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Silva DP, Coelho M, Soares T, Vale TC, Correia Guedes L, Maciel ROH, Antunes AP, Camargos ST, Valadas A, Godinho C, Maia DP, Pita Lobo P, Maia RD, Teodoro T, Rieder CR, Velon AG, Tumas V, Barbosa ER, Teive HA, Ferraz HB, Rosas MJ, Calado A, Lampreia T, Simões R, Vila‐Chã N, Costa MM, Rodrigues AM, Caniça V, Cardoso F, Ferreira JJ. Handicap as a Measure of Perceived-Health Status in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1172-1180. [PMID: 37635780 PMCID: PMC10450228 DOI: 10.1002/mdc3.13826] [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: 01/04/2023] [Revised: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 08/29/2023] Open
Abstract
Background Handicap is a patient-centered measure of health status that encompasses the impact of social and physical environment on daily living, having been assessed in advanced and late-stage Parkinson's Disease (PD). Objective To characterize the handicap of a broader sample of patients. Methods A cross-sectional study of 405 PD patients during the MDS-UPDRS Portuguese validation study, using the MDS-UPDRS, Unified Dyskinesias Rating Scale, Nonmotor symptoms questionnaire, PDQ-8 and EQ-5D-3L. Handicap was measured using the London Handicap Scale (LHS). Results Mean age was 64.42 (±10.3) years, mean disease duration 11.30 (±6.5) years and median HY 2 (IQR, 2-3). Mean LHS was 0.652 (±0.204); "Mobility," "Occupation" and "Physical Independence" were the most affected domains. LHS was significantly worse in patients with longer disease duration, older age and increased disability. In contrast, PDQ-8 did not differentiate age groups. Handicap was significantly correlated with disease duration (r = -0.35), nonmotor experiences of daily living (EDL) (MDS-UPDRS-I) (r = -0.51), motor EDL (MDS-UPDRS-II) (r = -0.69), motor disability (MDS-UPDRS-III) (r = -0.49), axial signs of MDS-UPDRS-III (r = -0.55), HY (r = -0.44), presence of nonmotor symptoms (r = -0.51) and PDQ-8 index (r = -0.64) (all P < 0.05). Motor EDL, MDS-UPDRS-III and PDQ-8 independently predicted Handicap (adjusted R 2 = 0.582; P = 0.007). Conclusions The LHS was easily completed by patients and caregivers. Patients were mild-moderately handicapped, which was strongly determined by motor disability and its impact on EDL, and poor QoL. Despite correlated, handicap and QoL seem to differ in what they measure, and handicap may have an added value to QoL. Handicap seems to be a good measure of perceived-health status in a broad sample of PD.
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Affiliation(s)
- Daniela Pimenta Silva
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
| | - Miguel Coelho
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | | | | | - Leonor Correia Guedes
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | | | - Ana Patrícia Antunes
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
| | | | - Anabela Valadas
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM)
| | - Débora Palma Maia
- Movement Disorders UnitFederal University of Minas GeraisBelo HorizonteBrazil
| | - Patrícia Pita Lobo
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | - Raphael Doyle Maia
- Movement Disorders Unit, Hospital Universitário Cassiano Antônio MoraesFederal University of Espírito SantoEspírito SantoBrazil
| | - Tiago Teodoro
- Instituto de Medicina MolecularLisbonPortugal
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation TrustLondonUnited Kingdom
- Neuroscience Research Centre, Institute of Molecular and Clinical SciencesSt. George's University of LondonLondonUK
| | - Carlos R. Rieder
- Movement Disorders UnitHospital Santa Casa de Misericórdia de Porto AlegrePorto AlegreBrazil
- Federal University of Health Sciences of Porto AlegrePorto AlegreBrazil
| | - Ana Graça Velon
- Serviço de Neurologia do Centro Hospitalar de Trás‐os‐Montes e Alto DouroVila RealPortugal
| | - Vítor Tumas
- Department of Neuroscience and Behavior Sciences, Ribeirão Preto School of MedicineUniversity of São PauloRibeirão PretoBrazil
| | - Egberto Reis Barbosa
- Universidade de São Paulo, Faculdade de MedicinaDepartamento de Neurologia, Centro de Distúrbios do MovimentoSão PauloBrazil
| | - Hélio A.G. Teive
- Department of NeurologyUniversidade Federal do ParanáCuritibaBrazil
| | | | | | - Ana Calado
- Serviço de Neurologia do Centro Hospitalar de Lisboa CentralLisbonPortugal
| | - Tânia Lampreia
- Serviço de NeurologiaHospital Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - Rita Simões
- Serviço de NeurologiaHospital Beatriz ÂngeloLisbonPortugal
| | - Nuno Vila‐Chã
- Serviço de Neurologia do Hospital de Santo António, Centro Hospitalar Universitário do PortoPortoPortugal
| | - Maria Manuela Costa
- Serviço de NeurologiaHospital Pedro HispanoMatosinhosPortugal
- Serviço de NeurologiaHospital das Forças ArmadasPortoPortugal
| | | | | | - Francisco Cardoso
- Movement Disorders UnitFederal University of Minas GeraisBelo HorizonteBrazil
| | - Joaquim J. Ferreira
- CNS – Campus NeurológicoTorres VedrasPortugal
- Laboratory of Clinical Pharmacology, Faculty of MedicineUniversity of LisbonLisbonPortugal
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Sagar R, Sen MS, Kumar N, Chawla N. Longitudinal assessment of disability amongst patients of bipolar and unipolar depressive disorders presenting to a tertiary care center in North India. Int J Soc Psychiatry 2023; 69:70-77. [PMID: 34996324 DOI: 10.1177/00207640211070158] [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: 11/16/2022]
Abstract
OBJECTIVES To assess and compare the changes in disability scores associated with Bipolar Depression (BD) and Unipolar Depression (UD) over 1 year. METHODS A longitudinal study was taken up in adults diagnosed with unipolar or bipolar depressive disorder with current depressive episode. Diagnosis was made according to Schedule for Clinical Assessment in Neuropsychiatry. Severity scoring was done using Hamilton's Depression (HAM-D) rating scale and Hamilton's Anxiety (HAM-A) rating scale. Disability was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS) and London handicap Scale (LHS) at baseline, 6 and 12 months. RESULTS Sixty participants were recruited (42 UD and 18 BD). No significant differences were seen in socio-demographic parameters, except higher education levels and males being overrepresented in UD. Significant differences at baseline were seen in HAM-D (p = .001) and HAM-A (p = .003) scores. The extent of disability was seen to correlate with severity of illness only in case of BD at baseline. No significant differences were seen in the IDEAS scores at baseline. IDEAS score improved at each follow-up assessment (p < .001). LHS showed significant improvement over time in UD (p < .001), but not BD (p = .076). Percentage individuals meeting cut-off for benchmark disability (>40%) were comparable at baseline but were significantly more in the BD at 12-months (p = .049). CONCLUSION AND IMPLICATIONS Disability in psychiatry occurs equally amongst unipolar and bipolar depressive disorders and tends to improve over time, although the level of improvement may differ. It may not always correspond to severity of illness. These factors should be considered while certifying disability.
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Affiliation(s)
- Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mahadev Singh Sen
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Nishtha Chawla
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Del Brutto VJ, Rundek T, Sacco RL. Prognosis After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abba MA, Olaleye OA, Hamzat TK. Effects of over-ground walking and cognitive rehabilitation on cognition, brain-derived neurotrophic factor, participation and quality of life among stroke survivors: a study protocol. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1808056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Muhammad Aliyu Abba
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, Kano, Nigeria
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olubukola A. Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Talhatu K. Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Park EY, Won-Ho K. Participation restriction of stroke survivors: Verification of the moderating effects of demographic characteristics. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1674090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Eun-Young Park
- Professor of the Department of Secondary Special Education, College of Education, Jeonju University, 303 Cheonjam-ro, Wansan-gu 55069, South Korea
| | - Kim Won-Ho
- Professor of the Department of Physical Therapy, Ulsan College, 101 Bong su-ro, Dong-gu 44022, South Korea
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Hershkovitz A, Beloosesky Y, Brill S, Gottlieb D. Is a day hospital rehabilitation programme associated with reduction of handicap in stroke patients? Clin Rehabil 2016; 18:261-6. [PMID: 15137557 DOI: 10.1191/0269215504cr731oa] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: (1) To assess whether a rehabilitation day hospital programme is associated with a reduced handicap level of stroke patients. (2) To estimate the relationship between the London Handicap Scale (LHS) and other outcome measures. (3) To examine the effect of demographic parameters (age, gender, family status, education) on LHS scores. Design: A prospective longitudinal survey. Setting: An urban geriatric rehabilitation day hospital. Subjects: Two hundred and seven elderly stroke patients admitted between December 1999 and February 2001. Main outcome measures: London Handicap Scale (LHS), Functional Independent Measure (FIM), Nottingham Extended ADL Index, timed get up and go test. Results: LHS scores at discharge changed significantly (p < 0.008) for mobility, physical independence and occupation. The overall change in LHS score was 2.3 points (20%); effect size 0.43. A significant relationship was found between discharge score of LHS and admission score of FIM, Nottingham Index, timed get up and go and age. Multiple linear regressions did not identify a good predictor for the discharge score of LHS. Higher education was associated with higher LHS scores on admission (p= 0.016) but with less success in correcting handicap (p= 0.046). Conclusions: A day hospital programme is associated with reduced level of handicap in stroke patients. The LHS is a useful and simple scale for measuring change in these patients. LHS in stroke patients correlates with other outcome measures, yet they cannot be used interchangeably. A significant relationship between education and level of handicap exists.
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Affiliation(s)
- Avital Hershkovitz
- Beit Rivka Geriatric Rehabilitation Center Day Hospital, Petach Tikva, Israel.
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Vincent-Onabajo GO, Ihaza LO, Usman Ali M, Ali Masta M, Majidadi R, Modu A, Umeonwuka C. Impact of social support on participation after stroke in Nigeria. Top Stroke Rehabil 2016; 23:305-10. [DOI: 10.1080/10749357.2016.1155279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Quality of life of individuals born preterm: a systematic review of assessment approaches. Qual Life Res 2016; 25:2123-39. [PMID: 26995563 DOI: 10.1007/s11136-016-1259-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE To review the existing literature regarding factors associated with quality of life (QoL) of individuals who were born preterm. The review focuses on assessment approaches and information sources. METHODS A systematic review of empirical studies published in PubMed, PsycARTICLES, PsycINFO, LILACS, and SciELO databases between 2007 and 2015. Search terms were chosen that relate preterm birth to QoL. RESULTS Twenty-two articles were included. Of these, ten investigated QoL in children, six investigated adolescents, and six investigated adults. All studies used generic instruments to assess QoL. There was a high rate of parental report to assess QoL in studies of children. Adolescent and adult studies most often assessed QoL through self-report. Parents of children who were born preterm reported worse QoL for their children compared with parents of children born full term. Teenagers and adults who were born preterm self-reported more positive outcomes in their QoL. The main risk factors associated with worse QoL in children who were born preterm were congenital malformations, mechanical ventilation during the neonatal phase, cognitive impairments, behavioral problems, physical disabilities, low family income, and black race. CONCLUSIONS Agreement between parents and children about QoL in preterm individuals was lower in younger age groups compared with older age groups. The differences in QoL throughout the different age groups may have arisen because of developmental changes or differences in the source of information used (i.e., parent report or self-report). We recommend that QoL assessments in children born preterm should consider both parent report and self-report.
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Vincent-Onabajo GO, Hamzat TK, Owolabi MO. Consistent determinants of health-related quality of life in the first 12 months after stroke: a prospective study in Nigeria. Top Stroke Rehabil 2015; 22:127-33. [DOI: 10.1179/1074935714z.0000000033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Joubert J, Davis SM, Hankey GJ, Levi C, Olver J, Gonzales G, Donnan GA. ICARUSS, the Integrated Care for the Reduction of Secondary Stroke trial: rationale and design of a randomized controlled trial of a multimodal intervention to prevent recurrent stroke in patients with a recent cerebrovascular event, ACTRN = 12611000264987. Int J Stroke 2015; 10:773-7. [PMID: 25907853 DOI: 10.1111/ijs.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/18/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The majority of strokes, both ischaemic and haemorrhagic, are attributable to a relatively small number of risk factors which are readily manageable in primary care setting. Implementation of best-practice recommendations for risk factor management is calculated to reduce stroke recurrence by around 80%. However, risk factor management in stroke survivors has generally been poor at primary care level. A model of care that supports long-term effective risk factor management is needed. AIM To determine whether the model of Integrated Care for the Reduction of Recurrent Stroke (ICARUSS) will, through promotion of implementation of best-practice recommendations for risk factor management reduce the combined incidence of stroke, myocardial infarction and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. DESIGN A prospective, Australian, multicentre, randomized controlled trial. SETTING Academic stroke units in Melbourne, Perth and the John Hunter Hospital, New South Wales. SUBJECTS 1000 stroke survivors recruited as from March 2007 with a recent (<3 months) stroke (ischaemic or haemorrhagic) or a TIA (brain or eye). RANDOMIZATION Randomization and data collection are performed by means of a central computer generated telephone system (IVRS). INTERVENTION Exposure to the ICARUSS model of integrated care or usual care. PRIMARY OUTCOME The composite of stroke, MI or death from any vascular cause, whichever occurs first. SECONDARY OUTCOMES Risk factor management in the community, depression, quality of life, disability and dementia. STATISTICAL POWER With 1000 patients followed up for a median of one-year, with a recurrence rate of 7-10% per year in patients exposed to usual care, the study will have at least 80% power to detect a significant reduction in primary end-points CONCLUSION The ICARUSS study aims to recruit and follow up patients between 2007 and 2013 and demonstrate the effectiveness of exposure to the ICARUSS model in stroke survivors to reduce recurrent stroke or vascular events and promote the implementation of best practice risk factor management at primary care level.
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Affiliation(s)
- J Joubert
- Departments of Medicine and Neurology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, St Vincents Hospital, Melbourne, Victoria, Australia
| | - S M Davis
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Florey Institute, Melbourne, Victoria, Australia
| | - G J Hankey
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - C Levi
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - J Olver
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Gonzales
- Department of Neurology, St Vincents Hospital, Melbourne, Victoria, Australia
| | - G A Donnan
- Florey Institute, Melbourne, Victoria, Australia
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Vazirinejad R, Joorian J, Taghavi MM, Lilley JM, Sayadi Anari AR. The Persian Version of a Participation Scale: Is It Valid and Reliable Enough for Use among Iranian Patients with Multiple Sclerosis? J Clin Neurol 2015; 11:157-63. [PMID: 25851894 PMCID: PMC4387481 DOI: 10.3988/jcn.2015.11.2.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/23/2014] [Accepted: 11/25/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study was to determine the face and criterion validity, stability reliability, and internal consistency of the Persian version of the Impact on Participation and Autonomy (IPA-p) scale among Iranian people with multiple sclerosis (MS). METHODS Trained experts interviewed 364 MS patients and their relatives to assess the criterion validity, stability reliability, and internal consistency of the IPA-p scale. Ten specialists from different disciplines were also recruited to assess its face validity. A consent form was completed by the patients and their relatives. Internal consistency reliability was measured using Cronbach's alpha and stability reliability was assessed using interclass correlation coefficients (ICCs). The test-retest method was used to detect the reliability of the questioner. The study subjects completed the IPA-p scale on two occasions separated by an interval of 30-45 days. Study checklists were also used to assess the face validity, stability reliability, and internal consistency of the IPA-p scale. RESULTS About 50% of the respondents reported their perceived overall participation to be "good" or "very good" and 60% of the specialists rated the ability of the IPA-p scale to measure what it was designed for as "excellent." Spearman correlation coefficients were >0.8 for all but one IPA-p domain. Cronbach's alpha between the mean IPA-p scale scores achieved on two separate occasions ranged from 0.858 to 0.913. The highest and lowest internal consistencies belonged to the "social relationships" and "education and learning" domains, respectively. The test-retest ICCs for the nine domains were between 0.789 and 0.919, and all were significant at p<0.001. CONCLUSIONS The IPA-p questionnaire can be considered a valid and reliable instrument for assessing self-reported participation among Iranian MS patients.
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Affiliation(s)
- Reza Vazirinejad
- Social Determinants of Health Research Centre, Medical School, Rafsanjan University, Rafsanjan, Iran
| | - Javad Joorian
- Social Medicine Department, Medical School, Rafsanjan University, Rafsanjan, Iran
| | | | - Jeanette M Lilley
- Division of Rehabilitation and Ageing, Nottingham University Medical School, The Medical School, Queens Medical Centre, Nottingham, UK
| | - Ahmad Reza Sayadi Anari
- Social Determinants of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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Park EY, Choi YI. Rasch analysis of the London Handicap Scale in stroke patients: a cross-sectional study. J Neuroeng Rehabil 2014; 11:114. [PMID: 25077991 PMCID: PMC4122052 DOI: 10.1186/1743-0003-11-114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although activity and participation are the target domains in stroke rehabilitation interventions, there is insufficient evidence available regarding the validity of participation measurement. The purpose of this study was to investigate the psychometric properties of the London Handicap Scale in community-dwelling stroke patients, using Rasch analysis. METHODS Participants were 170 community-dwelling stroke survivors. The data were analyzed using Winsteps (version 3.62) with the Rasch model to determine the unidimensionality of item fit, the distribution of item difficulty, and the reliability and suitability of the rating process for the London Handicap Scale. RESULTS Data of 16 participants did not fit the Rasch model and there were no misfitting items. The person separation value was 2.42, and the reliability was .85; furthermore, the rating process for the London Handicap Scale was found to be suitable for use with stroke patients. CONCLUSIONS This was the first trial to investigate the psychometric properties of the London Handicap Scale using Rasch analysis; the results supported the suitability of this scale for use with stroke patients.
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Affiliation(s)
| | - Yoo-Im Choi
- Department of Occupational Therapy, School of Medicine, Wonkwang University, PO Box 570-749, 460 Iksandae-ro, Iksan, Jeollabuk-do, Republic of Korea.
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Hagell P, Westergren A. The Significance of Importance: An Evaluation of Ferrans and Powers’ Quality of Life Index. Qual Life Res 2013; 15:867-76. [PMID: 16721646 DOI: 10.1007/s11136-005-5467-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2005] [Indexed: 11/25/2022]
Abstract
Ferrans and Powers' Quality of Life Index (QLI) defines and assesses quality of life (QoL) in terms of importance-weighted life satisfaction. This study assessed the value of such weights and explored the relationship between weighted and unweighted (satisfaction only) scores and single-item rated overall life satisfaction (LS) and QoL. Data were collected by a postal survey to 81 Parkinson's disease patients (88% response rate). Correlations between weighted and unweighted QLI scores were >or=0.96, except for one subscale (r ( s ) = 0.85). Item non-response rates ranged between 4.2 and 45.1% and 1.4 and 38% for the weighted and unweighted QLI, respectively. Cronbach's alpha exceeded 0.7 for weighted and unweighted versions of two out of the four subscales and the total score. Scaling success rates were similar for weighted and unweighted scores and did not support the current subscale structure. Unexpectedly, weighted total scores correlated stronger with LS than with QoL, and unweighted scores displayed the opposite pattern. This study found no advantages by using importance-weighted satisfaction scores. The correlational pattern with overall LS and QoL challenges the QLI approach to QoL, although these observations may relate to the use of multiplicative item weights. This study has implications also beyond the QLI regarding, e.g., the use of multiplicative weights and the relationship between life satisfaction and QoL.
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Affiliation(s)
- Peter Hagell
- Division of Gerontology and Caring Sciences, Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden .
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Social Participation after Stroke: One-Year Follow-Up of Stroke Survivors in Nigeria. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/532518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Stroke may negatively affect social participation in survivors. Aims. This study assessed the pattern of social participation in a sample of Nigerian stroke survivors across the first 12 months after stroke. Methods. Stroke survivors were consecutively recruited while on admission at a tertiary health institution. The London handicap scale was used to assess social participation at 1, 3, 6, 9, and 12 months at the homes of the stroke survivors. Overall and domain-specific patterns of social participation were examined independently and also in relation to initial stroke severity. Results. Overall social participation significantly improved over 12 months (), while significant improvements were observed only in the mobility, physical independence, and work and leisure domains at P equals 0.04, 0.04, and 0.05, respectively. In spite of the improvement in the work and leisure domain, the domain recorded the lowest level of participation. Social participation also differed by initial stroke severity with severe stroke survivors having the lowest level of participation across 12 months after stroke. Conclusions. The poor outcome in the work and leisure domain of social participation and in individuals with initial severe stroke has implications for planning and provision of appropriate long-term stroke rehabilitation.
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Abstract
Background: Stroke is one of the most common disabling conditions of adulthood. Participation problems are extremely common post-stroke. Occupational therapists, by virtue of their commitment to enabling occupation, are in a strong position to help stroke survivors improve their participation. To demonstrate effectiveness, occupational therapists must be able to provide evidence of post-treatment changes in participation. Objective: The objective of this paper was to identify participation measures that have been developed for, or tested with, individuals who have experienced a stroke and to review them for use as occupational therapy outcome measures. Method: A literature review was carried out to locate relevant tools. These tools were then rated for psychometric and clinical properties that are critical for clinical outcome measurement. In addition, the theoretical fit of each evaluation with occupational therapy's commitment to client-centredness was considered. Results: Ten evaluations were identified and rated. These ratings were designed to assist occupational therapists to choose a participation measure for their practice. Conclusion: Selection and use of such a measure will help occupational therapists to document its effectiveness in improving participation among stroke survivors.
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Affiliation(s)
- Dorothy Kessler
- Research Trainee, Bruyere Research Institute, and PhD Student, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Mary Egan
- Scientist, Bruyere Research Institute, and Professor, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
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Kelders R, van Brakel W, Beise K, Irwanto. Testing and validating a simplified scale to measure social participation of people with disabilities in Indonesia. Disabil Rehabil 2011; 34:638-46. [DOI: 10.3109/09638288.2011.615369] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Graven C, Brock K, Hill K, Ames D, Cotton S, Joubert L. From rehabilitation to recovery: protocol for a randomised controlled trial evaluating a goal-based intervention to reduce depression and facilitate participation post-stroke. BMC Neurol 2011; 11:73. [PMID: 21682910 PMCID: PMC3135526 DOI: 10.1186/1471-2377-11-73] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/18/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is much discourse in healthcare about the importance of client-centred rehabilitation, however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal-directed practice that reflects patients' valued activities. In addition, the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear. In community based rehabilitation, interventions based on patients' perceived needs may be more likely to alter such outcomes. In this paper, we describe the methodology of a randomised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke. The effectiveness of this intervention in reducing the severity of post-stroke depression, improving participation status and health-related quality of life is examined. The impact on carers is also examined. METHODS/DESIGN Patients (and their primary carers, if available) are randomly allocated to an intervention or control arm of the study. The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities. Intervention methods include: telephone contacts, written information provision, home visitation, and contact with treating health professionals, with further relevant health service referrals as required. The control involves treatment as usual, as determined by inpatient and community rehabilitation treating teams. Formal blinded assessments are conducted at discharge from inpatient rehabilitation, and at six and twelve months post-stroke. The primary outcome is depression. Secondary outcome measures include participation and activity status, health-related quality of life, and self-efficacy. DISCUSSION The results of this trial will assist with the development of a model for community-based rehabilitation management for stroke patients and their carers, with emphasis on goal-directed practice to enhance home and community participation status. Facilitation of participation in valued activities may be effective in reducing the incidence or severity of post-stroke depression, as well as enhancing the individual's perception of their health-related quality of life. The engagement of carers in the rehabilitation process will enable review of the influence of the broader social context on recovery. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000042347.
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Affiliation(s)
- Christine Graven
- School of Health Sciences, The University of Melbourne, Parkville, Victoria 3052, Australia
- Physiotherapy Department, St.Vincent's Hospital Melbourne, PO Box 2900, Fitzroy, Victoria 3065, Australia
| | - Kim Brock
- Physiotherapy Department, St.Vincent's Hospital Melbourne, PO Box 2900, Fitzroy, Victoria 3065, Australia
| | - Keith Hill
- Faculty of Health Sciences, La Trobe University and Northern Health, Bundoora, Victoria 3086, Australia
- National Ageing Research Institute, PO Box 2127, Royal Melbourne Hospital, Victoria 3050, Australia
| | - David Ames
- National Ageing Research Institute, PO Box 2127, Royal Melbourne Hospital, Victoria 3050, Australia
| | - Susan Cotton
- Orygen Youth Health Research Centre, Locked Bag 10, Parkville, Victoria 3052, Australia
| | - Lynette Joubert
- School of Health Sciences, The University of Melbourne, Parkville, Victoria 3052, Australia
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Pheby D, Lacerda E, Nacul L, Drachler MDL, Campion P, Howe A, Poland F, Curran M, Featherstone V, Fayyaz S, Sakellariou D, Leite JCDC. A Disease Register for ME/CFS: Report of a Pilot Study. BMC Res Notes 2011; 4:139. [PMID: 21554673 PMCID: PMC3118997 DOI: 10.1186/1756-0500-4-139] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 05/09/2011] [Indexed: 11/22/2022] Open
Abstract
Background The ME/CFS Disease Register is one of six subprojects within the National ME/CFS Observatory, a research programme funded by the Big Lottery Fund and sponsored by Action for ME. A pilot study in East Anglia, East Yorkshire, and London aimed to address the problem of identifying representative groups of subjects for research, in order to be able to draw conclusions applicable to the whole ME/CFS population. While not aiming for comprehensive population coverage, this pilot register sought to recruit participants with ME/CFS in an unbiased way from a large population base. Those recruited are constituting a cohort for long-term follow-up to shed light on prognosis, and a sampling frame for other studies. Findings Patients with unidentified chronic fatigue were identified in GP databases using a READ-code based algorithm, and conformity to certain case definitions for ME/CFS determined. 29 practices, covering a population aged 18 to 64 of 143,153, participated. 510 patients with unexplained chronic fatigue were identified. 265 of these conformed to one or more case definitions. 216 were invited to join the register; 160 agreed. 96.9% of participants conformed to the CDC 1994 (Fukuda) definition; the Canadian definition defined more precisely a subset of these. The addition of an epidemiological case definition increased case ascertainment by approximately 4%. A small-scale study in a specialist referral service in East Anglia was also undertaken. There was little difference in pattern of conformity to case definitions, age or sex among disease register participants compared with subjects in a parallel epidemiological study who declined to participate. One-year follow-up of 50 subjects showed little change in pain or fatigue scores. There were some changes in conformity to case definitions. Conclusions Objective evaluation indicated that the aim of recruiting participants with ME/CFS to a Disease Register had been fulfilled, and confirmed the feasibility of our approach to case identification, data processing, transmission, storage, and analysis. Future developments should include expansion of the ME/CFS Register and its linkage to a tissue sample bank and post mortem tissue archive, to facilitate support for further research studies.
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Affiliation(s)
- Derek Pheby
- Buckinghamshire New University, Uxbridge Campus, 106, Oxford Road, Uxbridge, Middlesex, UB8 1NA, UK.
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Barker-Collo SL, Feigin VL, Lawes CMM, Parag V, Senior H. Attention deficits after incident stroke in the acute period: frequency across types of attention and relationships to patient characteristics and functional outcomes. Top Stroke Rehabil 2011; 17:463-76. [PMID: 21239370 DOI: 10.1310/tsr1706-463] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Attention deficits are common post stroke and result in poorer functional outcomes. This study examined the frequency of attention deficits after incident stroke and their correlates. METHOD Attention of 94 stroke survivors was assessed using the Bells test, Trails Making Test A/B, 2.4- and 2.0-second trials of the Paced Auditory Serial Addition Test (PASAT), and Integrated Auditory Visual Continuous Performance Test (IVA-CPT) within 3 weeks post stroke. Wider functioning was assessed using the Medical Short Form-36 (SF-36) Physical and Mental Component Summary scores (PCS and MCS), London Handicap Scale, Modified Rankin Scale, General Health Questionnaire-28, and Cognitive Failures Questionnaire (CFQ). RESULTS Most participants were impaired or very impaired on the IVA-CPT (z scores ≯ 3 SDs below normative mean) but not other attention measures. Functional independence and cognitive screening test (Mini-Mental State Examination) performance were significantly related to IVA-CPT, Trails A/B, and Bells tests but not PASAT. Better performance across the Bells test was related to better SF-36 PCS, whereas Trails A and the PASAT were related to SF-36 MCS. Better CFQ naming was related to Trails B, whereas worse CFQ memory was related to better PASAT performance. CONCLUSION Attention deficits are common post stroke, though frequency varies widely across the forms of attention assessed, with tests of neglect and speeded attention tasks being linked to quality of life. This variability of performance and linking to wider outcomes suggests the need for comprehensive assessment of attention and that attention is a viable target for rehabilitative efforts.
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Chahal N, Barker-Collo S, Feigin V. Cognitive and Functional Outcomes of 5-Year Subarachnoid Haemorrhage Survivors: Comparison to Matched Healthy Controls. Neuroepidemiology 2011; 37:31-8. [DOI: 10.1159/000328647] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 04/19/2011] [Indexed: 11/19/2022] Open
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Kutlay Ş, Küçükdeveci AA, Yanık B, Elhan A, Öztuna D, Tennant A. The interval scaling properties of the London Handicap Scale: an example from the adaptation of the scale for use in Turkey. Clin Rehabil 2010; 25:248-55. [DOI: 10.1177/0269215510380829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To adapt the London Handicap Scale into the Turkish language, and to investigate the scaling properties of this version in a sample of people who have experienced a stroke. Design: After the translation process, the internal construct validity was tested by Rasch analysis and the reliability by internal consistency and intraclass correlation coefficient. The interval scaling properties were assessed by contrasting the raw and weighted London Handicap Scale scores with the Rasch latent estimates. Setting: An outpatient rehabilitation unit of a university hospital. Subjects: One hundred and eighty-eight community-dwelling post-stroke patients (mean age 63 (SD 12) years, 54% male) were assessed by the Turkish version of the London Handicap Scale. Results: After adjustment for local dependency, the data showed good fit to Rasch model expectations with a mean item fit −0.240 (SD 1.868), person fit −0.403 (SD 0.893) and chi-square interaction 8.55 (df 10, P = 0.575). The reliability was good with a Cronbach’s α and intraclass correlation coefficient of 0.845. Analysis of the scaling properties showed that either the raw London Handicap Scale score or its weighted score were non-linear with respect to the Rasch latent estimate. Conclusions: The London Handicap Scale is a valid and reliable scale for use in stroke in Turkey. Its unweighted raw scores and weighted scores are equivalent and ordinal, but a linear transformation is possible through Rasch analysis.
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Affiliation(s)
- Şehim Kutlay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ankara
| | - Ayşe A Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ankara
| | - Burcu Yanık
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Fatih
| | - Atilla Elhan
- Department of Biostatistics, Faculty of Medicine, University of Ankara, Turkey
| | - Derya Öztuna
- Department of Biostatistics, Faculty of Medicine, University of Ankara, Turkey
| | - Alan Tennant
- Department of Rehabilitation Medicine, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, UK
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Brock K, Black S, Cotton S, Kennedy G, Wilson S, Sutton E. Goal achievement in the six months after inpatient rehabilitation for stroke. Disabil Rehabil 2009; 31:880-6. [PMID: 19037772 DOI: 10.1080/09638280802356179] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of the project was to identify characteristics associated with successful re-integration into the community post-inpatient rehabilitation after stroke. A key issue was determining re-integration from the person's perspective, taking into account the person's preferred lifestyle choices. METHOD RESEARCH DESIGN A prospective exploratory follow up study. PARTICIPANTS A consecutive sample of 45 participants discharged from IP rehabilitation following stroke and 23 carers associated with the participants. MEASURES Goal attainment scaling was utilised to determine successful community integration. Factors that may have contributed to goal achievement were measured prior to discharge and at 6 months post-discharge. Scales used include the Functional Independence Measure, Mini Mental test, the CES-D depression scale and a self-efficacy scale, Strategies Used by People to Promote Health. London Handicap Scale scores and Carer Strain Index were collected at 6 months. RESULTS Twenty percent of participants achieved all their goals. Significant correlations were observed between goal achievement score and concurrent measures of physical function, depression and self efficacy at 6 months post-discharge. CONCLUSIONS Stroke survivors who achieved their goals were less likely to be depressed, showed stronger self efficacy beliefs and more positive perceptions of their participation in everyday and community life.
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Affiliation(s)
- Kim Brock
- Rehabilitation Unit, St Vincent's Health, Melbourne, Fitzroy 3065, Victoria, Australia.
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Ackerley SJ, Gordon HJ, Elston AF, Crawford LM, McPherson KM. Assessment of quality of life and participation within an outpatient rehabilitation setting. Disabil Rehabil 2009; 31:906-13. [DOI: 10.1080/09638280802356419] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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van Brakel WH, Anderson AM, Mutatkar RK, Bakirtzief Z, Nicholls PG, Raju MS, Das-Pattanayak RK. The Participation Scale: Measuring a key concept in public health. Disabil Rehabil 2009; 28:193-203. [PMID: 16467054 DOI: 10.1080/09638280500192785] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To develop a scale to measure (social) participation for use in rehabilitation, stigma reduction and social integration programmes. METHOD A scale development study was carried out in Nepal, India and Brazil using standard methods. The instrument was to be based on the Participation domains of the International Classification of Functioning, Disability and Health (ICF), be cross-cultural in nature and assess client-perceived participation. Respondents rated their participation in comparison with a "peer", defined as "someone similar to the respondent in all respects except for the disease or disability". RESULTS An 18-item instrument was developed in seven languages. Crohnbach's alpha was 0.92, intra-tester stability 0.83 and inter-tester reliability 0.80. Discrimination between controls and clients was good at a Participation Score threshold of 12. Responsiveness after a "life change" was according to expectation. CONCLUSIONS The Participation Scale is reliable and valid to measure client-perceived participation in people affected by leprosy or disability. It is expected to be valid in other (stigmatised) conditions also, but this needs confirmation. The scale allows collection of participation data and impact assessment of interventions to improve social participation. Such data may be compared between clients, interventions and programmes. The scale is suitable for use in institutions, but also at the peripheral level.
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Affiliation(s)
- Wim H van Brakel
- Royal Tropical Institute, KIT Leprosy Unit, Wibautstraat 137 J, 1097 DN Amsterdam, The Netherlands.
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Dubuc N, Haley S, Ni P, Kooyoomjian J, Jette A. Function and disability in late life: comparison of the Late-Life Function and Disability Instrument to the Short-Form-36 and the London Handicap Scale. Disabil Rehabil 2009; 26:362-70. [PMID: 15204488 DOI: 10.1080/09638280410001658667] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE We evaluated the Late-Life Function and Disability Instrument's (LLFDI) concurrent validity, comprehensiveness and precision by comparing it with the Short-Form-36 physical functioning (PF-10) and the London Handicap Scale (LHS). METHODS We administered the LLFDI, PF-10 and LHS to 75 community-dwelling adults (> 60 years of age). We used Pearson correlation coefficients to examine concurrent validity and Rasch analysis to compare the item hierarchies, content ranges and precision of the PF-10 and LLFDI function domains, and the LHS and the LLFDI disability domains. RESULTS LLFDI Function (lower extremity scales) and PF-10 scores were highly correlated (r = 0.74 - 0.86, p > 0.001); moderate correlations were found between the LHS and the LLFDI Disability limitation (r = 0.66, p < 0.0001) and Disability frequency (r = 0.47, p < 0.001) scores. The LLFDI had a wider range of content coverage, less ceiling effects and better relative precision across the spectrum of function and disability than the PF-10 and the LHS. The LHS had slightly more content range and precision in the lower end of the disability scale than the LLFDI. CONCLUSIONS The LLFDI is a more comprehensive and precise instrument compared to the PF-10 and LHS for assessing function and disability in community-dwelling older adults.
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Affiliation(s)
- Nicole Dubuc
- Center for Rehabilitation Effectiveness, Sargent College of Health and Rehabilitation Sciences, Boston University, MA 02215, USA
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Simioni S, Ruffieux C, Kleeberg J, Bruggimann L, Annoni JM, Schluep M. Preserved decision making ability in early multiple sclerosis. J Neurol 2008; 255:1762-9. [PMID: 19009335 DOI: 10.1007/s00415-008-0025-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 05/09/2008] [Accepted: 06/05/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this study was to assess decision making in patients with multiple sclerosis (MS) at the earliest clinically detectable time point of the disease. METHODS Patients with definite MS (n = 109) or with clinically isolated syndrome (CIS, n = 56), a disease duration of 3 months to 5 years, and no or only minor neurological impairment (Expanded Disability Status Scale [EDSS] score 0-2.5) were compared to 50 healthy controls using the Iowa Gambling Task (IGT). RESULTS The performance of definite MS, CIS patients, and controls was comparable for the two main outcomes of the IGT (learning index: p = 0.7; total score: p = 0.6). The IGT learning index was influenced by the educational level and the co-occurrence of minor depression. CIS and MS patients developing a relapse during an observation period of 15 months dated from IGT testing demonstrated a lower learning index in the IGT than patients who had no exacerbation (p = 0.02). When controlling for age, gender and education, the difference between relapsing and non-relapsing patients was at the limit of significance (p = 0.06). CONCLUSION Decision making in a task mimicking real life decisions is generally preserved in early MS patients as compared to controls. A possible consequence of MS relapsing activity in the impairment of decision making ability is also suspected in the early phase of MS.
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Affiliation(s)
- S Simioni
- Dept. of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
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Chapman TT, Richard RL, Hedman TL, Renz EM, Wolf SE, Holcomb JB. Combat casualty hand burns: evaluating impairment and disability during recovery. J Hand Ther 2008; 21:150-8; quiz 159. [PMID: 18436137 DOI: 10.1197/j.jht.2007.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Accepted: 12/08/2007] [Indexed: 02/03/2023]
Abstract
This study evaluated the use of the American Medical Association (AMA) impairment guides and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in U.S. military casualties recovering from burn injury to the hand. Study sample included patients with burns to at least one hand and complete evaluations of impairment and disability upon discharge from the hospital and at a follow-up visit less than four months later. AMA and DASH scores were calculated for each visit and standardized response means (SRMs) were calculated to indicate responsiveness. Correlation between impairment and disability was assessed at discharge and follow-up and scores were examined for ability to discriminate between casualties returned to duty (RTD) and casualties not returned to duty (N-RTD). Both outcome instruments revealed a statistically significant change in scores between visits (p<0.001) with corresponding SRM indexes greater than 0.8 (large effect). There was a moderate correlation (r=0.50) between impairment and disability at discharge and a moderately high correlation (r=0.74) at follow-up. Both AMA and DASH scores clearly discriminated between casualties RTD (AMA 10+/-10 and DASH 12+/-12) and casualties N-RTD (AMA 39+/-19 and DASH 41+/-17) with improved accuracy at follow-up visit. The AMA and DASH can provide a comprehensive assessment of impairment and disability and may be used to detect changes in patient health status over time while clearly discriminating between RTD and N-RTD in combat casualties recovering from burn injury to the hand(s).
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Affiliation(s)
- Ted T Chapman
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA
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Basra MKA, Edmunds O, Salek MS, Finlay AY. Measurement of family impact of skin disease: further validation of the Family Dermatology Life Quality Index (FDLQI). J Eur Acad Dermatol Venereol 2008; 22:813-21. [DOI: 10.1111/j.1468-3083.2008.02593.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cott CA, Wiles R, Devitt R. Continuity, transition and participation: preparing clients for life in the community post-stroke. Disabil Rehabil 2008; 29:1566-74. [PMID: 17922327 DOI: 10.1080/09638280701618588] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To examine issues of continuity and transition facing clients as they return to life in the community following stroke and the role of rehabilitation in this process. KEY FINDINGS AND IMPLICATIONS The sudden onset of disability following a stroke represents a major disruption to the continuity of a person's life experience. Rehabilitation has an important role in the transition from the non-disabled to the disabled state however current rehabilitation services and outcomes post-stroke focus on functional recovery rather than on a return to meaningful roles and activities and pay little attention to the transition from the non-disabled to the disabled self. Although some current rehabilitation models address the importance of involvement in a life situation, they do not adequately address issues of the role of the environment, the nature of community, the importance of meaning and choice when thinking about life situations, and change in abilities across the life course. CONCLUSIONS Models of rehabilitation service delivery need to move to a chronic disease management model that incorporates outcomes that are meaningful to clients, and not the assumed needs or outcomes as defined by rehabilitation professionals.
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Affiliation(s)
- Cheryl A Cott
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Canada.
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Wilson K, Mottram P, Hussain M. Survival in the community of the very old depressed, discharged from medical inpatient care. Int J Geriatr Psychiatry 2007; 22:974-9. [PMID: 17299805 DOI: 10.1002/gps.1773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the prevalence and associated risk factors of depression in older patients discharged home from acute medical care and their influence on duration of survival in the community. DESIGN A cross-sectional, prevalence study of depression in recently discharged patients and a prospective, case-controlled study of depressed and psychiatrically asymptomatic sub groups, exploring the relationship between depression, associated risk factors, and duration of survival in the community. SETTING A community study of patients aged 75 and older discharged from the Countess of Chester Hospital and Wirral Hospitals Trust serving Wirral and West Cheshire, England. PARTICIPANTS Three hundred and eleven patients were entered into the prevalence study. One hundred and fifty-eight patients (54 depressed and 104 asymptomatic) were entered into the prospective case controlled study and followed up for up to two years. MEASUREMENTS Depression was defined by GMS/AGECAT criteria. Demographic details, handicap, pain, forced expiratory volume and social network were measured as dependent variables in the prevalence study and included in the analysis of risk factors potentially associated with duration of survival in the community. RESULTS A depression prevalence rate of 17.4% was found. Age (p = 0.049, CI; 0.813, 0.999), forced expiratory volume (p = 0.034, CI; 0.991, 1.000) and handicap (p = 0.000, CI; 1.268, 1.723) were associated with depression but depression (p = 0.040, CI; 1.039, 4.915) was the only base-line variable associated with reduced survival in the community as defined by mortality and re-admission. CONCLUSIONS Depression is common in older people discharged from acute medical care and is a major risk factor for reduced duration of community survival.
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Geyh S, Cieza A, Kollerits B, Grimby G, Stucki G. Content comparison of health-related quality of life measures used in stroke based on the international classification of functioning, disability and health (ICF): a systematic review. Qual Life Res 2007; 16:833-51. [PMID: 17294283 DOI: 10.1007/s11136-007-9174-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 01/03/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine and compare the contents of health-related quality of life (HRQoL) measures used in stroke, based on the ICF as the frame of reference. DESIGN We conducted a systematic literature review to select current generic and condition-specific HRQoL measures applied in stroke. We examined the contents of the selected measures by linking the concepts within the instruments' items to the ICF. RESULTS The systematic literature review resulted in the selection of six generic and seven stroke-specific HRQoL measures. Within the selected instruments we identified 979 concepts. To map these concepts, we used 200 different ICF categories. None of the ICF categories is contained in all of the instruments. The most frequently used category is 'b152 Emotional functions' contained in 53 items from 10 instruments. Stroke-specific measures more often address 'Mental functions', while the selected generic instruments more often include Environmental Factors. DISCUSSION The present study provides an overview on current HRQoL measures in stroke with respect to their covered contents and provides valuable information to facilitate the selection of appropriate instruments for specific purposes in clinical as well as research settings.
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Affiliation(s)
- S Geyh
- ICF Research Branch of the WHO FIC Collaborating Center (DIMDI), IHRS, Ludwig-Maximilians-University, Munich, Germany
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Pajalic Z, Karlsson S, Westergren A. Functioning and subjective health among stroke survivors after discharge from hospital. J Adv Nurs 2006; 54:457-66. [PMID: 16671975 DOI: 10.1111/j.1365-2648.2006.03844.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper reports a study exploring functioning (functions, activities and participation) and subjective health among stroke survivors 6 months after discharge from hospital. A further aim was to investigate patterns of functions and activities, and associations between functioning and subjective health. BACKGROUND Nurses tend to emphasize functional and activity outcomes and rarely look to people's participation in their social world. By integrating individual and social contextual factors in their assessments, nurses will have a powerful tool to broaden their outlook. The International Classification of Functioning, Disability and Health can be used as a framework for understanding the consequences of stroke. Studies are needed, however to make the International Classification of Functioning operational for practical use. METHODS A cross-sectional and explorative design was used using structured interviews and assessments with a number of scales with 89 stroke survivors 6 months after their hospital stay. The measures used were Personal Activities of Daily Living, including cognitive ability, transfer, dressing, bathing, energy to eat, ingestion, swallowing, going to the toilet, faecal continence, and urinary continence; and Instrumental Activities of Daily Living, including washing clothes, cooking, cleaning, transport and shopping. Factor analysis was performed for functions and activities and the final solution had an explained variance of 70%. The data were collected during autumn 2003 and spring 2004. FINDINGS Close associations (r(s) > 0.5) were found between Activities of Daily Living in relation to participation and subjective physical health. CONCLUSION Existing Activities of Daily Living scales were expanded and found to relate to a participation scale and a subjective health scale. Using these scales in nursing care has the potential to correct current bias towards functions and activities by broadening the focus to include the social as well as the physical.
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Affiliation(s)
- Zada Pajalic
- Department of Health Sciences, Kristianstad University, Kristianstad, Sweden.
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Groothuis-Oudshoorn CGM, Chorus AMJ, Taeke van Beekum W, Detmar SB, van den Hout WB. Modelling and estimation of valuations for the Dutch London Handicap Scale. JOURNAL OF HEALTH ECONOMICS 2006; 25:1119-38. [PMID: 16516990 DOI: 10.1016/j.jhealeco.2006.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2005] [Accepted: 01/13/2006] [Indexed: 05/06/2023]
Abstract
This paper presents a study to estimate a preference-based participation index from the Dutch London Handicap Scale (LHS) classification system that can be applied to past or future Dutch LHS data sets. A subset of 60 states were valued by a representative sample of 285 respondents of the Dutch general adult population. Different models were estimated for predicting health state valuations for all 46,656 states defined by the LHS. Several criteria were used for comparison of the different models and for arguing which one is the most preferred model to use. Our data showed that using the English index would give systematic errors for the Dutch population preferences.
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Westergren A, Hagell P. Initial validation of the Swedish version of the London Handicap Scale. Qual Life Res 2006; 15:1251-6. [PMID: 16972161 DOI: 10.1007/s11136-006-0054-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To adapt and evaluate the unweighted version of the London Handicap Scale (LHS) for use in Sweden. MATERIALS & METHODS Respondent burden, linguistic validity and patient perceived relevance was assessed in 16 neurologically ill patients. Internal consistency reliability and construct validity were evaluated among 89 stroke survivors six months after discharge. RESULTS Patients perceived the LHS as relevant and easy to understand and complete. Mean time to complete the questionnaire was 10 min. Cronbach's alpha reliability was 0.85. The LHS differentiated between patients living at home and in special accommodations. As expected, scores correlated strongly and weakly with indices of related and more remote constructs, respectively. There were no floor-, but large ceiling effects. CONCLUSIONS The observations reported here are in accordance with previous studies using the original British LHS and provide initial support for the reliability and validity of the instrument for use in Sweden. However, ceiling effects may limit its usefulness as an outcome measure.
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Affiliation(s)
- Albert Westergren
- Division of Gerontology and Caring Sciences, Department of Health Sciences, Faculty of Medicine, Lund University, P.O. box 157, 221 00 SE Lund, Sweden.
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Chau J, Martin CR, Thompson DR, Chang AM, Woo J. Factor structure of the Chinese version of the Geriatric Depression Scale. PSYCHOL HEALTH MED 2006; 11:48-59. [PMID: 17129894 DOI: 10.1080/13548500500093688] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Depression is common in patients following stroke and has been found to be related to the degree of functional disability, recovery and engagement in rehabilitation. Consequently, screening for depression is crucial in this group in order to facilitate the delivery of appropriate psychological support. The current study sought to determine key psychometric properties of the Chinese version of the Geriatric Depression Scale (GDS) in this group. Three versions of the GDS were evaluated, these being the 30-item original measure (GDS-30), the short-form version comprising 15 items (GDS-SF) and a recently developed innovative four-item version (GDS-4). Confirmatory factor analysis revealed the GDS-30 and GDS-SF to offer an acceptable fit to data suggesting utility of these measures for screening. However, the GDS-4 offered a poor fit to the data, suggesting this measure was an inadequate measure of depression in this clinical group. Further, though GDS-30 and GDS-SF measures revealed good internal consistency, the performance of the GDS-4 was marginal. However, all GDS-derived measures demonstrated excellent convergent and divergent validity. It is concluded that the GDS-30 is a useful and appropriate screening instrument in this group. Further, the GDS-SF shows promise in terms of development as a multidimensional measure of depression that may have predictive and outcome monitoring potential. The psychometric shortcomings of the GDS-4 strongly suggest that this measure is unsuitable for screening in this clinical group.
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Affiliation(s)
- Janita Chau
- Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
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D'Alisa S, Baudo S, Mauro A, Miscio G. How does stroke restrict participation in long-term post-stroke survivors? Acta Neurol Scand 2005; 112:157-62. [PMID: 16097957 DOI: 10.1111/j.1600-0404.2005.00466.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the factors determining 'restricted participation' in a selected population of long-term post-stroke survivors. MATERIALS AND METHODS Seventy-three consecutive post-stroke inpatients were scored for mood and restriction in participation by means of self-administered questionnaires, respectively the Hospital Anxiety and Depression Scale (HADS/A; HADS/D) and London Handicap Scale (LHS). Neurological impairment and functional disability were evaluated with the Unified Neurological Stroke Scale (UNSS) and Functional Independence Measure (FIM). RESULTS Physical independence and occupation were the most severely affected domains on the LHS. UNSS, FIM, HADS/A, HADS/D scores were significant determinants of restriction in participation at univariate analysis performed with each LHS domain. FIM score and emotional status finally emerged as the independent determinants of restricted participation for the LHS domains most related to body function (mobility, physical independence, occupation). Depression was the determinant factor for orientation and social integration. CONCLUSION Functional disability and mood disorders may independently contribute to the restricted participation of post-stroke patients. Most of the LHS domains remain stable over time.
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Affiliation(s)
- S D'Alisa
- Department of Neurology, Istituto Auxologica Italiano, IRCCS, 'San Giuseppe' Hospital, Piancavallo-Oggebio (VB), Italy
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de Kleijn P, van Genderen FR, van Meeteren NLU. Assessing functional health status in adults with haemophilia: towards a preliminary core set of clinimetric instruments based on a literature search in Rheumatoid Arthritis and Osteoarthritis. Haemophilia 2005; 11:308-18. [PMID: 16011581 DOI: 10.1111/j.1365-2516.2005.01117.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
People with haemophilia experience a progressive deterioration of their functional health status. Regular clinical assessment of functional health status provides insight into their process of disablement. As such, the development of a core-set of measurement tools is warranted. The aim of this study was to gather data to prepare a (preliminary) core set of clinically relevant and feasible instruments to assess the functional health status of adults with haemophilia, and to indicate their psychometric qualities. Therefore, clinimetric instruments frequently used in two haemophilia-resembling diseases (Rheumatoid Arthritis and Osteoarthritis) were reviewed from the literature. An extensive search in Medline yielded 13 relevant review articles, incorporating a total of 182 instruments, of which 40 were appropriate for haemophilia. Of these 40 instruments 3 measure body structures, 13 body functions, 19 activities (of which 5 are performance based and 14 self-report based), and 3 measure participation. This classification is based on the International Classification of Functioning, Disability and Health. Detailed information regarding the psychometrics (reliability, validity and responsiveness) of four instruments is described fully in the literature, whereas the psychometrics of the majority of the other instruments are only partly described. The results of this literature study may contribute to the formation of a (preliminary) core set of clinimetric instruments to assess the functional health status of adults with haemophilia. Decisions on the final core set should be held within the Musculoskeletal Committee of the World Federation of Haemophilia.
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Affiliation(s)
- P de Kleijn
- Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, The Netherlands.
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O' Shea SD, Taylor NF, Paratz JD. Measuring changes in activity limitation and participation restriction in people with COPD. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2005. [DOI: 10.12968/ijtr.2005.12.6.18278] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Simone D O' Shea
- Wodonga Regional Health Service, PO Box 156, Wodonga VIC 3689, Australia
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Heinemann AW. Putting outcome measurement in context: A rehabilitation psychology perspective. Rehabil Psychol 2005. [DOI: 10.1037/0090-5550.50.1.6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sturm JW, Dewey HM, Donnan GA, Macdonell RAL, McNeil JJ, Thrift AG. Handicap after stroke: how does it relate to disability, perception of recovery, and stroke subtype?: the north North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2002; 33:762-8. [PMID: 11872901 DOI: 10.1161/hs0302.103815] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Knowledge of patterns of handicap after stroke and of the relationship among handicap, disability, perception of recovery, and stroke subtype is limited. The aim of this study was to assess handicap 3 and 12 months after first-ever stroke in a community-based study. METHODS All strokes occurring in a population of 133 816 people were found and assessed. Patients were classified as having cerebral infarction (CI) or intracerebral hemorrhage (ICH) according to imaging or autopsy findings. Cases of CI were categorized using the Oxfordshire stroke classification. Handicap, disability, and perception of recovery were assessed 3 and 12 months after stroke using the London Handicap Scale, Barthel Index, and the question "Have you made a complete recovery from your stroke?" The association between disability and handicap was examined using Pearson's correlation. Differences in handicap among subtypes of CI were evaluated using one-way ANOVA. RESULTS There were 264 cases of CI or ICH. Of surviving patients, 113 (59%) were assessed at 3 months and 107 (64%) at 12 months. The domains of handicap most affected were physical independence and occupation. Only half the variance in handicap was due to disability. Of patients without disability, those who claimed complete recovery were less handicapped than those who claimed incomplete recovery. Patients with total anterior circulation infarction were more handicapped at 3 and 12 months than those with other subtypes of CI. CONCLUSIONS Stroke patients were handicapped across many domains. Handicap is only partly explained by disability. Stroke subtype should be considered in the interpretation of outcome data.
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Affiliation(s)
- Jonathan W Sturm
- National Stroke Research Institute and Department of Neurology, Austin & Repatriation Medical Centre, West Heidelberg, Victoria 3081, Australia.
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Abstract
OBJECTIVES To describe instruments that have been developed to quantify (aspects of) social outcomes in research on persons with a disability, and to evaluate the clinimetric characteristics of some of the more prominent and promising measures. DATA SOURCES Literature in social health, social psychiatry, developmental disabilities, independent living, gerontology, medical rehabilitation, and quality of life studies. STUDY SELECTION Social outcomes are defined as those changes or differences in the social functioning (broadly defined) of persons with disabilities that result directly or indirectly from impairments and functional limitations. Excluded were measures that focus on purely physical or psychologic aspects of functioning, apply to children only, or quantify 1 social domain only. DATA EXTRACTION For 16 instruments the distribution of items across the participation domains of the International Classification of Impairments, Activities, and Participation is presented, as well as a distribution of items by metrics used. For 5, clinimetric information from published studies were reviewed and summarized in letter grades. DATA SYNTHESIS Several instruments have broad coverage, acceptable respondent burden, and moderate to good reliability, validity, and sensitivity. CONCLUSIONS Social outcomes should be more routinely included in disability and rehabilitation research. Recommendations for selection and further development are made.
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Affiliation(s)
- M P Dijkers
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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