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Orange C, Lanhers C, Coll G, Coste N, Dutheil F, Hauret I, Pereira B, Coudeyre E. Determinants of Return to Work After a Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:359-368. [PMID: 37797913 DOI: 10.1016/j.apmr.2023.08.027] [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: 08/22/2022] [Revised: 08/13/2023] [Accepted: 08/26/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To identify prognostic factors for return to work (RTW) after stroke. DATA SOURCES PubMed, MEDLINE, Cochrane, and Embase were systematically searched. STUDY SELECTION Studies had to include people of working age (<65 years old) at the time of stroke (ischemic, hemorrhagic, or subarachnoid hemorrhage). The evaluation of RTW and rate of RTW had to be mentioned. Study selection was done by 2 independent authors. In total, 1241 articles were screened, 39 met all inclusion criteria. DATA EXTRACTION Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or with a third author. Quality was assessed using the Scottish Intercollegiate Guidelines Network quality assessment tool. DATA SYNTHESIS Among the 39 studies, prognostic factors for RTW were hemorrhagic stroke (odds ratio 0.53 [95% confidence interval 0.45-0.60], n=18 studies), sex (men) (1.26 [1.14-1.40], n=31), aphasia (0.37 [0.20-0.69], n=7), occupation (white collar worker) (1.84 [1.64-2.06], n=17), independence in activities of daily living (3.99 [1.73-9.23], n=7), and stroke severity (NIHSS) (1.23 [1.08-1.39], n=6). CONCLUSIONS This meta-analysis highlighted positive and negative prognostic factors associated with RTW after stroke. Two categories were distinguished: modifiable and non-modifiable prognostic factors. This study provides information to help understand the issues, set appropriate objectives and implement appropriate strategies to guide people to RTW after stroke. Randomized controlled studies are needed to better evaluate work-place intervention programs as well as the effects of intravenous thrombolysis, and cognitive and neuropsychological rehabilitation on return-to-work rates after stroke.
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Affiliation(s)
- Charles Orange
- Physical Medicine and Rehabilitation, CMPR Maurice Gantchoula Pionsat, France; Physical Medicine and Rehabilitation, INRAE, UNH, Université Clermont-Auvergne, university hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Charlotte Lanhers
- Physical Medicine and Rehabilitation, CMPR Maurice Gantchoula Pionsat, France
| | - Guillaume Coll
- University hospital of Clermont-Ferrand, Neurosurgery B, Clermont-Ferrand, France
| | - Nicolas Coste
- Physical Medicine and Rehabilitation, Notre-Dame, Chamalières, France
| | - Frederic Dutheil
- Occupational and Environmental Medicine, CNRS, LaPSCo, Physiological and Psychosocial Stress, university hospital of Clermont-Ferrand, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Isabelle Hauret
- Physical Medicine and Rehabilitation, INRAE, UNH, Université Clermont-Auvergne, university hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Clinical research and innovation direction, biostatistics, university hospital of Clermont-Ferrand, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Physical Medicine and Rehabilitation, INRAE, UNH, Université Clermont-Auvergne, university hospital of Clermont-Ferrand, Clermont-Ferrand, France
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Larsen SM, Bille-Hangaard K, Johansson S, Ytterberg C, Rosenbek Minet L. Physiotherapists' and occupational therapists' experiences with cross-sectoral coordination of rehabilitation for people with mild stroke - a qualitative interview study. Disabil Rehabil 2024:1-8. [PMID: 38214668 DOI: 10.1080/09638288.2024.2302560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To meet the needs of people with mild stroke, multidisciplinary, person-centred, cross-sectoral rehabilitation is internationally recommended. However, there seem to be gaps in the rehabilitation process. The aim of this study was to investigate how occupational therapists and physiotherapists experience working in cross-sectoral rehabilitation for people with mild stroke. MATERIALS AND METHODS Data were generated through interviews with occupational therapists and physiotherapists working in four different Danish rehabilitation settings. Four group interviews and two individual interviews with a total of 19 participants were conducted. Ricoeur's theory of interpretation was used to interpret and discuss the data. RESULTS Four themes were identified: the risk of overlooking symptoms: better safe than sorry; varying degrees of involvement of people with mild stroke; spontaneous involvement of relatives; and contextual challenges for coherence in the rehabilitation process. CONCLUSION The therapists experienced challenges in coordinating rehabilitation across sectors due to the timing of the needs assessment and contextual challenges. They used a preventive strategy of sending a plan or referral for later re-assessment. The therapists involved people with mild stroke to varying degrees. They involved relatives spontaneously. For successful rehabilitation, ongoing assessment, recognition of collaboration factors and relative involvement are essential.
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Affiliation(s)
- Stina Meyer Larsen
- Centre for Innovative Medical Technology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Kirstine Bille-Hangaard
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lisbeth Rosenbek Minet
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Rivella C, Zanetti A, Bertamino M, Primavera L, Moretti P, Viterbori P. Emotional and social functioning after stroke in childhood: a systematic review. Disabil Rehabil 2023; 45:4175-4189. [PMID: 36384380 DOI: 10.1080/09638288.2022.2144490] [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: 05/20/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To provide an overview of the effects of pediatric stroke on emotional and social functioning in childhood. METHODS A literature review was completed in accordance with the Preferred Reporting Items for Systematic Reviews. A systematic search of studies on internalizing problems and social functioning after pediatric stroke in PsycInfo, PsycArticles, and PubMed databases was conducted from inception to November 2021. A total of 583 studies were identified, and 32 met the inclusion criteria. RESULTS The review suggests that children after stroke are at risk of developing internalizing problems and a wide range of social difficulties. Internalizing problems are often associated with environmental factors such as family functioning and parents' mental health. In addition, a higher risk of developing psychosocial problems is associated with lower cognitive functioning and severe neurological impairment. CONCLUSIONS The assessment of psychological well-being and social functioning after pediatric stroke is helpful to provide adequate support to children and their families. Future studies are needed to better investigate these domains and to develop adequate methodologies for specific interventions.Implication for rehabilitationThis paper reviews research concerning emotional and social functioning following pediatric stroke in order to provide helpful information to clinicians and families and to improve rehabilitation pathways.Emotional and social functioning should be addressed during post-stroke evaluation and follow-up, even when physical and cognitive recovery is progressing well.Care in pediatric stroke should include volitional treatment and address emotional and social issues.
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Affiliation(s)
- Carlotta Rivella
- Department of Educational Science, University of Genoa, Genoa, Italy
| | - Alice Zanetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Paolo Moretti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Viterbori
- Department of Educational Science, University of Genoa, Genoa, Italy
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4
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Walker S, Goodfellow H, Pookarnjanamorakot P, Murray E, Bindman J, Blandford A, Bradbury K, Cooper B, Hamilton FL, Hurst JR, Hylton H, Linke S, Pfeffer P, Ricketts W, Robson C, Stevenson FA, Sunkersing D, Wang J, Gomes M, Henley W, Collaboration LWCR. Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study. BMJ Open 2023; 13:e069217. [PMID: 37286327 DOI: 10.1136/bmjopen-2022-069217] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES To describe self-reported characteristics and symptoms of treatment-seeking patients with post-COVID-19 syndrome (PCS). To assess the impact of symptoms on health-related quality of life (HRQoL) and patients' ability to work and undertake activities of daily living. DESIGN Cross-sectional single-arm service evaluation of real-time user data. SETTING 31 post-COVID-19 clinics in the UK. PARTICIPANTS 3754 adults diagnosed with PCS in primary or secondary care deemed suitable for rehabilitation. INTERVENTION Patients using the Living With Covid Recovery digital health intervention registered between 30 November 2020 and 23 March 2022. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the baseline Work and Social Adjustment Scale (WSAS). WSAS measures the functional limitations of the patient; scores of ≥20 indicate moderately severe limitations. Other symptoms explored included fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), depression (Patient Health Questionnaire-Eight Item Depression Scale), anxiety (Generalised Anxiety Disorder Scale, Seven-Item), breathlessness (Medical Research Council Dyspnoea Scale and Dyspnoea-12), cognitive impairment (Perceived Deficits Questionnaire, Five-Item Version) and HRQoL (EQ-5D). Symptoms and demographic characteristics associated with more severe functional limitations were identified using logistic regression analysis. RESULTS 3541 (94%) patients were of working age (18-65); mean age (SD) 48 (12) years; 1282 (71%) were female and 89% were white. 51% reported losing ≥1 days from work in the previous 4 weeks; 20% reported being unable to work at all. Mean WSAS score at baseline was 21 (SD 10) with 53% scoring ≥20. Factors associated with WSAS scores of ≥20 were high levels of fatigue, depression and cognitive impairment. Fatigue was found to be the main symptom contributing to a high WSAS score. CONCLUSION A high proportion of this PCS treatment-seeking population was of working age with over half reporting moderately severe or worse functional limitation. There were substantial impacts on ability to work and activities of daily living in people with PCS. Clinical care and rehabilitation should address the management of fatigue as the dominant symptom explaining variation in functionality.
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Affiliation(s)
- Sarah Walker
- Department of Health and Community Sciences (Medical School), University of Exeter, Exeter, UK
| | - Henry Goodfellow
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Elizabeth Murray
- Primary Care and Population Health, University College London, London, UK
| | - Julia Bindman
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Ann Blandford
- UCLIC, Department of Computer Science, University College London, London, UK
| | | | - Belinda Cooper
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona L Hamilton
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Hannah Hylton
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Stuart Linke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Paul Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | | | - Chris Robson
- 10 Queen Street Place, London, EC4R 1AG, Living With Ltd, London, UK
| | - Fiona A Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - David Sunkersing
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jiunn Wang
- Department of Applied Health Research, University College London, London, UK
| | - Manuel Gomes
- Department of Applied Health Research, University College London, London, UK
| | - William Henley
- Department of Health and Community Sciences (Medical School), University of Exeter, Exeter, UK
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5
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Jeffares I, Merriman NA, Doyle F, Horgan F, Hickey A. Designing stroke services for the delivery of cognitive rehabilitation: A qualitative study with stroke rehabilitation professionals. Neuropsychol Rehabil 2023; 33:24-47. [PMID: 34648412 DOI: 10.1080/09602011.2021.1977155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This qualitative study explored the potential to deliver cognitive rehabilitation for post-stroke cognitive impairment (PSCI), with a specific focus on barriers and facilitators to its delivery from the perspective of Irish stroke rehabilitation professionals. Sixteen semi-structured interviews were completed with healthcare professionals in both hospital and community settings. The sample comprised physiotherapists, occupational therapists, nurses, a stroke physician, a psychologist, a neuropsychologist, a speech and language therapist, a dietician, and a public health nurse. Interviews were audio-recorded and analysed in NVivo using inductive Thematic Analysis. Barriers and facilitators to the delivery of cognitive rehabilitation were identified and described under four key themes: (i) Cognitive screening; (ii) Cognitive rehabilitation: no one size fits all; (iii) Psychology: the lost dimension of stroke rehabilitation; and (iv) Joining the dots in the community. Staffing required to deliver cognitive rehabilitation for PSCI was highlighted as under-resourced in the Republic of Ireland. Inadequate resourcing of neuropsychology and stroke-related psychological services, in particular, has had negative implications for the delivery of cognitive rehabilitation. Stroke-specific cognitive rehabilitation expertise is virtually inaccessible in the community, highlighting an urgent need for investment in specialist rehabilitation teams to deliver cognitive rehabilitation in this setting.
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Affiliation(s)
- Isabelle Jeffares
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh A Merriman
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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6
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Shimizu D, Miyahara T, Tanemura R. Community-based practical behavioral intervention in public transportation for people with acquired brain injury: study of two cases using a single-case experimental design study. Neurocase 2022; 28:302-309. [PMID: 35914121 DOI: 10.1080/13554794.2022.2106876] [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: 10/16/2022]
Abstract
The purpose of this paper was to report on the progress of a behavioral approach to enable patients with acquired brain injury (age 57, male, stroke and age 36, old, female, TBI) using a community activity support center to commute alone using public transportation. In this study, two ABI patients were intervened to enable them to use public transportation. The frequency of intervention was once a month or once a week. The two community-dwelling adults each had post-ABI attention and memory deficits and anxiety. A-B-A single-case experimental design was employed for this study. The transportation route was stepped into multiple steps. Each step was scored in a unique way to determine the degree of assistance the participant received from others. This score was considered the main outcome. Tau-U analysis was used for statistical analysis. Statistically significant improvements in public transportation use were shown between baseline and intervention. There were no significant differences between the intervention and follow-up periods. The results suggest that behavioral interventions are beneficial in reacquiring the ability to use public transportation and that the intervention effects are sustained.
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Affiliation(s)
- Daisuke Shimizu
- Department of Occupational Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | | | - Rumi Tanemura
- Department of Rehabilitation Science, Kobe University, Graduate School of Health Sciences, Kobe, Japan
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7
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Verstraeten S, Berkhoff A, Mark R, Sitskoorn M. Can subjective cognitive complaints at three months post stroke predict alteration in information processing speed during the first year? NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 30:472-485. [PMID: 35249465 DOI: 10.1080/13825585.2022.2048786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cognitive impairment, particularly slowing of information processing speed (IPS), is prevalent after stroke. However, the link between subjective cognitive complaints (SCC) and cognitive deficit remains unclear. This study evaluated the link between SCC at three months post stroke and deficit as well as objective alterations in IPS in the first year post stroke. Patients (N = 200) and healthy controls (N = 105) took part in the COMPlaints After Stroke study (COMPAS). SCC, IPS and depression were evaluated at 3 months, 1 and 2 years post stroke. The Reliable Change Index was used to assess change in IPS in the first year post. Approximately one out of three patients showed deficit in IPS irrespective of time post stroke, while a change in IPS (N = 117) over time was relatively uncommon. SCC at three months post stroke did not predict change in IPS between three months and one year post stroke, where depressive symptoms did show a link. Cross sectional data showed a deficit in IPS in a substantial number of stroke patients irrespective of the point in time. Longitudinal data revealed a further decline in a small subgroup in the first year post stroke, which was not predicted by SCC at three months post stroke. The findings show that, irrespective of time post stroke and even when stroke is relatively mild, impairment in IPS is prevalent, but cannot be predicted by the complaints patients express. The link with depressive symptoms needs more exploration.
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Affiliation(s)
- Sonja Verstraeten
- Department of Medical Psychology, Máxima Medical Center, Veldhoven, The Netherlands
| | | | - Ruth Mark
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Margriet Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
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8
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Turner GM, Aquino MRJV, Atkins L, Foy R, Mant J, Calvert M. Factors influencing follow-up care post-TIA and minor stroke: a qualitative study using the theoretical domains framework. BMC Health Serv Res 2022; 22:235. [PMID: 35189884 PMCID: PMC8859903 DOI: 10.1186/s12913-022-07607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Follow-up care after transient ischaemic attack (TIA) and minor stroke has been found to be sub-optimal, with individuals often feeling abandoned. We aimed to explore factors influencing holistic follow-up care after TIA and minor stroke. Methods Qualitative semi-structured interviews with 24 healthcare providers (HCPs): 5 stroke doctors, 4 nurses, 9 allied health professionals and 6 general practitioners. Participants were recruited from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Interview transcripts were deductively coded using the Theoretical Domains Framework and themes were generated from coded data. Results There was no clear pathway for supporting people with TIA or minor stroke after rapid specialist review in hospital; consequently, these patients had limited access to HCPs from all settings (‘Environmental context and resources’). There was lack of understanding of potential needs post-TIA/minor stroke, in particular residual problems such as anxiety/fatigue (‘Knowledge’). Identification and management of needs was largely influenced by HCPs’ perceived role, professional training (‘Social professional role and identity’) and time constraints (‘Environmental context and resources’). Follow-up was often passive – with onerous on patients to seek support – and predominantly focused on acute medical management (‘Intentions’/‘Goal’). Conclusions Follow-up care post-TIA/minor stroke is currently sub-optimal. Through identifying factors which influence follow-up, we can inform guidelines and practical strategies to improve holistic healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07607-0.
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Affiliation(s)
- Grace M Turner
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK. .,Centre for Patient Reported Outcomes Research, University of Birmingham, B15 2TT, Birmingham, UK. .,NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, Birmingham, UK.
| | - Maria Raisa Jessica V Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Lou Atkins
- Centre for Behaviour Change, University College London, WC1E 6BT, London, UK
| | - Robbie Foy
- Leeds Institute for Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, B15 2TT, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, B15 2TT, Birmingham, UK.,NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, B15 2TT, Birmingham, UK
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9
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Zirbes C, Jones A, Manzel K, Denburg N, Barrash J. Assessing the Effects of Healthy and Neuropathological Aging on Personality with the Iowa Scales of Personality Change. Dev Neuropsychol 2021; 46:393-408. [PMID: 34283684 DOI: 10.1080/87565641.2021.1956500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Personality changes in older adults with brain disease may be confounded by effects of normal aging. In this cross-sectional study, ratings with the Iowa Scales of Personality Change for 62 healthy older adults (OA-H, aged 60+) were compared to matched older adults with brain diseases (OA-BD). OA-H did not show any significant personality changes from middle age to older adulthood. However, between 10% and 20% of OA-H developed a disturbance in Lack of Stamina, Inflexibility, Lability, and Lack of Insight. Otherwise, the pattern of findings suggesting normal aging effects on personality disturbances in clinical groups are generally minimal.
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Affiliation(s)
- Christian Zirbes
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, United States
| | - Andrew Jones
- Department of Computer Science, Princeton University, Princeton, United States
| | - Kenneth Manzel
- Department of Neurology, University of Iowa, Iowa City, United States
| | - Natalie Denburg
- Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, United States
| | - Joseph Barrash
- Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, United States
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10
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Samuelsson H, Viken J, Redfors P, Holmegaard L, Blomstrand C, Jern C, Jood K. Cognitive function is an important determinant of employment amongst young ischaemic stroke survivors with good physical recovery. Eur J Neurol 2021; 28:3692-3701. [PMID: 34242459 DOI: 10.1111/ene.15014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE This cross-sectional cohort study aims at investigating young ischaemic stroke survivors with good physical recovery 7 years post-stroke in order to analyze the relation between late cognitive ability and employment. METHODS Consecutive ischaemic stroke survivors participating in the Sahlgrenska Academy Study on Ischemic Stroke, <55 years of age at stroke onset, and with no or minimal persisting neurological deficits corresponding to a score ≤2 on the National Institutes of Health Stroke Scale at long-term follow-up 7 years post-stroke were included. At this follow-up, the participants were assessed with respect to general cognitive function, processing speed, executive functions, cardiovascular risk factors, self-reported employment, cognitive difficulties, fatigue, depressive symptoms, anxiety and physical function. RESULTS Seven years post-stroke 112/142 (79%) had part-time or full-time work and 30/142 (21%) had full-time disability pension or sick leave. Compared to those with full-time disability pension or sick leave, participants with current employment demonstrated significantly better performance with respect to general cognitive function and processing speed, and significantly lower self-ratings for cognitive difficulties, physical limitations, fatigue and depressed mood. Multivariable logistic regression selected self-rated memory (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.61-4.21), processing speed (OR 3.50, 95% CI 1.67-7.33) and self-rated communication skills (OR 3.46, 95% CI 1.75-6.85) as most important correlates (area under the curve 0.83-0.87) of having current employment. CONCLUSION This study indicates that cognitive dysfunction is an important contributor to long-term work disability amongst young stroke survivors with good physical recovery.
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Affiliation(s)
- Hans Samuelsson
- Department of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jo Viken
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lukas Holmegaard
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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Verstraeten S, Mark RE, Dieleman J, van Rijsbergen M, de Kort P, Sitskoorn MM. Motor Impairment Three Months Post Stroke Implies A Corresponding Cognitive Deficit. J Stroke Cerebrovasc Dis 2020; 29:105119. [PMID: 32912505 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/06/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND While both motor and cognitive impairment are common after stroke, the focus of (early) treatment has always been on motor deficit. AIMS The objective of the current study was to explore the link between motor and cognitive performance in stroke patients and to examine whether motor performance is associated with cognitive functioning at three months post stroke. METHODS In both stroke patients (n = 142) and controls (n = 135), with the groups matched on age, gender and premorbid IQ, motor functioning was evaluated using both objective (Purdue Pegboard Test) and subjective measures (specific items from the Frenchay Activities Index and Barthel Index). Cognition, specifically information processing speed, working memory and cognitive flexibility, was assessed using objective tasks. The data were analyzed using Pearson product-moment correlation coefficients and logistic regression. RESULTS Significant correlations between motor and cognitive functioning were found in stroke patients. The objective motor task was stronger than subjective measures in statistically explaining and predicting cognitive deficit, irrespective of stroke severity. CONCLUSIONS We conclude that motor impairment at three months post-stroke should serve as a 'red flag' for professionals: cognitive impairment is likely and should also be evaluated.
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Affiliation(s)
- Sonja Verstraeten
- Department of Medical Psychology, Máxima Medical Center, The Netherlands.
| | - Ruth E Mark
- Department of Cognitive Neuropsychology, Tilburg University, The Netherlands
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Bou Ali I, Farah R, Zeidan RK, Chahine MN, Al Sayed G, Asmar R, Hosseini H, Salameh P. Stroke symptoms impact on mental and physical health: A Lebanese population based study. Rev Neurol (Paris) 2020; 177:124-131. [PMID: 32653213 DOI: 10.1016/j.neurol.2020.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/27/2020] [Accepted: 03/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVE Stroke symptoms in the absence of diagnosed stroke are common worldwide and associated with stroke risk factors and great impact on the physical and mental health functioning. The aim of this study was to assess, at the national level, the association of stroke symptoms with mental and physical health. METHODS Quality of life was assessed using physical and mental component summary scores (PCS and MCS) of the Short Form 12v2 Health Survey in the Lebanese population. We assessed the differences in the mean PCS and MCS scores among asymptomatic individuals with no stroke/transient ischemic attack (TIA) history (n=1167), symptomatic individuals with no stroke/TIA history (n=125) and those with stroke/TIA history (n=46). Psychometric properties of the Lebanese version of the SF- 12v2 were evaluated using principal component analysis. RESULTS Symptomatic individuals had an average PCS scores of 2.31 (95%CI: 0.75-3.88) points lower and those with stroke/TIA history had 3.26 (95%CI: 1.01-5.51) points lower when compared with asymptomatic individuals with no stroke/TIA history. Similarly, MCS scores for symptomatic individuals were 2.58 (95%CI: 1.02-4.13) points lower and those with stroke/TIA history had 3.28 (95%CI: 1.06-5.50) points lower than asymptomatic individuals. CONCLUSION Physical and mental health functioning declined among symptomatic individuals and those with stroke/TIA history. Thus, frequent monitoring for the early detection of stroke symptoms may be recommended.
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Affiliation(s)
- I Bou Ali
- Lebanese University, Faculty of Pharmacy, Hadath, Lebanon.
| | - R Farah
- Lebanese University, Faculty of Pharmacy, Hadath, Lebanon; Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - R K Zeidan
- Lebanese University, Faculty of Public Health 2, Fanar, Lebanon; Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - M N Chahine
- Lebanese University, Faculty of Medical Sciences, Hadath, Lebanon; Foundation-Medical Research Institutes, F-MRI, Beirut, Lebanon
| | - G Al Sayed
- Foundation-Medical Research Institutes, F-MRI, Beirut, Lebanon
| | - R Asmar
- Foundation-Medical Research Institutes, F-MRI, Beirut, Lebanon
| | - H Hosseini
- Department of Neurology, Henri-Mondor Hospital AP-HP, Creteil, France
| | - P Salameh
- Lebanese University, Faculty of Pharmacy, Hadath, Lebanon; Lebanese University, Faculty of Medical Sciences, Hadath, Lebanon; Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Faculty of Public Health, Lebanese University, Beirut, Lebanon
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13
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Turner GM, McMullan C, Atkins L, Foy R, Mant J, Calvert M. TIA and minor stroke: a qualitative study of long-term impact and experiences of follow-up care. BMC FAMILY PRACTICE 2019; 20:176. [PMID: 31847828 PMCID: PMC6918619 DOI: 10.1186/s12875-019-1057-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/21/2019] [Indexed: 12/15/2022]
Abstract
Background Transient ischaemic attack (TIA) and minor stroke are often considered transient events; however, many patients experience residual problems and reduced quality of life. Current follow-up healthcare focuses on stroke prevention and care for other long-term problems is not routinely provided. We aimed to explore patient and healthcare provider (HCP) experiences of residual problems post-TIA/minor stroke, the impact of TIA/minor stroke on patients’ lives, and current follow-up care and sources of support. Methods This qualitative study recruited participants from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Semi-structured interviews were conducted with 12 TIA/minor stroke patients and 24 HCPs from primary, secondary and community care. Data was analysed using framework analysis. Results A diverse range of residual problems were reported post-TIA/minor stroke, including psychological, cognitive and physical impairments. Consultants and general practitioners generally lacked awareness of these long-term problems; however, there was better recognition among nurses and allied HCPs. Residual problems significantly affected patients’ lives, including return to work, social activities, and relationships with family and friends. Follow-up care was variable and medically focused. While HCPs prioritised medical investigations and stroke prevention medication, patients emphasised the importance of understanding their diagnosis, individualised support regarding stroke risk, and addressing residual problems. Conclusion HCPs could better communicate information about TIA/minor stroke diagnosis and secondary stroke prevention using lay language, and improve their identification of and response to important residual impairments affecting patients.
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Affiliation(s)
- Grace M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK. .,Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Lou Atkins
- Centre for Behaviour Change, University College London, London, WC1E 6BT, UK
| | - Robbie Foy
- Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, B15 2TT, UK
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Sallam SA, Al-Khamis FA, Muaidi QI, Abdulla FA. Translation and validation of the stroke specific quality of life scale into Arabic. NeuroRehabilitation 2019; 44:283-293. [PMID: 31006693 DOI: 10.3233/nre-182552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a need to validate one of the specific stroke quality of life (QOL) scales into Arabic. OBJECTIVE To translate and validate the stroke specific quality of life (SSQOL) into Arabic. METHODS The SSQOL was translated into Arabic (SSQOL-A) according to a forward/backward translation protocol. 147 first time stroke survivors and 60 healthy subjects were recruited. Cronbach's α was used to measure internal consistency, test-retest reliability was measured by intraclass correlation coefficient (ICC). Acceptability was established by studying floor and ceiling effects. A linear correlation between SSQOL-A and the Short Form 36, the Beck Depression Inventory II, the Barthel Index and the National Institutes of Health Stroke Scale was done to assess construct validity. Discriminant and convergent validity were evaluated by correlating item to scale of each of the domains using Pearson correlation (rp). RESULTS The SSQOL-A has shown good internal consistency (Cronbach's α = 0.78-0.94) and test-retest reliability (ICC = 0.77-0.94). It has also shown acceptable construct validity (r2 = 0.06-0.55). Item to scale correlation showed acceptable convergent (0.76-0.98) and discriminant (0.12-0.53) validity. Mann-Whitney U test showed the ability of the SSQOL-A to differentiate between stroke survivors and healthy participants QOL. CONCLUSIONS SSQOL-A has good validity and reliability for patients with mild to moderate stroke.
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Affiliation(s)
- Somayeh A Sallam
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Fahd A Al-Khamis
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Qassim I Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Fuad A Abdulla
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, KSA
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15
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Duong P, Sauvé-Schenk K, Egan MY, Meyer MJ, Morrison T. Operational Definitions and Estimates of Return to Work Poststroke: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2019; 100:1140-1152. [DOI: 10.1016/j.apmr.2018.09.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022]
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16
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Mental health and BIS/BAS dimensions in Parkinson's disease and multiple sclerosis patients and in stroke survivors. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2018.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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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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Gall S, Phan H, Madsen TE, Reeves M, Rist P, Jimenez M, Lichtman J, Dong L, Lisabeth LD. Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke. Stroke 2018; 49:531-535. [PMID: 29438087 DOI: 10.1161/strokeaha.117.018417] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/03/2017] [Accepted: 12/20/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Seana Gall
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Hoang Phan
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Tracy E Madsen
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Mathew Reeves
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Pamela Rist
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Monik Jimenez
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Judith Lichtman
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Liming Dong
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Lynda D Lisabeth
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.).
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Turner GM, Backman R, McMullan C, Mathers J, Marshall T, Calvert M. Establishing research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:2. [PMID: 29416879 PMCID: PMC5784709 DOI: 10.1186/s40900-018-0089-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/10/2018] [Indexed: 06/08/2023]
Abstract
PLAIN ENGLISH SUMMARY What is the problem and why is this important? Mini-strokes are similar to full strokes, but symptoms last less than 24 h. Many people (up to 70%) have long-term problems after a mini-stroke, such as anxiety; depression; problems with brain functioning (like memory loss); and fatigue (feeling tired). However, the current healthcare pathway only focuses on preventing another stroke and care for other long-term problems is not routinely given. Without proper treatment, people with long-term problems after a mini-stroke could have worse quality of life and may find it difficult to return to work and their social activities. What is the aim of the research? We wanted to understand the research priorities of patients, health care professionals and key stakeholders relating to the long-term impact of mini-stroke. How did we address the problem? We invited patients, clinicians, researchers and other stakeholders to attend a meeting. At the meeting people discussed the issues relating to the long-term impact of mini-stroke and came to an agreement on their research priorities. There were three stages: (1) people wrote down their individual research suggestions; (2) in smaller groups people came to an agreement on what their top research questions were; and (3) the whole group agreed final research priorities. What did we find? Eleven people attended who were representatives for patients, GPs, stroke consultants, stroke nurses, psychologists, the Stroke Association (charity) and stroke researchers, The group agreed on eleven research questions which they felt were the most important to improve health and well-being for people who have had a mini-stroke.The eleven research questions encompass a range of categories, including: understanding the existing care patients receive (according to diagnosis and geographical location); exploring what optimal care post-TIA/minor stroke should comprise (identifying and treating impairments, information giving and support groups) and how that care should be delivered (clinical setting and follow-up pathway); impact on family members; and education/training for health care professionals. ABSTRACT Background Clinical management after transient ischaemic attack (TIA) and minor stroke focuses on stroke prevention. However, evidence demonstrates that many patients experience ongoing residual impairments. Residual impairments post-TIA and minor stroke may affect patients' quality of life and return to work or social activities. Research priorities of patients, health care professionals and key stakeholders relating to the long-term impact of TIA and minor stroke are unknown.Methods Our objective was to establish the top shared research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus. A one-day priority setting consensus meeting took place with representatives from different stakeholder groups in October 2016 (Birmingham, UK). Nominal group technique was used to establish research priorities. This involved three stages: (i) gathering research priorities from individual stakeholders; (ii) interim prioritisation in three subgroups; and (iii) final priority setting.Results The priority setting consensus meeting was attended by 11 stakeholders. The individual stakeholders identified 34 different research priorities. During the interim prioritisation exercise, the three subgroups generated 24 unique research priorities which were discussed as a whole group. Following the final consensus discussion, 11 shared research priorities were unanimously agreed.The 11 research questions encompass a range of categories, including: understanding the existing care patients receive (according to diagnosis and geographical location); exploring what optimal care post-TIA/minor stroke should comprise (identifying and treating impairments, information giving and support groups) and how that care should be delivered (clinical setting and follow-up pathway); impact on family members; and education/training for health care professionals.Conclusions Eleven different research priorities were established through stakeholder-centred consensus. These research questions could usefully inform the research agenda and policy decisions for TIA and minor stroke. Inclusion of stakeholders in setting research priorities is important to increase the relevance of research and reduce research waste.
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Affiliation(s)
- Grace M. Turner
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
| | - Ruth Backman
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
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20
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Edwards JD, Kapoor A, Linkewich E, Swartz RH. Return to work after young stroke: A systematic review. Int J Stroke 2017; 13:243-256. [PMID: 29189108 DOI: 10.1177/1747493017743059] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background The incidence of stroke in young adults is increasing. While many young survivors are able to achieve a good physical recovery, subtle dysfunction in other domains, such as cognition, often persists, and could affect return to work. However, reported estimates of return to work and factors affecting vocational outcome post-stroke vary greatly. Aims The aims of this systematic review were to determine the frequency of return to work at different time points after stroke and identify predictors of return to work. Summary of review Two electronic databases (Medline and Embase) were systematically searched for articles according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 6473 records were screened, 68 were assessed for eligibility, and 29 met all inclusion criteria (working-age adults with stroke, return to work evaluated as an outcome, follow-up duration reported, and publication within the past 20 years). Return to work increased with time, with median frequency increasing from 41% between 0 and 6 months, 53% at 1 year, 56% at 1.5 years to 66% between 2 and 4 years post-stroke. Greater independence in activities of daily living, fewer neurological deficits, and better cognitive ability were the most common predictors of return to work. Conclusion This review highlights the need to examine return to work in relation to time from stroke and assess cognition in working age and young stroke survivors. The full range of factors affecting return to work has not yet been explored and further evaluations of return to work interventions are warranted.
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Affiliation(s)
- Jodi D Edwards
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,2 Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada.,3 Institute for Clinical Evaluative Sciences, Toronto, Canada.,4 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Arunima Kapoor
- 5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
| | - Elizabeth Linkewich
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
| | - Richard H Swartz
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,2 Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada.,5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
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21
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Middag-van Spanje M, Smeets S, van Haastregt J, van Heugten C. Outcomes of a community-based treatment programme for people with acquired brain injury in the chronic phase: a pilot study. Neuropsychol Rehabil 2017; 29:305-321. [PMID: 28351198 DOI: 10.1080/09602011.2017.1298527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of the study was to evaluate the outcomes of Brainz, a low intensity community-based treatment programme for people with acquired brain injury (ABI). Participants were 62 people with sustained ABI (5.2 years post-injury, SD = 4.5) and 35 family caregivers. Participants attended two to five cognitive and physical group modules and received two hours of individual home treatment every two weeks. Primary outcomes for people with ABI were participation, perceived difficulties in daily life and need of care, level of goal attainment, and self-esteem. Primary family caregiver outcome was perceived burden of care. Attrition rate of people with ABI was 24% (n = 15), and of family caregivers was 31% (n = 11). People with ABI were more satisfied with the level of their participation after completing Brainz (p < .01), but showed no change in participation frequency or in restrictions (both ps > .01). They perceived fewer difficulties in daily life and less need of care (both ps < .01). Also, in two cognitive modules people improved on their goal achievement (p < .01). However, their self-esteem was reduced (p < .01). Caregiver burden was reduced (p < .01). This study has provided preliminary evidence of the effectiveness of a combined group-based clinical and individual home-based treatment programme, but more research is needed, preferably in larger controlled studies.
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Affiliation(s)
| | - Sanne Smeets
- b Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Maastricht University , MD Maastricht , The Netherlands
| | - Jolanda van Haastregt
- c Department of Health Services Research , CAPHRI School for Public Health and Primary Care, Maastricht University , MD Maastricht , The Netherlands
| | - Caroline van Heugten
- b Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Maastricht University , MD Maastricht , The Netherlands.,d Department of Neuropsychology and Psychopharmacology , Maastricht University , MD Maastricht , The Netherlands.,e Limburg Brain Injury Center , Maastricht , The Netherlands
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Hodson T, Gustafsson L, Cornwell P, Love A. Post-acute hospital healthcare services for people with mild stroke: a scoping review. Top Stroke Rehabil 2016; 24:288-298. [PMID: 28024459 DOI: 10.1080/10749357.2016.1267831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND People with mild stroke comprise a significant proportion of the overall stroke population. Previously this population has been viewed as having limited impairments, receiving minimal services following hospital discharge. Recent findings demonstrate that the implications of mild stroke are more significant than originally comprehended, warranting further services. OBJECTIVES To identify the evidence-base regarding services for people with mild stroke, post-acute hospital discharge, that target secondary prevention and/or changes following stroke. METHODS Scoping review utilizing the five-stage framework proposed by Arksey and O'Malley, with revisions by Levac, Colquhuon, and O'Brien. Framework stages included: identification of a research question and relevant studies, study selection, charting of data, and collating, summarizing, and reporting. A critical appraisal using the Downs and Black Checklist was added to determine methodological quality of studies. The search strategy used six databases: Pubmed, Embase, PsycINFO, CINAHL, OTseeker, and Scopus, alongside a hand-search. Three researchers were involved in article selection and two in critical appraisal. RESULTS Twelve articles met inclusion criteria from 589 identified. A number of study methodologies were used to assess services, with varying methodological qualities. Studies were located within two major regions in the world. Five main approaches to service provision were identified: telehealth, exercise and education, Comprehensive Cardiac Rehabilitation, one-off visits and care-plan development, and community group programs. The majority of programs focused on secondary prevention and were aimed at an impairment level, with a mix of findings observed. CONCLUSION Further development and assessment of services is warranted. Incorporation of the entire transition period, and research that is mild stroke and location-specific is advised. Attention to maximizing participation in daily life, secondary prevention, emotional well-being, and careful reporting is needed.
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Affiliation(s)
- Tenelle Hodson
- a School of Health and Rehabilitation Sciences, Occupational Therapy Division , The University of Queensland , St Lucia , Australia
| | - Louise Gustafsson
- a School of Health and Rehabilitation Sciences, Occupational Therapy Division , The University of Queensland , St Lucia , Australia
| | - Petrea Cornwell
- b Allied Health Research Collaborative , Metro North Hospital and Health Service, The Prince Charles Hospital , Chermside , Australia.,c School of Applied Psychology and Menzies Health Institute Queensland , Griffith University , Mt Gravatt, Australia
| | - Amanda Love
- d Rehabilitation and Acute Stroke Unit , The Prince Charles Hospital , Chermside , Australia
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How to Measure Recovery? Revisiting Concepts and Methods for Stroke Studies. Transl Stroke Res 2016; 7:388-94. [PMID: 27498680 DOI: 10.1007/s12975-016-0488-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/03/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
In clinical trials, assessing efficacy is based on validated scales, and the primary endpoint is usually based on a single scale. The aim of the review is to revisit the concepts and methods to design and analyze studies focused on restoration, recovery and or compensation. These studies are becoming more frequent with the development of restorative medicine. After discussing the definitions of recovery, we address the concept of recovery as the regain of lost capabilities, when the patient reaches a new equilibrium. Recovery is a dynamic process which assessment includes information from initial and final status, their difference, the difference between the final status of the patient and normality, and the speed of restoration. Finally, recovery can be assessed either for a specific function (focal restoration) or for a more global restoration. A single scale is not able to assess all the facets of a skill or a function, therefore complementary information should be collected and analyzed simultaneously to be tested in a single analysis. We are suggesting that recovery should be considered as a latent variable and therefore cannot be measured in pure form. We are also suggesting to customize the data collection and analysis according to the characteristics of the subjects, the mechanisms of action and consequences of the intervention. Moreover, recovery trials should benefit from latent variable analysis methods. Structural equation modeling is likely the best candidate for this approach applicable in pre-clinical and clinical studies.
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Northcott S, Marshall J, Hilari K. What Factors Predict Who Will Have a Strong Social Network Following a Stroke? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:772-83. [PMID: 27401538 DOI: 10.1044/2016_jslhr-l-15-0201] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 01/09/2016] [Indexed: 05/27/2023]
Abstract
PURPOSE Measures of social networks assess the number and nature of a person's social contacts, and strongly predict health outcomes. We explored how social networks change following a stroke and analyzed concurrent and baseline predictors of social networks 6 months poststroke. METHOD We conducted a prospective longitudinal observational study. Participants were assessed 2 weeks (baseline), 3 months, and 6 months poststroke. Measures comprised the Stroke Social Network Scale (Northcott & Hilari, 2013), Medical Outcomes Study Social Support Survey (Sherbourne & Stewart, 1991), National Institutes of Health Stroke Scale (Brott et al., 1989), Frenchay Aphasia Screening Test (Enderby, Wood, Wade, & Langton Hewer, 1987), Frenchay Activities Index (Wade, Legh-Smith, & Langton Hewer, 1985), and Barthel Index (Mahoney, Wood, & Barthel, 1958). Analyses of variance and standard multiple regression were used to analyze change and identify predictors. RESULTS Eighty-seven participants (37% with aphasia) were recruited; 71 (16% with aphasia) were followed up at 6 months. Social network scores declined poststroke (p = .001). Whereas the Children and Relatives factors remained stable, the Friends factor significantly weakened (p < .001). Concurrent predictors of social network at 6 months were perceived social support, ethnicity, aphasia, and extended activities of daily living (adjusted R2 = .42). There were 2 baseline predictors: premorbid social network and aphasia (adjusted R2 = .60). CONCLUSIONS Social networks declined poststroke. Aphasia was the only stroke-related factor measured at the time of the stroke that predicted social network 6 months later.
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1470] [Impact Index Per Article: 183.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Leonhardt A, Schmukle SC, Exner C. Evidence of Big-Five personality changes following acquired brain injury from a prospective longitudinal investigation. J Psychosom Res 2016; 82:17-23. [PMID: 26944394 DOI: 10.1016/j.jpsychores.2016.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/22/2015] [Accepted: 01/13/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Many studies using different assessment methods have reported personality changes after acquired brain injury (ABI). However, to our knowledge, no prospective study has yet been conducted to examine whether previous cross-sectional and retrospective results can be replicated in a longitudinal prospective design. Further, because clinical control groups were only rarely used, it remains debatable if the personality changes found are unique to patients with ABI or if they also affect patients with other disabilities. METHODS This study examined personality change in 114 participants with different kinds of ABI, 1321 matched controls (general control, GC), and 746 matched participants with restrictive impairments other than brain injury (clinical control, CC) in a prospective longitudinal design using data from the panel survey Household, Income and Labour Dynamics in Australia (HILDA). RESULTS Participants with ABI showed significantly larger declines in Extraversion and Conscientiousness compared with the GC group. When the ABI participants were compared with the CC group, only the difference in Conscientiousness remained significant. CONCLUSION Our prospective data corroborate evidence from previous cross-sectional studies that patients with ABI experience larger declines in Extraversion and Conscientiousness than the general population. Whereas the effect on Conscientiousness was unique to patients with ABI, the decline in Extraversion was also observed in participants with other impairments.
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Affiliation(s)
- Anne Leonhardt
- Department of Psychology, University of Leipzig, Neumarkt 9-19, D-04081 Leipzig, Germany.
| | - Stefan C Schmukle
- Department of Psychology, University of Leipzig, Neumarkt 9-19, D-04081 Leipzig, Germany
| | - Cornelia Exner
- Department of Psychology, University of Leipzig, Neumarkt 9-19, D-04081 Leipzig, Germany
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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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Ntsiea MV, Van Aswegen H, Lord S, Olorunju S S. The effect of a workplace intervention programme on return to work after stroke: a randomised controlled trial. Clin Rehabil 2014; 29:663-73. [PMID: 25322870 DOI: 10.1177/0269215514554241] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 09/12/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the effect of a workplace intervention programme on the rate of return to work of previously employed stroke survivors in the Gauteng province of South Africa. DESIGN A randomised controlled trial. SETTING Participants' workplaces and three hospitals with stroke rehabilitation facilities. SUBJECTS Eighty stroke survivors between the ages of 18 and 60 years who were employed at the time of stroke onset. INTERVENTION The workplace intervention programme was tailored according to functional ability and workplace challenges of each stroke survivor. The control group received usual stroke care which took into consideration job requirements but without workplace intervention. MAIN OUTCOMES The primary outcome was return to work rate. Secondary outcomes included activities of daily living (ADLs), mobility, basic cognitive function and perceived quality of life. RESULTS At six months follow-up 60% (n = 24) of stroke survivors in the intervention group returned to work compared to 20% (n = 8) in the control group (P <0.001). The odds ratio for return to work for stroke survivors in the intervention group was 5.2. For every unit increase in the ADLs and cognitive assessment score, the odds of return to work increased by 1.7 and 1.3 respectively; those who returned to work had better quality of life than those who did not return to work (P = 0.05). CONCLUSION A workplace intervention consisting of workability assessments and workplace visits was effective in facilitating return to work for stroke survivors in the Gauteng province of South Africa.
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Affiliation(s)
- M V Ntsiea
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - H Van Aswegen
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Lord
- Institute of Neuroscience, Newcastle University, UK
| | - S Olorunju S
- Biostatistics Unit, Medical Research Council of South Africa, South Africa
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Adamit T, Maeir A, Ben Assayag E, Bornstein NM, Korczyn AD, Katz N. Impact of first-ever mild stroke on participation at 3 and 6 month post-event: the TABASCO study. Disabil Rehabil 2014; 37:667-73. [PMID: 24889677 DOI: 10.3109/09638288.2014.923523] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE This study focused on the relationships between cognition, participation and quality of life (QoL) among first-ever mild ischemic stroke patients 3 months post-event. We hypothesized that significant correlations exist between cognition, executive functions (EF), QoL and participation; and that EF and QoL will significantly contribute to participation beyond demographics and stroke severity at 3 and from 3 to 6 months post-stroke. METHODS A prospective cohort study, recruiting consecutive first-ever stroke patients from a large tertiary hospital. The inclusion criteria were first event, mild stroke (NIHSS ≤ 5), and no previous significant neurological or cognitive impairment. In addition to assessment every 6 month at the hospital, an assessment battery was administered at home 3 months post-stroke. RESULTS Participants showed mild to moderate difficulties in cognition and participation (n = 249). Low to moderate correlations were found between cognition and EF with participation (-0.380, p < 0.05; r = 0.460, p < 0.001, respectively); and cognition with QoL (r = 0.421, p < 0.001). EF and QoL contributed significantly to participation at 3 months (R(2) = 0.961) and in addition education at 6 months (R(2) = 0.701). CONCLUSIONS Participants after mild ischemic stroke experienced cognitive and EF difficulties that affect their participation and QoL. Further studies are needed of mild stroke survivors to enhance our understanding of the variables that affect participation. IMPLICATIONS FOR REHABILITATION The findings of the current study have significant implications for the participation of people after mild stroke in the community. Health care systems in general and rehabilitation programs, in particular, do not consider that these clients need rehabilitation as most of them perform basic daily functions independently. Thus, although cognitive and EF deficits are found in people following even mild stroke, but are not externally apparent, these impairments are mostly neglected by the health care system. Mild stroke has long-term effects in most cases and effect family members as well. The implications of the study's results, as well as those of other studies, emphasize the necessity of follow-up and rehabilitation efforts at home and in the community. These efforts should focus on re-enabling the individual to participate in previous activities as much as possible and on providing support for family members. The strength of this study lies in the large number of participants who were evaluated at home in their natural environments. Studies of this kind are rarely performed in the participants' real-life settings, thus the current study provides an important perspective on the participation of this population in the community.
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Affiliation(s)
- Tal Adamit
- School of Occupational Therapy, Hebrew University , Jerusalem , Israel
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Spitzer J, Tse T, Baum CM, Carey LM. Mild impairment of cognition impacts on activity participation after stroke in a community-dwelling Australian cohort. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2014; 31:S8-S15. [PMID: 24650267 DOI: 10.3928/15394492-20101108-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 04/08/2010] [Indexed: 11/20/2022]
Abstract
Ongoing disability following stroke can severely impact activity participation and quality of life. The authors investigated the association between cognition and mood and activity participation in 30 survivors of stroke living in the community, using quantitative assessment tools. Non-parametric correlation analyses quantified the presence and strength of association between variables. Differences for those with cognitive impairment or with depressive symptoms were investigated. Survivors of stroke with cognitive impairment of even mild severity had significantly reduced participation in all activity domains. Significant differences in activity participation were not found with mood, although relatively few were identified as being depressed. The findings suggest that mild cognitive impairment after stroke is associated with participation limitations that are important for occupational therapists to consider when planning intervention.
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Skolarus LE, Burke JF, Brown DL, Freedman VA. Understanding stroke survivorship: expanding the concept of poststroke disability. Stroke 2013; 45:224-30. [PMID: 24281223 DOI: 10.1161/strokeaha.113.002874] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Limitations in essential daily activities are common among older adults after stroke, but little is known about restrictions in their ability to participate in valued social activities. We sought to broaden our understanding of disability after stroke by characterizing poststroke participation restrictions and investigating the extent to which they are accounted for by differences in physical and cognitive capacity, aphasia/dysarthria, depressive, and anxiety symptoms. METHODS Data from the 2011 National Health and Aging Trends Study (NHATS) were used to identify 892 self-reported stroke survivors aged≥65 years. One-to-one propensity matching was performed on demographics and comorbidities to create a matched sample. Participation restrictions were defined as reductions/absence in social activities valued by respondents because of their health or functioning. Physical and cognitive capacity, depressive and anxiety symptoms were measured by validated scales and aphasia/dysarthria by a single question. Comparisons using survey-weighted χ2 tests and logistic regression were made. RESULTS Stroke survivors had more participation restrictions (32.8% versus 23.5%; odds ratio, 1.59; 95% confidence interval, 1.28-1.95; P<0.01) than controls. Differences between stroke survivors and controls in any participation restriction and several components (attending religious service, clubs/classes, and going out for enjoyment) were eliminated after adjusting for physical capacity. Depressive and anxiety symptoms and aphasia/dysarthria were independent predictors of participation restrictions. CONCLUSIONS Stroke survivors have more participation restrictions than can be accounted for by sociodemographic profiles and comorbidity burden. Future work aimed at improving physical capacity, reducing depressive and anxiety symptoms, and improving aphasia/dysarthria has potential to enhance participation.
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Affiliation(s)
- Lesli E Skolarus
- From the Stroke Program (L.E.S., J.F.B., D.L.B.) and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor; and Center for Clinical Management and Research, Ann Arbor, VA (J.F.B.)
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Abstract
BACKGROUND Poststroke depression and cognitive dysfunction are common and are independent predictors of poor recovery. AIMS We assessed whether and how depression and cognition were correlated in the subacute period after stroke. METHOD We prospectively recruited 207 nondemented patients (Mini Mental State Examination ≥ 23) presenting with a first-ever ischemic stroke (127 males), mean age of 48·5 years (16·4 standard deviation), median 12 days after infarction, as assessed on magnetic resonance imaging. We administered a comprehensive neuropsychological battery involving cognitive domains including instrumental functions, memory, executive functions, and working memory. Depression was quantified with the Beck Depression Inventory. RESULTS Depression (Beck Depression Inventory > 9) was identified in 30·4% of the patients (95% confidence interval 24·2-37·2%). Median Beck Depression Inventory was 6. Median Mini Mental State Examination was 30. Cognitive dysfunctioning in at least one neuropsychological test was present in 89% (95% confidence interval 84-93%). Each point increase of Beck Depression Inventory was associated with an odd of 1·1 (95% confidence interval 1·04-1·19) of changing to a worse category of cognition. Stroke location was not correlated with depression. All cognitive domains were significantly correlated with depression. In multivariate analysis, the executive functions (P = 0·001) and the working memory (P = 0·009) were the best predictors of depression when adjusted for demographic and stroke characteristics. CONCLUSIONS The rates of depression and cognitive impairment were in the range of previous stroke studies. Our study suggested a strong relation between depression and cognition characterized by executive functions and working memory dysfunctioning.
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Affiliation(s)
- Marc Hommel
- Université Joseph Fourier, CHU, Grenoble, France
| | - Leeanne Carey
- Division of Neurorehabilitation and Recovery, National Stroke Research Institute, Florey Neuroscience Institutes, Victoria, Australia
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van Mierlo ML, Schröder C, van Heugten CM, Post MWM, de Kort PLM, Visser-Meily JMA. The Influence of Psychological Factors on Health-Related Quality of Life after Stroke: A Systematic Review. Int J Stroke 2013; 9:341-8. [DOI: 10.1111/ijs.12149] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 04/16/2013] [Indexed: 01/08/2023]
Abstract
Background and purpose Many stroke patients experience problems with health-related quality of life, but much of the variance of health-related quality of life after stroke remains unexplained. Health-related quality of life may be influenced by psychological factors, as these factors reflect the way people approach situations and react to stressful situations. The aim of this study was to systematically examine the relationship between psychological factors and health-related quality of life after stroke. Summary of review A systematic literature search was conducted in online databases PubMed, Embase, PsycINFO, and CINAHL in November 2011. A total of nine studies were included. Personality (i.e. problems of temperament and personality functions and neuroticism) was moderately negatively associated with health-related quality of life ( r = 0·26–0·49). Coping (i.e. situational and personal adaptation), internal locus of control, self-worth (i.e. self-esteem and self-efficacy), and hope and optimism were moderately positively associated with health-related quality of life ( r = 0·026–0·81). No evidence was found for an association between extraversion and health-related quality of life. Conclusions There is still a paucity of studies on psychological determinants of poststroke health-related quality of life. The reviewed studies supported the importance of psychological factors, but further research is needed to supplement the available evidence and to examine how psychological factors can be modified to improve health-related quality of life, and at what moment after the stroke these interventions should be given.
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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
| | - Carin Schröder
- 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. M. Post
- 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
- Department of Neurology, St Elisabeth Hospital, Tilburg, 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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Caeiro L, Ferro JM, Pinho e Melo T, Canhão P, Figueira ML. Post-Stroke Apathy: An Exploratory Longitudinal Study. Cerebrovasc Dis 2013; 35:507-13. [DOI: 10.1159/000350202] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/20/2013] [Indexed: 11/19/2022] Open
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Anderson S, Whitfield K. Social identity and stroke: ‘they don't make me feel like, there's something wrong with me’. Scand J Caring Sci 2012; 27:820-30. [DOI: 10.1111/j.1471-6712.2012.01086.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 07/09/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Sharon Anderson
- Social Support Research Program; Suite 700 University Terrace, University of Alberta; Edmonton AB Canada
| | - Kyle Whitfield
- Faculty of Extension, School of Public Health; University of Alberta; Edmonton AB Canada
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van Mierlo ML, van Heugten CM, Post MWM, Lindeman E, de Kort PLM, Visser-Meily JM. A Longitudinal Cohort Study on Quality of Life in Stroke Patients and Their Partners: Restore4Stroke Cohort. Int J Stroke 2012; 9:148-54. [DOI: 10.1111/j.1747-4949.2012.00882.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Stroke is a major cause of disability in the Western world. Its long-term consequences have a negative impact on the quality of life of both the patients and their partners. Aim The aim of the Restore4Stroke Cohort study is to investigate the changes in quality of life of stroke patients and their partners over time, and to determine factors predicting quality of life in several domains, especially personal and environmental factors. Method Multicentre prospective longitudinal cohort study. Inclusion and the first assessment take place during hospital stay in the first week post-stroke. Follow-up assessments take place at two months, six months, one year, and two years post-stroke. Recruitment of 500 patients from stroke units in six participation hospitals is foreseen. If the patient has a partner, he or she is also asked to participate in the study. Outcomes The main outcome is quality of life, considered from a health-related quality of life and domain-specific quality of life perspective. Factors predicting long-term quality of life will be determined by taking into account the health condition (pre-stroke health condition and stroke-related health condition), personal factors (e.g. coping and illness cognitions), and environmental factors (e.g. caregiver burden and social support). Discussion This study is expected to provide information about the changes in quality of life of stroke patients and their partners over time. Furthermore, the identification of factors predicting quality of life can be used to improve rehabilitation care and develop new interventions for stroke patients and their partners.
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Affiliation(s)
- Maria L. van Mierlo
- Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Caroline M. van Heugten
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Marcel W. M. Post
- Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Eline Lindeman
- Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Paul L. M. de Kort
- Department of Neurology, St. Elisabeth hospital, Tilburg, The Netherlands
| | - Johanna M.A. Visser-Meily
- Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
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Culler KH, Wang YC, Byers K, Trierweiler R. Barriers and facilitators of return to work for individuals with strokes: perspectives of the stroke survivor, vocational specialist, and employer. Top Stroke Rehabil 2011; 18:325-40. [PMID: 21914597 DOI: 10.1310/tsr1804-325] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to identify factors that facilitated or acted as a barrier to return to work (RTW) for stroke survivors. We applied 3 approaches to identify the factors. First, we conducted qualitative interviews with 10 stroke survivors about their RTW experience post stroke. Second, we surveyed 21 vocational specialists about barriers and facilitators of RTW based on their clinical practice. Last, we interviewed 7 employers who had experience in interviewing individuals with disabilities or had the authority to make hiring decisions. Descriptions of barriers and facilitators to RTW from these 3 perspectives were illustrated. Identified components were mapped based on the ICF framework. From stroke survivors' perspectives, factors affecting employment after stroke include neurological (motor, cognition, communication), social, personal, and environmental factors. Vocational specialists described similar barriers and facilitators of RTW as the stroke survivors but emphasized personal factors such as flexibility and being realistic in vocational goals. The employers explained that the candidate's disability plays no role in the hiring process and indicated that all applicants must meet the essential job requirements. Some employers described the benefits of having the support of vocational rehabilitation staff and being able to interact with the vocational rehabilitation specialists during the hiring process. The interaction allows the employer to gather initial information (consented to by the job applicant) about the applicants from the vocational rehabilitation service and to be educated about any specific needs related to the applicant's medical issues.
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Affiliation(s)
- Kathleen H Culler
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
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Barrash J, Asp E, Markon K, Manzel K, Anderson SW, Tranel D. Dimensions of personality disturbance after focal brain damage: investigation with the Iowa Scales of Personality Change. J Clin Exp Neuropsychol 2011; 33:833-52. [PMID: 21500116 PMCID: PMC3140575 DOI: 10.1080/13803395.2011.561300] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study employed a multistep, rational-empirical approach to identify dimensions of personality disturbance in brain-damaged individuals: (a) Five dimensions were hypothesized based on empirical literature and conceptual grounds; (b) principal components analysis was performed on the Iowa Scales of Personality Change (ISPC) to determine the pattern of covariance among 30 personality characteristics; (c) when discrepancies existed between principal components analysis results and conceptually based dimensions, empirical findings and clinical considerations were weighed to determine assignment of ISPC scales to dimensions; (d) the fit of data to the refined dimensions was assessed by examination of intercorrelations; (e) differential predictions concerning the relationship of dimensions to ventromedial prefrontal cortex (vmPFC) damage were tested. This process resulted in the specification of five dimensions: Disturbed Social Behavior, Executive/Decision-Making Deficits, Diminished Motivation/Hypo-Emotionality, Irascibility, and Distress. In accord with predictions, the 28 participants with vmPFC lesions, compared to 96 participants with focal lesions elsewhere in the brain, had significantly more Disturbed Social Behavior and Executive/Decision-Making Deficits and tended to have more Diminished Motivation/Hypo-Emotionality. Irascibility was not significantly higher among the vmPFC group, and the groups had very similar levels of Distress. The findings indicate that conceptually distinctive dimensions with differential relationships to vmPFC can be derived from the Iowa Scales of Personality Change.
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Affiliation(s)
- Joseph Barrash
- Department of Neurology, University of Iowa, Iowa City, USA.
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Gillespie DC, Joice S, Lawrence M, Whittick J. Interventions for post-stroke disturbances of mood and emotional behaviour: recommendations from SIGN 118. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.3.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David C Gillespie
- Department of Clinical Psychology, Astley Ainslie Hospital, Edinburgh
| | - Sara Joice
- Social Dimensions of Health Institute/School of Nursing and Midwifery, University of Dundee, Dundee
| | - Maggie Lawrence
- Centre for Evidence Based Care of Older People, Glasgow Caledonian University, Glasgow
| | - Janice Whittick
- Department of Clinical Psychology, Stratheden Hospital, Cupar, Scotland
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40
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Abstract
Current understanding of brain plasticity has lead to new approaches in ischemic stroke rehabilitation. Stroke units that combine good medical and nursing care with task-oriented intense training in an environment that provides confidence, stimulation and motivation significantly improve outcome. Repetitive trans-cranial magnetic stimulation (rTMS), and trans-cranial direct current stimulation (tDCS) are applied in rehabilitation of motor function. The long-term effect, optimal way of stimulation and possibly efficacy in cognitive rehabilitation need evaluation. Methods based on multisensory integration of motor, cognitive, and perceptual processes including action observation, mental training, and virtual reality are being tested. Different approaches of intensive aphasia training are described. Recent data on intensive melodic intonation therapy indicate that even patients with very severe non-fluent aphasia can regain speech through homotopic white matter tract plasticity. Music therapy is applied in motor and cognitive rehabilitation. To avoid the confounding effect of spontaneous improvement, most trials are preformed ≥3 months post stroke. Randomized controlled trials starting earlier after strokes are needed. More attention should be given to stroke heterogeneity, cognitive rehabilitation, and social adjustment and to genetic differences, including the role of BDNF polymorphism in brain plasticity.
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Affiliation(s)
- B B Johansson
- Department of Clinical Neuroscience, Wallenberg Neuroscience Center, Lund University, Sweden.
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41
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Wolf TJ, Barbee AR, White D. Executive Dysfunction Immediately after Mild Stroke. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2011; 31:S23-9. [DOI: 10.3928/15394492-20101108-05] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 08/09/2010] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to determine the presence of executive function deficits immediately after mild stroke that are known to impact participation in home, work, and community life. Individuals with mild stroke who were discharged from the acute setting to the home with few or no rehabilitation services were assessed within 1 week after discharge using a cognitive battery. Using rigorous criteria to identify a specific deficit in executive function, results showed that 66% of the population (N = 35) scored in the deficit range on at least one of the four measures of executive function; 27% of the population (N = 14) scored in the deficit range on two or more measures. Although deficits post-stroke are sometimes known to spontaneously recover, cognitive dysfunction of this nature often becomes chronic. This group is typically discharged with little or no rehabilitation; by detecting these deficits in the acute stage of stroke care, occupational therapists can make appropriate rehabilitation and follow-up recommendations.
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Brady MC, Clark AM, Dickson S, Paton G, Barbour RS. The impact of stroke-related dysarthria on social participation and implications for rehabilitation. Disabil Rehabil 2010; 33:178-86. [PMID: 20831375 DOI: 10.3109/09638288.2010.517897] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Each year an estimated 30,000-45,000 UK individuals experience stroke-related dysarthria (impairment of movements required to produce speech). Many will experience persistent dysarthria long after discharge from stroke services. Although we have some insight into the impact of other communication impairments, we have very limited information on the impact of dysarthria on social participation. PURPOSE To explore the impact of dysarthria on social participation following stroke. METHODS We report data from in-depth semi-structured interviews with 24 individuals with stroke-related dysarthria. RESULTS Our findings suggest a complex association between the severity of an individual's dysarthria and the impact on their social participation. Participants' descriptions highlighted their experiences of social participation and isolation. We further suggest that, in some cases, the coping strategies adopted by the participants could be seen to further exacerbate this isolation. These results have important implications for the prioritisation, planning and delivery of therapeutic interventions for people with dysarthria. CONCLUSIONS The impact of stroke-related dysarthria transcends the physiological impairment to impact upon individuals' social participation, which is key to the process of rehabilitation. The development and evaluation of the effectiveness of an intervention that addresses these impacts is the next challenge for therapists and researchers working in this area.
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Affiliation(s)
- Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK.
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Rush BK, McNeil RB, Gamble DM, Luke SH, Richie AN, Albers CS, Brown RD, Brott TG, Meschia JF. Behavioral Symptoms in Long-Term Survivors of Ischemic Stroke. J Stroke Cerebrovasc Dis 2010; 19:326-32. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 08/06/2009] [Accepted: 09/10/2009] [Indexed: 11/27/2022] Open
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Planton M, Peiffer S, Albucher JF, Barbeau E, Tardy J, Pastor J, Januel AC, Bezy C, Lemesle B, Puel M, Demonet JF, Chollet F, Pariente J. Évaluation du fonctionnement cognitif et psychocomportemental après un premier infarctus cérébral symptomatique. Rev Neurol (Paris) 2010. [DOI: 10.1016/s0035-3787(10)70022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jaillard A, Naegele B, Trabucco-Miguel S, LeBas JF, Hommel M. Hidden Dysfunctioning in Subacute Stroke. Stroke 2009; 40:2473-9. [DOI: 10.1161/strokeaha.108.541144] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Determining cognitive dysfunctioning (CDF) after stroke is an important issue because it influences choices for management in terms of return to previous activities. Because previous research in subacute stroke has shown important variations in CDF rates, we aimed to describe the frequency and neuropsychological profile of CDF in subacute stroke outside dementia. We used a large battery of tests to screen any potentially hidden CDF.
Methods—
Patients with Mini-Mental State Examination scores ≥23 were prospectively and consecutively included 2 weeks after a first-ever ischemic brain infarct. Stroke features were based on MRI. Four domains were evaluated: instrumental and executive functions, episodic memory, and working memory (WM). Patients were scored using means and compared with education- and age-matched control subjects. Then we attributed Z-scores for each test and each domain. The most relevant cognitive tests characterizing CDF were determined using logistic regression.
Results—
Among 177 patients (mean age, 50.6 years), 91.5% failed in at least one cognitive domain. WM was the most impaired domain (87.6%) with executive functions (64.4%), episodic memory (64.4%), and instrumental functions (24.9%) being relatively preserved. CDF was associated with age, education, depression, neurological deficit, and leukoaraiosis in bivariate analysis. Using logistic regression, WM tests and age predicted CDF (Modified Paced Auditorial Serial Addition Test: OR=0.96 CI=0.93 to 0.98; Owen-spatial-WM: OR=1.07 CI=1.02 to 1.12; age: OR=0.96 CI=0.93 to 0.98).
Conclusion—
CDF appears to be almost constant, although underestimated, in subacute stroke. WM could reflect some hidden dysfunctioning, which may interfere with rehabilitation and return to work. Clinical routine may include WM tests in young patients with mild stroke.
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Affiliation(s)
- Assia Jaillard
- From the Institut Fédératif de Recherche (A.J., J.F.L.), Unité d’Imagerie par Résonance Magnétique, Pôle Imagerie CHU Grenoble, France; Grenoble Institut des Neurosciences (A.J., B.N., J.F.L.), Inserm U.836, Equipe 5, Neuroimagerie Fonctionnelle et Métabolique, Grenoble, France; Unité Neurovasculaire (B.N., S.T.-M.), Pôle Neurologie-Psychiatrie, CHU Grenoble, France; and Centre d’Investigations cliniques (M.H.), INSERM CIC 003 CHU Grenoble, France
| | - Bernadette Naegele
- From the Institut Fédératif de Recherche (A.J., J.F.L.), Unité d’Imagerie par Résonance Magnétique, Pôle Imagerie CHU Grenoble, France; Grenoble Institut des Neurosciences (A.J., B.N., J.F.L.), Inserm U.836, Equipe 5, Neuroimagerie Fonctionnelle et Métabolique, Grenoble, France; Unité Neurovasculaire (B.N., S.T.-M.), Pôle Neurologie-Psychiatrie, CHU Grenoble, France; and Centre d’Investigations cliniques (M.H.), INSERM CIC 003 CHU Grenoble, France
| | - Sandra Trabucco-Miguel
- From the Institut Fédératif de Recherche (A.J., J.F.L.), Unité d’Imagerie par Résonance Magnétique, Pôle Imagerie CHU Grenoble, France; Grenoble Institut des Neurosciences (A.J., B.N., J.F.L.), Inserm U.836, Equipe 5, Neuroimagerie Fonctionnelle et Métabolique, Grenoble, France; Unité Neurovasculaire (B.N., S.T.-M.), Pôle Neurologie-Psychiatrie, CHU Grenoble, France; and Centre d’Investigations cliniques (M.H.), INSERM CIC 003 CHU Grenoble, France
| | - Jean François LeBas
- From the Institut Fédératif de Recherche (A.J., J.F.L.), Unité d’Imagerie par Résonance Magnétique, Pôle Imagerie CHU Grenoble, France; Grenoble Institut des Neurosciences (A.J., B.N., J.F.L.), Inserm U.836, Equipe 5, Neuroimagerie Fonctionnelle et Métabolique, Grenoble, France; Unité Neurovasculaire (B.N., S.T.-M.), Pôle Neurologie-Psychiatrie, CHU Grenoble, France; and Centre d’Investigations cliniques (M.H.), INSERM CIC 003 CHU Grenoble, France
| | - Marc Hommel
- From the Institut Fédératif de Recherche (A.J., J.F.L.), Unité d’Imagerie par Résonance Magnétique, Pôle Imagerie CHU Grenoble, France; Grenoble Institut des Neurosciences (A.J., B.N., J.F.L.), Inserm U.836, Equipe 5, Neuroimagerie Fonctionnelle et Métabolique, Grenoble, France; Unité Neurovasculaire (B.N., S.T.-M.), Pôle Neurologie-Psychiatrie, CHU Grenoble, France; and Centre d’Investigations cliniques (M.H.), INSERM CIC 003 CHU Grenoble, France
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