The mediating effect of psychological distress on functional dependence in stroke patients

Association between Post-Hospitalization Psychological Distress, Exercise Capacity, Physical Function and Health Status in COVID-19 Survivors

This study aims to determine whether post-hospitalization psychological distress is associated with exercise capacity, physical function and health status in COVID-19 survivors. In this observational study, hospitalized COVID patients were included and divided into two groups according to the mental component summary subscale of the 12-item Short-Form Health Survey. Patients with a score ≤ 45 were included in the psychological distress group, and patients with a score > 45 were included in the non-psychological distress group. The main variables were exercise capacity, physical function, and health status. Patients were evaluated at discharge, 3 months, and at 6 months follow-up. Finally, a total of 60 patients were included in the study. Significant differences were found in exercise capacity, physical function, and health status (p < 0.05), with worse results in the group with psychological distress at discharge and 3 months follow-up. At 6 months after discharge, COVID patients with psychological distress exhibited worse results in exercise capacity, physical function, and health status, being significant exercise capacity and physical function (p < 0.05). It can be concluded that COVID patients with psychological distress at hospital discharge reported worse exercise capacity, physical function and health status at hospital discharge, 3 months and 6 months follow-up.

Functional dependence among stroke survivors: A concept analysis

AIM

To report an analysis of the concept of functional dependence among stroke survivors.

BACKGROUND

Functional dependence among stroke survivors is a focal stimulus that leads to caregiver burden and can be measured and applied to research and theory in different ways depending on the researcher's interpretation of the concept.

DESIGN

A concept analysis was conducted using the method described by Walker and Avant.

DATA SOURCE

A review of the literature was conducted using the CINAHL and PubMed databases. Lay literature, such as the Merriam-Webster dictionary was included.

RESULTS

Through the identification and analysis of definitions and uses of the concept, the defining attributes were found to be (1) inability to perform regular functions and (2) dependence on a caregiver to perform regular functions which form the conceptual and operational definitions. A model, borderline, and the related case of the conceptual definition are provided. One antecedent, two consequences, and four empirical referents are identified, alongside the instruments used to measure the empirical referents.

CONCLUSIONS

With functional dependence being so closely tied to caregiver burden, researchers and clinicians should take a dyadic approach to caring for this patient population to ensure both perspectives are considered, and optimal patient outcomes are achieved.

Unravelling the complex interactions between self-awareness, cognitive change, and mood at 6-months post-stroke using the Y-shaped model

We investigated the relationships between cognitive change following stroke, awareness of cognitive impairments, and mood to further understanding of change processes influencing psychological outcomes post-stroke in line with the "Y-shaped" process model. Patients (n = 143; M_age = 73 years, SD = 13.73; 74 males) were assessed at 3-weeks (T1) and 6-months (T2) post-stroke and had completed the Oxford Cognitive Screen (T1 and T2), the Cognitive Failures Questionnaire (CFQ; T2), and the Hospital Anxiety and Depression Scale (HADS; T2). An ANCOVA controlling for disability relating to activities of daily living (ADL) revealed that awareness of cognitive impairment was significantly lower in participants with moderate-severe cognitive impairment. Regression analysis indicated that greater awareness of cognitive impairment and reduced independence in ADL were associated with greater emotional distress at T2. Cognitive improvement was associated with lower emotional distressat T2. Contrary to the awareness hypothesis, moderation analyses suggest that this effect was largest for those most cognitively impaired at T1. Findings emphasize the importance of monitoring stroke patients' capacity to be self-aware when assessing and formulating long-term post-stroke distress and have potential implications for improving long-term emotional status in those most cognitively impaired post-stroke, e.g., through psychoeducation, cognitive rehabilitation, and emotional support.

Effectiveness of autogenic relaxation training in addition to usual physiotherapy on emotional state and functional independence of stroke survivors

INTRODUCTION

The occurrence of post-stroke emotional problems is significant during the early post-stroke stage and affects the recovery of functionality among the survivors. Because stroke survivors require active engagement in rehabilitation to optimize the process of neuroplasticity in the initial stage of stroke, there is a need to integrate an intervention, preferably therapists-mediated during rehabilitation, which reduce emotional problems thus improve motivation level among the survivors. One such technique is autogenic relaxation training (ART). ART has been found to reduce anxiety and depression among patients with several medical conditions. However, its usage in stroke survivors during rehabilitation has been limited to date. Therefore, this study is intended to evaluate the effectiveness of ART in addition to usual physiotherapy in improving emotional state and functional level of stroke survivors during rehabilitation.

METHODS

This is an assessor blinded randomized controlled trial comparing 2 intervention approaches namely ART-added physiotherapy (experimental group) and usual physiotherapy (control group). A total of 70 post-stroke patients will be recruited and allocated into either the ART-added physiotherapy or the usual physiotherapy group. The ART-added physiotherapy group will undergo a 20-minute ART session followed by 40 minutes of usual physiotherapy. While the usual physiotherapy group will receive usual physiotherapy alone for 60 minutes. All participants will be treated once a week and are required to carry out a set of home exercises for 2 times per week during the 12-week intervention. Assessment of emotional status and functional independence will be carried out at pre-intervention and week 13 of the intervention with the use of Hospital anxiety and depression scale, Barthel index, and EuroQol-5 dimensions-5 levels. All data will be analyzed using descriptive and inferential statistics.

DISCUSSION

The expected main study outcome is an enhanced evidence-based physiotherapy program that may be used by physiotherapists in the rehabilitation of stroke patients with emotional disturbances.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12619001664134 (last updated on 28/11/2019).

Phenomena of Psychological Sufferings Among Nepalese Stroke Survivors and Analysis of Applicability of Samkhya Philosophy for Enhancing Their Psychological Wellbeing

Introduction

Psychological suffering is commonly found among stroke survivors, particularly in the acute stage.

Objectives

This study aimed to explore the phenomenon of psychological sufferings of stroke survivors and analyze the applicability of Samkhya philosophy for enhancing their psychological wellbeing.

Methods

A qualitative study was conducted at a university hospital of Nepal among 16 stroke patients in the acute stage, selected by purposive sampling. Data collection was done by using semi-structured interviews. Data were analyzed using deductive content analysis. Additionally, the analysis of Samkhya philosophy was done by using descriptive literature review from online databases.

Results

Stroke survivors in the acute stage experienced psychological sufferings, which were analyzed as intrinsic, extrinsic, and divine based on Samkhya philosophy. The intrinsic sufferings were (a) shock and denial with a sudden loss of normal body function, (b) worry about the possibility of lifelong disability and future life, and (c) fear and concern about the consequences of the disease to self. The extrinsic sufferings consisted of (a) worry when thinking about dependent family members and (b) feelings of making trouble or being a burden to the family members because of their dependency. The divine suffering consisted of feeling of being a burden caused by distress resulting from an inability to perform religious rituals. Samkhya philosophy explains the methods of relieving these sufferings by using yoga practice.

Conclusion

Psychological sufferings are prevalent among Nepalese stroke survivors, and Samkhya philosophy might be one of suitable strategies to relieve these sufferings of the Hindu stroke survivors in the acute stage, and promote their psychological wellbeing. This study recommends integrating yoga in caring for stroke patients in the acute stage to promote psychological wellbeing.

Anger and stroke: a potential association that deserves serious consideration

OBJECTIVE

To assess the relationship between states of anger and stroke.

METHODS

Systematic review of the literature.

RESULTS

In total, 21 papers were selected for the systematic review of data published on the subject of anger and stroke. A state of anger may be a risk factor for stroke, as well as a consequence of brain lesions affecting specific areas that are caused by a stroke. Scales to assess anger varied among authors. There was no consensus regarding the area of brain lesions that might lead to a state of anger. Although some authors agreed that lesions on the right side led to angrier behaviour, others found that lesions on the left side were more relevant to anger. Likewise, there was no consensus regarding the prevalence of anger pre or post-stroke. Some authors did not even find that these two conditions were related.

CONCLUSION

Although most authors have accepted that there is a relationship between anger and stroke, studies with uniform methodology need to be conducted if this association is to be properly evaluated and understood.