 01/26/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 11/02/2022] Open
Abstract
PURPOSE This study aims to explore a clear and evidence-based definition of adaptive behavior in stroke survivors and establish the antecedents, attributes, consequences, and empirical referents of the concept. METHODS The concept analysis was performed using the Walker and Avant methods as a framework. Data from 90 publications were collected using various databases (PubMed, EMBASE, CINAHL, RISS, and KISS) and applied in the analysis. RESULTS Adaptive behavior in stroke survivors was defined according to four attributes: realizing change, taking an optimistic view, restructuring daily activities to suit oneself, and carrying out one's own daily life. The conceptual structure of their adaptive behavior comprised stroke onset, functional changes, and emotional liability as antecedents and autonomy, family equilibrium, and quality of life as consequences. CONCLUSIONS Clarifying the concept of adaptive behavior in stroke survivors provides an understanding of the underlying attributes of this concept. Furthermore, it will facilitate the development of scales to measure the concept and the application of a theory-based intervention program that can improve adaptive behavior.
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Affiliation(s)
- Hyunsuk Choi
- Department of Nursing, College of Nursing, Chungnam National University, Munwharo 266 Junggu, Daejeon, 35015 Republic of Korea
| | - Ancho Lim
- Department of Nursing, College of Nursing, Chungnam National University, Munwharo 266 Junggu, Daejeon, 35015 Republic of Korea.
| | - Youngshin Song
- Department of Nursing, College of Nursing, Chungnam National University, Munwharo 266 Junggu, Daejeon, 35015 Republic of Korea.
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Zhang X, Wang D, Tian Y, Wei H, Liu X, Xiang T, Fan Y, Gao C, Huang J, Sha Z, Quan W, Zhang J, Jiang R. Risk Factors for Atorvastatin as a Monotherapy for Chronic Subdural Hematoma: A Retrospective Multifactor Analysis. Front Aging Neurosci 2021; 13:726592. [PMID: 34539386 PMCID: PMC8440973 DOI: 10.3389/fnagi.2021.726592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage in the aging population. We aimed to investigate the predictive factors for atorvastatin efficacy as a monotherapy for moderate CSDH. We retrospectively reviewed the medical records of patients who were diagnosed with moderate CSDH and received atorvastatin monotherapy between February 5, 2014, and November 7, 2015, in multiple neurosurgical departments. Univariate, multivariate and receiver operating characteristic curve analyses were performed to identify the potential significant factors indicative of the good therapeutic efficacy or poor therapeutic efficacy of atorvastatin for mild CSDH, such as age, sex, history of injury, Markwalder grading scale–Glasgow Coma Scale (MGS-GCS), Activities of Daily Life-the Barthel Index scale (ADL-BI), American Society of Anesthesiologists Physical Status classification system (ASA-PS), blood cell counts, serum levels and computed tomography findings. A total of 89 patients (75 men and 14 women) aged 24–88 years (mean age 61.95 ± 15.30 years) were followed-up for 24 weeks. Computed tomography findings at admission showed mixed-density hematoma in 22 patients, isodense hematoma in 13 patients, high-density hematoma in 26 patients, and low-density hematoma in 28 patients. In total, 3, 80, and 6 patients had MGS-GCS grades of 0, 1, and 2, respectively. The efficacy rate at 6 months was 87.6% (78/89). Eleven patients were switched to surgery due to a worsened neurological condition, of whom 8, 1, 1, and 1 had high-density, low-density, isodense and mixed-density hematomas, respectively. These patients were switched to surgery over a range of 2–27 days, with a median interval of 12 days after the medication treatment. Univariate and multivariate analyses, confirmed by ROC curves, revealed that high-density hematoma, basal cistern compression, and hematoma volume to be independent risk factors for the efficacy of atorvastatin monotherapy in patients with moderate CSDH. Atorvastatin is an effective monotherapy for the treatment of mild CSDH. High-density hematoma, basal cistern compression, and hematoma volume are independent predictors of the efficacy of atorvastatin as a non-surgical treatment. The results suggested that ADL-BI was more sensitive than the MGS-GCS and ASA-PS for determining patient outcomes in our moderate CSDH cohort.
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Affiliation(s)
- Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Huijie Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Tangtang Xiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Yibing Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Zhuang Sha
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Wei Quan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
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Greenham M, Gordon AL, Cooper A, Hearps S, Ditchfield M, Coleman L, Hunt RW, Mackay MT, Monagle P, Anderson V. Fatigue Following Pediatric Arterial Ischemic Stroke: Prevalence and Associated Factors. Stroke 2021; 52:3286-3295. [PMID: 34176311 DOI: 10.1161/strokeaha.120.033000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The aims of this study were to assess the prevalence of multidimensional fatigue symptoms 5 years after pediatric arterial ischemic stroke and identify factors associated with fatigue. METHODS Thirty-one children (19 males) with pediatric arterial ischemic stroke, participating in a larger prospective, longitudinal study, were recruited to this study at 5 years poststroke. Parent- and self-rated PedsQL Multidimensional Fatigue Scale scores were compared with published normative data. Associations between parent-rated PedsQL Multidimensional Fatigue Scale, demographics, stroke characteristics, and concurrent outcomes were examined. RESULTS Parent-rated total, general and cognitive fatigue were significantly poorer than population norms, with more than half of all parents reporting fatigue symptoms in their children. One-third of children also reported experiencing fatigue symptoms, but their ratings did not differ significantly from normative expectations, as such, all further analyses were on parent ratings of fatigue. Older age at stroke and larger lesion size predicted greater general fatigue; older age, female sex, and higher social risk predicted more sleep/rest fatigue. No significant predictors of cognitive fatigue were identified and only older age at stroke predicted total fatigue. Greater fatigue was associated with poorer adaptive functioning, motor skills, participation, quality of life, and behavior problems but not attention. CONCLUSIONS Fatigue is a common problem following pediatric arterial ischemic stroke and is associated with the functional difficulties often seen in this population. This study highlights the importance of long-term monitoring following pediatric arterial ischemic stroke and the need for effective interventions to treat fatigue in children.
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Affiliation(s)
- Mardee Greenham
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (M.G., A.C., S.H., R.W.H., M.T.M., P.M., V.A.).,School of Psychological Sciences, University of Melbourne, Australia. (M.G., V.A.)
| | - Anne L Gordon
- Pediatric Neuroscience Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom (A.L.G.).,Department of Population Health Sciences, Kings College London, United Kingdom (A.L.G.)
| | - Anna Cooper
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (M.G., A.C., S.H., R.W.H., M.T.M., P.M., V.A.).,Department of Pediatrics, University of Melbourne, Australia. (A.C., R.W.H., M.T.M., P.M.)
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (M.G., A.C., S.H., R.W.H., M.T.M., P.M., V.A.)
| | - Michael Ditchfield
- Pediatric Imaging, Monash Children's Hospital, Melbourne, Australia (M.D.).,Department of Radiology and Paediatrics, Monash University, Melbourne, Australia (M.D.)
| | - Lee Coleman
- Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Australia. (L.C.)
| | - Rod W Hunt
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (M.G., A.C., S.H., R.W.H., M.T.M., P.M., V.A.).,Department of Pediatrics, University of Melbourne, Australia. (A.C., R.W.H., M.T.M., P.M.).,Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia. (R.W.H.)
| | - Mark T Mackay
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (M.G., A.C., S.H., R.W.H., M.T.M., P.M., V.A.).,Department of Pediatrics, University of Melbourne, Australia. (A.C., R.W.H., M.T.M., P.M.).,Department of Neurology, The Royal Children's Hospital, Melbourne, Australia. (M.T.M.)
| | - Paul Monagle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (M.G., A.C., S.H., R.W.H., M.T.M., P.M., V.A.).,Department of Pediatrics, University of Melbourne, Australia. (A.C., R.W.H., M.T.M., P.M.).,Department of Haematology, The Royal Children's Hospital, Melbourne, Australia. (P.M.)
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia (M.G., A.C., S.H., R.W.H., M.T.M., P.M., V.A.).,School of Psychological Sciences, University of Melbourne, Australia. (M.G., V.A.).,Department of Psychology, The Royal Children's Hospital, Melbourne, Australia. (V.A.)
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8
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Forster A, Ozer S, Crocker TF, House A, Hewison J, Roberts E, Dickerson J, Carter G, Hulme C, Fay M, Richardson G, Wright A, McKevitt C, McEachan R, Foy R, Barnard L, Moreau L, Prashar A, Clarke D, Hardicre N, Holloway I, Brindle R, Hall J, Burton LJ, Atkinson R, Hawkins RJ, Brown L, Cornwall N, Dawkins B, Meads D, Schmitt L, Fletcher M, Speed M, Grenfell K, Hartley S, Young J, Farrin A. Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified.
Objectives
The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of participation (i.e. involvement in life situations).
Design
Five overlapping workstreams were undertaken – (1) refinement of content by semistructured interviews with stroke survivors and their carers and by a review of the literature to inform content and delivery of the care strategy; (2) exploration of service models by national survey and focus groups with purposely selected services; (3) intervention development by interaction with a reference group of stroke survivors, carers, and health and social care professionals; (4) refinement and pilot implementation of the developed intervention in three stroke services (case studies); and (5) a cluster randomised controlled feasibility trial in 10 stroke services across England and Wales.
Setting
The intervention development work and feasibility trial were in stroke services (inclusive of primary, secondary, community and social care provision) across England and Wales.
Participants
Participants were stroke survivors resident in the community and their carers, and health and social care professionals in the included stroke services.
Data sources
Interviews with 28 stroke survivors and their carers at least 9 months post stroke ascertained their needs and the barriers to and facilitators of addressing those needs. Additional literature reviews identified 23 needs. No evidence-based interventions to address these needs were reported; self-management was highlighted as a possible delivery mechanism. In workstream 2, a national survey revealed that the most common model of stroke service provision was care up to 12 months post stroke, reported by 46 (40%) services. Thirty-five (30%) services provided care up to 6 months post stroke and 35 (30%) provided care beyond 12 months, thus identifying 6 months post stroke as an appropriate delivery point for a new intervention. Through focus groups in a range of services, stroke survivors’ perceived unmet needs and the barriers to and enablers of service provision were identified.
Intervention
Using information obtained in workstreams 1 and 2 and working closely with a stakeholder reference group, we developed an intervention based on the unmet needs prioritised by stroke survivors and their carers (workstream 3). In workstream 4, action groups (clinicians, stroke survivors and researchers) were established in three stroke services that led implementation in their service and contributed to the iterative refinement of the intervention, associated training programme and implementation materials. The intervention (called New Start) was delivered at 6 months post stroke. Key components were problem-solving self-management with survivors and carers, help with obtaining usable information, and helping survivors and their carers build sustainable, flexible support networks.
Results
A cluster randomised feasibility trial (workstream 5) was successfully implemented in 10 stroke services across England and Wales, with associated process and health economic evaluations. Five services were randomised to provide New Start, while five continued with usual care; 269 participants were recruited. Progression criteria – in terms of our pre-determined (red, amber, green) criteria for progress to a full trial: target stroke survivor recruitment rates were achieved, on average, across sites (24.1 per site over 6 months, green); 216 (80.3%) registered stroke survivors returned follow-up questionnaires at 9 months (84.1% in the intervention arm and 75.8% in the usual care arm, green); according to data reported by sites, overall, 95.2% of registered stroke survivors were offered at least one session of the intervention (green); all five intervention sites had at least two facilitators deemed competent, delivered the New Start intervention and provided it to stroke survivors (green). However, at some sites, there were concerns regarding the number of stroke survivors being offered, accepting and receiving the intervention. Only small differences in outcomes and costs were observed between the New Start and usual care groups, and considerable uncertainty around the cost-effectiveness remains.
Conclusions
We report a complex programme of work that has described the longer-term needs of stroke survivors and highlighted evidence and service gaps. Working closely with stroke survivors, an intervention was developed that has been refined in three services and feasibility tested in a cluster randomised controlled trial. Further refinement of the target population and optimisation of the intervention materials is required prior to a full randomised controlled trial evaluation.
Future work
Optimisation of the intervention, and clearer specification of recipients, are required prior to a full trial evaluation.
Trial registration
Current Controlled Trials ISRCTN38920246.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anne Forster
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Allan House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Division of Health Services Research, School of Medicine, University of Leeds, Leeds, UK
| | | | - Josie Dickerson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Gill Carter
- Patient and public involvement contributor, York, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Alan Wright
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher McKevitt
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Rosemary McEachan
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Robbie Foy
- Division of Primary Care, Palliative Care and Public Health, School of Medicine, University of Leeds, Leeds, UK
| | - Lorna Barnard
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lauren Moreau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Arvin Prashar
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Natasha Hardicre
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Richard Brindle
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jessica Hall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ross Atkinson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca J Hawkins
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Nicola Cornwall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Laetitia Schmitt
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Speed
- Patient and public involvement contributor, York, UK
| | - Katie Grenfell
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John Young
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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9
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Allataifeh E, Khalil H, Almhdawi K, Al-Shorman A, Hawamdeh Z, El-Salem K, Bumin G. The clinical correlates of participation levels in people with multiple sclerosis. NeuroRehabilitation 2021; 47:153-160. [PMID: 32741791 DOI: 10.3233/nre-203131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) has a huge impact on patients and affects their ability to participate in meaningful activities. OBJECTIVE To identify motor and non-motor factors that are associated with the participation level in instrumental activities of daily living (IADL), leisure, social and religious activities in people with MS. METHOD This is a cross-sectional study conducted on 110 individuals with MS. The used outcome measures are: Arabic version of the Activity Card Sort, Berg Balance Scale, Modified Fatigue Impact Scale, Nine Hole Peg Test, 6-Minute Walk Test, Brief International Cognitive Assessment for Multiple Sclerosis, Stroop test and Hospital Anxiety and Depression Scale. RESULTS Hand function, balance, gender and cognitive status can predict the participation in IADL (R2 = 0.425, P < 0.0001); depression, age, and cognitive status can predict the participation in leisure activities (R2 = 0.372, P < 0.0001), and fatigue, balance and cognitive status can predict social activities participation (R2 = 0.492, P < 0.000). CONCLUSION Balance, cognition and fatigue affect the level of participation in instrumental activities of daily living, leisure, and religious and social activities.
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Affiliation(s)
- Eman Allataifeh
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Khader Almhdawi
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Alham Al-Shorman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad Hawamdeh
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Gonca Bumin
- School of Rehabilitation, Hacettepe University, Ankara, Turkey
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10
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Steensgaard R, Kolbaek R, Jensen JB, Angel S. Action research as a catalyst for change: Empowered nurses facilitating patient participation in rehabilitation. Nurs Inq 2020; 28:e12370. [PMID: 32662213 DOI: 10.1111/nin.12370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Abstract
Based on action research as a practitioner-involving approach, this article communicates the findings of a two-year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice-oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride.
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Affiliation(s)
- Randi Steensgaard
- Department of Neurology, Spinal Cord Injury Centre of Western Denmark, Central Region Hospital, Viborg, Denmark.,Center for Research in Clinical Nursing, Central Region Hospital, Viborg, Denmark
| | - Raymond Kolbaek
- Center for Research in Clinical Nursing, Central Region Hospital, Viborg, Denmark.,Department of Nursing, VIA University College, Viborg, Denmark
| | - Julie Borup Jensen
- Higher Education Research Unit, Capacity Building and Evaluation, ReCreate - Research Center for Creative and Immersive Learning Environments, Aalborg University, Aalborg, Denmark
| | - Sanne Angel
- Research Unit for Nursing and Healthcare, Institute of Public Health, Aarhus University, Aarhus, Denmark
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11
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Schindel D, Schneider A, Grittner U, Jöbges M, Schenk L. Quality of life after stroke rehabilitation discharge: a 12-month longitudinal study. Disabil Rehabil 2019; 43:2332-2341. [PMID: 31846594 DOI: 10.1080/09638288.2019.1699173] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To analyse trends in quality of life (QoL) development among older stroke patients within the first year after rehabilitation discharge, and to investigate the impact of including proxy interviews in research and practice. METHODS A prospective cohort study with follow-up at 3, 6, and 12 months with 411 patients and proxy respondents was conducted. The EUROHIS-QOL 8-item index was used to assess QoL. By performing descriptive analyses, QoL development over time was compared among subgroups. Linear mixed models were calculated to estimate mean changes from baseline to 12-month follow-up. The effects of patient characteristics and time on QoL were investigated using comprehensive mixed models. RESULTS One year after rehabilitation discharge, the majority of patients had neither maintained nor regained their initial QoL. Proxy respondents reported significantly lower QoL (22.6-29.5 points, p < 0.001). Characteristics associated with lower QoL were stroke severity, depression, and pain. Having a small social network was negatively associated with QoL (-1.66 points, 95%CI: -2.84/-0.48, p = 0.006). CONCLUSIONS Quality of life scores reported at the time of rehabilitation discharge are often not lasting. Including severely impaired patients via proxies reduces the risk of overestimating QoL outcomes. Outpatient's characteristics should be taken into account when planning therapy strategies to maintain previously achieved health goals. Regular re-assessments are required.Implications for rehabilitationThere should be an awareness that improvements in quality of life (QoL) achieved during rehabilitation are not sustainable.Regularly re-assessing pain status, psychological burden, and social network size could help clinicians to determine treatment strategies for maintaining and improving rehabilitation achievements.Conducting proxy interviews is required to assess disease burden of patients with severe stroke (e.g., non-linguistic patients).
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Affiliation(s)
- Daniel Schindel
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alice Schneider
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Michael Jöbges
- Department of Neurology, Brandenburg Klinik, Bernau, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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12
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Fernández-Solano AJ, Del Baño-Aledo ME, Rodríguez-Bailón M. Results of an occupational self-analysis program in people with acquired brain injury. A pilot study. Brain Inj 2019; 34:253-261. [PMID: 31730407 DOI: 10.1080/02699052.2019.1689576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The aim of this study was to evaluate the benefits of an occupational self-analysis program in people with acquired brain injury (ABI) in the areas of subjective health perception and occupational participation.Material and Method: This study explored the benefits of an occupational self-analysis program in people with ABI. The intervention group comprised 7 participants; the control group included 5 participants. Outcomes were measured using the SF-36 Health Survey and the Role Checklist. The contents of solicited participant diaries and a focus group discussion were also analyzed.Results: Compared to the control group, the intervention group showed statistically significant improvements in the SF-36 energy/fatigue subscale. The qualitative analysis revealed that participants in the intervention group increased their occupational participation in activities of daily living (ADL), social involvement, and leisure.Conclusion: The program helped participants improve their health perception and increase their occupational participation through learning about their supports and barriers for engaging in meaningful activities.
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13
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Della Vecchia C, Viprey M, Haesebaert J, Termoz A, Giroudon C, Dima A, Rode G, Préau M, Schott AM. Contextual determinants of participation after stroke: a systematic review of quantitative and qualitative studies. Disabil Rehabil 2019; 43:1786-1798. [PMID: 31646906 DOI: 10.1080/09638288.2019.1679897] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE From a patient's perspective, participation is a major determinant of quality of life. We aimed to review contextual factors, both personal and environmental, potentially associated with post-stroke participation. METHODS PubMed, PsycINFO, and Web of Science were searched for original quantitative and qualitative studies that investigated contextual factors of post-stroke participation, measured participation as the primary outcome, and met inclusion criteria. RESULTS Socio-demographic determinants were mostly unrelated with participation or showed discordant and inconclusive results. Although less investigated, psychosocial/psychological factors, particularly self-esteem and acceptance, were associated with participation in most studies. Motivation was found in qualitative studies, but discordant in quantitative ones. Environmental factors were even less investigated and mainly in qualitative studies among patients with communication disabilities. Among these, social support and attitude of others appeared to be major determinants of participation as well as physical environment and societal environment (services and polices). CONCLUSIONS Personal factors, particularly psychological and psychosocial factors, were identified as positively associated with post-stroke participation. Environmental factors such as support, relationships, and positive attitudes towards patients were major facilitators of participation as well as physical environment and accessibility to appropriate services. Most of these factors are modifiable and should be addressed to improve patient participation.Implications for RehabilitationPsychosocial factors (motivational aspects, acceptance of a new condition, self-esteem) and environmental factors (social support, attitudes towards the patient, physical environment, access to health, social services and policies) were identified as determinants of post-stroke participation.A structured evaluation of determinants of participation may be used in clinical practice to propose appropriate support and then improve patients' recoveryPrograms to improve patients' psychosocial skills such as self-esteem, acceptance, motivation should be tested and implemented, and policies to develop appropriate services accessibility should be encouraged.
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Affiliation(s)
- Claire Della Vecchia
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France.,Social Psychology Research Group (EA 4163 GRePS), Lyon 2 University, Bron, France
| | - Marie Viprey
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France.,Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France.,Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Anne Termoz
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France.,Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Caroline Giroudon
- Central Documentation Department, Hospices Civils de Lyon, Lyon, France
| | - Alexandra Dima
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Gilles Rode
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe ImpAct, Bron, France.,Service de Médecine Physique et Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Marie Préau
- Social Psychology Research Group (EA 4163 GRePS), Lyon 2 University, Bron, France.,INSERM UMR 912 SESSTIM, Aix-Marseille Université, Marseille, France
| | - Anne-Marie Schott
- Université Claude Bernard Lyon 1, University of Lyon, Lyon, France.,Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
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14
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Xiao L, Gao Y, Zeng K, Zhang L. Perceived participation and its determinants among young and middle-aged stroke survivors following acute care one month after discharge. Disabil Rehabil 2019; 43:648-656. [PMID: 31437066 DOI: 10.1080/09638288.2019.1636314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe the perceived participation and assess its determinants among young and middle-aged stroke patients following acute care one month after discharge in mainland China. METHODS Two hundred and twenty-three patients were consecutively recruited from two tertiary hospitals and were followed up 1 month after discharge in the outpatient department or their communities to assess their participation by using the Impact on Participation and Autonomy Questionnaire, with 23 patients lost to follow-up. Determinants (i.e., sociodemographic, diseased-related, physical, psychological, and social factors) of participation were identified in four domains: indoor autonomy; outdoor autonomy; family role; and social life. RESULTS The overall perceived participation of our respondents was good to fair. Forty-six (23.0%), 32 (16.0%), 13 (6.5%), and 19 (9.5%) perceived their participation as "very good" in the domains of indoor autonomy, family role, outdoor autonomy and social life, respectively. Stroke severity, depressive symptoms, and social support were the common determinants of participation for all the domains, with stroke severity being the strongest correlate. Activities of daily living was associated with indoor autonomy, family role, and outdoor autonomy, but not associated with social life. CONCLUSIONS The perceived participation of our respondents is relatively optimistic. Physical health along with mental and social status can affect participation. Tailored strategies should be implemented early in the rehabilitation phase to promote stoke survivors' participation in all the domains.Implications for rehabilitationAlthough the overall perceived participation of young and middle-aged stroke patients was fair to good, attention should be paid to their family roles.The strategies should be mainly focused on reducing the stroke severity to improve patients' participation.Improving patients' depressive symptom and social support can also be helpful for improving their participation.
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Affiliation(s)
- Lin Xiao
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yulin Gao
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Kai Zeng
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Lili Zhang
- School of Nursing, Southern Medical University, Guangzhou, China
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15
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Crocker TF, Ozer S, Brown L, Hall J, Forster A. Non-pharmacological interventions for longer-term stroke survivors or their carers: an overview of Cochrane Reviews. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Thomas F Crocker
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust; Academic Unit of Elderly Care and Rehabilitation; Temple Bank House Bradford Royal Infirmary Bradford UK BD9 6RJ
| | - Seline Ozer
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust; Academic Unit of Elderly Care and Rehabilitation; Temple Bank House Bradford Royal Infirmary Bradford UK BD9 6RJ
| | - Lesley Brown
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust; Academic Unit of Elderly Care and Rehabilitation; Temple Bank House Bradford Royal Infirmary Bradford UK BD9 6RJ
| | - Jessica Hall
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust; Academic Unit of Elderly Care and Rehabilitation; Temple Bank House Bradford Royal Infirmary Bradford UK BD9 6RJ
| | - Anne Forster
- University of Leeds; Academic Unit of Elderly Care and Rehabilitation; Temple Bank House, Bradford Royal Infirmary Duckworth Lane Bradford UK BD9 6RJ
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16
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Engel-Yeger B, Tse T, Josman N, Baum C, Carey LM. Scoping Review: The Trajectory of Recovery of Participation Outcomes following Stroke. Behav Neurol 2018; 2018:5472018. [PMID: 30271506 PMCID: PMC6151208 DOI: 10.1155/2018/5472018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/29/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Participation is a central concept in health and well-being and healthcare, yet operationalizing this concept has been difficult. Its definition, uses in healthcare, and impacts on recovery require ongoing research. Our review question goes like this: from the longitudinal evidence investigating participation among stroke survivors, what are the patterns of participation recovery in stroke survivors over time, and what interventions are used to improve participation? To fully understand these questions, we also ask, how is participation defined in the stroke literature, and what are the measures of participation used in the stroke literature? A systematic scoping review was undertaken using the search terms "stroke," "longitudinal," "participation," and "outcome" in seven databases. Articles included were published until April 2017, written in English, and had at least two longitudinal assessments of participation. Fifty-nine articles met the inclusion criteria. The International Classification of Functioning, Disability and Health was the most frequent definition of participation used (34%). There were 22 different measures of participation. Eight of ten studies demonstrated significant improvements in participation up to 12 months poststroke. Efficacy of interventions and their impact on participation varied. The various definitions, measures, and intervention efficacies of participation highlight the need for further research worldwide into achieving meaningful participation and quality of life among stroke survivors. Future practice should include participation as a main outcome measure.
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Affiliation(s)
- Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamara Tse
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Occupational Therapy Department, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Naomi Josman
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Leeanne M. Carey
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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17
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Kruisheer EM, Huenges Wajer IMC, Visser-Meily JMA, Post MWM. Course of Participation after Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2017; 26:1000-1006. [PMID: 28109733 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/21/2016] [Accepted: 11/29/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The study aimed to investigate participation problems in patients with subarachnoid hemorrhage (SAH), and the course of participation between 3 and 12 months post-SAH, and to identify determinants of this course. DESIGN This is a prospective cohort study. SETTING The study was done in the SAH outpatient clinic at the University Medical Center Utrecht. SUBJECTS Subjects included patients independent in activities of daily living who visited the SAH outpatient clinic for a routine follow-up visit 3 months after the event. MAIN MEASURES Participation was assessed using the restrictions scale of the Utrecht Scale for Evaluation of Rehabilitation-Participation at 3, 6, and 12 months post-SAH. Repeated measures analysis of variance was conducted to identify possible determinants of participation (demographic and SAH characteristics, mood, and cognition). RESULTS One hundred patients were included. Three months after SAH, the most commonly reported restrictions concerned work/unpaid work/education (70.5%), housekeeping (50.0%), and going out (45.2%). Twelve months post-SAH, patients felt most restricted in work/unpaid work/education (24.5%), housekeeping (23.5%), and chores in and around the house (16.3%). Participation scores increased significantly between 3 and 6 months, and between 3 and 12 months, post-SAH. The course of participation was associated with mood, cognition, and gender, but was in the multivariate analysis only determined by mood (F [1, 74] = 18.31, P = .000, partial eta squared: .20), showing lower participation scores at each time point for patients with mood disturbance. CONCLUSIONS Participation in functionally independent SAH patients improved over time. However, 1 out of 3 patients (34.9%) still reported one or more participation restrictions 12 months post-SAH. Mood disturbance was negatively associated with the course of participation after SAH.
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Affiliation(s)
- Elize M Kruisheer
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; National Military Rehabilitation Center Aardenburg, Doorn, The Netherlands
| | - Irene M C Huenges Wajer
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marcel W M Post
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands.
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18
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Liu H, Liu Z, Liu Y, Kan S, Yang J, Liu H. Effect of atorvastatin on resolution of chronic subdural hematoma: a prospective observational study [RETRACTED]. J Neurosurg 2016:1-10. [PMID: 27471887 DOI: 10.3171/2015.12.jns151991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is prevalent in the aged population and is commonly treated with bur hole drainage. This treatment, however, can lead to various surgical complications. Atorvastatin may cure CSDH via its antiinflammatory and proangiogenesis effects, but not all patients treated with this medication can avoid surgery. The authors' aim was to investigate the effect of atorvastatin and identify characteristics of patients with CSDH sensitive to atorvastatin therapy. METHODS A prospective, placebo-controlled observational study was conducted in 80 patients with evidence of CSDH. The patients were enrolled between February 2012 and August 2014 and were randomly assigned to either atorvastatin treatment (atorvastatin group) or placebo (control group). Patients were followed up for 12 months after initiation of treatment. Clinically relevant data were collected and compared between the 2 groups. The atorvastatin group was subdivided into patients who required surgery and those who did not, and characteristics of these subgroups were also compared. The relationship between atorvastatin treatment and need for surgery was investigated by means of multiple regression analysis using the following variables as predictors: age, sex, admission Markwalder grade, level of dependency in activities of daily living (ADL) as assessed with the modified Barthel Index, presence of hemiparesis, and hematoma volume. RESULTS The proportion of patients who required surgical intervention during the follow-up period was significantly lower in the atorvastatin group than in the control group (p = 0.001), and the mean time to surgery was longer in the atorvastatin group (p = 0.018). Within the atorvastatin group, there was a significant difference with respect to Markwalder grades, degree of dependency in ADL, percentage of patients with hemiparesis, and mean hematoma volume between the patients who required surgery during the follow-up period and those who did not (p = 0.002, p = 0.001, p = 0.001, and p = 0.012, respectively). The results of the logistic regression analysis showed that atorvastatin significantly reduced the probability of surgery and that female sex and favorable admission Markwalder grades and favorable dependency status with respect to ADL (independent, slightly dependent, or moderately dependent) were independent predictors of not requiring surgery. CONCLUSIONS Atorvastatin administration can promote the resolution of CSDH, especially for women with favorable Markwalder grades and favorable ADL dependency status at admission.
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Affiliation(s)
- Hua Liu
- Department of Neurosurgery, The Affiliated Brain Hospital, Nanjing Medical University, Nanjing
- Department of Neurosurgery, The First People's Hospital of Kunshan Affiliated with Jiangsu University, Suzhou, Jiangsu
| | - Zhongkun Liu
- Department of Neurosurgery, The People's Hospital of AnQiu City, Weifang, Shandong; and
| | - Yong Liu
- Department of Neurosurgery, The Affiliated Brain Hospital, Nanjing Medical University, Nanjing
| | - Shifeng Kan
- Department of Rehabilitation, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai, China
| | - Jian Yang
- Department of Neurosurgery, The First People's Hospital of Kunshan Affiliated with Jiangsu University, Suzhou, Jiangsu
| | - Hongyi Liu
- Department of Neurosurgery, The Affiliated Brain Hospital, Nanjing Medical University, Nanjing
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Karube N, Sasaki A, Hondoh F, Odagiri C, Hagii J, Seino S, Yasujima M, Osanai T. Quality of Life in Physical and Psychological Health and Social Environment at Posthospitalization Period in Patients with Stroke. J Stroke Cerebrovasc Dis 2016; 25:2482-7. [PMID: 27363621 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/06/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Interaction of quality of life (QOL) in physical and psychological health and social environment has not been tested in stroke during a posthospitalization period, and a better understanding of the components of QOL would lead to a more integrated and person-centered approach to health management and outcome optimization. We investigated how QOL emerges from the sequelae of stroke and interacts with each other during the posthospitalization period. METHODS We performed a cross-sectional study in 53 outpatients of stroke survivors (39 men and 14 women with a mean age of 66 years, 46 infarctions, and 7 hemorrhages). RESULTS Eight QOL domains of psychological health were scored by interview, and 2 of them ("desire to distend what they can do" or "desire to do rehabilitation") were associated with the improvement of physical health during the posthospitalization period (P < .05 and P = .08, respectively). These patients were characterized by the items like "I need to succeed for health improvement, to go home, to go back to work, and to see grandchildren" as goals to achieve their desire (P < .05). In interaction of QOL in psychological health and social environment, another psychological domain "to gain satisfaction from the experience" was closely related to the presence of hobby or work before stroke attack (P < .05). CONCLUSION During the posthospitalization period, QOL of psychological health may support that of physical health, being associated with the presence of hobby or work before stroke attack.
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Affiliation(s)
- Narumi Karube
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Aya Sasaki
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Fumika Hondoh
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Chiyo Odagiri
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Satoshi Seino
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | | | - Tomohiro Osanai
- Department of Nursing Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan.
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Torkia C, Best KL, Miller WC, Eng JJ. Balance Confidence: A Predictor of Perceived Physical Function, Perceived Mobility, and Perceived Recovery 1 Year After Inpatient Stroke Rehabilitation. Arch Phys Med Rehabil 2016; 97:1064-71. [PMID: 27060032 DOI: 10.1016/j.apmr.2016.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/16/2015] [Accepted: 03/02/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To estimate the effect of balance confidence measured at 1 month poststroke rehabilitation on perceived physical function, mobility, and stroke recovery 12 months later. DESIGN Longitudinal study (secondary analysis). SETTING Multisite, community-based. PARTICIPANTS Community-dwelling individuals (N=69) with stroke living in a home setting. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Activities-specific Balance Confidence scale; physical function and mobility subscales of the Stroke Impact Scale 3.0; and a single item from the Stroke Impact Scale for perceived recovery. RESULTS Balance confidence at 1 month postdischarge from inpatient rehabilitation predicts perceived physical function (model 1), mobility (model 2), and recovery (model 3) 12 months later after adjusting for important covariates. The covariates included in model 1 were age, sex, basic mobility, and depression. The covariates selected for model 2 were age, sex, balance capacity, and anxiety, and the covariates in model 3 were age, sex, walking capacity, and social support. The amount of variance in perceived physical function, perceived mobility, and perceived recovery that balance confidence accounted for was 12%, 9%, and 10%, respectively. CONCLUSIONS After discharge from inpatient rehabilitation poststroke, balance confidence predicts individuals' perceived physical function, mobility, and recovery 12 months later. There is a need to address balance confidence at discharge from inpatient stroke rehabilitation.
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Affiliation(s)
- Caryne Torkia
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Krista L Best
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - William C Miller
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada; Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Janice J Eng
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Potential predictors for health-related quality of life in stroke patients undergoing inpatient rehabilitation. Health Qual Life Outcomes 2015; 13:118. [PMID: 26243294 PMCID: PMC4524441 DOI: 10.1186/s12955-015-0314-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/24/2015] [Indexed: 12/16/2022] Open
Abstract
Background Improving HRQOL is the desired outcome for patients with stroke undergoing inpatient rehabilitation services. This study aimed to comprehensively identify the potential health-related quality of life (HRQOL) predictors in patients with stroke undergoing inpatient rehabilitation within the first year after stroke; thus far, such an investigation has not been conducted. Methods We enrolled 119 patients (88 males, 31 females) with stroke, and examined 12 potential predictors: age, sex, stroke type, stroke side, duration after onset, cognition (Mini-Mental State Examination; MMSE), depression (Beck Depression Inventory-II), stroke severity (National Institutes of Health Stroke Scale; NIHSS), upper- and lower-extremity motor function scores of the Fugl–Meyer Assessment (FMA) scale, balance (Berg Balance Scale; BBS), and functional status (Functional Independence Measure). HRQOL was measured using Stroke Impact Scale (SIS) 3.0. Results NIHSS score predicted the strength domain and total SIS score (41.5 % and 41.7 % of the variances, respectively). BBS score was a major predictor of mobility and participation/role domains (48.6 % and 10 % of the variances, respectively). MMSE score predicted the memory and communication domains (22.5 % and 36.3 % of the variances, respectively). Upper extremity score of the FMA scale predicted the daily living/instrumental activities of daily life and hand function domains (40.3 % and 20.6 % of the variances, respectively). Stroke side predicted the emotion domain (11.6 % of the variance). Conclusions NIHSS, MMSE, BBS, FMA, and stroke side predicted most HRQOL domains. These findings suggest that different factors predicted various HRQOL domains in patients with stroke.
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Forster A, Mellish K, Farrin A, Bhakta B, House A, Hewison J, Murray J, Patel A, Knapp M, Breen R, Chapman K, Holloway I, Hawkins R, Shannon R, Nixon J, Jowett A, Horton M, Alvarado N, Anwar S, Tennant A, Godfrey M, Young J. Development and evaluation of tools and an intervention to improve patient- and carer-centred outcomes in Longer-Term Stroke care and exploration of adjustment post stroke: the LoTS care research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundEvidence-based care pathways are required to support stroke patients and their carers in the longer term.AimsThe twofold aim of this programme of four interlinking projects was to enhance the care of stroke survivors and their carers in the first year after stroke and gain insights into the process of adjustment.Methods and resultsWe updated and further refined a purposely developed system of care (project 1) predicated on a patient-centred structured assessment designed to address areas of importance to patients and carers. The structured assessment is linked to evidence-based treatment algorithms, which we updated using a structured protocol: reviewing available guidelines, Cochrane reviews and randomised trials. A pragmatic cluster randomised controlled trial evaluation of the clinical effectiveness and cost-effectiveness of this system of care was undertaken in 29 community-based UK stroke care co-ordinator services (project 2). In total, 15 services provided the system of care and 14 continued with usual practice. The primary objective was to determine whether the intervention improved patient psychological outcomes (General Health Questionnaire-12) at 6 months; secondary objectives included functional outcomes for patients, outcomes for carers and cost-effectiveness, as measured through self-completed postal questionnaires at 6 and 12 months. A total of 800 patients and 208 carers were recruited; numbers of participants and their baseline characteristics were well balanced between intervention and control services. There was no evidence of statistically significant differences in primary or secondary end points or adverse events between the two groups, nor evidence of cost-effectiveness. Intervention compliance was high, indicating that this is an appropriate approach to implement evidence into clinical practice. A 22-item Longer-term Unmet Needs after Stroke (LUNS) questionnaire was developed and robustly tested (project 3). A pack including the LUNS questionnaire and outcome assessments of mood and social activity was posted to participants 3 or 6 months after stroke to assess acceptability and validity. The LUNS questionnaire was re-sent 1 week after return of the first pack to assess test–retest reliability. In total, 850 patients were recruited and the acceptability, validity and test–retest reliability of the LUNS questionnaire as a screening tool for post-stroke unmet need were confirmed. This tool is now available for clinical use. An in-depth qualitative investigation was undertaken with 22 patients (and carers) at least 1 year after stroke (project 4) to gain further insights into the experience of adjustment. This included initial semistructured interviews, limited observations and solicited diaries with a follow-up interview 3–4 months after the initial interview and highlighted a range of different trajectories for post-stroke recovery.ConclusionsThe programme has been completed as planned, including one of the largest ever stroke rehabilitation trials. This work highlights that successfully addressing the needs of a heterogeneous post-stroke population remains problematic. Future work could explore stratifying patients and targeting services towards patients (and carers) with specific needs, leading to a more specialised bespoke service. The newly developed LUNS questionnaire and the qualitative work will help inform such services.Trial registrationCurrent Controlled Trials ISRCTN67932305.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme. The Bradford Teaching Hospitals NHS Foundation Trust received additional funding for project 2 in the submitted work from the Stroke Association, reference number TSA 2006/15. The initial development work for the LUNS tool and the Longer-Term Stroke care (LoTS care) trial carried out before the start of the programme grant was funded by the Stroke Association, reference number TSADRC 2006/01.
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Affiliation(s)
- Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Science, University of Leeds, Leeds, UK
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kirste Mellish
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Bipin Bhakta
- Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds General Infirmary, Leeds, UK
| | - Allan House
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jenni Murray
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anita Patel
- Centre for the Economics of Mental and Physical Health, King’s College London, London, UK
| | - Martin Knapp
- Centre for the Economics of Mental and Physical Health, King’s College London, London, UK
- Personal Social Services Research Unit, London School of Economics & Political Science, London, UK
| | - Rachel Breen
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Katie Chapman
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Rebecca Hawkins
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Science, University of Leeds, Leeds, UK
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rosemary Shannon
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jane Nixon
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Adam Jowett
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Mike Horton
- Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds General Infirmary, Leeds, UK
| | - Natasha Alvarado
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Science, University of Leeds, Leeds, UK
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Shamaila Anwar
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alan Tennant
- Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds General Infirmary, Leeds, UK
| | - Mary Godfrey
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Science, University of Leeds, Leeds, UK
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Science, University of Leeds, Leeds, UK
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Translation and initial validation of the Chinese (Cantonese) version of community integration measure for use in patients with chronic stroke. BIOMED RESEARCH INTERNATIONAL 2014; 2014:623836. [PMID: 24995317 PMCID: PMC4065661 DOI: 10.1155/2014/623836] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/30/2014] [Indexed: 11/29/2022]
Abstract
Objectives. To (1) translate and culturally adapt the English version Community Integration Measure into Chinese (Cantonese), (2) report the results of initial validation of the Chinese (Cantonese) version of CIM (CIM-C) including the content validity, internal consistency, test-retest reliability, and factor structure of CIM-C for use in stroke survivors in a Chinese community setting, and (3) investigate the level of community integration of stroke survivors living in Hong Kong. Design. Cross-sectional study. Setting. University-based rehabilitation centre.
Participants. 62 (n = 62) subjects with chronic stroke. Methods. The CIM-C was produced after forward-backward translation, expert panel review, and pretesting. 25 (n = 25) of the same subjects were reassessed after a 1-week interval. Results. The items of the CIM-C demonstrated high internal consistency with a Cronbach's α of 0.84. The CIM-C showed good test-retest reliability with an intraclass correlation coefficient (ICC) of 0.84 (95% confidence interval, 0.64–0.93). A 3-factor structure of the CIM-C including “relationship and engagement,” “sense of knowing,” and “independent living,” was consistent with the original theoretical model. Hong Kong stroke survivors revealed a high level of community integration as measured by the CIM-C (mean (SD): 43.48 (5.79)). Conclusions. The CIM-C is a valid and reliable measure for clinical use.
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Sex differences in health-related quality of life among adult stroke patients in Northeastern China. J Clin Neurosci 2014; 21:957-61. [DOI: 10.1016/j.jocn.2013.08.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/18/2013] [Indexed: 01/08/2023]
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Ben Ari (Shevil) E, Johansson S, Ytterberg C, Bergström J, von Koch L. How are cognitive impairment, fatigue and signs of depression related to participation in daily life among persons with multiple sclerosis? Disabil Rehabil 2014; 36:2012-8. [DOI: 10.3109/09638288.2014.887797] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Effects of atorvastatin on chronic subdural hematoma: A preliminary report from three medical centers. J Neurol Sci 2014; 336:237-42. [DOI: 10.1016/j.jns.2013.11.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/29/2013] [Accepted: 11/04/2013] [Indexed: 12/14/2022]
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Mayo NE, Scott SC, Bayley M, Cheung A, Garland J, Jutai J, Wood-Dauphinee S. Modeling health-related quality of life in people recovering from stroke. Qual Life Res 2013; 24:41-53. [DOI: 10.1007/s11136-013-0605-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2013] [Indexed: 11/28/2022]
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Social Participation after Stroke: One-Year Follow-Up of Stroke Survivors in Nigeria. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/532518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Stroke may negatively affect social participation in survivors. Aims. This study assessed the pattern of social participation in a sample of Nigerian stroke survivors across the first 12 months after stroke. Methods. Stroke survivors were consecutively recruited while on admission at a tertiary health institution. The London handicap scale was used to assess social participation at 1, 3, 6, 9, and 12 months at the homes of the stroke survivors. Overall and domain-specific patterns of social participation were examined independently and also in relation to initial stroke severity. Results. Overall social participation significantly improved over 12 months (), while significant improvements were observed only in the mobility, physical independence, and work and leisure domains at P equals 0.04, 0.04, and 0.05, respectively. In spite of the improvement in the work and leisure domain, the domain recorded the lowest level of participation. Social participation also differed by initial stroke severity with severe stroke survivors having the lowest level of participation across 12 months after stroke. Conclusions. The poor outcome in the work and leisure domain of social participation and in individuals with initial severe stroke has implications for planning and provision of appropriate long-term stroke rehabilitation.
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Necessary and sufficient causes of participation post-stroke: practical and philosophical perspectives. Qual Life Res 2013; 23:39-47. [PMID: 23754685 DOI: 10.1007/s11136-013-0441-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Participation, a construct within the disability/functioning framework, is evaluated on a person's involvement in life situations including family, community, work, social, and civic life. In the context of recovering from a major health event, participation is a treatment goal and it is known to correlate with the quality of life. OBJECTIVE The purpose of this study is to track the dynamics of participation post-stroke in relationship to the dynamics of walking capacity, social support, and mood. METHODS An inception cohort was followed over the first post-stroke year. Group-based trajectory analysis, a form of latent class analysis, was used to identify distinctive groups of individuals with similar trajectories. Dual trajectories were used to estimate concordance between participation trajectory and trajectories for each of the three constructs under study. RESULTS From the sample of 102 persons (mean age 70), four trajectories of participation were identified, two of which were qualified as excellent and very good, and two qualified as fair and poor. All those with excellent walking showed excellent participation. However, people with excellent (and very good) community participation had a range of walking capacities. Most (82%) people with normal mood showed excellent participation. People with good mood but not meeting norms for age showed the complete range of participation trajectories from excellent to poor. The higher proportion of people with excellent or good social support (57%) showed excellent participation. CONCLUSION Two treatable component causes of participation, walking capacity and mood, were identified; of these, only excellent walking capacity could be considered a sufficient cause.
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Tse T, Douglas J, Lentin P, Carey L. Measuring participation after stroke: a review of frequently used tools. Arch Phys Med Rehabil 2012; 94:177-92. [PMID: 22982555 DOI: 10.1016/j.apmr.2012.09.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/29/2012] [Accepted: 09/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify and critique the measures currently used to assess participation in clinical stroke studies. DATA SOURCES Relevant articles published between January 2001 and April 2012 identified through Medline, CINAHL, and ProQuest Central databases. STUDY SELECTION Published articles involving poststroke assessment of participation. Case studies, cohort studies, and randomized controlled trials were included. DATA EXTRACTION The most frequently used measures were identified and the psychometric properties evaluated. Three raters independently evaluated each measure relative to the first and second coding levels of the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domain categories. DATA SYNTHESIS Thirty-six measures were identified. The Stroke Impact Scale (SIS), London Handicap Scale, Assessment of Life Habits (LIFE-H), Frenchay Activities Index, and Activity Card Sort (ACS) were used most frequently. No single measure met criteria across all psychometric indices, and not one covered all 9 of the ICF Activities and Participation domains. The SIS, LIFE-H, and ACS covered the widest range. The domains covered most frequently were Community, Social and Civic Life, Domestic Life, and Mobility. Learning and Applying Knowledge, General Tasks and Demands, and Communication were the domains less frequently covered. CONCLUSIONS This review identified and evaluated the most frequently used participation measures in clinical stroke studies. The SIS, LIFE-H, and ACS covered the ICF Activities and Participation domain categories most comprehensively. However, none of the measures covered all the ICF Activities and Participation domain categories. The information provided in this systematic review can be used to guide the selection of participation measures to meet specific clinical and research purposes.
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Affiliation(s)
- Tamara Tse
- The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Stroke Division, Heidelberg, Victoria, Australia.
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