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Braga MAF, Faria-Fortini I, de Menezes KKP, Santos JM, Rodrigues NAG, de Moura Silva EA, de Morais Faria CDC. General and Specific Quality of Life Course of Individuals with Different Levels of Stroke Severity: A One-Year Prospective Longitudinal Study. Clin Gerontol 2024:1-13. [PMID: 38872328 DOI: 10.1080/07317115.2024.2366833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
OBJECTIVES To compare the course of generic and specific health-related quality of life (HRQOL) of individuals with stroke, and its physical, mental, and social domains, at three, six, and 12 months after hospital discharge, considering the levels of stroke severity. METHODS This is a longitudinal study, in stroke individuals, assessed during hospital admission by the National Institutes of Health Stroke Scale (NIHSS), and divided into mild (NIHSS ≤3) or moderate/severe (NIHSS ≥4) disease. At three, six, and 12 months after hospital discharge, the individuals were assessed for generic (Short Form Health Survey-36: total score and physical and mental domains) and specific (Stroke Specific Quality of Life Scale: total score and social domain) HRQOL. A 2 × 2 repeated measures analysis of variance (ANOVA) with post-hoc was applied. RESULTS 146, 122, and 103 individuals were assessed at three, six and 12 months, respectively HRQOL courses showed different behaviors according to stroke severity (3.37≤F ≤ 4.62; 0.010≤p ≤ .036). Individuals with mild stroke showed significant changes in the physical domain, with a reduction between three and six months, and an increase between six and 12. Moderate/severe individuals showed a significant increase in all HRQOL variables between three and six months, and a maintenance of values for almost all variables, except for physical domain, which improved significantly between three and six months, and got significantly worse between six and 12. CONCLUSIONS HRQOL during the first year after stroke showed distinct trajectories, being stroke severity an important factor in identifying stroke subjects at risk of HRQOL decline. CLINICAL IMPLICATIONS These results demonstrate the importance of considering not only the phase of the stroke, the severity, and the general and specific HRQOL, but also the physical, social, and mainly the mental domain, which has long been neglected, when assessing this population.
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Affiliation(s)
- Marcela Aline Fernandes Braga
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Iza Faria-Fortini
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Jéssica Melo Santos
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Edvânia Andrade de Moura Silva
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Christina Danielli Coelho de Morais Faria
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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2
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Rodrigues NAG, da Silva SLA, Nascimento LR, de Paula Magalhães J, Sant'Anna RV, de Morais Faria CDC, Faria-Fortini I. R3-Walk and R6-Walk, Simple Clinical Equations to Accurately Predict Independent Walking at 3 and 6 Months After Stroke: A Prospective, Cohort Study. Arch Phys Med Rehabil 2024; 105:1116-1123. [PMID: 38281578 DOI: 10.1016/j.apmr.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To investigate if independent walking at 3 and 6 months poststroke can be accurately predicted within the first 72 hours, based on simple clinical bedside tests. DESIGN Prospective observational cohort study with 3-time measurements: immediately after stroke, and 3 and 6 months poststroke. SETTING Public hospital. PARTICIPANTS Adults with first-ever stroke evaluated at 3 (N=263) and 6 (N=212) months poststroke. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The outcome of interest was independent walking at 3 and 6 months after stroke. Predictors were age, walking ability, lower limb strength, motor recovery, spatial neglect, continence, and independence in activities of daily living. RESULTS The equation for predicting walking 3 months poststroke was 3.040 + (0.283 × FAC baseline) + (0.021 × Modified Barthel Index), and for predicting walking 6 months poststroke was 3.644 + (-0.014 × age) + (0.014 × Modified Barthel Index). For walking ability 3 months after stroke, sensitivity was classified as high (91%; 95% CI: 81-96), specificity was moderate (57%; 95% CI: 45-69), positive predictive value was high (76%; 95% CI: 64-86), and negative predictive value was high (80%; 95% CI: 60-93). For walking ability 6 months after stroke, sensitivity was classified as moderate (54%; 95% CI: 47-61), specificity was high (81%; 95% CI: 61-92), positive predictive value was high (87%; 95% CI: 70-96), and negative predictive value was low (42%; 95% CI: 50-73). CONCLUSIONS This study provided 2 simple equations that predict walking ability 3 and 6 months after stroke. This represents an important step to accurately identify individuals, who are at high risk of walking dependence early after stroke.
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Affiliation(s)
| | | | | | - Jordana de Paula Magalhães
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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3
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Slenders JPL, de Graaf JA, Post MWM, van Heugten CM, Van den Berg-Vos RM, Kwa VIH, Visser-Meily JMA. Participation in daily life activities at two months after stroke predicts long-term health-related quality of life. Top Stroke Rehabil 2024; 31:11-20. [PMID: 37056169 DOI: 10.1080/10749357.2023.2202017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND After stroke, many patients experience problems with participation in daily activities. Improving participation is the main goal in stroke rehabilitation. However, the longitudinal relationship between participation and health-related quality of life (HRQoL) remains unclear. OBJECTIVES This study aimed to examine (1) the predictive value of participation at two months on long-term HRQoL and (2) the longitudinal relationship between participation and HRQoL. METHODS In this multicenter, prospective cohort study, patients were assessed at two and 12 months after stroke. Participation was measured with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation - Participation. HRQoL was assessed with the three-level version of the EuroQoL five dimensions questionnaire index score. RESULTS This study included 291 patients. Mean age was 66.6 ± 12.4 years, 64.3% were male and mean National Institutes of Health Stroke Scale (NIHSS) was 2.5 ± 2.9. Multivariable linear regression, adjusted for demographic characteristics, stroke characteristics, physical and cognitive impairment, showed that a higher level of participation at two months correlated with a higher HRQoL at one year (B = .004; 95% CI =.002-.005). Patients whose participation improved had a greater increase in HRQoL, compared to patients without improvement (0.080 ± .21 versus -.054 ± .21; p < .001). CONCLUSIONS The level of participation at two months post-stroke predicts HRQoL at one year. Improvement in participation during the first year after stroke is associated with improvement in HRQoL. We recommend including the assessment of participation in daily activities at follow-up visits.
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Affiliation(s)
| | - Joris A de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Caroline M van Heugten
- School for Mental Health & Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, Netherlands
| | - Renske M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, Netherlands
- Department of Neurology, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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4
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Egan M, Kessler D, Gurgel-Juarez N, Chopra A, Linkewich E, Sikora L, Montgomery P, Duong P. Stroke rehabilitation adaptive approaches: A theory-focused scoping review. Scand J Occup Ther 2024; 31:1-13. [PMID: 37976402 DOI: 10.1080/11038128.2023.2257228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Stroke rehabilitation consists of restorative and adaptive approaches. Multiple adaptive approaches exist. AIMS/OBJECTIVES The objective of this study was to develop a framework for categorising adaptive stroke rehabilitation interventions, based on underlying theory. MATERIAL AND METHODS We searched multiple databases to April 2020 to identify studies of interventions designed to improve participation in valued activities. We extracted the name of the intervention, underlying explicit or implicit theory, intervention elements, and anticipated outcomes. Using this information, we proposed distinct groups of interventions based on theoretical drivers. RESULTS Twenty-nine adaptive interventions were examined in at least one of 77 studies. Underlying theories included Cognitive Learning Theory, Self-determination Theory, Social Cognitive Theory, adult learning theories, and Psychological Stress and Coping Theory. Three overarching theoretical drivers were identified: learning, motivation, and coping. CONCLUSIONS At least 29 adaptive approaches exist, but each appear to be based on one of three underlying theoretical drivers. Consideration of effectiveness of these approaches by theoretical driver could help indicate underlying mechanisms and essential elements of effective adaptive approaches. SIGNIFICANCE Our framework is an important advance in understanding and evaluating adaptive approaches to stroke rehabilitation.
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Affiliation(s)
- Mary Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dorothy Kessler
- School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | | | - Anchal Chopra
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | | | - Patrick Duong
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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5
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Braga MAF, Faria-Fortini ID, Dutra TMDFV, Silva EADM, Sant'Anna RV, Faria CDCDM. Functional independence measured in the acute phase of stroke predicts both generic and specific health-related quality of life: a 3-month prospective study in a middle-income country. Disabil Rehabil 2023; 45:4245-4251. [PMID: 36412142 DOI: 10.1080/09638288.2022.2147590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To identify acute predictors of both generic and specific health-related quality of life (HRQoL) 3 months after stroke in individuals from a middle-income country. MATERIALS AND METHODS A 3-month prospective study with individuals who had suffered their first stroke, without previous disability, discharged from a stroke unit. The dependent outcomes, assessed 3 months after stroke, were generic and specific HRQoL (SF-36 and SSQOL total scores, respectively). The predictors assessed in the stroke unit were age, sex, education level, duration of hospital stay, current living arrangement, stroke severity (National Institutes of Health Stroke Scale-NIHSS), functional independence (Modified Barthel Index-MBI), motor impairment (Fugl-Meyer Assessment), and lower- and upper-limb residual muscle strength deficits. Linear multiple regression analyses were employed to identify predictors of both generic (model-1) and specific (model-2) HRQoL (α = 5%). RESULTS One hundred twenty-six individuals were assessed at 3-month post-stroke (61.3 ± 13.6 years). Regression analysis showed that functional independence was the best predictor of both generic (R2 = 21%; F = 34.82; p < 0.001) and specific (R2 = 29%; F = 51.71; p < 0.001) HRQoL at 3-month post-stroke. CONCLUSION Both generic and specific HRQoL at 3-month post-stroke can be predicted by functional independence assessed in the acute phase with the MBI.
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Affiliation(s)
| | - Iza de Faria-Fortini
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | | | | | - Romeu Vale Sant'Anna
- Risoleta Toletino Neves Hospital, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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6
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Magalhães JP, Faria-Fortini I, Dutra TM, Sant'Anna R, Soares CLA, Teixeira-Salmela LF, Faria CD. Access to rehabilitation professionals by individuals with stroke one month after hospital discharge from a stroke unit in Brazil is insufficient regardless of the pandemic. J Stroke Cerebrovasc Dis 2023; 32:107186. [PMID: 37295173 PMCID: PMC10246573 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107186] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE To compare access to rehabilitation professionals by individuals with stroke one month after hospital discharge from a stroke unit in Brazil, before and during the COVID-19 pandemic. MATERIALS AND METHODS This longitudinal and prospective study included individuals aged 20 years or older without previous disabilities admitted into a stroke unit due to a first stroke. Individuals were divided into two groups: before (G1) and during (G2) the COVID-19 pandemic. Groups were matched for age, sex, education level, socioeconomic status, and stroke severity. One month after hospital discharge, individuals were contacted via telephone to collect data regarding their access to rehabilitation services based on the number of referred rehabilitation professionals. Then, between-group comparisons were conducted (α = 5%). RESULTS The access to rehabilitation professionals was similar between groups. Rehabilitation professionals accessed included medical doctors, occupational therapists, physical therapists, and speech therapists. The first consultation after hospital discharge was mainly provided by public services. Despite the pandemic, telehealth was not frequent in any period evaluated. In both groups, the number of accessed professionals (G1 = 110 and G2 = 90) was significantly lower than the number of referrals (G1 = 212 and G2 = 194; p < 0.001). CONCLUSIONS Access to rehabilitation professionals was similar between groups. However, the number of accessed rehabilitation professionals was lower than that of referred ones during both periods. This finding indicates a compromised comprehensiveness of care for individuals with stroke, regardless of the pandemic.
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Affiliation(s)
- Jordana P Magalhães
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Tamires Mfv Dutra
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Romeu Sant'Anna
- Department of Neurology, Hospital Risoleta Tolentino Neves, Belo Horizonte, MG, Brazil
| | - Carolina LA Soares
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luci F Teixeira-Salmela
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Christina Dcm Faria
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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7
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van Mastrigt G, van Heugten C, Visser-Meily A, Bremmers L, Evers S. Estimating the Burden of Stroke: Two-Year Societal Costs and Generic Health-Related Quality of Life of the Restore4Stroke Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191711110. [PMID: 36078828 PMCID: PMC9517815 DOI: 10.3390/ijerph191711110] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 05/07/2023]
Abstract
(1) Background: This study aimed to investigate two-year societal costs and generic health-related quality of life (QoL) using a bottom-up approach for the Restore4Stroke Cohort. (2) Methods: Adult post-stroke patients were recruited from stroke units throughout the Netherlands. The societal costs were calculated for healthcare and non-healthcare costs in the first two years after stroke. The QoL was measured using EQ-5D-3L. The differences between (sub)groups over time were investigated using a non-parametric bootstrapping method. (3) Results: A total of 344 post-stroke patients were included. The total two-year societal costs of a post-stroke were EUR 47,502 (standard deviation (SD = EUR 2628)). The healthcare costs decreased by two thirds in the second year -EUR 14,277 (95% confidence interval -EUR 17,319, -EUR 11,236). In the second year, over 50% of the total societal costs were connected to non-healthcare costs (such as informal care, paid help, and the inability to perform unpaid labor). Sensitivity analyses confirmed the importance of including non-healthcare costs for long-term follow-up. The subgroup analyses showed that patients who did not return home after discharge, and those with moderate to severe stroke symptoms, incurred significantly more costs compared to patients who went directly home and those who reported fewer symptoms. QoL was stable over time except for the stroke patients over 75 years of age, where a significant and clinically meaningful decrease in QoL over time was observed. (4) Conclusions: The non-healthcare costs have a substantial impact on the first- and second-year total societal costs post-stroke. Therefore, to obtain a complete picture of all the relevant costs related to a stroke, a societal perspective with a follow-up of at least two years is highly recommended. Additionally, more research is needed to investigate the decline in QoL found in stroke patients above the age of 75 years.
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Affiliation(s)
- Ghislaine van Mastrigt
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence:
| | - Caroline van Heugten
- MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Anne Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Leonarda Bremmers
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University, 3062 PA Rotterdam, The Netherlands
| | - Silvia Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction Utrecht, 3521 VS Utrechtcity, The Netherlands
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8
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Cox VC, Welten JJ, Schepers VP, Ketelaar M, Kruithof WJ, van Heugten CM, Visser-Meily JM. Burden, anxiety and depressive symptoms in partners – course and predictors during the first two years after stroke. Top Stroke Rehabil 2022:1-10. [DOI: 10.1080/10749357.2022.2098898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Vincent C.M. Cox
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Jennifer J.E. Welten
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Vera P.M. Schepers
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Willeke J. Kruithof
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
| | - Caroline M. van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
- Limburg Center for Brain Injury, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Johanna M.A. Visser-Meily
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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9
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Welten JJE, Cox VCM, Kruithof WJ, Visser-Meily JMA, Post MWM, van Heugten CM, Schepers VPM. Intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression and life satisfaction in patient-partner couples after stroke. Neuropsychol Rehabil 2022; 33:849-870. [PMID: 35297736 DOI: 10.1080/09602011.2022.2051564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many stroke patients and partners suffer from anxiety, depression, and low life satisfaction. Psychological factors such as coping style and self-efficacy can be protective factors within individuals. The close relationship between stroke patients and partners suggests that there may be interdependence in psychological functioning. The aim of this study was to examine intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression, and life satisfaction in patient-partners couples. In this prospective cohort study, pro-active coping (UPCC), general self-efficacy (GSES), anxiety (HADS-A), depression (HADS-D), and life satisfaction (1-6 scale) were assessed in 215 couples at 2 and 12 months post-stroke. Effects within couples were assessed using structural equation modelling. Several intra- and interpersonal effects of coping style and self-efficacy at 2 months post-stroke were related to emotional health at 12 months post-stroke. Most effects were intrapersonal effects. The interpersonal effects were small but showed that pro-active coping by the patient was associated with lower anxiety of the partner. Higher self-efficacy of the partner was associated with lower depression scores and higher life satisfaction of the patient. This study underscores the importance of a dyadic approach to post-stroke functioning. It supports a family-based approach for treating post-stroke emotional problems.
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Affiliation(s)
- J J E Welten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - V C M Cox
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - W J Kruithof
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - V P M Schepers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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10
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Verberne DPJ, van Mastrigt GAPG, Ponds RWHM, van Heugten CM, Kroese MEAL. Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual. BMJ Open 2021; 11:e039201. [PMID: 33632749 PMCID: PMC7908908 DOI: 10.1136/bmjopen-2020-039201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-as-usual. DESIGN Economic evaluation within a comparative effectiveness research design. SETTING Primary care (2016-2017) and community settings (2011-2013) in the Netherlands. PARTICIPANTS Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation. INTERVENTIONS Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-as-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke. PRIMARY AND SECONDARY OUTCOME MEASURES Main outcome measure of cost-effectiveness was quality-adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale. RESULTS Health outcomes were significantly better in stroke aftercare for QALYs (Δ=0.05; 95% CI 0.01 to 0.09) and social participation (Δ=4.91; 95% CI 1.89 to 7.93) compared with care-as-usual. Total societal costs were €1208 higher in stroke aftercare than in care-as-usual (95% CI -€3881 to €6057). Healthcare costs were in total €1208 higher in stroke aftercare than in care-as-usual (95% CI -€3881 to €6057). Average costs of stroke aftercare were €91 (SD=€3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of €24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a €50 000 willingness-to-pay level. CONCLUSIONS Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-as-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.
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Affiliation(s)
- Daan P J Verberne
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Ghislaine A P G van Mastrigt
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Rudolf W H M Ponds
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
- Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Faculty of Psychology and Neuroscience, Maastricht, The Netherlands
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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11
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Verberne DPJ, Kroese MEAL, Staals J, Ponds RWHM, van Heugten CM. Nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual. Disabil Rehabil 2020; 44:2849-2857. [PMID: 33242261 DOI: 10.1080/09638288.2020.1849417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To examine whether nurse-led stroke aftercare is beneficial for long-term psychosocial outcome of community-dwelling persons with stroke. MATERIALS AND METHODS Comparative effectiveness research design in which a prospective stroke aftercare cohort (n = 87) was compared to care-as-usual (n = 363) at six- and 12-months post stroke. Changes over time in cognitive and emotional problems experienced in daily life, fatigue and stroke impact on daily life were examined for stroke aftercare only. Multilevel modelling was used to compare stroke aftercare to care-as-usual concerning anxiety and depression symptoms, social participation and quality of life, over time. RESULTS Sample characteristics did not differ between cohorts except for stroke type and on average, more severe stroke in the stroke aftercare cohort (p < 0.05). Following stroke aftercare, anxiety and emotional problems decreased significantly (p < 0.05), whereas care-as-usual remained stable over time in terms of anxiety. No significant changes over time were observed on the other outcome domains. CONCLUSIONS Nurse-led stroke aftercare showed to be beneficial for emotional well-being in comparison to care-as-usual. Providing psychoeducation and emotional support seem effective elements but adding other therapeutic elements such as self-management strategies might increase the effectiveness of nurse-led stroke aftercare.Implications for rehabilitationRoutine stroke follow-up care should pay attention to psychosocial and emotional outcome in a systematic manner, in addition to secondary prevention.Healthcare professionals such as (specialized) nurses are needed to appropriately address the hidden cognitive and emotional consequences of stroke.Providing psychoeducation and emotional support in stroke aftercare diminish insecurities and worries in community-dwelling persons with stroke, leading to better outcomes.
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Affiliation(s)
- D P J Verberne
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - M E A L Kroese
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - J Staals
- Department of Neurology and Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - R W H M Ponds
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands.,Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Medical Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C M van Heugten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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12
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de Graaf JA, Schepers VPM, Nijsse B, van Heugten CM, Post MWM, Visser-Meily JMA. The influence of psychological factors and mood on the course of participation up to four years after stroke. Disabil Rehabil 2020; 44:1855-1862. [DOI: 10.1080/09638288.2020.1808089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J. A. de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - V. P. M. Schepers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
| | - B. Nijsse
- Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - C. M. van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - M. W. M. Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - J. M. A. Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
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13
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Slenders JPL, Verberne DPJ, Visser-Meily JMA, Van den Berg-Vos RM, Kwa VIH, van Heugten CM. Early cognitive and emotional outcome after stroke is independent of discharge destination. J Neurol 2020; 267:3354-3361. [PMID: 32583049 PMCID: PMC7577909 DOI: 10.1007/s00415-020-09999-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive and emotional problems occur frequently after stroke. Patients with minor stroke are more likely to be discharged home. This paper compares early cognitive and emotional outcomes in patients discharged home after stroke versus patients discharged to inpatient rehabilitation, and examines the effect of cognitive and emotional outcomes on long-term participation. METHODS In this multicenter prospective cohort study, patients with stroke were assessed at two months with the Hospital Anxiety and Depression Scale (HADS), the Checklist for Cognitive and Emotional Consequences following Stroke (CLCE-24) and the Montreal Cognitive Assessment (MoCA). One year post stroke, participation was assessed with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P Restriction). RESULTS The study included 332 patients. Two months post stroke, anxiety and cognitive problems were equally prevalent among patients discharged home (n = 243; 73%) and patients discharged to inpatient rehabilitation (n = 89; 27%) (HADS-A = 4.8 ± 3.9 versus 4.6 ± 4.0, p = 0.747; MoCA < 26: 66.7% versus 70.8%, p = 0.477; CLCE-cognition = 3.0 ± 2.9 versus 3.3 ± 2.8, p = 0.499). Depressive symptoms were less severe in patients discharged home (HADS-D = 4.3 ± 3.9 versus 5.5 ± 3.8, p = 0.010). In patients discharged home, cognitive complaints were predictive of long-term participation (B = - 2.03; 95% CI - 3.15, - 0.90), while cognitive or emotional outcomes were not predictive in patients discharged to inpatient rehabilitation. CONCLUSIONS Cognitive and emotional problems at two months post stroke were comparable between patients discharged home and those discharged to inpatient rehabilitation. For patients discharged home, cognitive complaints were predictive of long-term participation.
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Affiliation(s)
| | - Daan P J Verberne
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Renske M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
- Department of Neuropsychology and Psychopharmacology, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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14
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de Graaf JA, Nijsse B, Schepers VPM, van Heugten CM, Post MWM, Visser-Meily JMA. Which approach to measure cognitive functioning should be preferred when exploring the association between cognitive functioning and participation after stroke? Neuropsychol Rehabil 2020; 31:1207-1223. [PMID: 32496877 DOI: 10.1080/09602011.2020.1769687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A variety of approaches are currently used to explore the relationship between cognitive functioning and participation after stroke. We aimed to gain insight into the preferred approach to measure cognitive functioning when exploring the association between cognitive functioning and participation in the long term after stroke. In this inception cohort study 128 individuals with stroke participated and were assessed at a single time point three to four years after the event. Participation was measured using the Restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation. Subjective cognitive complaints were assessed using the Cognition subscale of the Checklist for Cognitive and Emotional Consequences (CLCE-24-C). Objective cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) and a neuropsychological test battery (NTB) testing multiple cognitive domains. Participation showed a strong correlation (r = 0.51) with the CLCE-24-C and moderate correlations with the domains of visuospatial perception (r = 0.37) and mental speed (r = 0.36). Backward linear regression analyses showed that participation restrictions were best explained by the combination of the CLCE-24-C and a test for visuospatial perception (R2 = 0.31). Our findings suggest the use of a combination of subjective cognitive complaints and objective cognitive performance to explore the relationship between cognitive functioning and participation after stroke.
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Affiliation(s)
- J A de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - B Nijsse
- Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - V P M Schepers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
| | - C M van Heugten
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - J M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
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15
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Defining the content of a minimal dataset for acquired brain injury using a Delphi procedure. Health Qual Life Outcomes 2020; 18:30. [PMID: 32066447 PMCID: PMC7027079 DOI: 10.1186/s12955-020-01286-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 02/10/2020] [Indexed: 12/17/2022] Open
Abstract
Background The lack of consistency in outcome measurement within the field of acquired brain injury (ABI) leads to incomparability of collected data and, consequently, reduced generalisation of findings. We aim to develop a set of standardised measures which can be used to obtain the minimum amount of data necessary to characterise ABI-patients across all healthcare sectors and disciplines and in every stage of recovery; i.e., an ABI-specific minimal dataset (MDS-ABI). The current study was conducted to identify the core outcome domains for adults with ABI (what to measure?) and to select the most suitable measurements within these domains (how to measure it?). Methods An initial comprehensive set of outcome domains and measurement instruments relevant for measuring the consequences of ABI was identified by a literature study. The selection of relevant domains was based on the International Classification of Functioning, Disability and Health framework. Measurement instruments were included in the Delphi procedure when they met pre-set requirements. A three-round Delphi study was conducted among Dutch experts (n = 48) using iterative web-based surveys to prioritise the proposed domains and instruments for the MDS-ABI. Throughout all rounds, participants could recommend additional or alternative domains and measurement instruments, and were fed back the collated group responses of the previous round. Results Response rates ranged from 89 to 100%. After three rounds, the expert panel reached consensus (≥51%) on the inclusion of 12 outcome domains (demographics, injury characteristics, comorbidity, cognitive functioning, emotional functioning, energy, mobility, self-care, communication, participation, social support and quality of life), measured with six measurement instruments, two screening questions and a registry of demographic- and injury information. No consensus was reached on how to measure quality of life. Conclusions The current study achieved consensus on the content of a minimal dataset for patients with ABI. The current version of the MDS-ABI will be evaluated and optimised if necessary in the near future.
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Stiekema APM, Nijsse B, de Kort PLM, Spikman JM, Visser-Meily JMA, van Heugten CM. The relationship between social cognition and participation in the long term after stroke. Neuropsychol Rehabil 2019; 31:278-292. [PMID: 31854264 DOI: 10.1080/09602011.2019.1692670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Social cognitive impairments may play a role in participation restrictions after stroke. Understanding their relationship could inform treatment approaches to improve participation. We investigated the relationship between social cognition and participation in the long term after stroke. Of 395 patients participating in a large prospective cohort study, cross-sectional data were available at 3-4 years post-stroke of 118 patients on tests for emotion recognition, theory of mind, empathy, and behaviour regulation. Participation was assessed with the Utrecht Scale for Evaluation of Rehabilitation - Participation (USER-P). Bivariate and multivariate regression analysis were used to examine the relationship between social cognitive domains and participation. The majority suffered from minor stroke (83.1% scored NIHSS 0-4). Only behaviour regulation was related to participation restrictions in bivariate analysis, but social cognitive impairments did not predict participation restrictions in multivariate regression in this group. To conclude, in a sample of minor stroke patients with mild impairments in theory of mind, emotion recognition and behavioural control, there were no associations with restrictions in participation. Research should examine whether a relationship is present in patients with more severe stroke. In addition, measuring social aspects of participation is necessary to further unravel this relationship, to determine treatment targets for improving participation.
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Affiliation(s)
- Annemarie P M Stiekema
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Limburg Brain Injury Center, Maastricht University, Maastricht, Netherlands.,Alzheimer Center Limburg, Maastricht University, Maastricht, Netherlands
| | - Britta Nijsse
- Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands
| | - Paul L M de Kort
- Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands
| | - Jacoba M Spikman
- Department of Neurology, Subdepartment of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Limburg Brain Injury Center, Maastricht University, Maastricht, Netherlands.,Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, Netherlands
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17
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Nijsse B, Spikman JM, Visser-Meily JM, de Kort PL, van Heugten CM. Social Cognition Impairments in the Long Term Post Stroke. Arch Phys Med Rehabil 2019; 100:1300-1307. [DOI: 10.1016/j.apmr.2019.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/23/2019] [Accepted: 01/29/2019] [Indexed: 12/31/2022]
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Verberne D, Tse T, Matyas T, Baum C, Post M, Carey L, van Heugten C. Comparing Participation Outcome Over Time Across International Stroke Cohorts: Outcomes and Methods. Arch Phys Med Rehabil 2019; 100:2096-2105. [PMID: 31158335 DOI: 10.1016/j.apmr.2019.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/25/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To enable a direct comparison of participation levels in the first year post-stroke, assessed by different outcome measures internationally. DESIGN Two prospective stroke cohort studies following persons from stroke onset to 12 months post-stroke. SETTING Community. PARTICIPANTS Persons with stroke (N=495), not living at a nursing home, from Australia STroke imAging pRevention and Treatment-Prediction and Prevention to Achieve optimal Recovery Endpoints after stroke (START-PrePARE; n=100) and the Netherlands (Restore4stroke; n=395). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Activity Card Sort-Australia and Utrecht Scale for Evaluation of Rehabilitation-Participation. Activity domains were matched across measures to find common denominators and original scoring methods were recoded, hereby enabling a direct comparison of retained activities. RESULTS Ninety-one (START-PrePARE) and 218 (Restore4stroke) persons with stroke were included for analyses. No major differences in background characteristics were observed between the cohorts; the Dutch cohort suffered from slightly more severe stroke. A higher level of participation was observed (radar charts) in the first months post-stroke for the Australian cohort than in the Dutch cohort, especially for unpaid work (P<.003). At 12 months post-stroke, participation levels were similar, without significant differences in retained activities using the defined common denominators (P>.003). CONCLUSIONS An international comparison of actual activities that persons re-engage in in the first year post-stroke was achieved using a new method and recoding of data. High levels of participation were observed in both cohorts. Unpaid work showed different frequencies at 2-3 months, contributing to different trajectories over time across cultures. Important insights were gained. Although valuable information is inevitably lost with recoding, the approach may assist future studies on the harmonization of data across cohorts, particularly for 1 of the key outcomes of stroke: participation.
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Affiliation(s)
- Daan Verberne
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience, Maastricht, The Netherlands; Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Tamara Tse
- Occupational Therapy, School of Allied Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Australia; Neurorehabilitation and Recovery, Stroke Division Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; St. Vincent's Hospital, Melbourne, Fitzroy, Australia
| | - Thomas Matyas
- Occupational Therapy, School of Allied Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Australia; Neurorehabilitation and Recovery, Stroke Division Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Marcel Post
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Australia; Neurorehabilitation and Recovery, Stroke Division Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Caroline van Heugten
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience, Maastricht, The Netherlands; Limburg Brain Injury Centre, Maastricht, The Netherlands; Maastricht University, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht, the Netherlands.
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Liu Z, Zhou X, Zhang W, Zhou L. Factors associated with quality of life early after ischemic stroke: the role of resilience. Top Stroke Rehabil 2019; 26:335-341. [DOI: 10.1080/10749357.2019.1600285] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Zhihui Liu
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, China
| | - Xuan Zhou
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, China
| | - Wei Zhang
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, China
| | - Lanshu Zhou
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, China
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Nijsse B, Spikman JM, Visser-Meily JMA, de Kort PLM, van Heugten CM. Social cognition impairments are associated with behavioural changes in the long term after stroke. PLoS One 2019; 14:e0213725. [PMID: 30875394 PMCID: PMC6420004 DOI: 10.1371/journal.pone.0213725] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/27/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Behavioural changes after stroke might be explained by social cognition impairments. The aim of the present study was to investigate whether performances on social cognition tests (including emotion recognition, Theory of Mind (ToM), empathy and behaviour regulation) were associated with behavioural deficits (as measured by proxy ratings) in a group of patients with relatively mild stroke. METHODS Prospective cohort study in which 119 patients underwent neuropsychological assessment with tests for social cognition (emotion recognition, ToM, empathy, and behaviour regulation) 3-4 years post stroke. Test scores were compared with scores of 50 healthy controls. Behavioural problems were assessed with the Dysexecutive Questionnaire (DEX) self rating and proxy rating scales. Pearson correlations were used to determine the relationship between the social cognition measures and DEX scores. RESULTS Patients performed significantly worse on emotion recognition, ToM and behaviour regulation tests than controls. Mean DEX-self score did not differ significantly from the mean DEX-proxy score. DEX-proxy ratings correlated with tests for emotion recognition, empathy, and behavioural regulation (lower scores on these items were associated with more problems on the DEX-proxy scale). CONCLUSIONS Social cognition impairments are present in the long term after stroke, even in a group of mildly affected stroke patients. Most of these impairments also turned out to be associated with a broad range of behavioural problems as rated by proxies of the patients. This strengthens the proposal that social cognition impairments are part of the underlying mechanism of behavioural change. Since tests for social cognition can be administered in an early stage, this would allow for timely identification of patients at risk for behavioural problems in the long term.
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Affiliation(s)
- Britta Nijsse
- Elisabeth-Tweesteden Hospital, Department of Neurology, Tilburg, The Netherlands
| | - Jacoba M. Spikman
- University of Groningen, Department of Clinical and Developmental Neuropsychology, Groningen, The Netherlands
- University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
| | - Johanna M. A. Visser-Meily
- Center of Excellence in Rehabilitation Medicine, collaboration between University Medical Center Utrecht and Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Rehabilitation, Physical Therapy Science and Sports, Utrecht, The Netherlands
| | - Paul L. M. de Kort
- Elisabeth-Tweesteden Hospital, Department of Neurology, Tilburg, The Netherlands
| | - Caroline M. van Heugten
- Maastricht University, Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht, The Netherlands
- Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands
- * E-mail:
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21
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Hu P, Yang Q, Kong L, Hu L, Zeng L. Relationship between the anxiety/depression and care burden of the major caregiver of stroke patients. Medicine (Baltimore) 2018; 97:e12638. [PMID: 30290641 PMCID: PMC6200450 DOI: 10.1097/md.0000000000012638] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To investigate the anxiety/depression of caregivers of stroke patients.This study used a cross-sectional survey design and convenience sampling.Totally, 117 caregivers of stroke patients were enrolled. Data were collected from questionnaires. Hamilton anxiety scale, Hamilton depression scale, and Zarit caregiver burden interview were performed. Multiple linear regression and correlation analysis were used.The anxiety score, depression score and total burden score of 117 stroke caregivers were 16.56 ± 8.02, 18.63 ± 9.39, and 25.88 ± 10.35, respectively. Anxiety symptoms, mild to moderate depressive symptoms, and severe depressive symptoms were found in 43.9%, 26.5%, and 27.4% of the caregivers, respectively. Daily care time and medical payment method were influencing factors for anxiety and depression (P < .05). Both anxiety and depression were positively correlated with total care burden score (P < .01).Anxiety and depression are common in the caregivers of stroke patients and are closely related to care burdens. In this regard, appropriate home care guidance, psychological counseling and social support should be provided to the caregivers to reduce their physical and mental burden.
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Affiliation(s)
- Ping Hu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Qing Yang
- School of Nursing, Hunan university of medicine, Huaihua
| | - Lingna Kong
- School of Nursing, Chongqing Medical University, Chongqing, China
| | - Luanjiao Hu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Lingqiong Zeng
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing
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22
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Verberne DPJ, Post MWM, Köhler S, Carey LM, Visser-Meily JMA, van Heugten CM. Course of Social Participation in the First 2 Years After Stroke and Its Associations With Demographic and Stroke-Related Factors. Neurorehabil Neural Repair 2018; 32:821-833. [PMID: 30178696 PMCID: PMC6146317 DOI: 10.1177/1545968318796341] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background. Many persons with stroke experience physical, cognitive, and emotional problems that contribute to restrictions in social participation. There is, however, a lack of knowledge on the long-term course of participation over time post-stroke. Objective. To describe the time course of participation up to 2 years post-stroke and to identify which demographic and stroke-related factors are associated with this time course. Methods. This was a multicenter, prospective cohort study following 390 persons with stroke from hospital admission up to 2 years (at 2, 6, 12, and 24 months). Multilevel modeling with linear and quadratic time effects was used to examine the course of the frequency of vocational and social/leisure activities, experienced restrictions, and satisfaction with participation. Results. The frequency of vocational activities increased up to 1 year post-stroke and leveled off thereafter. Older and lower-educated persons showed less favorable courses of participation than younger and higher-educated persons, respectively. The frequency of social/leisure activities decreased post-stroke. Participation restrictions declined up to 1 year post-stroke and leveled off thereafter. Persons dependent in activities of daily living (ADL) kept experiencing more restrictions throughout time than independent persons. Satisfaction with participation increased slightly over time. Conclusions. Changes in participation occurred mostly in the first year post-stroke. Particularly older and lower-educated persons, and those dependent in ADL showed less favorable courses of participation up to 2 years post-stroke. Clinicians can apply these findings in identifying persons most at risk of long-term unfavorable participation outcome and, thus, target rehabilitation programs accordingly.
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Affiliation(s)
- Daan P J Verberne
- 1 Maastricht University Medical Center, Netherlands.,2 Limburg Brain Injury Center, Maastricht, Netherlands
| | - Marcel W M Post
- 3 Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,4 University of Groningen, Netherlands
| | | | - Leeanne M Carey
- 5 La Trobe University, Melbourne, Australia.,6 Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Johanna M A Visser-Meily
- 3 Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,7 University Utrecht, Netherlands
| | - Caroline M van Heugten
- 1 Maastricht University Medical Center, Netherlands.,2 Limburg Brain Injury Center, Maastricht, Netherlands.,8 Maastricht University, Netherlands
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Sundin K, Pusa S, Jonsson C, Saveman BI, Östlund U. Envisioning the future as expressed within family health conversations by families of persons suffering from stroke. Scand J Caring Sci 2017; 32:707-714. [PMID: 28851069 DOI: 10.1111/scs.12501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The whole family is affected when a person suffers from stroke, but few studies have focused on families' expectations following the stroke. OBJECTIVE The aim of this study was to illuminate what persons with stroke and their family members talk about in Family Health Conversations (FamHCs) with focus on the future and how nurses leading these conversations apprehended the families' future shown in closing letters based on these conversations. METHOD In this study, seven families with a member ≤65 years who had suffered a stroke participated in FamHC in their homes after the person with stroke had been discharged from the rehabilitation clinic. The FamHC comprised a series of three conversations conducted every other week and a closing letter sent by the nurses to the family to conclude the series. In this study, the third conversations were recorded and they and the closing letters were transcribed and analysed using qualitative content analysis. RESULT The family members including the persons with stroke were found to be able to tell their stories and express their feelings, worries, losses, hopes and wishes for the future within the context of the Family Health Conversations. Support within the family was highlighted as essential to the satisfactory management of future situations. CONCLUSION The persons with stroke and their belonging family members' vision of the future was reflected over in the light of theories about beliefs, possible selves, hope and suffering, and the findings highlight the need for broader use of family conversations to support persons with stroke and their families to manage the future.
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Affiliation(s)
- Karin Sundin
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Susanna Pusa
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Carin Jonsson
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Ulrika Östlund
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
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van der Kemp J, Kruithof WJ, Nijboer TCW, van Bennekom CAM, van Heugten C, Visser-Meily JMA. Return to work after mild-to-moderate stroke: work satisfaction and predictive factors. Neuropsychol Rehabil 2017; 29:638-653. [DOI: 10.1080/09602011.2017.1313746] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jet van der Kemp
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Willeke J. Kruithof
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Tanja C. W. Nijboer
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Coen A. M. van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Centre, Wijk aan Zee, the Netherlands
- Coronel Institute of Occupational Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Caroline van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
| | - Johanna M. A. Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
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25
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van Mierlo M, van Heugten C, Post MWM, Hoekstra T, Visser-Meily A. Trajectories of health-related quality of life after stroke: results from a one-year prospective cohort study. Disabil Rehabil 2017; 40:997-1006. [PMID: 28288530 DOI: 10.1080/09638288.2017.1292320] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify trajectories of physical and psychosocial health-related quality of life (HRQoL) from two months to one-year post stroke and to determine the factors that are associated with trajectory membership. METHOD Multicenter prospective cohort study in which 351 stroke patients were followed up at 2, 6, and 12 months post stroke. Latent class growth mixture modeling was used to determine trajectories of physical and psychosocial HRQoL. Multinomial regression analyses were performed to predict trajectory membership. Potential predictors were demographic, stroke-related, and psychological factors. RESULTS Four trajectories were identified for both physical and psychosocial HRQoL: high, low, recovery, and decline. Comparing the low and recovery trajectories, the groups with low HRQoL were more likely to have higher scores for neuroticism. Comparison of the decline and high trajectories yielded the following predictors of physical HRQoL: discharged to a rehabilitation setting, less acceptance and more neuroticism, pessimism, helplessness, and passive coping. Predictors of psychosocial HRQoL were: discharged to a rehabilitation setting, less self-efficacy, and proactive coping, and more helplessness and passive coping. CONCLUSIONS The present study identified four distinct trajectories of physical and psychosocial HRQoL. The findings indicate that psychological factors are the most important factors in identifying stroke patients at risk of unfavorable HRQoL trajectories. Using these factors will help to identify vulnerable patients and guide rehabilitation in the early stages post stroke. Implications for rehabilitation Clinicians should be aware that health-related quality of life follows distinct trajectories stable high, stable low, recovery, or decline, after onset of stroke. Determining relevant psychological factors, in particular helplessness and passive coping, in stroke patients early after stroke is important because these are predictors of unfavorable health-related quality of life trajectories.
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Affiliation(s)
- Maria van Mierlo
- a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands
| | - Caroline van Heugten
- b Department of Psychiatry and Neuropsychology. School for Mental Health and Neuroscience , Maastricht University , Maastricht , The Netherlands.,c Department of Neuropsychology and Psychopharmacology , Maastricht University , Maastricht , The Netherlands
| | - Marcel W M Post
- a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.,d Center for Rehabilitation and Department of Rehabilitation Medicine , University of Groningen, and University Medical Center Groningen , Groningen , The Netherlands
| | - Trynke Hoekstra
- e Faculty of Earth and Life Sciences, Department of Health Sciences, and the EMGO Institute for Health and Care Research , VU University , Amsterdam , The Netherlands.,f Department of Epidemiology and Biostatistics , VU University Medical Center , Amsterdam , The Netherlands
| | - Anne Visser-Meily
- a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands
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26
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de Graaf JA, van Mierlo ML, Post MWM, Achterberg WP, Kappelle LJ, Visser-Meily JMA. Long-term restrictions in participation in stroke survivors under and over 70 years of age. Disabil Rehabil 2017; 40:637-645. [PMID: 28054834 DOI: 10.1080/09638288.2016.1271466] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to (1) assess differences in participation restrictions between stroke survivors aged under and over 70 years and (2) identify predictors associated with favorable and unfavorable long-term participation in both age groups. METHODS Prospective cohort study in which 326 patients were assessed at stroke onset, two months and one year after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was used to measure participation restrictions one year after stroke. Bivariate and multivariate logistic regression analyses were performed including demographic factors, stroke-related factors, emotional functioning and comorbidity as possible predictors. RESULTS Stroke survivors aged over 70 years perceived more participation restrictions in comparison to stroke survivors aged under 70 years one year after stroke. Independently significant predictors for unfavorable participation outcomes were advancing age, more severe stroke and anxiety symptoms in patients aged over 70 years, and female gender, more severe stroke, impaired cognition and depression symptoms in patients aged under 70 years. Lower age was the only independent predictor associated with favorable participation after one year in stroke survivors aged over 70 years. CONCLUSIONS This study emphasizes the need to pay more attention to participation restrictions in elderly stroke survivors. Implications for rehabilitation More attention in the rehabilitation process should be paid to restrictions in participation of stroke survivors aged older than 70 years, taking into account the different participation needs and predictors of older stroke survivors. Early screening on the presence of anxiety symptoms could potentially prevent long-term restrictions in participation in stroke survivors aged over 70-year old. Stroke survivors experience considerable restrictions in physical activity and mobility after one year, highlighting the need for the development of community-based exercise programs for stroke survivors.
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Affiliation(s)
- Joris A de Graaf
- a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , the Netherlands
| | - Maria L van Mierlo
- a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , the Netherlands
| | - Marcel W M Post
- a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , the Netherlands.,b Center for Rehabilitation and Department of Rehabilitation Medicine , University of Groningen and University Medical Center Groningen , Groningen , the Netherlands
| | - Wilco P Achterberg
- c Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , the Netherlands
| | - L Jaap Kappelle
- d Brain Center Rudolf Magnus and Department of Neurology , University Medical Center Utrecht , Utrecht , the Netherlands
| | - Johanna M A Visser-Meily
- a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , the Netherlands
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27
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Nijsse B, Visser-Meily JMA, van Mierlo ML, Post MWM, de Kort PLM, van Heugten CM. Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment. Stroke 2016; 48:98-104. [PMID: 27899753 DOI: 10.1161/strokeaha.116.014168] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/07/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The Montreal Cognitive Assessment (MoCA) is nowadays recommended for the screening of poststroke cognitive impairment. However, little is known about the temporal evolution of MoCA-assessed cognition after stroke. The objective of this study was to examine the temporal pattern of overall and domain-specific cognition at 2 and 6 months after stroke using the MoCA and to identify patient groups at risk for cognitive impairment at 6 months after stroke. METHODS Prospective cohort study in which 324 patients were administered the MoCA at 2 and 6 months post stroke. Cognitive impairment was defined as MoCA<26. Differences in cognitive impairment rates between 2 and 6 months post stroke were analyzed in different subgroups. Patients with MoCA score <26 at 2 months, who improved by ≥2 points by 6 months, were defined as reverters. Logistic regression analyses were used to identify determinants of (1) cognitive impairment at 6 months post stroke and (2) reverter status. RESULTS Between 2 and 6 months post stroke, mean MoCA score improved from 23.7 (3.9) to 24.7 (3.5), P<0.001. Prevalence of cognitive impairment at 2 months was 66.4%, compared with 51.9% at 6 months (P<0.001). More comorbidity and presence of cognitive impairment at 2 months were significant independent predictors of cognitive impairment 6 months post stroke. No significant determinants of reverter status were identified. CONCLUSIONS Although cognitive improvement is seen ≤6 months post stroke, long-term cognitive deficits are prevalent. Identifying patients at risk of cognitive impairment is, therefore, important as well as targeting interventions to this group.
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Affiliation(s)
- Britta Nijsse
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Johanna M A Visser-Meily
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands.
| | - Maria L van Mierlo
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Marcel W M Post
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Paul L M de Kort
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
| | - Caroline M van Heugten
- From the Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands (B.N., P.L.M.d.K.); Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Hoogstraat Rehabilitation, The Netherlands (J.M.A.V.-M., M.L.v.M., M.W.M.P.); Department of Rehabilitation Medicine, University Medical Center Groningen, The Netherlands (M.W.M.P.); and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (C.M.v.H.) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (C.M.v.H.), Maastricht University, The Netherlands
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Abstract
Malignant cerebral edema is a potential consequence of large territory cerebral infarction, as the resultant elevation in intracranial pressure may progress to transtentorial herniation, brainstem compression, and death. In appropriate patients, decompressive hemicraniectomy (DHC) reduces mortality without increasing the risk of severe disability. However, as the foundational DHC randomized, controlled trials excluded patients greater than 60 years of age, the appropriateness of DHC in older adults remains controversial. Recent clinical trials among elderly participants, including DESTINY II, reported that DHC reduces mortality, but may leave patients with substantial morbidity. Nationwide analyses have demonstrated generalizability of such data. However, what constitutes an acceptable outcome - the perspective on quality of life after survival with substantial disability - varies between clinicians, patients, and caregivers. Consequently, quality of life measures are being increasingly incorporated into stroke research. This review summarizes the impact of DHC in space-occupying cerebral infarction, and the influence of patient age on postoperative survival, functional capacity, and quality of life-all key factors in the clinical decision process. Ultimately, these data underscore the inherent complexity in balancing scientific evidence, clinical expertise, and patient and family preference when pursuing hemicraniectomy among the elderly.
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Affiliation(s)
- Faith C Robertson
- Harvard Medical School, Boston, Massachusetts, United States of America.,Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Hormuzdiyar H Dasenbrock
- Harvard Medical School, Boston, Massachusetts, United States of America.,Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.,Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - William B Gormley
- Harvard Medical School, Boston, Massachusetts, United States of America.,Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.,Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
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Kruithof WJ, Post MWM, van Mierlo ML, van den Bos GAM, de Man-van Ginkel JM, Visser-Meily JMA. Caregiver burden and emotional problems in partners of stroke patients at two months and one year post-stroke: Determinants and prediction. PATIENT EDUCATION AND COUNSELING 2016; 99:1632-1640. [PMID: 27103190 DOI: 10.1016/j.pec.2016.04.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/30/2016] [Accepted: 04/08/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES (a) To determine levels of and factors explaining partners' burden, anxiety and depressive symptoms at two months post-stroke, (b) to predict partners' burden, anxiety and depressive symptoms at one year post-stroke based on patient and partner characteristics available at two months post-stroke. METHODS Prospective cohort study. Partners of stroke patients (N=183) were included. Main outcome measures were the Caregiver Strain Index and the Hospital Anxiety and Depression Scale. RESULTS Many partners experienced high burden, anxiety and depressive symptoms. At two months post-stroke, these outcomes were associated with the partner variables: age, relationship satisfaction, pro-active coping, self-efficacy, everyday social support, burden, anxiety and depressive symptoms; and the patient variables: stroke severity and depressive symptoms. Partner outcomes at one year post-stroke were mainly predicted by the level of these outcomes at two months post-stroke. CONCLUSIONS Partner outcomes at two months post-stroke predict to a large degree partner outcomes at one year post-stroke. PRACTICE IMPLICATIONS Measuring partners' burden and anxiety and depressive symptoms in the post-acute phase is recommended to trace partners at risk of long-term burden and emotional problems.
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Affiliation(s)
- Willeke J Kruithof
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marcel W M Post
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria L van Mierlo
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Geertrudis A M van den Bos
- Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Janneke M de Man-van Ginkel
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
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Singh JA, Yu S. Allopurinol and the risk of stroke in older adults receiving medicare. BMC Neurol 2016; 16:164. [PMID: 27604082 PMCID: PMC5015204 DOI: 10.1186/s12883-016-0692-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies of allopurinol and stroke risk have provided contradictory findings, ranging from a protective effect to an increased risk. Our objective was to assess whether allopurinol use is associated with the risk of stroke in the elderly. METHODS We used the 5 % random sample of Medicare beneficiaries from 2006-2012 to study the association of new allopurinol initiation and incident stroke. We used multivariable-adjusted Cox regression models adjusted for age, gender, race, Charlson index, and cardio-protective medications (beta-blockers, ACE inhibitors, diuretics, statins) to calculate hazards ratio (HR) with 95 % confidence intervals (CI). Sensitivity analyses adjusted for coronary artery disease (CAD) risk factors including hypertension, hyperlipidemia, diabetes, and smoking instead of Charlson index. RESULTS Among 28,488 eligible episodes of incident allopurinol, 2,177 ended in incident stroke (7.6 % episodes). In multivariable-adjusted analyses, allopurinol use was associated with 9 % lower hazard ratio for stoke, 0.91 (95 % CI, 0.83 to 0.99). Compared to no allopurinol use, allopurinol use durations of 181 days to 2 years, 0.88 (95 % CI, 0.78 to 0.99) and >2 years, 0.79 (95 % CI, 0.65 to 0.96) were significantly associated with lower multivariable-adjusted hazard of stroke. Sensitivity analyses adjusted for CAD risk factors confirmed these findings. In subgroup analyses, significant associations were noted between allopurinol use and the risk of ischemic stroke, 0.89 (95 % CI, 0.81 to 0.98); associations were not significant for hemorrhagic stroke, 1.01 (95 % CI, 0.79 to 1.29). CONCLUSIONS Allopurinol use is associated with lower risk of stroke overall, more specifically ischemic stroke. This association is evident after 6-months of allopurinol use, and the hazard reduction increases with longer duration of use. Future studies need to examine underlying mechanisms.
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Affiliation(s)
- Jasvinder A. Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL USA
- Department of Medicine at School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL USA
- Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL USA
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN USA
- University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294 USA
| | - Shaohua Yu
- Department of Medicine at School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL USA
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Pucciarelli G, Buck HG, Barbaranelli C, Savini S, Simeone S, Juarez-Vela R, Alvaro R, Vellone E. Psychometric Characteristics of the Mutuality Scale in Stroke Patients and Caregivers. THE GERONTOLOGIST 2016; 56:e89-98. [DOI: 10.1093/geront/gnw083] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/30/2016] [Indexed: 11/14/2022] Open
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van Eeden M, Kootker JA, Evers SMAA, van Heugten CM, Geurts ACH, van Mastrigt GAPG. An economic evaluation of an augmented cognitive behavioural intervention vs. computerized cognitive training for post-stroke depressive symptoms. BMC Neurol 2015; 15:266. [PMID: 26715040 PMCID: PMC4696099 DOI: 10.1186/s12883-015-0522-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 12/11/2015] [Indexed: 11/22/2022] Open
Abstract
Background Stroke survivors encounter emotional problems in the chronic phase after stroke. Post-stroke depressive symptoms have major impact on health-related quality of life (HRQol) and lead to increased hospitalization and therefore substantial healthcare costs. We present a cost-effectiveness and cost-utility evaluation of a cognitive behavioural therapy augmented with occupational and movement therapy to support patients with a stroke with depressive symptoms in goal-setting and goal attainment (augmented CBT) in comparison with a computerized cognitive training program (CogniPlus) as a control intervention. Methods A trial-based economic evaluation was conducted from a societal perspective with a time horizon of 12 months. Stroke patients (aged 18+ years) with signs of depression (Hospital Anxiety and Depression Scale (HADS) – subscale depression > 7) were eligible to participate. Primary outcomes were the HADS and Quality Adjusted Life Years (QALYs) based on the three-level five-dimensional EuroQol (EQ-5D-3 L). Missing data were handled through mean imputation (costs) and multiple imputation (HADS and EuroQol), and costs were bootstrapped. Sensitivity analyses were performed to test robustness of baseline assumptions. Results Sixty-one patients were included. The average total societal costs were not significantly different between the control group (€9,998.3) and the augmented CBT group (€8,063.7), with a 95 % confidence interval (−5,284, 1,796). The augmented CBT intervention was less costly and less effective from a societal perspective on the HADS, and less costly and slightly more effective in QALYs, in comparison with the control treatment. The cost-effectiveness and cost-utility analyses provided greater effects and fewer costs for the augmented CBT group, and fewer effects and costs for the HADS. Based on a willingness to pay (WTP) level of €40,000 per QALY, the augmented CBT intervention had a 76 % chance of being cost-effective. Sensitivity analyses showed robustness of results. Conclusion The stroke-specific augmented CBT intervention did not show convincing cost-effectiveness results. In addition to other literature, this study provided new insights into the potential cost-effectiveness of an adjusted cognitive behavioural therapy intervention. However, as our study showed a 76 % chance of being cost-effective for one outcome measure (QALY) and did not provide convincing cost-effectiveness results on the HADS we recommend further research in a larger population.
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Affiliation(s)
- M van Eeden
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,MHeNS, School for Mental Health & Neuroscience; Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - J A Kootker
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - C M van Heugten
- MHeNS, School for Mental Health & Neuroscience; Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - A C H Geurts
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - G A P G van Mastrigt
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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van Eeden M, van Heugten C, van Mastrigt GAPG, van Mierlo M, Visser-Meily JMA, Evers SMAA. The burden of stroke in the Netherlands: estimating quality of life and costs for 1 year poststroke. BMJ Open 2015; 5:e008220. [PMID: 26614618 PMCID: PMC4663410 DOI: 10.1136/bmjopen-2015-008220] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To assess and explore over 1 year poststroke (1) the societal costs, (2) changes in costs and quality of life (QoL) and (3) the relation between costs and QoL. DESIGN The current study is a burden of disease study focusing on the cost-of-illness (in Euros) and QoL (in utilities) after stroke. SETTING Adult patients with stroke were recruited from stroke units in hospitals and followed for 1 year. PARTICIPANTS Data were collected from 395 patients with stroke. MAIN OUTCOME MEASURES Costs and QoL expressed in utilities. METHODS Cost categories were identified through a bottom-up method. The Dutch 3-level 5-dimensional EuroQol (EQ-5D-3L) was used to calculate utilities. Non-parametric bootstrapping was applied to test for statistical differences in costs. Subgroup analyses were performed to identify predictors for costs and QoL. Robustness of results was tested via sensitivity analyses. RESULTS The total societal costs for 1 year poststroke were €29 484 (n=352) of which 74% were in the first 6 months. QoL remained stable over time. The discharge location was a significant predictor for cost and QoL; men had a significantly higher QoL than women and younger patients (<65) had significantly more costs than older patients (>65). Ceiling effects appear on all dimension of the EQ-5D-3L. Costs and QoL show a weak correlation (r=-0.29). Sensitivity analyses showed robustness of results. CONCLUSIONS We found lower patient costs and higher QoL than expected. This may be explained by the good state of health of our study population and by change in the Dutch healthcare system, which has led to considerable shorter hospitalisation poststroke. Future research must question the use of the EQ-5D-3L in a similar population due to ceiling effects. TRIAL REGISTRATION NUMBER NTR3051.
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Affiliation(s)
- M van Eeden
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Faculty of Health, Medicine & Life Sciences MHeNS, Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - C van Heugten
- Faculty of Health, Medicine & Life Sciences MHeNS, Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
- Faculty of Psychology & Neuroscience, Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - G A P G van Mastrigt
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - M van Mierlo
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - J M A Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - S M A A Evers
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Healthcare, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Persson J, Holmegaard L, Karlberg I, Redfors P, Jood K, Jern C, Blomstrand C, Forsberg-Wärleby G. Spouses of Stroke Survivors Report Reduced Health-Related Quality of Life Even in Long-Term Follow-Up. Stroke 2015; 46:2584-90. [DOI: 10.1161/strokeaha.115.009791] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The consequences for the family of stroke survivor are generally studied in a short-term perspective. The aim of this study was to assess long-term aspects of health-related quality of life among spouses of stroke survivors.
Methods—
Data on stroke survivors, controls, and spouses were collected from the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). The health-related quality of life of spouses was assessed by the Short Form-36, and the characteristics of stroke survivors were assessed using the National Institutes of Health Stroke Scale, the Mini-Mental State Examination, the Hospital Anxiety and Depression Scale, the Barthel Index, and the modified Rankin Scale.
Results—
Dyads of 248 stroke survivors aged <70 at stroke onset and 245 dyads of matched controls were included. Spouses of stroke survivors and spouses of controls had a median age of 64 and 65, respectively; proportion of men was 35% and 34%, respectively. The spouses of stroke survivors reported lower scores in all the mental domains (
P
=0.045;
P
<0.001), as well as in the domains of general health (
P
=0.013) and physical role (
P
=0.006), compared with the spouses of controls. Predictors of poor physical health of the spouses were their own age and the level of global disability of the stroke survivor. Predictors of poor mental health of the spouses were depressive symptoms, cognitive impairment, and global disability among the stroke survivors.
Conclusions—
The health-related quality of life of spouses of stroke survivors is reduced not only during the first years but also in the long-term perspective.
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Affiliation(s)
- Josefine Persson
- From the Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (J.P., L.H., P.R., K.J., C.B., G.F.-W.), Department of Public Health and Community Medicine, Institute of Medicine (I.K.), and Department of Medical and Clinical Genetics, Institute of Biomedicine (C.J.), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lukas Holmegaard
- From the Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (J.P., L.H., P.R., K.J., C.B., G.F.-W.), Department of Public Health and Community Medicine, Institute of Medicine (I.K.), and Department of Medical and Clinical Genetics, Institute of Biomedicine (C.J.), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ingvar Karlberg
- From the Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (J.P., L.H., P.R., K.J., C.B., G.F.-W.), Department of Public Health and Community Medicine, Institute of Medicine (I.K.), and Department of Medical and Clinical Genetics, Institute of Biomedicine (C.J.), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Petra Redfors
- From the Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (J.P., L.H., P.R., K.J., C.B., G.F.-W.), Department of Public Health and Community Medicine, Institute of Medicine (I.K.), and Department of Medical and Clinical Genetics, Institute of Biomedicine (C.J.), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- From the Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (J.P., L.H., P.R., K.J., C.B., G.F.-W.), Department of Public Health and Community Medicine, Institute of Medicine (I.K.), and Department of Medical and Clinical Genetics, Institute of Biomedicine (C.J.), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christina Jern
- From the Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (J.P., L.H., P.R., K.J., C.B., G.F.-W.), Department of Public Health and Community Medicine, Institute of Medicine (I.K.), and Department of Medical and Clinical Genetics, Institute of Biomedicine (C.J.), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christian Blomstrand
- From the Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (J.P., L.H., P.R., K.J., C.B., G.F.-W.), Department of Public Health and Community Medicine, Institute of Medicine (I.K.), and Department of Medical and Clinical Genetics, Institute of Biomedicine (C.J.), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Forsberg-Wärleby
- From the Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (J.P., L.H., P.R., K.J., C.B., G.F.-W.), Department of Public Health and Community Medicine, Institute of Medicine (I.K.), and Department of Medical and Clinical Genetics, Institute of Biomedicine (C.J.), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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van Mierlo ML, van Heugten CM, Post M, de Kort P, Visser-Meily J. Life satisfaction post stroke: The role of illness cognitions. J Psychosom Res 2015; 79:137-42. [PMID: 26038087 DOI: 10.1016/j.jpsychores.2015.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe illness cognitions two months and two years post stroke and to investigate changes in illness cognitions over time. We also examined the associations between illness cognitions and life satisfaction at two months and two years post stroke and investigated if changes in illness cognitions predicted life satisfaction two years post stroke, taking demographic and stroke-related factors and emotional symptoms into account. METHODS Prospective cohort study in which 287 patients were assessed at two months and two years post stroke. The illness cognitions helplessness (maladaptive), acceptance (adaptive) and perceiving benefits (adaptive) were measured with the Illness Cognition Questionnaire. Life satisfaction was assessed with two life satisfaction questions. Correlational and regression analyses were performed. RESULTS Patients experienced both maladaptive and adaptive illness cognitions two months and two years post stroke. Only acceptance increased significantly from two months to two years post stroke (p≤0.01). Helplessness, acceptance and perceiving benefits were significantly associated with life satisfaction at two months (R2=0.42) and two years (R2=0.57) post stroke. Furthermore, illness cognitions two months post stroke and changes in illness cognitions predicted life satisfaction two years post stroke (R2=0.57). CONCLUSION Illness cognitions and changes in illness cognitions were independently associated with life satisfaction two years post stroke. It is therefore important during rehabilitation to focus on reducing maladaptive behavior and feelings to promote life satisfaction, and on promoting adaptive illness cognitions.
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Affiliation(s)
- M L van Mierlo
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - C M van Heugten
- Maastricht University, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, The Netherlands; Maastricht University, Department of Neuropsychology and Psychopharmacology, Maastricht, The Netherlands
| | - Mwm Post
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Plm de Kort
- Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Jma Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
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Nijsse B, van Heugten CM, van Mierlo ML, Post MWM, de Kort PLM, Visser-Meily JMA. Psychological factors are associated with subjective cognitive complaints 2 months post-stroke. Neuropsychol Rehabil 2015. [PMID: 26207868 DOI: 10.1080/09602011.2015.1065280] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate which psychological factors are related to post-stroke subjective cognitive complaints, taking into account the influence of demographic and stroke-related characteristics, cognitive deficits and emotional problems. In this cross-sectional study, 350 patients were assessed at 2 months post-stroke, using the Checklist for Cognitive and Emotional consequences following stroke (CLCE-24) to identify cognitive complaints. Psychological factors were: proactive coping, passive coping, self-efficacy, optimism, pessimism, extraversion, and neuroticism. Associations between CLCE-24 cognition score and psychological factors, emotional problems (depressive symptoms and anxiety), cognitive deficits, and demographic and stroke characteristics were examined using Spearman correlations and multiple regression analyses. Results showed that 2 months post-stroke, 270 patients (68.4%) reported at least one cognitive complaint. Age, sex, presence of recurrent stroke(s), comorbidity, cognitive deficits, depressive symptoms, anxiety, and all psychological factors were significantly associated with the CLCE-24 cognition score in bivariate analyses. Multiple regression analysis showed that psychological factors explained 34.7% of the variance of cognitive complaints independently, and 8.5% (p < .001) after taking all other factors into account. Of all psychological factors, proactive coping was independently associated with cognitive complaints (p < .001), showing that more proactive coping related to less cognitive complaints. Because cognitive complaints are common after stroke and are associated with psychological factors, it is important to focus on these factors in rehabilitation programmes.
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Affiliation(s)
- Britta Nijsse
- a Department of Neurology , St Elisabeth Hospital , Tilburg , The Netherlands
| | - Caroline M van Heugten
- b Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience , Maastricht University , Maastricht , The Netherlands.,c Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience , Maastricht University , Maastricht , The Netherlands
| | - Marloes L van Mierlo
- d Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine , University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands
| | - Marcel W M Post
- d Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine , University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands
| | - Paul L M de Kort
- a Department of Neurology , St Elisabeth Hospital , Tilburg , The Netherlands
| | - Johanna M A Visser-Meily
- d Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine , University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands
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Associations of proactive coping and self-efficacy with psychosocial outcomes in individuals after stroke. Arch Phys Med Rehabil 2015; 96:1484-91. [PMID: 25921978 DOI: 10.1016/j.apmr.2015.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/29/2015] [Accepted: 04/09/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the associations of proactive coping and self-efficacy with psychosocial outcomes in individuals after stroke. DESIGN Cross-sectional study. Regression analyses were performed. SETTING Outpatient settings of hospitals and rehabilitation centers. PARTICIPANTS Individuals after stroke (N=112; mean age ± SD, 57.1±8.9y; mean time ± SD since stroke, 18.9±28.5mo). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Proactive coping was measured using the Utrecht Proactive Coping Competence scale (UPCC), and self-efficacy was measured using the General Self-Efficacy Scale (GSES). Psychosocial outcomes were measured as (1) participation with the use of the restriction and satisfaction subscales of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation); (2) emotional problems with the use of the Hospital Anxiety and Depression Scale (HADS); (3) life satisfaction with the use of 2 questions (2LS); and (4) health-related quality of life (HRQOL) with the use of the Short Stroke-Specific Quality of Life scale (SS-QOL-12). RESULTS Higher UPCC scores were associated with lower HADS scores (β=-.55, P<.001) and with higher USER-Participation satisfaction (β=.31, P=.001), 2LS (β=.34, P<.001), and SS-QOL-12 scores (β=.44, P<.001). The influence of UPCC scores on HRQOL was indirect through self-efficacy. Higher GSES scores were associated with higher UPCC scores (β=.65, P<.001), which in turn were associated with lower HADS scores (β=-.51, P<.001). GSES scores were directly associated with higher SS-QOL-12 scores (β=.32, P=.002). GSES scores did not influence the association between UPCC scores and any of the psychosocial outcomes (all P>.0025). CONCLUSIONS Proactive coping and self-efficacy have different associations with each of the psychosocial outcomes. Therefore, outcome-specific models appear to be necessary to describe these associations.
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Blömer AMV, van Mierlo ML, Visser-Meily JM, van Heugten CM, Post MW. Does the Frequency of Participation Change After Stroke and Is This Change Associated With the Subjective Experience of Participation? Arch Phys Med Rehabil 2015; 96:456-63. [DOI: 10.1016/j.apmr.2014.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 08/15/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
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van Mierlo ML, van Heugten CM, Post MW, de Kort PL, Visser-Meily JM. Psychological factors determine depressive symptomatology after stroke. Arch Phys Med Rehabil 2015; 96:1064-70. [PMID: 25681672 DOI: 10.1016/j.apmr.2015.01.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify psychological factors related to poststroke depressive symptoms. DESIGN Cross-sectional study, with patients assessed at 2 months poststroke. SETTING Patients with stroke from 6 general hospitals. PARTICIPANTS Stroke patients (N=344; mean age ± SD, 66.9±12.3y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The presence of clinical depressive symptoms was determined with the depression subscale of the Hospital Anxiety and Depression Scale 2 months poststroke. Psychological factors assessed were extraversion, neuroticism, optimism, pessimism, self-efficacy, helplessness, acceptance, perceiving benefits, proactive coping, and passive coping. RESULTS Bivariate correlations and multivariate backward logistic regression were used to analyze associations between psychological factors and poststroke depressive symptoms, accounting for demographic and stroke-related factors. More neuroticism, pessimism, passive coping, and helplessness, and less extraversion, optimism, self-efficacy, acceptance, perceived benefits, and proactive coping were bivariately associated with the presence of depressive symptoms. Multivariate logistic regression analysis showed that more helplessness (odds ratio [OR]=1.17) and passive coping (OR=1.19) and less acceptance (OR=.89) and perceived benefits (OR=.89) were independently significantly associated with the presence of poststroke depressive symptoms (Nagelkerke R(2)=.49). CONCLUSIONS We found a relationship between psychological variables and the presence of depressive symptoms 2 months poststroke. It is important to take these factors into account during poststroke rehabilitation.
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Affiliation(s)
- Maria L van Mierlo
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Marcel W Post
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul L de Kort
- Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Johanna M Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
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Kruithof WJ, Post MWM, Visser-Meily JMA. Measuring negative and positive caregiving experiences: a psychometric analysis of the Caregiver Strain Index Expanded. Clin Rehabil 2015; 29:1224-33. [DOI: 10.1177/0269215515570378] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 12/15/2014] [Indexed: 11/16/2022]
Abstract
Objective: To compare the psychometric properties of the Caregiver Strain Index Expanded with those of the original Caregiver Strain Index among partners of stroke patients. Design and subjects: Cross-sectional validation study among 173 caregivers of stroke patients six months post-stroke. Main measures: Outcome measure: Caregiver Strain Index Expanded. Reference measures: Hospital Anxiety and Depression Scale, two questions on life satisfaction, Barthel Index and Montreal Cognitive Assessment. Additionally, National Institutes of Health Stroke Scale. Results: Neither the Caregiver Strain Index Expanded nor the original Caregiver Strain Index showed floor or ceiling effects. The sum score of the positive items showed a ceiling effect and was skewed to the right (2.20). Principal component analysis revealed no clear underlying item clustering. Alpha values of the Caregiver Strain Index Expanded and the original Caregiver Strain Index were good (0.82 and 0.83), but the alpha value of the positive subscale of the Caregiver Strain Index Expanded was too low (0.51). Convergent validity was confirmed for the Caregiver Strain Index Expanded, the original Caregiver Strain Index and the positive subscale. The Caregiver Strain Index Expanded and the original Caregiver Strain Index showed nearly identical correlations with the reference measures. Negative caregiving experiences were more strongly related to partners’ mood and life satisfaction than positive caregiving experiences. In the regression analyses, the positive subscale showed little added value in predicting partners’ mood and life satisfaction. Conclusion: The addition of five positively phrased items does not improve the psychometric properties of the Caregiver Strain Index.
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Affiliation(s)
- Willeke J Kruithof
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marcel WM Post
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna MA Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Jaracz K, Grabowska-Fudala B, Górna K, Kozubski W. Consequences of stroke in the light of objective and subjective indices: A review of recent literature. Neurol Neurochir Pol 2014; 48:280-6. [DOI: 10.1016/j.pjnns.2014.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
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Kootker JA, Fasotti L, Rasquin SMC, van Heugten CM, Geurts ACH. The effectiveness of an augmented cognitive behavioural intervention for post-stroke depression with or without anxiety (PSDA): the Restore4Stroke-PSDA trial. BMC Neurol 2012; 12:51. [PMID: 22769041 PMCID: PMC3433315 DOI: 10.1186/1471-2377-12-51] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 07/07/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-Stroke Depression with or without Anxiety (PSDA) is a common disorder in the chronic phase of stroke. Neuropsychiatric problems, such as PSDA, have a negative impact on social reintegration and quality of life. Currently, there is no evidence-based treatment available for reducing PSDA symptoms. In the recent literature on depression in the general population it has been shown that depression complaints can diminish by cognitive behavioural therapy (CBT). In the current study, the effectiveness of augmented, activation-based and individually tailored CBT on the reduction of depression and anxiety will be investigated in patients with PSDA. Additionally, the effects on various secondary outcome measures, such as quality of life, goal attainment and societal participation will be evaluated. This study is embedded in a consortium of 4 interrelated studies on quality of life after stroke (Restore4Stroke). METHODS/DESIGN A multi-centre, assessor-blind, randomized controlled trial is conducted. A sample of 106 PSDA patients, as assessed with the Hospital Anxiety and Depression Scale (HADS depression subscale >7), will be recruited and randomly allocated to either an experimental or a control group. The experimental intervention consists of an augmented CBT intervention. The intervention is based on CBT principles of recognizing, registering, and altering negative thoughts and cognitions so that mood, and emotional symptoms are improved. CBT is augmented with direct in-vivo activation offered by occupational or movement therapists. Patients in the control group will receive a computerized cognitive training intervention. Outcomes will be assessed at baseline, immediately post intervention, and at 6 and 12 months follow up. DISCUSSION This study is the first randomized clinical trial that evaluates the (maintenance of) effects of augmented CBT on post-stroke depression with or without anxiety symptoms. Together with three other projects, the Restore4Stroke PSDA trial will provide novel information about the (treatment of) emotional problems and quality of life after stroke. TRIAL REGISTRATION TRIAL REGISTRATION NUMBER Dutch Trial Register NTR2999.
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Affiliation(s)
- Joyce A Kootker
- Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
- Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands
| | - Sascha MC Rasquin
- Adelante Rehabilitation Foundation Limburg, Limburg, The Netherlands
- Dept Rehabilitation, CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Alexander CH Geurts
- Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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