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Barakou I, Hackett KL, Finch T, Hettinga FJ. Self-regulation of effort for a better health-related quality of life: a multidimensional activity pacing model for chronic pain and fatigue management. Ann Med 2023; 55:2270688. [PMID: 37871249 PMCID: PMC10595396 DOI: 10.1080/07853890.2023.2270688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE To propose a comprehensive multidimensional model of activity pacing that improves health-related quality of life and promotes sustained physical activity engagement among adults with chronic conditions. MATERIALS AND METHODS A narrative review was conducted to examine the existing literature on activity pacing, health-related quality of life, pain and fatigue management, and physical activity promotion in chronic conditions. RESULTS The literature revealed a lack of a cohesive approach towards a multidimensional model for using activity pacing to improve health-related quality of life. A comprehensive multidimensional model of activity pacing was proposed, emphasizing the importance of considering all aspects of pacing for sustained physical activity engagement and improved health-related quality of life. The model incorporates elements such as rest breaks, self-regulatory skills, environmental factors, and effective coping strategies for depression/anxiety. It takes into account physical, psychological, and environmental factors, all of which contribute significantly to the enhancement of health-related quality of life, physical function, and overall well-being, reflecting a holistic approach. CONCLUSIONS The model offers guidance to researchers and clinicians in effectively educating patients on activity pacing acquisition and in developing effective interventions to enhance physical activity engagement and health outcomes among adults with chronic conditions. Additionally, it serves as a tool towards facilitating discussions on sustained physical activity and a healthy lifestyle for patients, which can eventually lead to improved quality of life.
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Affiliation(s)
- Ioulia Barakou
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Katie L. Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- CRESTA Fatigue Clinic, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
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Delgado P, Yihun Y. Integration of Task-Based Exoskeleton with an Assist-as-Needed Algorithm for Patient-Centered Elbow Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23052460. [PMID: 36904662 PMCID: PMC10006945 DOI: 10.3390/s23052460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 05/14/2023]
Abstract
This research presents an Assist-as-Needed (AAN) Algorithm for controlling a bio-inspired exoskeleton, specifically designed to aid in elbow-rehabilitation exercises. The algorithm is based on a Force Sensitive Resistor (FSR) Sensor and utilizes machine-learning algorithms that are personalized to each patient, allowing them to complete the exercise by themselves whenever possible. The system was tested on five participants, including four with Spinal Cord Injury and one with Duchenne Muscular Dystrophy, with an accuracy of 91.22%. In addition to monitoring the elbow range of motion, the system uses Electromyography signals from the biceps to provide patients with real-time feedback on their progress, which can serve as a motivator to complete the therapy sessions. The study has two main contributions: (1) providing patients with real-time, visual feedback on their progress by combining range of motion and FSR data to quantify disability levels, and (2) developing an assist-as-needed algorithm for rehabilitative support of robotic/exoskeleton devices.
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Nayak A, Bhave AC, Misri Z, Unnikrishnan B, Mahmood A, Joshua AM, Karthikbabu S. Facilitators and barriers of community reintegration among individuals with stroke: a scoping review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2023. [DOI: 10.1080/21679169.2022.2156599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Akshatha Nayak
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Aishwarya C. Bhave
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Zulkifli Misri
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Amreen Mahmood
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Abraham M. Joshua
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust, Coimbatore, The Tamil Nadu Dr. M.G.R. Medical University, Chennai
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Wan LP, Yang GM, Dong HY, Liang XX, He Y. Perceived participation and autonomy structural relationships among related factors in patients with stroke and hypertension in China: A ISM model approach. Front Public Health 2023; 10:1070998. [PMID: 36711350 PMCID: PMC9874123 DOI: 10.3389/fpubh.2022.1070998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023] Open
Abstract
Aims To explore the structural relationship between perceived participation and autonomy among older adults with stroke and hypertension in home and community-based services (HCBSs) in the eastern coastal region of China. Design An explorative cross-sectional study. Methods From July to September 2021, a total of 714 respondents were reported to have stroke and hypertension, and their information was used in the analysis of this study. A multiple linear regression analysis was used to explore the factors influencing factors older adults' perceived participation and autonomy. Using the ISM model, we analyzed the factors affecting social participation in patients with stroke and hypertension and explained the logical relationships and hierarchy among the factors. Results The mean score of perceived participation was 58.34 ± 27.57. Age, marital status, health insurance, living status, number of children, chronic diseases, sleep time, frequency of outings, and health utility value were significant factors affecting perceived participation and autonomy with stroke and hypertension patients. Among them, health insurance is the direct factor on the surface, age, number of children, chronic diseases, sleep time, frequency of outings, and health utility value are the intermediate indirect factors, and marital status and living status are the deep-rooted factors. Conclusion By the study that the hierarchical structure provides a visualization of interrelationships and interdependences among the influencing factors of perceived participation and autonomy. It also may be a significant complement to traditional variable-entered approaches and construct an optimized multidimensional perspective of participation and autonomy. Future research should focus on optimizing the living environment of older adults with stroke and hypertension to explore the model of rehabilitative intervention and help patients successfully reintegrate into their families/societies.
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Affiliation(s)
| | | | | | | | - Yan He
- College of Public Health, Zhengzhou University, Zhengzhou, China
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Sakr F, Dabbous M, Akel M, Salameh P, Hosseini H. Construction and Validation of the 17-Item Stroke-Specific Quality of Life Scale (SS-QOL-17): A Comprehensive Short Scale to Assess the Functional, Psychosocial, and Therapeutic Factors of QOL among Stroke Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15668. [PMID: 36497746 PMCID: PMC9741031 DOI: 10.3390/ijerph192315668] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: The exiting stroke-specific quality of life (SS-QOL) measure scales are limited by their excessive length, inconsistent validity, and restricted breadths of assessment. The objectives of this study were to construct and validate a comprehensive short SS-QOL scale to assess stroke-related outcomes and QOL and determine the socioeconomic, sociodemographic, and pharmacotherapeutic predictors of QOL among stroke survivors. (2) Methods: The novel 17-item SS-QOL scale (SS-QOL-17) was constructed with the aim of providing a well-balanced measuring tool to depict QOL widely while ensuring the simplicity of administration. (3) Results: The SS-QOL-17 structure was validated over a solution of three factors with a Kaiser-Meyer-Olkin measure of sampling adequacy = 0.894 and a significant Bartlett's test of sphericity (p < 0.001). The Cronbach's alpha of the SS-QOL-17 was 0.903. Better QOL was correlated to financial wellbeing (beta 0.093, p < 0.001), and medication adherence (beta 0.305, p = 0.004), whereas reduced QOL was correlated to older age (beta -0.117, p = 0.014), illiteracy (beta -6.428, p < 0.001), unemployment (beta -6.170, p < 0.001), and higher amount of prescribed medication (beta -1.148, p < 0.001). (4) Conclusions: The SS-QOL-17 is a valid and reliable tool with promising psychometric properties. It is useful in clinical practice and research settings to evaluate the post-stroke therapeutic and rehabilitation outcomes.
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Affiliation(s)
- Fouad Sakr
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, 94010 Créteil, France
- UMR 955 INSERM, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, 94010 Créteil, France
- School of Pharmacy, Lebanese International University, Beirut 1105, Lebanon
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut 1105, Lebanon
| | - Marwan Akel
- School of Pharmacy, Lebanese International University, Beirut 1105, Lebanon
- International Pharmaceutical Federation (FIP), 2517 The Hague, The Netherlands
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut 1103, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut 1103, Lebanon
- School of Medicine, Lebanese American University, Byblos 4504, Lebanon
- Faculty of Public Health, Lebanese University, Beirut 1103, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia 2408, Cyprus
| | - Hassan Hosseini
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, 94010 Créteil, France
- UMR 955 INSERM, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, 94010 Créteil, France
- Stroke Unit, Service de Neurologie, CHU Henri Mondor, 94010 Créteil, France
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Perceived Community Participation and Associated Factors in People With Stroke. Arch Rehabil Res Clin Transl 2022; 4:100210. [PMID: 36123973 PMCID: PMC9482037 DOI: 10.1016/j.arrct.2022.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To examine individual- and environmental-level factors associated with perceived participation performance and satisfaction in people with chronic stroke. Design Cross-sectional study using secondary data analysis of baseline data from a randomized controlled trial. Setting Community-based setting. Participants Community-dwelling adults with mild to moderate stroke (N=113; mean age=57 years; 58 males). Interventions Not applicable. Main Outcome Measures Main outcomes were measured with the Reintegration to Normal Living Index (perceived participation performance) and Patient-Reported Outcome Measure Information System satisfaction with participation in social roles (perceived participation satisfaction). Other variables collected included personal (eg, age, perceived recovery), health-related (eg, time since stroke, number of comorbidities), body function–related (eg, Stroke Impact Scale, Center for Epidemiologic Studies Depression Scale), and environmental (eg, World Health Organization Quality of Life Short Form Environmental subscale) data. Results Depression, fatigue, mobility, and environmental support showed moderate to strong, statistically significant associations with participation performance and satisfaction in people with stroke. Perceived recovery was moderately associated with participation performance but not with participation satisfaction. Conclusions Returning to participation is a complex process after stroke. Results suggest that various personal, body function–related, and environmental factors are associated with participation performance and satisfaction.
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Butt JH, Kragholm K, Kruuse C, Christensen H, Iversen HK, Johnsen SP, Rørth R, Vinding NE, Yafasova A, Christiansen CB, Gislason GH, Torp-Pedersen C, Køber L, Fosbøl EL. Workforce Attachment after Ischemic Stroke - The Importance of Time to Thrombolytic Therapy. J Stroke Cerebrovasc Dis 2021; 30:106031. [PMID: 34450481 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106031] [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: 05/27/2021] [Revised: 06/23/2021] [Accepted: 08/01/2021] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES The ability to remain in employment addresses an important consequence of stroke beyond the usual clinical parameters. However, data on the association between time to intravenous thrombolysis and workforce attachment in patients with acute ischemic stroke are sparse. MATERIALS AND METHODS In this nationwide cohort study, stroke patients of working age (18-60 years) treated with thrombolysis (2011-2016) who were part of the workforce prior to admission and alive at discharge were identified using the Danish Stroke Registry. The association between time to thrombolysis and workforce attachment one year later was examined with multivariable logistic regression. RESULTS The study population comprised 1,329 patients (median age 51 years [25th-75th percentile 45-56], 67.3% men). The median National Institutes of Health Stroke Scale score at presentation was 4 (25th-75th percentile 2-8), and the median time from symptom-onset to initiation of thrombolysis was 140min (25th-75th percentile 104-196min). The proportion of patients who were part of the workforce at one-year follow-up was 64.6%, 64.3%, 64.9%, and 60.0% in patients receiving thrombolysis within 90min, between 91-180min, between 181-270min, and after 270min, respectively. In adjusted analysis, time to thrombolysis between 91-180min, 181-270min, and >270min was not significantly associated with workforce attachment compared with thrombolysis received ≤90min of symptom-onset (ORs 0.89 [95%CI 0.60-1.31], 0.93 [0.66-1.31], and 0.80 [0.43-1.52], respectively). CONCLUSIONS In patients of working age admitted with stroke and treated with thrombolysis, two out of three were part of the workforce one year after discharge. There was no graded relationship between time to thrombolysis and the likelihood of workforce attachment.
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Affiliation(s)
- Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark.
| | | | - Christina Kruuse
- Department of Neurology, Herlev-Gentofte University Hospital, Denmark
| | - Hanne Christensen
- Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Denmark
| | - Helle K Iversen
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark
| | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Naja Emborg Vinding
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Adelina Yafasova
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
| | | | - Gunnar H Gislason
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark
| | | | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
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8
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Cardiovascular disease and meaning in life: A systematic literature review and conceptual model. Palliat Support Care 2021; 19:367-376. [PMID: 33960285 DOI: 10.1017/s1478951520001261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Previous studies have shown that psychological stress and mental health problems increase the risk for cardiovascular disease (CVD) events, such as heart attack or stroke. Furthermore, after CVD events, the majority of patients report large stress. However, psychological treatments have only modest effects in CVD patients. Therefore, it has been argued that new conceptual models are needed to understand the aetiology of stress and mental health problems in CVD patients. Therefore, this study included a systematic literature review and a conceptual model on the role of meaning in life for psychological stress, mental health, and CVD risks. METHODS A systematic literature review was conducted on relationships between CVD and meaning in life. PRISMA/MOOSE review guidelines were followed. These findings were used to build a conceptual model. RESULTS The literature review included 113 studies on meaning and CVD. The included studies described meaning as a predictor of cardiovascular risks and health, meaning-centered needs of patients in conversations with medical staff, meaning-centered changes after CVD events, meaning-centered coping with CVD, meaning as motivator of CVD-related lifestyle changes, and meaning as an element in psychological treatments of CVD patients. In sum, the literature showed that a central clinical concern for patients is their question how to live a meaningful life despite CVD. Meaning-centered concerns seem to lead to lower motivation to make lifestyle changes, more psychological stress, lower quality-of-life, worse physical well-being, and increased CVD risk. The ability to live a meaningful life after CVD events is related with lower stress, better mental health, and several biomarkers. SIGNIFICANCE OF RESULTS An evidence-based conceptual framework was developed for the relationship between meaning and CVD. It may be hypothesized CVD patients may benefit from psychological therapies focused on meaning.
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Kapoor A, Scott C, Lanctot KL, Herrmann N, Murray BJ, Thorpe KE, Lien K, Sicard M, Swartz RH. Symptoms of depression and cognitive impairment in young adults after stroke/transient ischemic attack. Psychiatry Res 2019; 279:361-363. [PMID: 31272664 DOI: 10.1016/j.psychres.2019.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/15/2019] [Accepted: 06/16/2019] [Indexed: 01/29/2023]
Abstract
Depression and cognitive complaints are common after stroke; these issues have been studied in older populations, but not in the young. Two hundred and seventy four eligible stroke and TIA patients consented to participate and complete the Center for Epidemiologic Studies Depression Scale, and National Institute of Neurological Disorders and Stroke - Canadian Stroke Network 30-min neuropsychological battery; 57 (21%) were ≤ 50 years of age. Younger patients reported greater symptoms of depression and less executive dysfunction than older patients. This study highlights age differences in post-stroke depression symptoms and cognitive impairment, and emphasizes the need for screening across ages.
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Affiliation(s)
- Arunima Kapoor
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Courtney Scott
- Department of Medicine (Neurology), Mackenzie Health, Richmond Hill, Ontario, Canada
| | - Krista L Lanctot
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Brian J Murray
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Karen Lien
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michelle Sicard
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard H Swartz
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada.
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10
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Zhao JL, Chen PM, Zhang T, Li H, Lin Q, Mao YR, Huang DF. Inter-rater and Intra-rater Reliability of the Chinese Version of the Action Research Arm Test in People With Stroke. Front Neurol 2019; 10:540. [PMID: 31191435 PMCID: PMC6548837 DOI: 10.3389/fneur.2019.00540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/07/2019] [Indexed: 01/17/2023] Open
Abstract
Purpose: To detect the inter-rater and intra-rater reliability of the Chinese version of the Action Research Arm Test (C-ARAT) in patients recovering from a first stroke. Methods: Fifty-five participants (45 men and 10 women) with a mean age of 58.67 ± 12.45 (range: 22–80) years and a mean post-stroke interval of 6.47 ± 12.00 (0.5–80) months were enrolled in this study. To determine the inter-rater reliability, the C-ARAT was administered to each participant by two raters (A and B) with varying levels of experience within 1 day. To determine intra-rater reliability, rater A re-administered the C-ARAT to 33 of the 55 participants on the second day. Intra-class correlation coefficients (ICCs) and Bland–Altman plots were used to analyse the inter-rater and intra-rater reliability. Results: Regarding inter-rater reliability, the total, grasping, gripping, pinching, and gross movement scores received respective ICCs of 0.998, 0.997, 0.995, 0.997, and 0.960 (all p < 0.001), indicating excellent inter-rater reliability in stroke patients. Regarding intra-rater reliability, the corresponding ICCs were 0.987, 0.980, 0.975, 0.944, and 0.954 (all p < 0.001), again indicating excellent intra-rater reliability. The Bland–Altman plots yielded a mean difference of 0.15 with 95% limits of agreement (95%LOA) ranging from −2.16 to 2.46 for the inter-rater measurements and a mean difference of −1.06 with 95%LOA ranging from −6.43 to 4.31 for the intra-rater measurement. The C-ARAT thus appeared to be a stable scoring method. Conclusions: The C-ARAT yielded excellent intra-rater and inter-rater reliability for evaluating the paretic upper extremities of stroke patients. Therefore, our results supported the use of the C-ARAT in this population.
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Affiliation(s)
- Jiang-Li Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pei-Ming Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tao Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Rehabilitation Department, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Qiang Lin
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu-Rong Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dong-Feng Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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11
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Ezekiel L, Collett J, Mayo NE, Pang L, Field L, Dawes H. Factors Associated With Participation in Life Situations for Adults With Stroke: A Systematic Review. Arch Phys Med Rehabil 2019; 100:945-955. [DOI: 10.1016/j.apmr.2018.06.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 01/09/2023]
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Gateway to Recovery: A Comparative Analysis of Stroke Patients' Experiences of Change and Learning in Norway and Denmark. Rehabil Res Pract 2019; 2019:1726964. [PMID: 30775038 PMCID: PMC6354139 DOI: 10.1155/2019/1726964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/19/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives The recovery process is reported by stroke survivors to be a change process fraught with crises and hazard. Interaction with health professionals and others may play a central role in establishing renewed control over life. Research Questions (1) How do patients handle and overcome experienced changes after stroke? (2) How do they experience the support to handle these changes during the first year after stroke? (3) How do the similarities and differences transpire in Danish and Norwegian contexts? Methodology. A qualitative method was chosen. Six patients from Denmark and five patients from Norway (aged 25-66) were followed up until one year after stroke, by way of individual interviews. The data were analyzed (using NVivo 11) by means of phenomenological analysis. Findings The participants described four main issues in the recovery process that impacted the experienced changes: (i) strategies and personal factors that promote motivation, (ii) the involvement of family, social network, and peers, (iii) professionals' support, and (iv) social structures that limit the recovery process. There was a diversity of professional support and some interesting variations in findings about factors that affected recovery and the ability to manage a new life situation between Central Denmark and Northern Norway. Both Norwegian and Danish participants experienced positive changes and progress on the bodily level, as well as in terms of activity and participation. Furthermore, they learned how to overcome limitations, especially in bodily functions and daily activities at home. Unfortunately, progress or support related to psychosocial rehabilitation was almost absent in the Norwegian data.
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Qafarizadeh F, Kalantari M, Ansari NN, Baghban AA, Jamebozorgi A. The effect of kinesiotaping on hand function in stroke patients: A pilot study. J Bodyw Mov Ther 2018; 22:829-831. [PMID: 30100319 DOI: 10.1016/j.jbmt.2017.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 07/26/2017] [Accepted: 07/29/2017] [Indexed: 02/05/2023]
Abstract
Upper extremity motor impairment is one of the most prevalent problems following stroke. Considering the functional importance of the upper extremity in the daily life, the purpose of this study was to investigate the effect of kinesiotaping (KT) on hand function and spasticity in individuals following a stroke. Eight individuals who had experienced a stroke, with their age ranging from 47 to 66, participated in this pretest-posttest clinical study. An I- strip of tape was placed on the extensor muscles of the forearm. Primary outcome measures were the Modified Modified Ashwoth Scale, Box and Block test, and Nine Hole Peg test. At the immediate assessment, there were significant differences between two hand function tests scores. Secondary assessment was done after one week and the results showed significant differences between two hand function test scores. There was no significant change in flexor muscles spasticity after the intervention. This pilot study indicated that KT in the direction of the extensor muscles could result in better hand function in stroke patients.
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Affiliation(s)
- Fathollah Qafarizadeh
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Minoo Kalantari
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Sports Medicine Research Center, Tehran University of Medical Sciences, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aliasqar Jamebozorgi
- Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Acute Predictors of Social Integration Following Mild Stroke. J Stroke Cerebrovasc Dis 2018; 27:1025-1032. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/19/2017] [Accepted: 11/04/2017] [Indexed: 11/24/2022] Open
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15
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Lyu M, Lambelet C, Woolley D, Zhang X, Chen W, Ding X, Gassert R, Wenderoth N. Training wrist extensor function and detecting unwanted movement strategies in an EMG-controlled visuomotor task. IEEE Int Conf Rehabil Robot 2018; 2017:1549-1555. [PMID: 28814040 DOI: 10.1109/icorr.2017.8009468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke patients often suffer from severe upper limb paresis. Rehabilitation treatment typically targets motor impairments as early as possible, however, muscular contractions, particularly in the wrist and fingers, are often too weak to produce overt movements, making the initial phase of rehabilitation training difficult. Here we propose a new training tool whereby electromyographic (EMG) activity is measured in the wrist extensors and serves as a proxy of voluntary corticomotor drive. We used the Myo armband to develop a proportional EMG controller which allowed volunteers to perform a simple visuomotor task by modulating wrist extensor activity. In this preliminary study six healthy participants practiced the task for one session (144 trials), which resulted in a significant reduction of the average trial time required to move and hold a cursor in different target zones (p < 0.001, ANOVA), indicating skill learning. Additionally, we implemented an EMG based classifier to distinguish between the desired movement strategy and unwanted alternatives. Validation of the classifier indicated that accuracy for detecting rest, wrist extension and unwanted strategies was 92.5 + 6.9% (M + SD) across all participants. When performing the motor task the classification algorithm flagged 4.3 + 3.5% of the trials as 'unwanted strategies', even in healthy subjects. We also report initial feedback from a survey submitted to two chronic stroke patients to inquire about feasibility and acceptance of the general setup by patients.
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Edwards JD, Kapoor A, Linkewich E, Swartz RH. Return to work after young stroke: A systematic review. Int J Stroke 2017; 13:243-256. [PMID: 29189108 DOI: 10.1177/1747493017743059] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background The incidence of stroke in young adults is increasing. While many young survivors are able to achieve a good physical recovery, subtle dysfunction in other domains, such as cognition, often persists, and could affect return to work. However, reported estimates of return to work and factors affecting vocational outcome post-stroke vary greatly. Aims The aims of this systematic review were to determine the frequency of return to work at different time points after stroke and identify predictors of return to work. Summary of review Two electronic databases (Medline and Embase) were systematically searched for articles according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 6473 records were screened, 68 were assessed for eligibility, and 29 met all inclusion criteria (working-age adults with stroke, return to work evaluated as an outcome, follow-up duration reported, and publication within the past 20 years). Return to work increased with time, with median frequency increasing from 41% between 0 and 6 months, 53% at 1 year, 56% at 1.5 years to 66% between 2 and 4 years post-stroke. Greater independence in activities of daily living, fewer neurological deficits, and better cognitive ability were the most common predictors of return to work. Conclusion This review highlights the need to examine return to work in relation to time from stroke and assess cognition in working age and young stroke survivors. The full range of factors affecting return to work has not yet been explored and further evaluations of return to work interventions are warranted.
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Affiliation(s)
- Jodi D Edwards
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,2 Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada.,3 Institute for Clinical Evaluative Sciences, Toronto, Canada.,4 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Arunima Kapoor
- 5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
| | - Elizabeth Linkewich
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
| | - Richard H Swartz
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,2 Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada.,5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
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Munce SE, Perrier L, Shin S, Adhihetty C, Pitzul K, Nelson ML, Bayley MT. Strategies to improve the quality of life of persons post-stroke: protocol of a systematic review. Syst Rev 2017; 6:184. [PMID: 28882175 PMCID: PMC5590115 DOI: 10.1186/s13643-017-0579-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While many outcomes post-stroke (e.g., depression) have been previously investigated, there is no complete data on the impact of a variety of quality improvement strategies on the quality of life and physical and psychological well-being of individuals post-stroke. The current paper outlines a systematic review protocol on the impact of quality improvement strategies on quality of life as well as physical and psychological well-being of individuals with stroke. METHODS MEDLINE, CINAHL, EMBASE, and PsycINFO databases will be searched. Two independent reviewers will conduct all levels of screening, data abstraction, and quality appraisal. Only randomized controlled trials that report on the impact of quality improvement strategies on quality of life outcomes in people with stroke will be included. The secondary outcomes will be physical and psychological well-being. Quality improvement strategies include audit and feedback, case management, team changes, electronic patient registries, clinician education, clinical reminders, facilitated relay of clinical information to clinicians, patient education, (promotion of) self-management, patient reminder systems, and continuous quality improvement. Studies published since 2000 will be included to increase the relevancy of findings. Results will be grouped according to the target group of the varying quality improvement strategies (i.e., health system, health care professionals, or patients) and/or by any other noteworthy grouping variables, such as etiology of stroke or by sex. DISCUSSION This systematic review will identify those quality improvement strategies aimed at the health system, health care professionals, and patients that impact the quality of life of individuals with stroke. Improving awareness and utilization of such strategies may enhance uptake of stroke best practices and reduce inappropriate health care utilization costs. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42017064141.
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Affiliation(s)
- Sarah E.P. Munce
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, University of Toronto, 550 University Avenue, Toronto, Ontario M5G 2A2 Canada
| | - Laure Perrier
- University of Toronto, Gerstein Science Information Centre, 9 King’s College Circle, Toronto, Ontario M5S 1A5 Canada
| | - Saeha Shin
- Dalla Lana School of Public Health, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S 1A1 Canada
| | - Chamila Adhihetty
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th floor, 155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Kristen Pitzul
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th floor, 155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Michelle L.A. Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th floor, 155 College Street, Toronto, Ontario M5T 3M6 Canada
- Lunenfeld-Tanenbaum Research Institute; Sinai Health System, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5 Canada
| | - Mark T. Bayley
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, University of Toronto, 550 University Avenue, Toronto, Ontario M5G 2A2 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th floor, 155 College Street, Toronto, Ontario M5T 3M6 Canada
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18
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Merz ZC, Van Patten R, Mulhauser K, Fucetola R. Exploratory factor analysis of the reintegration to normal living index in a stroke population. Top Stroke Rehabil 2016; 24:158-162. [PMID: 27486007 DOI: 10.1080/10749357.2016.1215398] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND The reintegration to normal living index (RNLI) is a global assessment of patient quality of life often utilized in stroke populations. Previous studies in various general disability samples have consistently reported a two-factor solution for the RNLI. Despite its common use with stroke patients, the RNLI has not been psychometrically evaluated in an exclusively stroke sample. This study is believed to represent the first factor analysis of the RNLI using a sample comprised exclusively of individuals who have survived cerebral infarct. OBJECTIVE The aim of this study is to evaluate the psychometric properties of the RNLI in assessing quality of life of stroke survivors. METHODS We retrospectively examined RNLI scores of 928 adults with strokes of varying severities as part of a multidisciplinary, interinstitutional collaboration across an academic medical center, acute care hospital, and rehabilitation center. We utilized a principal component factor analysis to evaluate the factor structure of the RNLI. RESULTS Mean RNLI scores ±SD for the sample were 75.26 ± 19.85, ranging between 20 and 100. The Cronbach α was .94. A scree test for factor retention strongly suggested a single factor solution, explaining 64.50% of the total variance. CONCLUSIONS Previous factor analyses on the RNLI utilizing general disability samples commonly report a two-factor solution. Our data support the presence of a single factor solution across the RNLI within a large sample comprised exclusively of stroke survivors. This suggests that the RNLI acts as more of a unitary measure of quality of life within a stroke sample relative to other disabled samples.
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Affiliation(s)
- Zachary C Merz
- a Department of Psychology , Saint Louis University , St. Louis , MO , USA
| | - Ryan Van Patten
- a Department of Psychology , Saint Louis University , St. Louis , MO , USA
| | - Kyler Mulhauser
- a Department of Psychology , Saint Louis University , St. Louis , MO , USA
| | - Robert Fucetola
- b Department of Neurology , Washington University School of Medicine , St. Louis , MO , USA
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Levasseur M, Généreux M, Desroches J, Carrier A, Lacasse F, Chabot É, Abecia A, Gosselin L, Vanasse A. How to Find Lessons from the Public Health Literature: Example of a Scoping Study Protocol on the Neighborhood Environment. Int J Prev Med 2016; 7:83. [PMID: 27413514 PMCID: PMC4926543 DOI: 10.4103/2008-7802.184311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/10/2015] [Indexed: 11/17/2022] Open
Abstract
Background: As key determinants of many favorable health and quality of life outcomes, it is important to identify factors associated with mobility and social participation. Although several investigations have been carried out on mobility, social participation and neighborhood environment, there is no clear integration of these results. This paper presents a scoping study protocol that aims to provide a comprehensive understanding of how the physical and social neighborhood environment is associated with or influences mobility and social participation in older adults. Methods: The rigorous methodological framework for scoping studies is used to synthesize and disseminate current knowledge on the associations or influence of the neighborhood environment on mobility and social participation in aging. Nine databases from public health and other fields are searched with 51 predetermined keywords. Using content analysis, all data are exhaustively analyzed, organized, and synthesized independently by two research assistants. Discussion: A comprehensive synthesis of empirical studies provides decision-makers, clinicians and researchers with current knowledge and best practices regarding neighborhood environments with a view to enhancing mobility and social participation. Such a synthesis represents an original contribution and can ultimately support decisions and development of innovative interventions and clear guidelines for the creation of age-supportive environments. Improvements in public health and clinical interventions might be the new innovation needed to foster health and quality of life for aging population. Finally, the aspects of the associations or influence of the neighborhood environment on mobility and social participation not covered by previous research are identified. Conclusions: Among factors that impact mobility and social participation, the neighborhood environment is important since interventions targeting it may have a greater impact on an individual's mobility and social participation than those targeting individual factors. Although investigations from various domains have been carried out on this topic, no clear integration of these results is available yet.
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Affiliation(s)
- Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada; Research Centre on Aging, Eastern Townships Integrated University Centre for Health and Social Services - Sherbrooke Hospital University Centre (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, J1H 4C4, Canada
| | - Mélissa Généreux
- Department Public Health, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, J1J 1B1, Canada
| | - Josiane Desroches
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada; Research Centre on Aging, Eastern Townships Integrated University Centre for Health and Social Services - Sherbrooke Hospital University Centre (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, J1H 4C4, Canada
| | - Annie Carrier
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada; Research Centre on Aging, Eastern Townships Integrated University Centre for Health and Social Services - Sherbrooke Hospital University Centre (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, J1H 4C4, Canada
| | - Francis Lacasse
- CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, J1H 4C4, Canada
| | - Éric Chabot
- Réseau de transport de Longueuil, Longueuil, Quebec, J4G 2M4, Canada
| | - Ana Abecia
- Centre d'études de l'Asie de l'est, Faculté des Arts et des Sciences, Université de Montréal, Pavillon 3744, rue Jean-Brillant, Montreal, Quebec, H3C 3J7, Canada
| | - Louise Gosselin
- Sherbrooke Healthy City Inc., Sherbrooke, Quebec, J1H 5H9, Canada
| | - Alain Vanasse
- Etienne-LeBel Clinical Research Centre, CHUS, Sherbrooke, Quebec, J1H 5N4, Canada; Department of Emergency and Family Medicine, Université de Sherbrooke, PRIMUS Research Group, Sherbrooke, Quebec, J1H 5N4, Canada
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Björkdahl A, Nilsson AL, Grimby G, Sunnerhagen KS. Does a short period of rehabilitation in the home setting facilitate functioning after stroke? A randomized controlled trial. Clin Rehabil 2016; 20:1038-49. [PMID: 17148515 DOI: 10.1177/0269215506071230] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the effect of three weeks of rehabilitation in the home setting for younger patients with stroke with the aim of improving activity level. Design: A randomized controlled study with blinded evaluations at discharge, three weeks, three months and one year after discharge. Setting: Home of the patient or the ordinary day rehabilitation clinic at the university hospital. Subjects: Fifty-eight patients (median age 53 years) consecutively discharged from inpatient rehabilitation with a first occurrence of stroke participated in training directly after discharge. Intervention: Rehabilitation was given for 9 hours/week over three weeks. The home group received individually tailored training, based on the patient's needs and desires, with a focus on activities in their natural context. Support and information were also given. The intervention in the day clinic group was aimed mainly at improved functions. Main measures: The main outcome was activity, assessed with the Assessment of Motor and Process Skill (AMPS). The impairment level was also evaluated. Costs were estimated. Result: There were no significant differences between the groups on any of the four assessments. However, there seemed to be an earlier improvement on some measures (including AMPS) for the home group. For both groups there was a greater improvement on the activity level than on the impairment level. The costs of the home group were less than half of the costs of the day clinic group. Conclusion: With the present results, both rehabilitation programmes could be recommended, however, further studies are needed to define patients who may specifically benefit from the home rehabilitation programme. Costs should be taken into consideration.
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Affiliation(s)
- Ann Björkdahl
- Institute of Clinical Neuroscience-Rehabilitation Medicine, Göteborg University, Guldhedsgatan 19, 413-45 Göteborg, Sweden.
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Hershkovitz A, Beloosesky Y, Brill S, Gottlieb D. Is a day hospital rehabilitation programme associated with reduction of handicap in stroke patients? Clin Rehabil 2016; 18:261-6. [PMID: 15137557 DOI: 10.1191/0269215504cr731oa] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: (1) To assess whether a rehabilitation day hospital programme is associated with a reduced handicap level of stroke patients. (2) To estimate the relationship between the London Handicap Scale (LHS) and other outcome measures. (3) To examine the effect of demographic parameters (age, gender, family status, education) on LHS scores. Design: A prospective longitudinal survey. Setting: An urban geriatric rehabilitation day hospital. Subjects: Two hundred and seven elderly stroke patients admitted between December 1999 and February 2001. Main outcome measures: London Handicap Scale (LHS), Functional Independent Measure (FIM), Nottingham Extended ADL Index, timed get up and go test. Results: LHS scores at discharge changed significantly (p < 0.008) for mobility, physical independence and occupation. The overall change in LHS score was 2.3 points (20%); effect size 0.43. A significant relationship was found between discharge score of LHS and admission score of FIM, Nottingham Index, timed get up and go and age. Multiple linear regressions did not identify a good predictor for the discharge score of LHS. Higher education was associated with higher LHS scores on admission (p= 0.016) but with less success in correcting handicap (p= 0.046). Conclusions: A day hospital programme is associated with reduced level of handicap in stroke patients. The LHS is a useful and simple scale for measuring change in these patients. LHS in stroke patients correlates with other outcome measures, yet they cannot be used interchangeably. A significant relationship between education and level of handicap exists.
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Affiliation(s)
- Avital Hershkovitz
- Beit Rivka Geriatric Rehabilitation Center Day Hospital, Petach Tikva, Israel.
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22
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Sveen U, Thommessen B, Bautz-Holter E, Wyller TB, Laake K. Well-being and instrumental activities of daily living after stroke. Clin Rehabil 2016; 18:267-74. [PMID: 15137558 DOI: 10.1191/0269215504cr719oa] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the relationship between subjective well-being and competence in instrumental activities of daily living after stroke. Design: Cross-sectional with evaluation at six months post stroke. Subjects: Eighty-two patients admitted to an acute stroke unit, of whom 64 were seen at six months. The mean age was 77.5 years, 55% were females and 55% were living alone. Main outcome measures: The General Health Questionnaire (GHQ-20 version), a well-being scale, was factor analysed and yielded three dimensions, named ‘coping’, ‘anxiety’ and ‘satisfaction’ that served as main outcomes. Results: Explanatory variables were the four subscales of the Nottingham IADL scale, the Ullevaal Aphasia Screening test, urinary continence and demographics. Structural equation modelling showed that the GHQ dimension ‘satisfaction’ related significantly to the Nottingham subscale ‘leisure activities’ (β = -0.38, p= 0.01), whereas ‘coping’ was indirectly associated with ‘leisure activities’ by its correlation with ‘satisfaction’ (R= 0.26, p= 0.01). None of the outcomes were statistically associated with aphasia, continence or the background variables. Conclusion: ‘Leisure activities’ demonstrated the strongest association to subjective well-being as expressed by the ‘satisfaction’ dimension. In stroke rehabilitation leisure activities should be addressed when assessing function and planning intervention.
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Affiliation(s)
- Unni Sveen
- Department of Geriatric Medicine, Ullevål University Hospital, Oslo, Norway.
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Clarke P, Black SE. Quality of Life Following Stroke: Negotiating Disability, Identity, and Resources. J Appl Gerontol 2016. [DOI: 10.1177/0733464805277976] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Residual physical and cognitive impairments following a stroke can pose a significant threat to a survivor’s quality of life. Yet, there is not always a direct one-to-one correlation between functional disability and subjective quality of life. This research investigated the complexity of factors that influence quality of life after stroke, using qualitative interviews. Results indicate that a stroke has a significant impact on the quality of life of survivors, but some individuals find ways to adapt to their functional disabilities and report a high quality of life. Common elements of this process consist of reordering priorities to focus on those activities considered most salient to an individual’s identity; then drawing on existing resources, including health services and social supports, to maintain a customary activity, even in a modified form, retaining salient aspects of the individual’s identity and maintaining a sense of continuity in his or her life.
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24
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Multiple sessions of transcranial direct current stimulation and upper extremity rehabilitation in stroke: A review and meta-analysis. Clin Neurophysiol 2016; 127:946-955. [DOI: 10.1016/j.clinph.2015.04.067] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/19/2015] [Accepted: 04/15/2015] [Indexed: 11/21/2022]
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Tavener M, Thijsen A, Hubbard IJ, Francis JL, Grennall C, Levi C, Byles J. Acknowledging How Older Australian Women Experience Life After Stroke: How Does the WHO 18-Item Brief ICF Core Set for Stroke Compare? Health Care Women Int 2015; 36:1311-26. [DOI: 10.1080/07399332.2015.1055747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Levasseur M, Généreux M, Bruneau JF, Vanasse A, Chabot É, Beaulac C, Bédard MM. Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: results from a scoping study. BMC Public Health 2015; 15:503. [PMID: 26002342 PMCID: PMC4460861 DOI: 10.1186/s12889-015-1824-0] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 05/06/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Since mobility and social participation are key determinants of health and quality of life, it is important to identify factors associated with them. Although several investigations have been conducted on the neighborhood environment, mobility and social participation, there is no clear integration of the results. This study aimed to provide a comprehensive understanding regarding how the neighborhood environment is associated with mobility and social participation in older adults. METHODS A rigorous methodological scoping study framework was used to search nine databases from different fields with fifty-one keywords. Data were exhaustively analyzed, organized and synthesized according to the International Classification of Functioning, Disability and Health (ICF) by two research assistants following PRISMA guidelines, and results were validated with knowledge users. RESULTS The majority of the 50 selected articles report results of cross-sectional studies (29; 58%), mainly conducted in the US (24; 48%) or Canada (15; 30%). Studies mostly focused on neighborhood environment associations with mobility (39; 78%), social participation (19; 38%), and occasionally both (11; 22%). Neighborhood attributes considered were mainly 'Pro ducts and technology' (43; 86) and 'Services, systems and policies' (37; 74%), but also 'Natural and human-made changes' (27; 54%) and 'Support and relationships' (21; 42%). Mobility and social participation were both positively associated with Proximity to resources and recreational facilities, Social support, Having a car or driver's license, Public transportation and Neighborhood security, and negatively associated with Poor user-friendliness of the walking environment and Neighborhood insecurity. Attributes of the neighborhood environment not covered by previous research on mobility and social participation mainly concerned 'Attitudes', and 'Services, systems and policies'. CONCLUSION Results from this comprehensive synthesis of empirical studies on associations of the neighborhood environment with mobility and social participation will ultimately support best practices, decisions and the development of innovative inclusive public health interventions including clear guidelines for the creation of age-supportive environments. To foster mobility and social participation, these interventions must consider Proximity to resources and to recreational facilities, Social support, Transportation, Neighborhood security and User-friendliness of the walking environment. Future studies should include both mobility and social participation, and investigate how they are associated with 'Attitudes', and 'Services, systems and policies' in older adults, including disadvantaged older adults.
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Affiliation(s)
- Mélanie Levasseur
- University of Sherbrooke, 2500 University Blvd., J1K 2R1, Sherbrooke, QC, Canada.
- Research Centre on Aging, Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke, 1036 Belvedere South, J1H 4C4, Sherbrooke, QC, Canada.
| | - Mélissa Généreux
- University of Sherbrooke, 2500 University Blvd., J1K 2R1, Sherbrooke, QC, Canada.
- Research Centre on Aging, Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke, 1036 Belvedere South, J1H 4C4, Sherbrooke, QC, Canada.
- Public Health Department, Health and Social Services Agency, 300 King East, Suite 300, J1J 1B1, Sherbrooke, QC, Canada.
| | - Jean-François Bruneau
- University of Sherbrooke, 2500 University Blvd., J1K 2R1, Sherbrooke, QC, Canada.
- Montreal Polytechnique, Downtown Station, P.O. Box 6079, H3C 3A7, Montreal, QC, Canada.
| | - Alain Vanasse
- University of Sherbrooke, 2500 University Blvd., J1K 2R1, Sherbrooke, QC, Canada.
- Research Centre, CHUS, 3001 12th Avenue North, J1H 5N4, Sherbrooke, QC, Canada.
| | - Éric Chabot
- Ordre des urbanistes du Québec, H2Y 3V4, Montreal, QC, Canada.
| | - Claude Beaulac
- Ordre des urbanistes du Québec, H2Y 3V4, Montreal, QC, Canada.
| | - Marie-Michèle Bédard
- University of Sherbrooke, 2500 University Blvd., J1K 2R1, Sherbrooke, QC, Canada.
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Egan M, Kessler D, Laporte L, Metcalfe V, Carter M. A Pilot Randomized Controlled Trial of Community-Based Occupational Therapy in Late Stroke Rehabilitation. Top Stroke Rehabil 2014; 14:37-45. [PMID: 17901014 DOI: 10.1310/tsr1405-37] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic participation deficits are common following stroke. We hypothesized that a brief period of occupation-focused, client-centered occupational therapy would lead to improved participation in valued activities for individuals who had experienced strokes 6 or more months previously. Sixteen individuals were randomized to the intervention or no-treatment control group. All participants identified up to five activities in which they wished to improve. Following intervention, both groups rated their performance of these activities similarly. However, those who received the intervention rated their satisfaction with these activities significantly higher than did the participants who did not receive the occupational therapy intervention. There were no differences between postintervention measures of well-being or overall participation. Further evaluation of such a program of late stroke rehabilitation is recommended.
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Affiliation(s)
- Mary Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
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28
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Rochette A, Desrosiers J, Bravo G, St-Cyr-Tribble D, Bourget A. Changes in Participation After a Mild Stroke: Quantitative and Qualitative Perspectives. Top Stroke Rehabil 2014; 14:59-68. [PMID: 17577968 DOI: 10.1310/tsr1403-59] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE AND METHOD This descriptive study is aimed at documenting changes in participation level (accomplishment of daily activities and social roles) from quantitative (n = 35) and qualitative (n = 5) perspectives in individuals who have had a first "mild" stroke compared to their prestroke level. With advances in technology (e.g., increased use of thrombolitic therapy), the prevalence of mild stroke is expected to increase. Yet these strokes are rarely referred to rehabilitation, and little is known about the consequences of stroke on patients' lives. CONCLUSION Results of both methods confirmed significant impact of the stroke on participation level that is persistent even 6 months poststroke.
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Affiliation(s)
- Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Québec, Canada
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Desrosiers J, Rochette A, Noreau L, Bourbonnais D, Bravo G, Bourget A. Long-Term Changes in Participation After Stroke. Top Stroke Rehabil 2014; 13:86-96. [PMID: 17082173 DOI: 10.1310/tsr1304-86] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE People who have had a stroke may have difficulty resuming some of their previous activities, which leads to a decline in their participation in daily activities and social roles. The purposes of this study were to compare participation 6 months (T1) and between 2 and 4 years (T2) after discharge from a rehabilitation unit and to verify if any changes were associated with changes in personal and environmental factors. METHOD Participation of people who had had a stroke was measured at T1 and T2 with the Assessment of Life Habits. RESULTS A significant reduction (p < .001) in participation in daily activities was observed, specifically in the following categories: nutrition, p < .001; fitness, p = .004; personal care, p < .001; and housing, p = .001. However, participation in social roles was maintained during this period (p = .10). The increased perception of technology as a facilitator (environmental factor) over time explained a part of the decline in participation (R2 = 0.13). CONCLUSION Factors associated with the reduction in participation in daily activities should be further studied in order to prevent this decline.
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Affiliation(s)
- Johanne Desrosiers
- Department of Rehabilitation, Research Center on Aging, University Institute of Geriatrics of Sherbrooke, Université de Sherbrooke, Québec, Canada
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Montgomery P, Jermyn D, Bailey P, Nangia P, Egan M, Mossey S. Community reintegration of stroke survivors: the effect of a community navigation intervention. J Adv Nurs 2014; 71:214-25. [PMID: 25040142 DOI: 10.1111/jan.12471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2014] [Indexed: 11/28/2022]
Abstract
AIM The overall aim of the proposed study is to examine a newly implemented navigation intervention intended to support stroke survivors' community integration during the first year following hospital discharge in four regions of Ontario, Canada. BACKGROUND Stroke is a leading cause of disability worldwide. Stroke survivors living in the community require regular, ongoing follow-up to assess recovery, prevent deterioration and maximize health outcomes. Internationally published evidence, often conducted in large urban centres, suggests that community reintegration services are an important component of the continuum of care for stroke survivors. This evidence, however, often does not address the particular challenges inherent in smaller urban and rural contexts. DESIGN The design of this 2-year mixed-method study will use cohort and focused ethnography. METHODS The three stages of this study include: (1) collection of quantitative data to profile the health status, support and extent of community reintegration of stroke survivors; (2) collection of qualitative data from stroke survivors and their care partners about community reintegration and navigation; and following triangulation of findings (3) knowledge translation activities. This study was ethically approved by the academic Research Ethics Board and clinical Research Ethics Board (Sudbury, Ontario) and funded by the Ontario Stroke Network (Canada). DISCUSSION Results will describe experiences and outcomes of a community navigation intervention. Engagement of multiple stakeholders has the potential to develop a shared understanding of community reintegration and generate evidence informed recommendations for service enhancement at critical points in stroke recovery to support survivor and community well-being.
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The Influence of Mood-Related Variables on Activity and Participation in Individuals With Chronic Stroke. TOPICS IN GERIATRIC REHABILITATION 2014. [DOI: 10.1097/tgr.0000000000000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
In face of any severe stroke, the questions for health professionals in charge of the patient are: will the handicap be acceptable for the patient? But can we predict an acceptable handicap for the patient? For his family? When we know that the cognitive disorders, consequences of severe stroke often modify, in a major way, the behaviour of these patients? Given these difficulties for estimate vital and functional prognosis and even more the quality of life of patients with severe stroke, collective reflexions between physicians and nurses are essential, reflexions taking into account preferences and values of patients. Use of resuscitation resources for severe stroke patients implies to offer them the best rehabilitation. So, questions about health pathways for severe stroke are essential: which structures for these patients, which technologies, which medical, medico-social and social supports, which human accompaniment the society can propose to the patients and to their family, so that they have an acceptable quality of life.
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Affiliation(s)
- F Woimant
- Service de neurologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Agence régionale de santé Île-de-France, 35, rue de la Gare, 75019 Paris, France.
| | - Y Biteye
- Agence régionale de santé Île-de-France, 35, rue de la Gare, 75019 Paris, France
| | - P Chaine
- Service de neurologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Crozier
- Service des urgences cérébrovasculaires, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Community reintegration after stroke. Hong Kong Physiother J 2013. [DOI: 10.1016/j.hkpj.2013.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Megari K. Quality of Life in Chronic Disease Patients. Health Psychol Res 2013; 1:e27. [PMID: 26973912 PMCID: PMC4768563 DOI: 10.4081/hpr.2013.e27] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/01/2013] [Accepted: 03/02/2013] [Indexed: 12/04/2022] Open
Abstract
During the past decades there was an increasing predominance of chronic disorders, with a large number of people living with chronic diseases that can adversely affect their quality of life. The aim of the present paper is to study quality of life and especially Health-related quality of life (HRQoL) in chronic diseases. HRQOL is a multidimensional construct that consists of at least three broad domains – physical, psychological, and social functioning – that are affected by one’s disease and/or treatment. HRQoL is usually measured in chronic conditions and is frequently impaired to a great extent. In addition, factors that are associated with good and poor HRQoL, as well as HRQoL assessment will be discussed. The estimation of the relative impact of chronic diseases on HRQoL is necessary in order to better plan and distribute health care resources aiming at a better HRQoL. [«All the people perceive the concept of living good or being well, that is the same as being happy». (Aristotle. 384-322 BC. Ethica Nichomachea)]
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Affiliation(s)
- Kalliopi Megari
- School of Psychology, Aristotle University of Thessaloniki , Greece
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Koton S, Telman G, Kimiagar I, Tanne D. Gender differences in characteristics, management and outcome at discharge and three months after stroke in a national acute stroke registry. Int J Cardiol 2013; 168:4081-4. [PMID: 23871354 DOI: 10.1016/j.ijcard.2013.07.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 06/29/2013] [Accepted: 07/03/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The importance of gender as an independent risk factor for poor outcome is not clear. We examined gender differences in patients' characteristic, management and outcome at discharge and 3-months after acute stroke in a national hospital-based registry. METHODS Data were derived from the triennial two-month national Acute Stroke Israeli Registry (Feb-March 2004, March-April 2007, April-May 2010). Unselected patients in all Israeli hospitals (n = 28) were included. Outcome at 3-month was assessed in a sub-sample. Logistic regression models were used in the study of gender as an independent risk factor for poor outcome. RESULTS In total, 5034 patients (88.5% ischemic stroke, 9.6% ICH and 1.9% undetermined stroke) were included, of them 2285 (45.4%) women. Follow-up at 3-month was completed for 1040 patients, 41.9% women. Women showed higher rates of cardiovascular risk factors in-hospital death (p = 0.007) and poor functional outcome (p < 0.0001). Following adjustment for age, prior disability, NIHSS, prior stroke and risk factors, risk estimates (ORs, 95%CI) for women compared to men were 0.72 (0.55-0.96) for in-hospital death, 1.03 (0.83-1.29) for discharge to a nursing home or death, and 1.01 (0.86-1.20) for disability. Poor outcomes at 3-month were significantly more common in women; however, adjusted risk estimates were not significantly increased: OR 0.95 (95%CI 0.50-1.81) for death at 3-months, 1.41 (0.99-2.01) for Barthel Index ≤ 60, 1.24 (0.90-1.72) for dependency and 0.88 (0.55-1.39) for living in a nursing home or death. CONCLUSION Gender-differences in risk of death and poor functional outcome after stroke are mainly explained by dissimilarities in patients' characteristics and stroke severity.
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Affiliation(s)
- Silvia Koton
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Kitzmüller G, Häggström T, Asplund K. Living an unfamiliar body: the significance of the long-term influence of bodily changes on the perception of self after stroke. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:19-29. [PMID: 22422133 DOI: 10.1007/s11019-012-9403-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of this study is to illuminate the significance of the long-term influence of bodily changes on the perception of self after stroke by means of narrative interviews with 23 stroke survivors. A phenomenological-hermeneutic approach inspired by the philosophy of Merleau-Ponty and Ricoeur is the methodological framework. Zahavi's understanding of the embodied self and Leder's concept of dys-appearance along with earlier research on identity guide the comprehensive understanding of the theme. The meaning of bodily changes after stroke can be understood as living with an altered perception of self. Stroke survivors perceive their bodies as fragile, unfamiliar and unreliable and tend to objectify them. The weak and discomforting body that 'cannot' demands constant, comprehensive awareness to keep itself in play. These long-term and often permanent consequences of bodily weakness may turn stroke survivors' intentionality inwards, away from external activities and projects and relationships with others. Negative judgements from others are added to lost roles and positions and threaten the vulnerable self. Stroke survivors try to regain familiarity with their body by their life-long project of testing its boundaries. Mastering important tasks helps them strengthen their self-concept. Health care workers should be aware of the embodied self and engage in long-term dialogues with stroke survivors to strengthen positive perceptions of body and self. More research is needed to understand destructive post-stroke phenomena such as fatigue and pain and to find effective methods to help stroke survivors regain wholeness of body and self.
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Affiliation(s)
- Gabriele Kitzmüller
- Faculty of Health and Society, Narvik University College, Lodve Langesgt. 2, Pb. 385, 8505 Narvik, Norway.
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Abstract
The objective of the study was to determine how performance on cognitive assessments administered in the subacute phase of mild stroke change or remain stable over time. A prospective longitudinal cohort pilot study was used to assess the cognitive status of participants with mild stroke (n = 20) at two time points: (1) within 3 weeks post-discharge from the acute care setting following mild stroke, and (2) approximately 6 months post-mild stroke. Participants were given a battery of cognitive assessments at both time points that included the following measures: (1) Short Blessed Test, (2) California Verbal Learning Test (CVLT), (3) Connor's Continuous Performance Task (CPT), and (4) The Delis-Kaplan Executive Function System (DKEFS) Trail Making subtest. The only significant differences between the test administrations was on the CVLT Short Delay Free Recall (p = .027) and Long Delay Free Recall (p = .002) which was likely due to practice effects associated with this measure. The results of the study show that performance on standardised cognitive testing in the early phases of mild stroke remained stable over a 6 month period. These results help justify the necessity and ability to assess cognition immediately post-mild stroke in order to make accurate and appropriate rehabilitation recommendations.
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Affiliation(s)
- Timothy J. Wolf
- Program in Occupational Therapy, Washington University School of Medicine, Saint Louis, Missouri
- Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri
| | - Morgan C. Rognstad
- Program in Occupational Therapy, Washington University School of Medicine, Saint Louis, Missouri
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Efstratiadou EA, Chelas EN, Ignatiou M, Christaki V, Papathanasiou I, Hilari K. Quality of life after stroke: evaluation of the Greek SAQOL-39g. Folia Phoniatr Logop 2012; 64:179-86. [PMID: 23108447 DOI: 10.1159/000340014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Stroke and aphasia rehabilitation aims to improve people's quality of life. Yet, scales for measuring health-related quality of life in stroke typically exclude people with aphasia. They are also primarily available in English. An exception is the 39-item generic version of the Stroke and Aphasia Quality of Life Scale (SAQOL-39g). This scale has been tested with people with aphasia; it has been adapted for use in many countries including Greece. The aim of this study was to examine the psychometric properties of the Greek SAQOL-39g. METHODS An interview-based psychometric study was carried out. Participants completed: receptive subtests of the Frenchay Aphasia Screening Test, the Greek SAQOL-39g, the 12-item General Health Questionnaire, the Frenchay Activities Index, the Montreal Cognitive Assessment and the Barthel Index. RESULTS 86 people took part; 26 provided test-retest reliability data. The Greek SAQOL-39g demonstrated excellent acceptability (minimal missing data; no floor/ceiling effects), test-retest reliability [intraclass correlation coefficient = 0.96 (overall scale), 0.83-0.99 (domains)] and internal consistency [Cronbach's alpha = 0.96 (overall scale), 0.92-0.96 (domains)]. There was strong evidence for convergent [r = 0.53-0.80 (overall scale), 0.54-0.89 (domains)] and discriminant validity [r = 0.52 (overall scale), 0.04-0.48 (domains)]. CONCLUSION The Greek SAQOL-39g is a valid and reliable scale. It is a promising measure for use in stroke and aphasia treatment prioritization, outcome measurement and service evaluation.
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Olai L, Borgquist L, Svärdsudd K. Health problems in elderly patients during the first post-stroke year. Ups J Med Sci 2012; 117:318-27. [PMID: 22554141 PMCID: PMC3410292 DOI: 10.3109/03009734.2012.674572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 03/05/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A wide range of health problems has been reported in elderly post-stroke patients. AIM The aim of this study was to analyse the prevalence and timing of health problems identified by patient interviews and scrutiny of primary health care and municipality elderly health care records during the first post-stroke year. METHODS A total of 390 consecutive patients, ≥65 years, discharged alive from hospital after a stroke event, were followed for 1 year post-admission. Information on the health care situation during the first post-stroke year was obtained from primary health care and municipal elderly health care records and through interviews with the stroke survivors, at 1 week after discharge, and 3 and 12 months after hospital admission. RESULTS More than 90% had some health problem at some time during the year, while based on patient record data only 4-8% had problems during a given week. The prevalence of interview-based health problems was generally higher than record-based prevalence, and the ranking order was moderately different. The most frequently interview-reported problems were associated with perception, activity, and tiredness, while the most common record-based findings indicated pain, bladder and bowel function, and breathing and circulation problems. There was co-occurrence between some problems, such as those relating to cognition, activity, and tiredness. CONCLUSIONS Almost all patients had a health problem during the year, but few occurred in a given week. Cognitive and communication problems were more common in interview data than record data. Co-occurrence may be used to identify subtle health problems.
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Affiliation(s)
- Lena Olai
- Department of Public Health and Caring Sciences, Uppsala University, Family Medicine and Preventive Medicine Section, Uppsala, Sweden.
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Gall SL, Tran PL, Martin K, Blizzard L, Srikanth V. Sex Differences in Long-Term Outcomes After Stroke. Stroke 2012; 43:1982-7. [DOI: 10.1161/strokeaha.111.632547] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seana L. Gall
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Pham Lan Tran
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Kara Martin
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Leigh Blizzard
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
| | - Velandai Srikanth
- From the Menzies Research Institute Tasmania (S.L.G., P.L.T., K.M., L.B., V.S.), University of Tasmania, Hobart, Tasmania Australia; and the Stroke and Ageing Research Centre (V.S.), Department of Medicine, Southern Clinical School, Monash University, Monash, Australia
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Chen HF, Lin KC, Wu CY, Chen CL. Rasch validation and predictive validity of the action research arm test in patients receiving stroke rehabilitation. Arch Phys Med Rehabil 2012; 93:1039-45. [PMID: 22420887 DOI: 10.1016/j.apmr.2011.11.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 11/16/2011] [Accepted: 11/29/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To validate the internal construct and predictive validity of the Action Research Arm Test (ARAT). DESIGN Secondary study. SETTING Seven medical centers. PARTICIPANTS Patients with stroke (N=191). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The internal construct validity of the ARAT score at pretreatment was examined using Rasch analysis. The predictive validity was examined by the correlations between performance on the ARAT before treatment and scores on the Wolf Motor Function Test, the Motor Activity Log, and the Stroke Impact Scale after treatment. RESULTS The 4-point ARAT scale had a disordered rating scale structure. Further Rasch modeling suggested revising the original 4-point scale into a 3-point scale. The 19 items measured 1 construct. The item difficulty hierarchy indicated that excluding the gross subtest, a score of 3 on the first item of any other subtest indicated the highest motor ability, and a score of 1 (the revised lowest rating) on the second item indicated the lowest motor ability. Tasks of "place hand behind head" and "place hand on top of head" showed poor item fit and item bias relevant to participants' ages. The ARAT items can reliably separate participants into 5.44 strata. Moderate to good correlations indicated good predictive validity. CONCLUSIONS The ARAT possesses good psychometric properties in stroke patients with mild to moderate motor severity and without severe cognitive impairment, and has evidence of unidimensionality, predictive validity, and reliability. The revised 3-point rating scale is recommended when the ARAT is administered on this population. The "place hand behind head" and "place hand on top of head" tasks misfit the Rasch model's expectations. Future studies are needed in the use of the ARAT on stroke patients with different levels of motor severity or with cognitive impairment.
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Affiliation(s)
- Hui-fang Chen
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Hilari K, Needle JJ, Harrison KL. What Are the Important Factors in Health-Related Quality of Life for People With Aphasia? A Systematic Review. Arch Phys Med Rehabil 2012; 93:S86-95. [DOI: 10.1016/j.apmr.2011.05.028] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/18/2011] [Accepted: 05/31/2011] [Indexed: 01/02/2023]
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Graven C, Brock K, Hill K, Joubert L. Are rehabilitation and/or care co-ordination interventions delivered in the community effective in reducing depression, facilitating participation and improving quality of life after stroke? Disabil Rehabil 2011; 33:1501-20. [DOI: 10.3109/09638288.2010.542874] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Smeeton NC, Corbin DOC, Hennis AJM, Hambleton IR, Rose AMC, Fraser HS, Heuschmann PU, Wolfe CDA. A comparison of outcome for stroke patients in Barbados and South London. Int J Stroke 2010; 6:112-7. [PMID: 21371271 DOI: 10.1111/j.1747-4949.2010.00558.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Little is known about the poststroke outcome in Caribbean populations. We investigated differences in the activities of daily living, level of social activities, living circumstances and survival for stroke patients in Barbados and London. METHODS Data were collected from the South London Stroke Register and the Barbados Register of Strokes for patients with a first-ever stroke registered between January 2001 and December 2004. The ability to perform activities of daily living was measured by the Barthel Index and level of social activities by the Frenchay Activities Index. Living circumstances were categorised into private household vs. institutional care. Death and dependency, activities of daily living and social activities were assessed at three-months, one- and two-years using logistic regression, adjusted for differences in demographic, socioeconomic and stroke severity characteristics. RESULTS At three-months, a high level of social activities was more likely for the Barbados Register of Strokes (odds ratio 1.84; 95% confidence interval 1.03-3.29); there were no differences in activities of daily living; and Barbados Register of Strokes patients were less likely to be in institutional care (relative risk ratio 0.38; 95% confidence interval 0.18-0.79). Following adjustment, Barbados Register of Strokes patients had a higher risk of mortality at three-months (relative risk ratio 1.85; 95% confidence interval 1.03-3.30), one-year (relative risk ratio 1.83; 95% confidence interval 1.08-3.09) and two-years (relative risk ratio 1.82; 95% confidence interval 1.08-3.07). This difference was due to early poststroke deaths; for patients alive at four-weeks poststroke, survival thereafter was similar in both settings. CONCLUSIONS In Barbados, there was evidence for a healthy survivor effect, and short-term social activity was greater than that in the South London Stroke Register.
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Affiliation(s)
- Nigel C Smeeton
- Division of Health and Social Care Research, King's College London, London, UK.
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Lindenberg R, Renga V, Zhu LL, Nair D, Schlaug G. Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients. Neurology 2010; 75:2176-84. [PMID: 21068427 DOI: 10.1212/wnl.0b013e318202013a] [Citation(s) in RCA: 393] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Motor recovery after stroke depends on the integrity of ipsilesional motor circuits and interactions between the ipsilesional and contralesional hemispheres. In this sham-controlled randomized trial, we investigated whether noninvasive modulation of regional excitability of bilateral motor cortices in combination with physical and occupational therapy improves motor outcome after stroke. METHODS Twenty chronic stroke patients were randomly assigned to receive 5 consecutive sessions of either 1) bihemispheric transcranial direct current stimulation (tDCS) (anodal tDCS to upregulate excitability of ipsilesional motor cortex and cathodal tDCS to downregulate excitability of contralesional motor cortex) with simultaneous physical/occupational therapy or 2) sham stimulation with simultaneous physical/occupational therapy. Changes in motor impairment (Upper Extremity Fugl-Meyer) and motor activity (Wolf Motor Function Test) assessments were outcome measures while functional imaging parameters were used to identify neural correlates of motor improvement. RESULTS The improvement of motor function was significantly greater in the real stimulation group (20.7% in Fugl-Meyer and 19.1% in Wolf Motor Function Test scores) when compared to the sham group (3.2% in Fugl-Meyer and 6.0% in Wolf Motor Function Test scores). The effects outlasted the stimulation by at least 1 week. In the real-stimulation group, stronger activation of intact ipsilesional motor regions during paced movements of the affected limb were found postintervention whereas no significant activation changes were seen in the control group. CONCLUSIONS The combination of bihemispheric tDCS and peripheral sensorimotor activities improved motor functions in chronic stroke patients that outlasted the intervention period. This novel approach may potentiate cerebral adaptive processes that facilitate motor recovery after stroke. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for adult patients with ischemic stroke treated at least 5 months after their first and only stroke, bihemispheric tDCS and simultaneous physical/occupational therapy given over 5 consecutive sessions significantly improves motor function as measured by the Upper Extremity Fugl-Meyer assessment (raw change treated 6.1 ± 3.4, sham 1.2 ± 1.0).
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Affiliation(s)
- R Lindenberg
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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Utz KS, Dimova V, Oppenländer K, Kerkhoff G. Electrified minds: Transcranial direct current stimulation (tDCS) and Galvanic Vestibular Stimulation (GVS) as methods of non-invasive brain stimulation in neuropsychology—A review of current data and future implications. Neuropsychologia 2010; 48:2789-810. [DOI: 10.1016/j.neuropsychologia.2010.06.002] [Citation(s) in RCA: 284] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 04/15/2010] [Accepted: 06/03/2010] [Indexed: 10/19/2022]
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Fallahpour M, Jonsson H, Joghataei MT, Kottorp A. Impact on Participation and Autonomy (IPA): Psychometric evaluation of the Persian version to use for persons with stroke. Scand J Occup Ther 2010; 18:59-71. [DOI: 10.3109/11038121003628353] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Accomplishment level and satisfaction with social participation of older adults: association with quality of life and best correlates. Qual Life Res 2010; 19:665-75. [PMID: 20237957 DOI: 10.1007/s11136-010-9633-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to (1) explore whether quality of life (QOL) is more associated with satisfaction with social participation (SP) than with level of accomplishment in SP and (2) examine respective correlates of accomplishment level and satisfaction with SP. METHODS A cross-sectional design was used with a convenience sample of 155 older adults (mean age=73.7; 60% women) having various levels of activity limitations. Accomplishment level and satisfaction with SP (dependent variables) were estimated with the social roles items of the assessment of life habits. Potential correlates were human functioning components. RESULTS Correlations between QOL and accomplishment level and satisfaction with SP did not differ (P=0.71). However, best correlates of accomplishment level and satisfaction with SP were different. Higher accomplishment level of SP was best explained by younger age, activity level perceived as stable, no recent stressing event, better well-being, higher activity level, and fewer obstacles in "Physical environment and accessibility" (R2=0.79). Greater satisfaction with SP was best explained by activity level perceived as stable, better self-perceived health, better well-being, higher activity level, and more facilitators in "Social support and attitudes" (R2=0.51). CONCLUSION With some exceptions, these best correlates may be positively modified and thus warrant special attention in rehabilitation interventions.
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Chau JPC, Thompson DR, Twinn S, Chang AM, Woo J. Determinants of participation restriction among community dwelling stroke survivors: a path analysis. BMC Neurol 2009; 9:49. [PMID: 19735548 PMCID: PMC2746173 DOI: 10.1186/1471-2377-9-49] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 09/07/2009] [Indexed: 11/25/2022] Open
Abstract
Background Apart from promoting physical recovery and assisting in activities of daily living, a major challenge in stroke rehabilitation is to minimize psychosocial morbidity and to promote the reintegration of stroke survivors into their family and community. The identification of key factors influencing long-term outcome are essential in developing more effective rehabilitation measures for reducing stroke-related morbidity. The aim of this study was to test a theoretical model of predictors of participation restriction which included the direct and indirect effects between psychosocial outcomes, physical outcome, and socio-demographic variables at 12 months after stroke. Methods Data were collected from 188 stroke survivors at 12 months following their discharge from one of the two rehabilitation hospitals in Hong Kong. The settings included patients' homes and residential care facilities. Path analysis was used to test a hypothesized model of participation restriction at 12 months. Results The path coefficients show functional ability having the largest direct effect on participation restriction (β = 0.51). The results also show that more depressive symptoms (β = -0.27), low state self-esteem (β = 0.20), female gender (β = 0.13), older age (β = -0.11) and living in a residential care facility (β = -0.12) have a direct effect on participation restriction. The explanatory variables accounted for 71% of the variance in explaining participation restriction at 12 months. Conclusion Identification of stroke survivors at risk of high levels of participation restriction, depressive symptoms and low self-esteem will assist health professionals to devise appropriate rehabilitation interventions that target improving both physical and psychosocial functioning.
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Affiliation(s)
- Janita P C Chau
- Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong.
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Abstract
Caregiver burden following stroke is increasingly recognised as a significant health care concern. A growing number of studies have evaluated the patient, caregiver, and social support factors that contribute to increased caregiver burden. We conducted a systematic review of this literature to guide future research. A search of the MEDLINE, PsyclNFO, CINAHL, and EMBASE databases (up to July 2008) and reference sections of published studies using a structured search strategy yielded 24 relevant articles. Studies were included if they evaluated predictors and/or correlates of caregiver burden in the setting of stroke. The prevalence of caregiver burden was 25–54% and remained elevated for an indefinite period following stroke. In studies that evaluated independent baseline predictors of subsequent caregiver burden, none of the factors reported were consistent across studies. In studies that assessed concurrent factors independently contributing to caregiver burden in the poststroke period, patient characteristics and social support factors were inconsistently reported. Several studies identified caregiver mental health and the amount of time and effort required of the caregiver as significant determinants of caregiver burden. Our findings highlight the need for more research to identify caregivers in need of support and guide the development and implementation of appropriate interventions to offset caregiver burden.
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Affiliation(s)
- H. Rigby
- Dalhousie University, Halifax, NS, Canada
| | - G. Gubitz
- Dalhousie University, Halifax, NS, Canada
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - S. Phillips
- Dalhousie University, Halifax, NS, Canada
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
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