Quality of life and psychological problems in patients undergoing neurological rehabilitation

Health-related quality of life and associated factors among adult patients with epilepsy in public hospitals of Wolaita zone, southern Ethiopia. An embedded mixed method study

BACKGROUND

The socioeconomic and overall quality of life of patients with epilepsy are significantly impacted by the disease, which is one of the most prevalent chronic noncommunicable brain disorders. Less consideration has, however, been given to research in Ethiopia generally and the study setting in particular. Consequently, the purpose of this study was to assess the health-related quality of life and associated factors among adult patients with epilepsy in public hospitals in the Wolaita zone of southern Ethiopia.

METHODS

A facility-based embedded mixed method with cross-sectional and phenomenological study designs was carried out on 423 adult patients with epilepsy from August 1 to August 30, 2022. Systematic and criterion-purposive sampling was employed for the cross-sectional and phenomenological designs, respectively, to select study participants. Quantitative data were entered into Kobo Toolbox and then exported to SPSS Version 25 for analysis. The frequency, percentage, and cross-tabulation of the different variables were then determined. Finally, the magnitude and associated factors were first analyzed using binary logistic regression and then multivariate logistic regression. P < 0.05 was chosen as the level of statistical significance. An inductive thematic approach was used for qualitative data analysis.

RESULTS

A total of 423 patients with epilepsy were included in the study, making the response rate 100%. The overall prevalence of poor quality of life among patients with epilepsy in the study area was 53 percent (95% CI: 48.24-57.76). Being single (AOR = 4.457, 95% CI: 1.149, 17.282), having poor social support (AOR = 3.741, 95% CI: 2.107, 6.643), having uncontrolled seizures (AOR = 2.154, 95% CI: 1.234, 3.759), and having a high frequency of seizures (AOR = 5.192, 95% CI: 1.574, 17.126) were significantly associated factors with quality of life. Lack of social support, a fear of drug side effects, and worry about their disease were findings from the qualitative perspective added to the perspective of the quantitative findings.

CONCLUSION

One in every two patients with epilepsy in this study had a poor quality of life. Being single, the frequency of seizures, and a lack of social support all have a significant association. Public health initiatives should continue to strive to create positive awareness of epilepsy in society in addition to managing the clinical aspect of the disease.

An assessment of disability and quality of life in people with spinal cord injury upon discharge from a Bangladesh rehabilitation unit

DESIGN

Cross-sectional.

OBJECTIVES

The purpose of the study was to determine the level of disability and quality of life of people with spinal cord injury at the end of their inpatient rehabilitation at a rehabilitation center in Bangladesh. These outcomes were considered indicators of successful rehabilitation and a basis for comparing the success of reintegration into community.

SETTING

Center for the Rehabilitation of the Paralyzed, Bangladesh.

METHODS

Two standard structured questionnaires, the WHODAS 2.0 and WHOQOL-BREF, was used to collect data to assess level of disability and quality of life (QOL). Data were analyzed using Mann-Whitney-U test and Kruskal-Wallis test.

RESULTS

One hundred participants (91 men and 9 women) with SCI were recruited. Just prior to discharge from in-patient rehabilitation at CRP people with SCI perceived themselves overall as having on average a mild level of disability, and good QOL in physical, psychological, and environmental health domains. They indicated poor QOL in the social health domain. There were some specific differences in various WHODAS 2.0 Domains and overall scores when comparing age, gender, type and level of injury, occupation, and income. Between-group comparisons indicated that male participants had a significantly higher quality of life in the Environmental Health Domain and those with a paraplegic injury had a significantly higher quality of life in the Physical Health Domain.

CONCLUSION

By the end of their rehabilitation people with SCI had a relatively positive perception of level of disability and QOL. However, the results of other research has found that post-discharge their disability level increase and QOL decrease across all domains. Hence, it is recommended that more monitoring of level of disability and QOL is conducted post-discharge, along with a greater focus on community-based rehabilitation strategies and procedures to contribute to long-term reduction in level of disability and improved QOL.

The effect of the Mediterranean diet on health outcomes in post-stroke adults: a systematic literature review of intervention trials

BACKGROUND

Stroke represents a major source of mortality and morbidity worldwide. Guidelines for stroke management and secondary prevention focus on reducing stroke-related risk factors such as smoking cessation, exercise and diet. Several clinical practice guidelines specifically recommend a Mediterranean diet (MD) for individuals with stroke. However, these recommendations rely primarily on observational research. The aim of this review is to critically appraise the current experimental evidence assessing the use of a Mediterranean diet on health outcomes in post-stroke adults.

METHODS

A systematic literature review was conducted of original research which assessed the role of a Mediterranean diet on health outcomes in post-stroke adults. The following databases were searched: PROQUEST, SCOPUS (Elsevier), MEDLINE (EBSCO), EMBase and Cochrane Library up to the 25th of August 2021.

RESULTS

A total of 6 studies from a total of 5838 identified studies met the full inclusion criteria and were included in this review. Several different health outcomes were assessed, including blood pathology tests, physical examinations, secondary vascular events and mortality. The Mediterranean diet appears to be beneficial for systolic and diastolic blood pressure, LDL cholesterol, BMI and waist circumference.

CONCLUSION

This review suggests a Mediterranean diet may be helpful for several health outcomes in post-stroke adults. However, more research is needed to confirm these findings. To ensure robust methodology and replication of results, specific details of the included and excluded foods, quantities and serving sizes should be reported in future research.

Leveraging Factors of Self-Efficacy and Motivation to Optimize Stroke Recovery

The International Classification of Functioning, Disability and Health framework recognizes that an individual's functioning post-stroke reflects an interaction between their health condition and contextual factors encompassing personal and environmental factors. Personal factors significantly impact rehabilitation outcomes as they determine how an individual evaluates their situation and copes with their condition in daily life. A key personal factor is self-efficacy-an individual's belief in their capacity to achieve certain outcomes. Self-efficacy influences an individual's motivational state to execute behaviors necessary for achieving desired rehabilitation outcomes. Stroke rehabilitation practice and research now acknowledge self-efficacy and motivation as critical elements in post-stroke recovery, and increasing evidence highlights their contributions to motor (re)learning. Given the informative value of neuroimaging-based biomarkers in stroke, elucidating the neurological underpinnings of self-efficacy and motivation may optimize post-stroke recovery. In this review, we examine the role of self-efficacy and motivation in stroke rehabilitation and recovery, identify potential neural substrates underlying these factors from current neuroimaging literature, and discuss how leveraging these factors and their associated neural substrates has the potential to advance the field of stroke rehabilitation.

The quality of life of stroke survivors in the Indian setting: A systematic review and meta-analysis

Background:

The significant burden of stroke on the mortality rates of developing countries, including India, is well-documented in the literature. However, robust data regarding the aggregates of evidence on the quality of life (QOL) of stroke survivors is limited.

Objective:

To gather relevant information for policymakers on the QOL of stroke survivors based on observational studies conducted in the Indian setting.

Methods:

We searched PubMed, Scopus, and Google Scholar for studies conducted in the Indian setting. The methodological quality of each study was scored, and data were extracted from the published reports. The risk of bias assessment was conducted based on the JBI Critical Appraisal Checklist criteria. The relevant data regarding QOL were analyzed by a random effects model using R software.

Results:

16 studies were included in the systematic review in which the majority of the studies recruited study participants in the hospital-based setting with an average duration of 3-6 months following the stroke episode. Our findings suggest that the pooled mean quality of life in the four dimensions of the World Health Organization Quality of Life instrument (WHOQOL-BREF) were ranged from 46.86 to 61.37 and the overall Stroke Specific Quality of Life scale (SS-QOL) mean score was 157.16. There was a significant inconsistency among the included studies as heterogeneity was high (I² >97%).

Conclusion:

Assessment of the quality of life among stroke survivors is a crucial step to predict the illness' imposed burden and ascertain the effectiveness of the treatment. The present meta-analysis elucidates the aggregate estimates of quality of life and contributes to the research on the quality of life following a stroke in an Indian context.

Effects of App-Based Transitional Care on the Self-Efficacy and Quality of Life of Patients With Spinal Cord Injury in China: Randomized Controlled Trial

BACKGROUND

Spinal cord injury (SCI) severely impairs the physical and mental health of patients, decreasing their self-efficacy in coping with daily life and quality of life (QOL). In China, a large gap remains between the complex long-term health needs of SCI patients and the current community care system. With the prevalence of mobile terminals, the usage of mobile health apps has the potential to fill this gap by extending qualified medical resources to the families of SCI patients. Our team developed the app Together for the transitional care of home-dwelling SCI patients in China.

OBJECTIVE

This study aimed to evaluate the effects of app-based transitional care on the self-efficacy and QOL of SCI patients.

METHODS

Through a three-round Delphi process, an Android app was designed. Both medical staff and patients could access the app. Medical staff used it for providing remote transitional care to SCI patients. Patients used it to view transitional care time and send messages to medical staff. Thereafter, a multicenter and assessor-blinded randomized controlled trial was conducted. Participants (n=98) who had SCI and lived at home following discharge were recruited and randomly assigned to a study group (n=49) and control group (n=49) using a randomized number list in four research centers. Patients in both groups received systematic discharge education before discharge. The study group received five follow-ups conducted by trained nurses through the app, which had four core functions, namely remote assessment, health education, interdisciplinary referral, and patient interaction, at weeks 2, 4, 6, 8, and 12 following discharge. The control group received a routine telephone follow-up conducted by nurses at week 12 following discharge. The outcome measures were the Moorong Self-Efficacy Scale (MSES) and 36-item Short-Form Health Survey (SF-36) scores. Data were collected before discharge (T0) and at weeks 12 (T1) and 24 following discharge (T2). Differences between the groups were tested by repeated measures analysis of variance and simple effect analysis.

RESULTS

After the follow-up, the total MSES scores in the study group improved over time (T0=67.80, T1=71.90, and T2=76.29) and were higher than those in the control group (T2=64.49) at 24 weeks following discharge (simple effect analysis: F1=8.506, P=.004). Regarding the total SF-36 score, although it was higher in patients from the study group (T2=65.36) than those from the control group (T2=58.77) at 24 weeks following discharge, only time effects were significant (F2,95=6.671, P=.002) and neither the group effects nor the interaction effects influenced the change in QOL (group effects: F1,96=0.082, P=.78; interaction effects: F2,95=3.059, P=.052).

CONCLUSIONS

This study confirmed that app-based transitional care improves the self-efficacy of SCI patients. Nevertheless, QOL improvement is not yet evident. Future investigations with larger sample sizes and longer observation periods are warranted to further verify the effects.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-IPR-17012317; http://www.chictr.org.cn/showproj.aspx?proj=19828.

A Cross-Sectional Study of Quality of Life among Subjects with Epilepsy Attending a Tertiary Care Hospital

INTRODUCTION

Epilepsy is a chronic disorder associated with profound physical and psychological consequences leading to impaired quality of life (QoL). Evaluation of the QoL among epileptics would throw light on various factors that impair or affect the QoL in such a population.

AIM

To study the QoL among epileptic patients attending outpatient departments of a tertiary care hospital and to identify various factors that affect the QoL in such a population.

MATERIALS AND METHODS

A cross-sectional observational questionnaire based study, including patients with epilepsy, who were on antiepileptic drugs, on follow-up for minimum one year, aged more than 18years, both sexes and who were seizure free in the previous 24hours. The World Health Organisation Quality of Life (WHOQOL-BREF) questionnaire was administered to those included in the study. The data was analysed using Statistical Package for Social Sciences (SPSS) version 20 and statistical tests like t-test for independent variables and Analysis of Variance (ANOVA) were used to compare the QoL scores.

RESULTS

Of the 98 subjects 61.2% were males, majority were educated upto high school level and most of them were employed in unskilled labour. The mean total QOL score was 53.9 (15.8). There was a significant lower mean total QOL score among people with low educational status and poor seizure control.

CONCLUSION

Epilepsy is a syndrome associated with chronic drug use and regular long term follow-ups to hospitals. These treatment and disease associated problems affects the QOL of the subjects significantly in various squares of life. We found that a lower education and having seizure in the recent past affected the QOL scores.

Prevalence of depression, fatigue, and sleep disturbances in patients with myelopathy: Their relation with functional and neurological recovery

OBJECTIVES

To observe the prevalence of fatigue, depression, and sleep disturbance in patients with myelopathy and their correlation with neurological and functional recovery.

PATIENTS AND METHODS

Study conducted in a university tertiary research hospital with 127 patients with myelopathy (92 males) admitted to neurorehabilitation unit between January 2010 and December 2013. Mean age was 32.71 ± 13.08 years (range 15-65 years), and mean duration of injury was 76.22 ± 82.5 days (range 14-365 days). Functional status and impairments were assessed using Barthel Index and Spinal Cord Independence Measures. Depression, fatigue, and sleep disturbances were assessed using Hospital Anxiety and Depression Scale, Fatigue Severity Scale, and Pittsburgh Sleep Quality Index scales, respectively. Neurological recovery was assessed using American Spinal Injury Association's impairment scale.

RESULTS

Forty-four out of 104 (42%) patients had borderline or confirmed depression, 36/108 (33%) had significant fatigue, and 62/106 (58%) had significant sleep disturbances at admission. Significant correlation was observed between change in fatigue and depression scores with change in functional status scores (P < 0.05) but no correlation (P > 0.05) between change in sleep disturbance scores and functional status score and neurological recovery (P > 0.05). Similarly, change in fatigue and depression scores had no correlation with neurological status improvement. Fatigue, depression, and sleep disturbance scores showed significant improvement, that is, admission vs. discharge scores (P < 0.05) with significant correlation between improvement in all three variables (P < 0.05).

CONCLUSIONS

Study variables showed significant improvement in the present study with myelopathy patients but not necessarily correlating with functional and neurological recovery.

Quality of life and probable psychological distress among male workers at a construction site, Kolar district, Karnataka, India

Introduction:

The construction industry, which mainly consists of migrant labouers is one of the largest employers in the unorganized sector in India. These workers work in poor conditions and are often vulnerable to exploitation. These workers also do not have health care benefits and often these factors lead to poor quality of life (QOL) and psychological distress.

Objectives:

To assess the QOL, probable psychological distress and associated factors among male construction workers.

Materials and Methods:

A cross-sectional study was conducted between September 2013 and November 2013 among 404 male workers. These construction workers were enrolled by consecutive sampling at a construction area in Kolar district, Kaarnataka, India. The study tools used were World Health Organization (WHO) QOL-BREF and 12-Item General Health Questionnaire (GHQ-12) to assess QOL and probable psychological distress, respectively. The transformed scores in WHO QOL-BREF in all four domains ranged 0–100. The four domain scores are scaled in a positive direction with higher scores indicating a higher QOL. Associations were done using statistical tests such as Chi-square, correlation, regression, independent samples t-test, and analysis of variance (ANOVA).

Results:

A total of 404 male workers with a mean age of 25.6 ± 7.3 years were studied. Mean scores of various domains of QOL were 68.5 ± 13.7 (physical), 59.9 ± 13.5 (psychological), 64.3 ± 16.4 (social), and 44.1 ± 12.8 (environmental). On the self- rating scale, 59 (14.6%) workers were rated as having poor QOL. The prevalence of probable psychological distress was 27.5%. Factors such as increasing age, being currently married, and low educational status were found to be significantly associated (P < 0.05) with poor QOL and psychological distress. There was a significant negative correlation (P < 0.05) between QOL and psychological distress and a positive correlation between income and QOL.

Conclusion:

The QOL in the environmental domain, which mainly deals with living conditions, health, and recreational facilities was found to be poor and there was a high prevalence of probable psychological distress among workers. This indicates a need for improving workplace amenities, and access to health and recreational facilities.

Physical Activity and Quality of Life among Adults with Paraplegia in Odisha, India

OBJECTIVES

The complete rehabilitation of patients with spinal cord injuries (SCI) comprises both physical and psychosocial factors. This study therefore aimed to assess physical activity and quality of life (QOL) among paraplegic patients with SCI in Odisha, India.

METHODS

This cross-sectional prospective study was conducted between March 2010 and December 2013. All paraplegic patients treated at the Swami Vivekanand National Institute of Rehabilitation Training & Research in Odisha, India, during the study period who met the inclusion criteria were invited to participate in the study (n = 364). Structured face-to-face interviews were held with participants and QOL and physical activity were assessed using the abbreviated World Health Organization QOL instrument and the Physical Activity Scale for Individuals with Physical Disabilities, respectively.

RESULTS

A total of 84 people participated in the study (response rate: 23.1%). The mean age was 32.54 ± 10.75 years and 90.5% of the participants were male. Participants had a low mean metabolic equivalent score (18.18 ± 10.68 hours/day). Additionally, low mean scores were noted for the physical health, psychological well-being, social relationships and environment QOL domains (49.76 ± 18.74, 48.57 ± 17.04, 57.88 ± 17.04 and 49.85 ± 17.77, respectively). There was a strong positive association between levels of physical activity and all QOL domains (P <0.050). Physical activity and employment status were significant predictors of all QOL domains (P <0.001).

CONCLUSION

Low physical activity levels and QOL were noted among the paraplegic subjects. Interventions promoting physical activity and employment may help to improve QOL among this patient group.

Quality of life of individuals with stroke and their caregivers in a city of Triângulo Mineiro

Objective: To compare the quality of life (QoL) of individuals with stroke and their caregivers. Methods: This is an observational cross-sectional survey, involving 83 individuals who suffered a stroke. The participants were divided into four groups: group of individuals with stroke who have caregivers (44), group of individuals with stroke without caregivers (39), group of caregivers (44) and a reference group (83) in the period of March to May 2010. To assess QoL, the instrument used was the WHOQOL-bref. Results: The highest scores for the four fields were observed increasingly for the group of individuals with stroke with caregivers, the stroke group without caregivers followed by the group of caregivers and the reference group. The comparison of scores between groups showed that the presence of stroke and the fact of being caregiver affect QoL in all domains of WHOQOL-bref. Conclusion: It was possible to understand the negative impact that stroke causes in the lives of the affected ones and their caregivers, in order to better target public health policies.

Technology to help persons with extensive neuro-motor impairment and lack of speech with their leisure occupation and communication

These two studies were aimed at extending the assessment of technology-aided programs to enhance leisure occupation or communication with persons with extensive neuro-motor impairment and lack of speech. Specifically, Study I implemented the program for leisure occupation with two post-stroke patients. Study II implemented the program for communication with two persons affected by amyotrophic lateral sclerosis (ALS). In Study I, a computer system presented the participants with a variety of stimuli. The participants could select/access those stimuli by microswitch activation or could bypass them by abstaining from microswitch responses. In Study II, the participants used a computer-aided telephone system that allowed them to choose via microswitch activation the persons to call. On the computer screen, they also had words and phrases that they could activate during the calls to influence the conversation with the persons called. Data from both studies were largely positive. The post-stroke patients showed high levels of stimulus selection (access) and extended engagement. The patients with ALS were able to make phone calls and to select the words/phrases to influence the conversations. The relevance of technology-aided programs for leisure occupation and communication of persons with extensive multiple disabilities was discussed.

Psychiatric comorbidity and quality of life in patients with post-stroke emotional incontinence

OBJECTIVE

We aimed to investigate the associations of post-stroke emotional incontinence (PSEI) with various psychiatric symptoms and quality of life independent of potential covariates in survivors of acute stroke.

METHODS

A total of 423 stroke patients were assessed within 2 weeks of the index event. Psychiatric symptoms were assessed by the Symptom Checklist-90-Revised (SCL-90-R), which has nine domains comprising Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism. Quality of life was measured using the World Health Organization Quality of Life abbreviated form (WHOQOL-BREF), which has four domains related to physical factors, psychological factors, social relationships, and environmental context. Associations of PSEI with scores on the SCL-90-R and WHOQOL-BREF were investigated using pairwise logistic regression model adjustment for potential sociodemographic and clinical covariates.

RESULTS

PSEI was present in 51 (12.1%) patients. PSEI was associated with the Obsessive-Compulsive, Interpersonal Sensitivity, and Hostility symptom dimensions of the SCL-90-R and with the psychological factors and social relationships domains of the WHOQOL-BREF independent of important covariates including previous stroke, stroke severity, and physical disability.

CONCLUSION

PSEI causes some aspects of psychiatric distress and negatively affects psychological and interpersonal quality of life. For patients with PSEI, special attention to psychiatric comorbidity and quality of life is needed, even in the acute stage of stroke.

Psychiatric morbidity in patients with transverse myelitis and stroke: A comparison

BACKGROUND

Psychiatric morbidity may be highly prevalent in transverse myelitis (TM), but data on this aspect are limited.

AIM

To assess psychiatric morbidity in a clinical sample of patients with idiopathic TM compared to patients with a recent stroke.

MATERIALS AND METHODS

Consecutive patients with idiopathic TM and stroke (30 each) underwent two-stage screening with the General Health Questionnaire-12 (GHQ-12) and Structured Clinical Interview for Axis I DSM-IV Disorders - Clinician Version (SCID I-CV), and ratings of depression, disability levels, and cognitive impairment.

RESULTS

Seventy percent of the patients with TM scored above the cut-off on the GHQ; 30% had a positive diagnosis of a psychiatric disorder. Major depression (17%) was the commonest psychiatric disorder. Mini-Mental State Examination (MMSE) scores indicated cognitive impairment in 23% of patients with TM. Higher GHQ-12 scores were associated with greater disability. These results were similar to those obtained among patients with stroke.

CONCLUSION

A high prevalence of psychological distress and psychiatric morbidity was found in idiopathic TM. This morbidity was associated with greater disability.

Quality of life in adults with spinal cord injury living in the community

STUDY DESIGN

The study design used is cross-sectional descriptive survey.

OBJECTIVES

The aim of this study is to describe the subjective and objective quality of life (QoL) of adults with chronic non-traumatic spinal cord injury (NT-SCI) and to compare the objective and subjective QoL of adults with chronic NT-SCI with adults who have a chronic traumatic spinal cord injury (T-SCI) and the general population.

SETTING

Living in the general community (non-residential care), Australia.

PARTICIPANTS

The study included 443 adults with SCI (T-SCI, n=381) (NT-SCI, n=62), all SCI ≥6 months duration.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Objective and subjective QoL domains--Comprehensive QoL Scale for Adults, version 5 (COMQoL-A5); acceptance subscale--the Spinal Cord Lesion Coping Strategies Questionnaire, version 1 Australia (SCL CSQ v1.0 Australia).

RESULTS

Despite demographic differences, only the objective QoL domain material (higher in NT-SCI) and the subjective QoL domain health (lower in NT-SCI) were significantly different between the SCI subgroups. In contrast, five of the seven objective domains and four of the seven subjective domains were significantly lower in the SCI sample as a whole, compared with the general population. Post hoc analyses suggested that aetiology of the SCI was not responsible for QoL differences within the cohort with SCI.

CONCLUSION

On the whole, aetiology makes little difference to QoL outcomes after SCI. The QoL of adults with chronic T-SCI and NT-SCI fall significantly below that of the general population in most domains.

Caregiver Burden and Quality of Life of Older Persons With Stroke

This article reports a preliminary investigation in India of the association between caregiver burden and quality of life (QOL) in older persons with stroke after controlling for disability, depression, and sociodemographic factors. A cross-sectional analysis was carried out with 46 stroke patients attending a community hospital in India. The primary outcome variable was patient QOL assessed using the World Health Organization Quality of Life questionnaire–short form (WHOQOL-Bref). The primary explanatory variable was caregiver burden, assessed using the Zarit Inventory. Patient economic dissatisfaction ( F = 6.12, p = .04), patient depression ( F = 20.8, p < .001), and caregiver burden ( F = 7.36, p = .009) were found to be associated with lower patient QOL. Caregiver burden was independently associated with lower patient QOL after controlling for patient depression, disability, and economic dissatisfaction (standardized B coefficient = −0.28, p = .03). The level of caregiver burden was a significant correlate of QOL after stroke. Implications for future studies and practice are discussed.

An overview of Indian research in depression

Depression as a disorder has always been a focus of attention of researchers in India. Over the last 50-60 years, large number of studies has been published from India addressing various aspects of this commonly prevalent disorder. The various aspects studied included epidemiology, demographic and psychosocial risk factor, neurobiology, symptomatology, comorbidity, assessment and diagnosis, impact of depression, treatment related issues and prevention of depression in addition to the efficacy and tolerability of various antidepressants. Here, we review data on various aspects of depression, originating from India.