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Lee LJ, Choi SY, Lee HS, Han SW. Efficacy analysis of virtual reality-based training for activities of daily living and functional task training in stroke patients: A single-subject study. Medicine (Baltimore) 2023; 102:e33573. [PMID: 37083778 PMCID: PMC10118341 DOI: 10.1097/md.0000000000033573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Virtual reality (VR)-based training for functions such as cognition, upper extremities, balancing, and activities of daily living (ADL) has been used on stroke patients, and its efficacy has been reported. However, no comparison has been made between the efficacy of VR-based training for daily activities that exactly reproduces ADL and functional training. Therefore, this study sought to analyze the difference in independency enhancement of VR-based training for daily activities compared to cognitive and motor functional training. PATIENT CONCERNS AND DIAGNOSIS This study was conducted on 4 patients who have been diagnosed with stroke and are currently receiving rehabilitation therapy in G hospital located in the city of Gwangju, using A-B-A'-B' design from single-subject experimental designs. INTERVENTIONS Intervention was performed in 2 ways: application of VR-based training for daily activities after the application of cognitive and motor function training; and application of cognitive and motor function training after the application of VR-based training for daily activities. The Assessment of Motor and Process Skills, Computer Cognitive Screening Assessment System, Box and Block Test, and Grip and Pinch Strength Test were used to measure the changes in the performance of daily activities, cognitive function, and upper extremities function. OUTCOMES The results confirmed that the performance of daily activities, cognitive function, and upper extremities function was improved after the application of VR-based intervention. In addition, the efficacy of independency enhancement was maximized by the early approach of training for daily activities at the time of VR-based intervention in stroke patients. CONCLUSIONS VR-based intervention of training for daily activities and functional training can be considered to benefit the improvement of the performance of daily activities, cognitive function, and upper extremities function in stroke patients. In addition, although functional training was also effective in enhancing independency and functional improvement in stroke patients, an early approach to training for ADL based on tasks with objectives was deemed to be more effective.
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Affiliation(s)
- Lan-Ju Lee
- Department of Occupational Therapy, Gwangju Heemang Hospital, Haseo-ro, Buk-gu, Gwangju, Korea
| | - Seong-Youl Choi
- Department of Occupational Therapy, Kangwon National University, Dogye-eup, Samcheok-si, Gangwon-do, Korea
| | - Hye-Sun Lee
- Department of Occupational Therapy, Kwangju Women’s University, Yeodae-gil, Gwangsan-gu, Gwangju, Korea
| | - Sang-Woo Han
- Department of Occupational Therapy, Kwangju Women’s University, Yeodae-gil, Gwangsan-gu, Gwangju, Korea
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Pinelli M, Manetti S, Lettieri E. Assessing the Social and Environmental Impact of Healthcare Technologies: Towards an Extended Social Return on Investment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5224. [PMID: 36982131 PMCID: PMC10049561 DOI: 10.3390/ijerph20065224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Stroke is the third leading cause of death and disability overall worldwide. Upper limb impairment is a common consequence for stroke survivors, having negative impact on their quality of life. Robotic rehabilitation, through repetitive and monitored movements, can improve their status. Developed by a team of researchers at Politecnico di Milano, AGREE is an exoskeleton for upper limb rehabilitation at the stage gate between translational research and clinical validation. Since the cost of this device is particularly high, the present study aimed to provide a framework for assessing its value. The Social Return on Investment (SROI) method, able to grasp the economic, social and environmental impact of an activity, was applied, using expert opinions of a pool of clinical engineers and healthcare professionals from different Italian hospitals to obtain information. Environmental impacts were estimated through Life Cycle Assessment in terms of CO2 emissions and incorporated in the analysis. Considering a 5-year period, the SROI for a single exoskeleton was 3.75:1, and the SROI for the number of exoskeletons projected to be sold was 2.868:1, thus resulting largely in value for money. This study provides a model for combining economic, social and environmental outcomes that, besides contributing to theory, could be useful for decision-making.
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Miller P, Vakidis T, Taylor N, Baker T, Stella J, Egerton-Warburton D, Hyder S, Staiger P, Bowe SJ, Shepherd J, Zordan R, Walby A, Jones ML, Caldicott D, Barker D, Hall M, Doran CM, Ezard N, Preisz P, Havard A, Shakeshaft A, Akhlaghi H, Kloot K, Lowry N, Bumpstead S. Most common principal diagnoses assigned to Australian emergency department presentations involving alcohol use: a multi-centre study. Aust N Z J Public Health 2022; 46:903-909. [PMID: 36121276 DOI: 10.1111/1753-6405.13303] [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: 12/01/2021] [Revised: 04/01/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Alcohol is the most widely consumed psychoactive substance in Australia and the consequences of alcohol consumption have enormous personal and social impacts. This study aimed to describe the principal diagnoses of emergency department (ED) presentations involving alcohol use in the previous 12 hours at eight hospitals in Victoria and the Australian Capital Territory, Australia. METHODS Twelve months' data (1 July 2018 - 30 June 2019) were collected from eight EDs, including demographics, ICD-10 codes, hospital location and self-reported drinking in the preceding 12 hours. The ten most common ICD-10 discharge codes were analysed based on age, sex and hospital geographic area. RESULTS ICD codes pertaining to mental and behavioural disorders due to alcohol use accounted for the highest proportion in most EDs. Suicide ideation/attempt was in the five highest ICD codes for all but one hospital. It was the second most common alcohol-related presentation for both males and females. CONCLUSIONS Alcohol plays a major role in a range of presentations, especially in relation to mental health and suicide. IMPLICATIONS FOR PUBLIC HEALTH The collection of alcohol involvement in ED presentations represents a major step forward in informing the community about the burden of alcohol on their health resources.
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Affiliation(s)
- Peter Miller
- School of Psychology, Deakin University, Victoria
| | - Thea Vakidis
- School of Psychology, Deakin University, Victoria
| | - Nicholas Taylor
- School of Psychology, Deakin University, Victoria.,National Drug Research Institute, Curtin University, Victoria
| | - Tim Baker
- Centre for Rural Emergency Medicine, Faculty of Health, Deakin University, Victoria.,South West Healthcare, Victoria
| | | | | | | | | | | | - Jonathan Shepherd
- Crime and Security Research Institute, Cardiff University, Wales, UK
| | - Rachel Zordan
- St Vincent's Hospital Melbourne, Victoria.,Melbourne Medical School, University of Melbourne, Victoria
| | | | - Martyn Lloyd Jones
- VMO Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria.,Alfred Addiction and Mental Health, the Alfred Hospital, Victoria
| | | | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, New South Wales
| | | | - Christopher M Doran
- Cluster for Resilience and Well-being, Appleton Institute, Central Queensland University, Queensland
| | - Nadine Ezard
- St Vincent's Hospital Sydney, National Centre for Clinical Research on Emerging Drugs, New South Wales.,National Drug and Alcohol Research Centre, UNSW Sydney, New South Wales
| | - Paul Preisz
- St Vincent's Hospital Darlinghurst, New South Wales.,Faculty of Medicine & Health, UNSW Sydney, New South Wales.,School of Medicine, University Notre Dame, New South Wales
| | - Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, New South Wales.,Centre for Big Data Research in Health, UNSW Sydney, New South Wales
| | | | - Hamed Akhlaghi
- St Vincent's Hospital Melbourne, Victoria.,Melbourne Medical School, University of Melbourne, Victoria
| | - Kate Kloot
- School of Medicine, Deakin University, Victoria
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Qu JF, Zhong HH, Liang WC, Chen YK, Liu YL, Li W. Neuroimaging risk factors for participation restriction after acute ischemic stroke: 1-year follow-up study. J Investig Med 2021; 70:363-368. [PMID: 34611033 PMCID: PMC8819659 DOI: 10.1136/jim-2020-001675] [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] [Accepted: 09/15/2021] [Indexed: 11/06/2022]
Abstract
The aim of the present study was to determine the neuroimaging predictors of poor participation after acute ischemic stroke. A total of 443 patients who had acute ischemic stroke were assessed. At 1-year recovery, the Reintegration to Normal Living Index was used to assess participation restriction. We also assessed the Activities of Daily Living Scale and modified Rankin Scale (mRS) score. Brain MRI measurement included acute infarcts and pre-existing abnormalities such as enlarged perivascular spaces, white matter lesions, ventricular-brain ratio, and medial temporal lobe atrophy (MTLA). The study included 324 men (73.1%) and 119 women (26.9%). In the univariate analysis, patients with poor participation after 1 year were older, more likely to be men, had higher National Institutes of Health Stroke Scale (NIHSS) score on admission, with more histories of hypertension and atrial fibrillation, larger infarct volume, more severely enlarged perivascular spaces and MTLA, and more severe periventricular hyperintensities and deep white matter hyperintensities. Patients with participation restriction also had poor activities of daily living (ADL) and mRS score. Multiple logistic regression showed that, in model 1, age, male gender, NIHSS score on admission, and ADL on follow-up were significant predictors of poor participation, accounting for 60.2% of the variance. In model 2, which included both clinical and MRI variables, male gender, NIHSS score on admission, ADL on follow-up, and MTLA were significant predictors of poor participation, accounting for 61.2% of the variance. Participation restriction was common after acute ischemic stroke despite good mRS score. Male gender, stroke severity, severity of ADL on follow-up, and MTLA may be predictors of poor participation. Trial registration number ChiCTR1800016665.
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Affiliation(s)
- Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Huo-Hua Zhong
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Wen-Cong Liang
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Wei Li
- Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
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Wijeratne T, Sales C, Wijeratne C, Jakovljevic M. Happiness: A Novel Outcome Measure in Stroke? Ther Clin Risk Manag 2021; 17:747-754. [PMID: 34349515 PMCID: PMC8327473 DOI: 10.2147/tcrm.s307587] [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: 02/20/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022] Open
Abstract
In this narrated review, we draw attention to the use of happiness as a novel outcome measure in clinical research studies regarding patients with stroke. Commonly used outcome measures in clinical trials in stroke rehabilitation include the modified Rankin Score (mRS), Functional Impairment Measures (FIM), Barthel Index and quality of life (QoL). Despite being a part of QoL, happiness is arguably a significant construct on its own. While QoL assesses perceptions of various extrinsic aspects of life, happiness may be used as a measure of subjective enjoyment of life after an illness. We review the literature discussing the use of happiness as a formal outcome measure in stroke care and subacute and long-term stroke rehabilitation. Ultimately we recommend the wider use of happiness as an outcome measure where appropriate in these settings. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/iJY-DFLp2WU
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Affiliation(s)
- Tissa Wijeratne
- Department of Neurology, Sunshine Hospital, Western Health, St. Albans, VIC, Australia.,Department of Psychology & Counselling, School of Psychology & Public Health, La Trobe University, Bundoora, VIC, Australia.,Department of Medicine, AIMSS, Melbourne Medical School, University of Melbourne, Sunshine Hospital, St Albans, VIC, Australia.,Department of Medicine, University of Rajarata, Salypura, Anuradhapuraya, Sri Lanka
| | - Carmela Sales
- Department of Neurology, Sunshine Hospital, Western Health, St. Albans, VIC, Australia.,Department of Psychology & Counselling, School of Psychology & Public Health, La Trobe University, Bundoora, VIC, Australia
| | | | - Mihajlo Jakovljevic
- Department Global Health Economics & Policy, University of Kragujevac Faculty of Medical Sciences, Kragujevac, Serbia.,Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan
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Rieke JD, Matarasso AK, Yusufali MM, Ravindran A, Alcantara J, White KD, Daly JJ. Development of a combined, sequential real-time fMRI and fNIRS neurofeedback system to enhance motor learning after stroke. J Neurosci Methods 2020; 341:108719. [PMID: 32439425 DOI: 10.1016/j.jneumeth.2020.108719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND After stroke, wrist extension dyscoordination precludes functional arm/hand. We developed a more spatially precise brain signal for use in brain computer interface (BCI's) for stroke survivors. NEW METHOD Combination BCI protocol of real-time functional magnetic resonance imaging (rt-fMRI) sequentially followed by functional near infrared spectroscopy (rt-fNIRS) neurofeedback, interleaved with motor learning sessions without neural feedback. Custom Matlab and Python code was developed to provide rt-fNIRS-based feedback to the chronic stroke survivor, system user. RESULTS The user achieved a maximum of 71 % brain signal accuracy during rt-fNIRS neural training; progressive focus of brain activation across rt-fMRI neural training; increasing trend of brain signal amplitude during wrist extension across rt-fNIRS training; and clinically significant recovery of arm coordination and active wrist extension. COMPARISON WITH EXISTING METHODS Neurorehabilitation, peripherally directed, shows limited efficacy, as do EEG-based BCIs, for motor recovery of moderate/severely impaired stroke survivors. EEG-based BCIs are based on electrophysiological signal; whereas, rt-fMRI and rt-fNIRS are based on neurovascular signal. CONCLUSION The system functioned well during user testing. Methods are detailed for others' use. The system user successfully engaged rt-fMRI and rt-fNIRS neurofeedback systems, modulated brain signal during rt-fMRI and rt-fNIRS training, according to volume of brain activation and intensity of signal, respectively, and clinically significantly improved limb coordination and active wrist extension. fNIRS use in this case demonstrates a feasible/practical BCI system for further study with regard to use in chronic stroke rehab, and fMRI worked in concept, but cost and some patient-use issues make it less feasible for clinical practice.
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Affiliation(s)
- Jake D Rieke
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Department of Biomedical Engineering (BME), NEB Building, University of Florida, Gainesville, FL, 32608, USA
| | - Avi K Matarasso
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Dept of Chemical Engineering, NEB Building, UF, Gainesville, FL, 32608, USA
| | - M Minhal Yusufali
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Department of Biomedical Engineering (BME), NEB Building, University of Florida, Gainesville, FL, 32608, USA
| | - Aniruddh Ravindran
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Department of Biomedical Engineering (BME), NEB Building, University of Florida, Gainesville, FL, 32608, USA
| | - Jose Alcantara
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Department of Biomedical Engineering (BME), NEB Building, University of Florida, Gainesville, FL, 32608, USA
| | - Keith D White
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Janis J Daly
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Dept of Neurology, College of Medicine, UF, Gainesville, FL, 32608, USA.
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Veronese G, Pepe A, Massaiu I, De Mol AS, Robbins I. Posttraumatic growth is related to subjective well-being of aid workers exposed to cumulative trauma in Palestine. Transcult Psychiatry 2017; 54:332-356. [PMID: 28540769 DOI: 10.1177/1363461517706288] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study examined how stress reactions after traumatic events influence subjective well-being (SWB) via the indirect effect of posttraumatic growth (PTG) in two samples of Palestinian professional helpers from the Gaza Strip and West Bank ( n = 201). Using the General Health Questionnaire (GHQ-12) as a dependent measure of well-being, and PTGI-10, PANAS-20, WHO-5 BREF, and IES-13 questionnaires as independent variables, structural equation modelling (SEM) was used to examine whether: (a) cumulative trauma was negatively and directly related to subjective well-being; (b) levels of trauma were positively and directly related to posttraumatic growth; and (c) PTG was positively and directly related to subjective well-being. The findings suggest that posttraumatic growth contributes to mitigating and buffering (on the order of approximately 10%) the effect of trauma on subjective well-being. PTG seems to be a resource that can help aid workers deal with the consequences of stressful life events. Clinical implications and directions for supervision and training are discussed.
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ArmAssist Robotic System versus Matched Conventional Therapy for Poststroke Upper Limb Rehabilitation: A Randomized Clinical Trial. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7659893. [PMID: 28251157 PMCID: PMC5306984 DOI: 10.1155/2017/7659893] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/15/2016] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
Abstract
The ArmAssist is a simple low-cost robotic system for upper limb motor training that combines known benefits of repetitive task-oriented training, greater intensity of practice, and less dependence on therapist assistance. The aim of this preliminary study was to compare the efficacy of ArmAssist (AA) robotic training against matched conventional arm training in subacute stroke subjects with moderate-to-severe upper limb impairment. Twenty-six subjects were enrolled within 3 months of stroke and randomly assigned to the AA group or Control group (n = 13 each). Both groups were trained 5 days per week for 3 weeks. The primary outcome measure was Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, and the secondary outcomes were Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS) and Barthel index (BI). The AA group, in comparison to the Control group, showed significantly greater increases in FMA-UE score (18.0 ± 9.4 versus 7.5 ± 5.5, p = 0.002) and WMFT-FAS score (14.1 ± 7.9 versus 6.7 ± 7.8, p = 0.025) after 3 weeks of treatment, whereas the increase in BI was not significant (21.2 ± 24.8 versus 13.1 ± 10.7, p = 0.292). There were no adverse events. We conclude that arm training using the AA robotic device is safe and able to reduce motor deficits more effectively than matched conventional arm training in subacute phase of stroke. The study has been registered at the ClinicalTrials.gov, ID: NCT02729649.
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Petitte T, Mallow J, Barnes E, Petrone A, Barr T, Theeke L. A Systematic Review of Loneliness and Common Chronic Physical Conditions in Adults. ACTA ACUST UNITED AC 2015; 8:113-132. [PMID: 26550060 PMCID: PMC4636039 DOI: 10.2174/1874350101508010113] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.
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Affiliation(s)
- Trisha Petitte
- West Virginia University School of Nursing, United State of America
| | - Jennifer Mallow
- West Virginia University School of Nursing, United State of America ; Robert Wood Johnson Nurse Faculty Scholar, United State of America
| | - Emily Barnes
- West Virginia University School of Nursing, United State of America
| | - Ashley Petrone
- Department of Neurobiology and Anatomy, Center for Neuroscience, West Virginia, United State of America ; Center for Basic and Translational Stroke Research, West Virginia, United State of America
| | - Taura Barr
- West Virginia University School of Nursing, United State of America ; Department of Neurobiology and Anatomy, Center for Neuroscience, West Virginia, United State of America ; Center for Basic and Translational Stroke Research, West Virginia, United State of America ; Robert Wood Johnson Nurse Faculty Scholar, United State of America
| | - Laurie Theeke
- West Virginia University School of Nursing, United State of America ; Robert Wood Johnson Nurse Faculty Scholar, United State of America
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Sivan M, Gallagher J, Makower S, Keeling D, Bhakta B, O'Connor RJ, Levesley M. Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting. J Neuroeng Rehabil 2014; 11:163. [PMID: 25495889 PMCID: PMC4280043 DOI: 10.1186/1743-0003-11-163] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/05/2014] [Indexed: 11/29/2022] Open
Abstract
Background Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness. Methods hCAAR device comprises of a joystick handle moved by the weak upper limb to perform tasks on the computer screen. The device provides assistance to the movements depending on users ability. Nineteen participants (stroke survivors with upper limb weakness) were recruited. Outcome measures performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and 1 month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI) and ABILHAND. Results Two participants were unable to use hCAAR: one due to severe paresis and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. No serious adverse events were reported. The median usage time was 433 minutes (IQR 250 – 791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes. Conclusions The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently for eight weeks in their own homes with minimal supervision from healthcare professionals. Statistically significant improvements were observed in the kinematic and clinical outcomes in the study. Electronic supplementary material The online version of this article (doi:10.1186/1743-0003-11-163) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds LS1 3EX, UK.
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Theeke L, Horstman P, Mallow J, Lucke-Wold N, Culp S, Domico J, Barr T. Quality of life and loneliness in stroke survivors living in Appalachia. J Neurosci Nurs 2014; 46:E3-15. [PMID: 25365057 PMCID: PMC4413920 DOI: 10.1097/jnn.0000000000000097] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Negative outcomes of stroke are associated with poorer quality of life (QoL) and impact stroke recovery. The purpose of this study was to characterize QoL and loneliness in a sample of rural Appalachian stroke survivors within 1 year of stroke. METHODS Using mail survey methodology, survey data were collected from 121 ischemic and hemorrhagic stroke survivors living in West Virginia using 13 subscales from the Neuro-QOL survey and the three-item UCLA Loneliness Scale. Statistical Package for Social Sciences v. 20 was used to conduct descriptive, comparative, and predictive analyses. Multiple linear regression models were used to assess explanatory value of loneliness for QoL domains while controlling for comorbidities. RESULTS Participants who were discharged to a nursing home had poorer QoL when compared with those who were discharged to home. Stroke survivors who continued to smoke were less satisfied with social roles and reported higher mean loneliness and depression scores. History of psychological problems negatively correlated with all QoL domains and loneliness scores. Loneliness predicted poorer QoL even when controlling for age, gender, and significant comorbidities. CONCLUSION Nurses need to assess for loneliness, include loneliness in care planning, and implement smoking cessation and cognitive behavioral interventions. Interventions that target loneliness for stroke survivors could potentially diminish psychological sequelae after stroke and enhance QoL.
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Affiliation(s)
- Laurie Theeke
- Questions or comments about this article may be directed to Laurie Theeke, PhD FNP-BC GCNS-BC, at . She is an Associate Professor, West Virginia University (WVU) School of Nursing, Morgantown, WV. Patricia Horstman, RN MSN NEA-BC, is Director, Clinical Program Development, WVU Healthcare, Morgantown, WV. Jennifer Mallow, PhD FNP-BC, is Assistant Professor, WVU School of Nursing, Morgantown, WV. Noelle Lucke-Wold, BSN RN, is Student, WVU School of Nursing, Morgantown, WV. Stacey Culp, PhD, is Research Assistant Professor, WVU Healthcare, Morgantown, WV. Jennifer Domico, RN CCRP, is Nurse Clinician, WVU Healthcare, Morgantown, WV. Taura Barr, PhD RN, is Assistant Professor, WVU School of Nursing and Emergency Medicine, Morgantown, WV
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Donkor ES, Owolabi MO, Bampoh PO, Amoo PK, Aspelund T, Gudnason V. Profile and health-related quality of life of Ghanaian stroke survivors. Clin Interv Aging 2014; 9:1701-8. [PMID: 25336935 PMCID: PMC4199965 DOI: 10.2147/cia.s62371] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of mortality with a major effect on health-related quality of life (HRQoL). There are no previous studies exploring HRQoL among stroke survivors in Ghana, despite the increasing public health significance of the disease in this country. Here we describe the profile of and factors associated with HRQoL among stroke survivors in Ghana. METHODS This was a cross-sectional study involving 156 stroke survivors and 156 age- and sex-matched, apparently healthy controls. A robust HRQoL questionnaire involving seven domains was used to collect data from the study participants. Clinical epidemiology data were also collected from stroke survivors on parameters such as stroke severity and risk factors. Statistical analyses were performed on the interrelationships among the study variables. RESULTS The mean ages of the stroke survivors and healthy controls were 58.0 (standard deviation, 11.4) and 57.6 (standard deviation, 12.0) years, respectively. Fifty-three percent (86) of the stroke survivors had mild stroke and 35.3% (55) had moderate stroke, whereas 12.2% (19) had severe stroke. Ischemic infarction was the prevalent stroke subtype (78.1%). Hypertension was the most common risk factor (89%) among the stroke survivors, followed by diabetes (29%). HRQoL scores ranged from 57.7% (cognitive domain) to 80.0% (spirit domain) for stroke survivors, whereas HRQoL scores of the control group ranged from 65.6% (cognitive domain) to 85.2% (soul domain). For each HRQoL domain, significantly higher scores were observed for the control group compared with the stroke survivors, at P<0.05. Determinants of HRQoL of stroke survivors in multivariate analysis included age, stroke severity, poststroke duration, stroke recurrence, frequency of laughter, and negative emotions. CONCLUSION The most affected HRQoL domains are of the physical, psychoemotional, and cognitive domains. Rehabilitation of stroke patients in this region should include interventions targeted at these domains and modifying the statistical determinants of HRQoL where possible.
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Affiliation(s)
- Eric S Donkor
- College of Health Sciences, University of Ghana, Accra, Ghana ; Centre for Public Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Mayowa O Owolabi
- Department of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | - Philip K Amoo
- Public Health Unit, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Thor Aspelund
- Centre for Public Health Sciences, University of Iceland, Reykjavík, Iceland ; Icelandic Heart Association Research Institute, Kopavogur, Iceland
| | - Vilmundur Gudnason
- Centre for Public Health Sciences, University of Iceland, Reykjavík, Iceland ; Icelandic Heart Association Research Institute, Kopavogur, Iceland
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Reliability and validity of the Nigerian (Hausa) version of the Stroke Impact Scale (SIS) 3.0 index. BIOMED RESEARCH INTERNATIONAL 2014; 2014:302097. [PMID: 25276774 PMCID: PMC4170699 DOI: 10.1155/2014/302097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/25/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022]
Abstract
This study aims to test the translated Hausa version of the stroke impact scale SIS (3.0) and further evaluate its psychometric properties. The SIS 3.0 was translated from English into Hausa and was tested for its reliability and validity on a stratified random sample adult stroke survivors attending rehabilitation services at stroke referral hospitals in Kano, Nigeria. Psychometric analysis of the Hausa-SIS 3.0 involved face, content, criterion, and construct validity tests as well as internal and test-retest reliability. In reliability analyses, the Cronbach's alpha values for the items in Strength, Hand function, Mobility, ADL/IADL, Memory and thinking, Communication, Emotion, and Social participation domains were 0.80, 0.92, 0.90, 0.78, 0.84, 0.89, 0.58, and 0.74, respectively. There are 8 domains in stroke impact scale 3.0 in confirmatory factory analysis; some of the items in the Hausa-SIS questionnaire have to be dropped due to lack of discriminate validity. In the final analysis, a parsimonious model was obtained with two items per construct for the 8 constructs (Chi-square/df < 3, TLI and CFI > 0.9, and RMSEA < 0.08). Cross validation with 1000 bootstrap samples gave a satisfactory result (P = 0.011). In conclusion, the shorter 16-item Hausa-SIS seems to measure adequately the QOL outcomes in the 8 domains.
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Niklasson J, Lövheim H, Gustafson Y. Morale in very old people who have had a stroke. Arch Gerontol Geriatr 2014; 58:408-14. [DOI: 10.1016/j.archger.2013.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 11/19/2013] [Accepted: 11/21/2013] [Indexed: 12/21/2022]
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Bakken LN, Kim HS, Finset A, Lerdal A. Subjective sleep quality in relation to objective sleep estimates: comparison, gender differences and changes between the acute phase and the six-month follow-up after stroke. J Adv Nurs 2013; 70:639-50. [DOI: 10.1111/jan.12228] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/27/2013] [Accepted: 07/20/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Linda N. Bakken
- Faculty of Health Sciences; Buskerud University College; Drammen Norway
- Department of Behavioural Sciences in Medicine; Institute of Basic Medical Sciences; Faculty of Medicine; University of Oslo; Norway
| | - Hesook Suzie Kim
- Faculty of Health Sciences; Buskerud University College; Drammen Norway
| | - Arnstein Finset
- Department of Behavioural Sciences in Medicine; Institute of Basic Medical Sciences; Faculty of Medicine; University of Oslo; Norway
| | - Anners Lerdal
- Department of Research; Lovisenberg Diakonale Hospital; Oslo Norway
- Department of Nursing Science; Institute of Health and Society; Faculty of Medicine; University of Oslo; Norway
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Mavaddat N, Van der Linde R, Savva GM, Brayne C, Mant J. What determines the self-rated health of older individuals with stroke compared to other older individuals? A cross-sectional analysis of the Medical Research Council Cognitive Function and Aging Study. BMC Geriatr 2013; 13:85. [PMID: 23968389 PMCID: PMC3847649 DOI: 10.1186/1471-2318-13-85] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 08/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor self-rated health has been associated with poorer objective health outcomes across a range of conditions including stroke. Identification of factors associated with poor self-rated health in stroke survivors has received little attention compared to that in other older individuals. This study identifies determinants of self-rated health in older individuals with or without a history of stroke participating in the population-representative MRC Cognitive Function and Aging Study (MRC CFAS). METHODS The MRC CFAS is a multicentred longitudinal survey of a population representative sample of people in their 65th year and older at baseline. Baseline interview included questions about functional disability, psychiatric history, independent living status, social interactions, and cognitive function. Multiple logistic regression was used to determine associations between demographic, physical, cognitive, psychological and social factors with poor self-rated health among those with and without stroke. RESULTS After excluding those with impaired cognitive function, 776 individuals out of 11,957 reported a stroke. Factors associated with self-rated health were similar between those with or without a stroke in older individuals. Poorer self-rated health in those who had suffered a stroke was associated predominantly with the presence of comorbidity with diabetes (OR 3.5; 95% CI 1.5-8.1) and not "getting out and about" (OR 2.6; 95% CI 1.7-4.1) even after adjustment for disability levels and for depression. In those without a stroke the most important determinants were disability (OR 3.9; 95% CI 3.2-4.8) and not "getting out and about" (OR 2.9; 95% CI 2.5-3.3). The presence of disability was less strongly associated with poor self-rated health in those with a history of stroke than those without due to a substantially higher reporting of poor self-rated health in the non-disabled stroke group than the non-disabled stroke-free group, while those with disabilities reported poor self-rated health irrespective of stroke status. CONCLUSIONS Self-rated health is determined by a range of psychological and social factors in addition to disability in older patients with stroke. Addressing social integration and mobility out of the home is an important element of rehabilitation for older people with stroke as well as those without.
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Affiliation(s)
- Nahal Mavaddat
- Department of Public Health and Primary Care, University of Cambridge Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - Rianne Van der Linde
- Department of Public Health and Primary Care, University of Cambridge Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - George M Savva
- School of Nursing Sciences, University of East Anglia Norwich Research Park, Norwich NR4 7TJ, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
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Huang YH, Wu CY, Lin KC, Hsieh YW, Snow WM, Wang TN. Determinants of change in stroke-specific quality of life after distributed constraint-induced therapy. Am J Occup Ther 2013; 67:54-63. [PMID: 23245783 DOI: 10.5014/ajot.2013.004820] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We identified the predictive factors of change in quality of life (QOL) after a distributed form of constraint-induced therapy (dCIT) among stroke survivors. METHOD Seventy-four participants were treated with dCIT. We identified eight potential determinants of change: age, gender, side of lesion, time since stroke, cognitive status, motor impairment of the upper extremity, activities of daily living (ADLs), and instrumental ADLs (IADLs). The Stroke-Specific Quality of Life Scale (SS-QOL) was used to assess QOL. RESULTS Right-sided lesion and onset >17 mo earlier determined greater improvement in the SS-QOL Energy domain. Onset >10 mo earlier, poorer IADL performance, and age >68 yr predicted improvement in the Family Role, Mobility, and Mood domains, respectively. CONCLUSION Side of lesion, time since stroke, IADL performance, and age were the most important determinants of QOL in patients receiving stroke motor rehabilitation.
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Affiliation(s)
- Yan-Hua Huang
- Department of Occupational Therapy, School of Health and Human Services, College of Professional Studies, California State University, Dominguez Hills, USA
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Adegoke BO, Oni AA, Gbiri CA, Akosile CO. Paralytic poliomyelitis: Quality of life of adolescent survivors. Hong Kong Physiother J 2012. [DOI: 10.1016/j.hkpj.2012.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ho NSK, Tong KY, Hu XL, Fung KL, Wei XJ, Rong W, Susanto EA. An EMG-driven exoskeleton hand robotic training device on chronic stroke subjects: task training system for stroke rehabilitation. IEEE Int Conf Rehabil Robot 2012; 2011:5975340. [PMID: 22275545 DOI: 10.1109/icorr.2011.5975340] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An exoskeleton hand robotic training device is specially designed for persons after stroke to provide training on their impaired hand by using an exoskeleton robotic hand which is actively driven by their own muscle signals. It detects the stroke person's intention using his/her surface electromyography (EMG) signals from the hemiplegic side and assists in hand opening or hand closing functional tasks. The robotic system is made up of an embedded controller and a robotic hand module which can be adjusted to fit for different finger length. Eight chronic stroke subjects had been recruited to evaluate the effects of this device. The preliminary results showed significant improvement in hand functions (ARAT) and upper limb functions (FMA) after 20 sessions of robot-assisted hand functions task training. With the use of this light and portable robotic device, stroke patients can now practice more easily for the opening and closing of their hands at their own will, and handle functional daily living tasks at ease. A video is included together with this paper to give a demonstration of the hand robotic system on chronic stroke subjects and it will be presented in the conference.
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Affiliation(s)
- N S K Ho
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Morris JH, van Wijck F, Joice S, Donaghy M. Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction. Disabil Rehabil 2012; 35:291-9. [DOI: 10.3109/09638288.2012.691942] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gbiri CA, Akinpelu AO. Quality of life of Nigerian stroke survivors during first 12 months post-stroke. Hong Kong Physiother J 2012. [DOI: 10.1016/j.hkpj.2012.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Coupar F, Pollock A, Legg LA, Sackley C, van Vliet P. Home-based therapy programmes for upper limb functional recovery following stroke. Cochrane Database Syst Rev 2012; 2012:CD006755. [PMID: 22592715 PMCID: PMC6464926 DOI: 10.1002/14651858.cd006755.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND With an increased focus on home-based stroke services and the undertaking of programmes, targeted at upper limb recovery within clinical practice, a systematic review of home-based therapy programmes for individuals with upper limb impairment following stroke was required. OBJECTIVES To determine the effects of home-based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke. SEARCH METHODS We searched the Cochrane Stroke Group's Specialised Trials Register (May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to May 2011), EMBASE (1980 to May 2011), AMED (1985 to May 2011) and six additional databases. We also searched reference lists and trials registers. SELECTION CRITERIA Randomised controlled trials (RCTs) in adults after stroke, where the intervention was a home-based therapy programme targeted at the upper limb, compared with placebo, or no intervention or usual care. PRIMARY OUTCOMES were performance in activities of daily living (ADL) and functional movement of the upper limb. SECONDARY OUTCOMES were performance in extended ADL and motor impairment of the arm. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of risk of bias in terms of method of randomisation and allocation concealment (selection bias), blinding of outcome assessment (detection bias), whether all the randomised patients were accounted for in the analysis (attrition bias) and the presence of selective outcome reporting. MAIN RESULTS We included four studies with 166 participants. No studies compared the effects of home-based upper limb therapy programmes with placebo or no intervention. Three studies compared the effects of home-based upper limb therapy programmes with usual care. PRIMARY OUTCOMES we found no statistically significant result for performance of ADL (mean difference (MD) 2.85; 95% confidence interval (CI) -1.43 to 7.14) or functional movement of the upper limb (MD 2.25; 95% CI -0.24 to 4.73)). SECONDARY OUTCOMES no statistically significant results for extended ADL (MD 0.83; 95% CI -0.51 to 2.17)) or upper limb motor impairment (MD 1.46; 95% CI -0.58 to 3.51). One study compared the effects of a home-based upper limb programme with the same upper limb programme based in hospital, measuring upper limb motor impairment only; we found no statistically significant difference between groups (MD 0.60; 95% CI -8.94 to 10.14). AUTHORS' CONCLUSIONS There is insufficient good quality evidence to make recommendations about the relative effect of home-based therapy programmes compared with placebo, no intervention or usual care.
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Affiliation(s)
- Fiona Coupar
- Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK.
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Donnellan C, Hickey A, Hevey D, O'Neill D. Effect of mood symptoms on recovery one year after stroke. Int J Geriatr Psychiatry 2010; 25:1288-95. [PMID: 21086539 DOI: 10.1002/gps.2482] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Depression and anxiety are the most common mood symptoms and psychological consequences of stroke. This study aimed to examine the influence of acute depression and anxiety symptoms on functional recovery and health-related quality of life (HRQoL) one year after stroke. METHODS At one month and one year after stroke, the prevalence and severity of depression and anxiety symptoms were examined in consecutively admitted patients, using the Hospital Anxiety and Depression Scale (HADS). Functional recovery was assessed using the Nottingham Extended Activities of Daily Living (NEADL) and HRQoL using the Stroke-Specific Quality of Life scale (SSQOL). RESULTS In 107 patients, the prevalence of depression and anxiety symptoms was 35% at one month and 36% and 34%, respectively, at one year. Depression symptoms were significantly associated with functional ability (r = -0.19, p < 0.05) and HRQoL (r = -0.41, p < 0.001) at one year. Anxiety symptoms were significantly associated with HRQoL (r = -0.33, p < 0.001) only. Multivariate analyses indicated that both depression (β = -0.33, p < 0.001) and anxiety (β = -0.26, p < 0.01) symptoms explained some variance in HRQoL at one month and did not predict functional recovery or HRQoL at one year, after controlling for other independent variables such as stroke severity and pre-morbid conditions. DISCUSSION Mood symptoms following acute stroke were associated with a poorer HRQoL one year later but only depression symptoms influenced functional recovery. Other clinical factors such as pre-morbid conditions may need to be taken into consideration when determining the effect of mood symptoms on stroke recovery.
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Affiliation(s)
- C Donnellan
- Department of Medical Gerontology, Trinity College Dublin, Ireland.
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Gupta A, Deepika S, Taly AB, Srivastava A, Surender V, Thyloth M. Quality of life and psychological problems in patients undergoing neurological rehabilitation. Ann Indian Acad Neurol 2010; 11:225-30. [PMID: 19893678 PMCID: PMC2771998 DOI: 10.4103/0972-2327.44557] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 06/30/2008] [Accepted: 07/03/2008] [Indexed: 11/15/2022] Open
Abstract
Aim: To assess the quality of life (QoL) and prevalence of psychological problems (PP) in patients with neurological illness, and their correlation with functional abilities. Materials and Methods: Prospective cross-sectional study conducted in the neurological rehabilitation unit of tertiary research hospital in 30 consecutive hospitalized patients (21 men), age 16-55 years (34.63±11.87). Outcome Measure: WHOQoL-BREF was used to assess QoL. The prevalence of PP was recorded using Hospital Anxiety Depression Scale (HADS) and General Health Questionnaire (GHQ-12). QoL and HADS scores were correlated with functional abilities using mean Barthel Index (BI) Score. Results: The duration of illness was three to 30 months (10.63±7.83) and their primary diagnoses were stroke 12, traumatic spinal cord injury seven and non-traumatic spinal cord lesion 11. Twenty-two patients qualified for GHQ-12 caseness, with 15 patients having distress (score ≥15) and seven having severe problem and psychological distress (score≥20). Twenty five patients had abnormal anxiety and 17 had abnormal depression on HADS (abnormal = 8-21), with moderate to severe anxiety and depression (scores≥11) in nine and three patients respectively. The mean WHOQoL-BREF transformed scores (on WHOQoL 0-100 scale) were (38.83±8.02), (50.76±9.79), (48.53±18.46) and (49.13±10.63) in physical, psychological, social, and environmental domains respectively. The social domain of QoL had significant correlation (P<.05) with functional abilities. Conclusion: Patients with neurological disorders requiring inpatient rehabilitation have impaired QoL that affects all domains of life. There is high prevalence of psychological problems, including anxiety and depression. The social domain of QoL adversely affected functional abilities, but the correlation between PP and functional abilities was insignificant.
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Affiliation(s)
- Anupam Gupta
- Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
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Akinpelu AO, Gbiri CA. Quality of life of stroke survivors and apparently healthy individuals in southwestern Nigeria. Physiother Theory Pract 2009; 25:14-20. [DOI: 10.1080/09593980802622669] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hilari K, Byng S, Pring T. Measuring Well-Being in Aphasia: The GHQ-28 Versus the NHP. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/14417040109003719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Song R, Tong KY, Hu X, Li L. Assistive control system using continuous myoelectric signal in robot-aided arm training for patients after stroke. IEEE Trans Neural Syst Rehabil Eng 2008; 16:371-9. [PMID: 18701384 DOI: 10.1109/tnsre.2008.926707] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In some stroke rehabilitation programs, robotic systems have been used to aid the patient to train. In this study, a myoelectrically controlled robotic system with 1 degree-of-freedom was developed to assist elbow training in a horizontal plane with intention involvement for people after stroke. The system could provide continuous assistance in extension torque, which was proportional to the amplitude of the subject's electromyographic (EMG) signal from the triceps, and could provide resistive torques during movement. This study investigated the system's effect on restoring the upper limb functions of eight subjects after chronic stroke in a twenty-session rehabilitation training program. In each session, there were 18 trials comprising different combinations of assistive and resistive torques and an evaluation trial. Each trial consisted of five cycles of repetitive elbow flexion and extension between 90 degrees and 0 degrees at a constant velocity of 10 degrees/s. With the assistive extension torque, subjects could reach a more extended position in the first session. After 20 sessions of training, there were statistically significant improvements in the modified Ashworth scale, Fugl-Meyer scale for shoulder and elbow, motor status scale, elbow extension range, muscle strength, and root mean square error between actual elbow angle and target angle. The results showed that the twenty-session training program improved upper limb functions.
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Affiliation(s)
- Rong Song
- Department of Health Technology and informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
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A Comparison of Bilateral and Unilateral Upper-Limb Task Training in Early Poststroke Rehabilitation: A Randomized Controlled Trial. Arch Phys Med Rehabil 2008; 89:1237-45. [DOI: 10.1016/j.apmr.2007.11.039] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 10/26/2007] [Accepted: 11/05/2007] [Indexed: 11/20/2022]
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Nagayoshi M, Iwata N, Hachisuka K. Factors associated with life satisfaction in Japanese stroke outpatients. Disabil Rehabil 2008; 30:222-30. [PMID: 17852205 DOI: 10.1080/09638280701255266] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To measure life satisfaction in Japanese stroke outpatients and randomly-sampled community residents and to investigate variables influencing their life satisfaction. METHOD Data on the demographic and clinical profiles, Satisfaction in Daily Life (SDL), other measurements, were obtained from 869 stroke outpatients (552 males, 317 females) and 748 community-dwelling elderly (360 males, 388 females), aged 55 years and older. Differences in categorical variables and continuous variables were tested by chi-square test and ANCOVA with age as the covariate, respectively. RESULTS The 11 SDL items were subjected to a factor analysis, which extracted two factors. Factor 1 (F1), labeled as 'satisfaction with one's own abilities', included satisfaction with housework, self-care, gait, physical health, hobby and leisure, social intercourse and mental health. Factor 2 (F2), 'satisfaction with external factors', included satisfaction with partner/ family relationship, economic state and social security, and house facilities. Both F1 and F2 scores were significantly lower for stroke outpatients (M = 19.7 and 10.9, respectively) than for community-dwelling elderly (M = 28.2 and 12.0, respectively) (p < 0.001). Living conditions were significantly associated with F2, but not with F1. Males living alone scored lowest on F2 than the others for both groups. Among stroke outpatients, both F1 and F2 scores differed significantly by the type of hemiparesis and the severity of aphasia. CONCLUSIONS SDL of stroke outpatients, which was lower than community-dwelling elderly, differed by the type of hemiparesis, the severity of aphasia, and living conditions. The effects of living conditions might vary with gender.
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Affiliation(s)
- Misako Nagayoshi
- Fukuoka City Handicapped Person's Welfare Center, 1-2-8 Nagahama, Chuo-ku, Fukuoka 810-0072, Japan.
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Owolabi MO. Determinants of health-related quality of life in Nigerian stroke survivors. Trans R Soc Trop Med Hyg 2008; 102:1219-25. [PMID: 18556034 DOI: 10.1016/j.trstmh.2008.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Revised: 05/06/2008] [Accepted: 05/06/2008] [Indexed: 10/21/2022] Open
Abstract
Stroke is a leading cause of disability in developing countries. It is crucial to identify factors influencing health-related quality of life (HRQOL) in stroke survivors in this setting so that such factors can be efficiently manipulated in order to maximize HRQOL improvement. This is the first study of these determinants in Nigerian stroke patients. One hundred consecutive consenting stroke survivors were studied in Ibadan. The stroke levity scale (SLS) was used to assess stroke severity. HRQOL was assessed using the psychometrically robust HRQOL in stroke patients (HRQOLISP) questionnaire. HRQOL determinants were sought among variables such as age, gender, socio-economic class (SEC), post-stroke duration, side, type and number of strokes, SLS, modified Rankin scale (mRS), social support, and Likert-graded responses to laughter and negative feelings frequencies. Gender, aphasia, handedness, stroke side, type and frequency as well as SEC had no significant impact on HRQOL. The determinants of HRQOL were SLS, mRS, social support, laughter and negative feelings frequencies. Aside from stroke levity and disability, psychosocial factors such as emotional responses and social support determine HRQOL in stroke survivors. Both neuroscience and clinical management of stroke might benefit from a corresponding broader integrative conceptual framework for life after stroke.
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Affiliation(s)
- Mayowa Ojo Owolabi
- Department of Medicine, University College Hospital, PMB 5116, 200001, Ibadan, Nigeria.
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Mota JF, Nicolato R. Qualidade de vida em sobreviventes de acidente vascular cerebral: instrumentos de avaliação e seus resultados. JORNAL BRASILEIRO DE PSIQUIATRIA 2008. [DOI: 10.1590/s0047-20852008000200013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: Os objetivos deste estudo foram identificar os instrumentos genéricos e específicos utilizados na avaliação da qualidade de vida (QV) e os seus resultados em sobreviventes de acidente vascular cerebral (AVC). MÉTODOS: Realizou-se revisão da literatura dos últimos dez anos, com população acima de 18 anos, nos bancos de dados MedLine e Lilacs, cujas publicações utilizassem instrumentos padronizados e validados no país de origem. Combinaram-se os descritores quality of life, cerebrovascular accident, stroke, QV e acidente cerebrovascular. RESULTADOS: Consideraram-se relevantes 96 estudos e 31 entram neste trabalho, de acordo com os critérios de inclusão. Foram encontrados cinco tipos diferentes de instrumentos genéricos/perfil, nove genérico/utility e dois específicos. O mais freqüente foi o SF-36, em 45,2% dos estudos. Observou-se que a baixa QV relacionou-se, principalmente, ao déficit da função física, à presença de depressão ou de seus sintomas, ser do sexo feminino e ser mais idoso. De modo geral, os sujeitos no pós-AVC possuíam pior QV do que aqueles que não sofreram o evento. CONCLUSÃO: Foram encontrados 16 instrumentos para avaliação da QV. A baixa QV foi prevalente nos sobreviventes pós-AVC e se correlacionou com a função física, a depressão, o sexo e a idade.
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Affiliation(s)
| | - Rodrigo Nicolato
- Instituto de Previdência dos Servidores do Estado de Minas Gerais
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de Albuquerque Citero V, de Araújo Andreoli PB, Nogueira-Martins LA, Baxter Andreoli S. New Potential Clinical Indicators of Consultation–Liaison Psychiatry's Effectiveness in Brazilian General Hospitals. PSYCHOSOMATICS 2008; 49:29-38. [DOI: 10.1176/appi.psy.49.1.29] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Coupar F, Legg L, Pollock A, Sackley C, van Vliet P. Home-based therapy programmes for upper limb functional recovery following stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd006755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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White JH, Alston MK, Marquez JL, Sweetapple AL, Pollack MR, Attia J, Levi CR, Sturm J, Whyte S. Community-Dwelling Stroke Survivors: Function Is Not the Whole Story With Quality of Life. Arch Phys Med Rehabil 2007; 88:1140-6. [PMID: 17826459 DOI: 10.1016/j.apmr.2007.06.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare function and quality of life in community-dwelling stroke survivors at 1, 3, and 5 years after stroke. DESIGN A community-based, cross-sectional study of 3 retrospective cohorts. SETTING Community-dwelling stroke survivors in Australia. PARTICIPANTS The 3 cohorts comprised 30 participants each at 1, 3, and 5 years poststroke discharge from a tertiary referral hospital. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Stroke severity, comorbidity, medications used, and demographic information were recorded. Poststroke function was assessed using the Modified Rankin Scale, Mini-Mental State Examination, Stroke Impact Scale, and Multidimensional Scale of Perceived Social Support. RESULTS This cross-sectional study provides insights into trends in stroke survivors over time. A high proportion of stroke survivors use community services, even those who are independent with activities of daily living. Although there was little attrition in medication use over time except for warfarin, this was from a baseline of suboptimal compliance and adherence with stroke preventive therapies. Stroke survivors report high levels of perceived social support; however, emotional well-being was low overall. The data suggest that those who are independent at 1 year tend to remain independent, although this was an extrapolation from serial cross-sections and needs to be explored in a longitudinal study. CONCLUSIONS Stroke survivors' function does not change significantly over time. A high proportion of survivors require community services. The development of needs-related effective long-term service delivery models is required.
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Affiliation(s)
- Jennifer H White
- Hunter Stroke Service, Rankin Park Centre, John Hunter Hospital, Hunter New England Area Health Service, and Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, New South Wales, Australia.
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Darlington ASE, Dippel DWJ, Ribbers GM, van Balen R, Passchier J, Busschbach JJV. Coping strategies as determinants of quality of life in stroke patients: a longitudinal study. Cerebrovasc Dis 2007; 23:401-7. [PMID: 17406109 DOI: 10.1159/000101463] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 11/30/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Quality of life (QoL) is reduced for stroke patients and coping strategies have been suggested as determinants of QoL. Thus far the relationship between coping and QoL has only been examined in small-scale cross-sectional designs. Therefore, the current study set out to examine this relationship in a longitudinal setting. METHODS Stroke patients who were discharged home were interviewed at 4 different time points; just before discharge (T1), and 2 months (T2), 5 months (T3) and 9-12 months after discharge (T4). QoL was measured by the EQ-5D index score and the SF-36 utility score and coping expressed in terms of tenacious goal pursuit and flexible goal adjustment. Modified Rankin scale was assessed as a measure of general functioning. RESULTS Eighty stroke patients were included. Coping was not predictive of QoL at T1 and T2 but rather at T3 and T4. At T4 both coping strategies determined the levels of QoL as measured with the EQ-5D index score; higher levels of tenacious goal pursuit as well as flexible goal adjustment were associated with higher levels of QoL. This regression model explained 44% of the variance. CONCLUSIONS Coping is a powerful determinant of QoL, but only more than 5 months after discharge; before this time QoL is mainly determined by general functioning. Both coping strategies were important determinants of QoL.
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Kikusui T, Winslow JT, Mori Y. Social buffering: relief from stress and anxiety. Philos Trans R Soc Lond B Biol Sci 2006; 361:2215-28. [PMID: 17118934 PMCID: PMC1764848 DOI: 10.1098/rstb.2006.1941] [Citation(s) in RCA: 362] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Communication is essential to members of a society not only for the expression of personal information, but also for the protection from environmental threats. Highly social mammals have a distinct characteristic: when conspecific animals are together, they show a better recovery from experiences of distress. This phenomenon, termed 'social buffering', has been found in rodents, birds, non-human primates and also in humans. This paper reviews classical findings on social buffering and focuses, in particular, on social buffering effects in relation to neuroendocrine stress responses. The social cues that transmit social buffering signals, the neural mechanisms of social buffering and a partner's efficacy with respect to social buffering are also detailed. Social contact appears to have a very positive influence on the psychological and the physiological aspects of social animals, including human beings. Research leading towards further understanding of the mechanisms of social buffering could provide alternative medical treatments based on the natural, individual characteristics of social animals, which could improve the quality of life.
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Affiliation(s)
- Takefumi Kikusui
- Laboratory of Veterinary Ethology, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan.
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Donnellan C, Hevey D, Hickey A, O'Neill D. Defining and quantifying coping strategies after stroke: a review. J Neurol Neurosurg Psychiatry 2006; 77:1208-18. [PMID: 17043290 PMCID: PMC2077363 DOI: 10.1136/jnnp.2005.085670] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The coping strategies that people use after a stroke may influence recovery. Coping measures are generally used to assess the mediating behaviour between a stressor (ie, disease or condition) and the physical or psychological outcome of an individual. This review evaluates measures that quantified coping strategies in studies on psychological adaptation to stroke. The main aspects of the coping measures reviewed were (a) conceptual basis; (b) coping domains assessed; (c) coping strategies used after a stroke; and (d) psychometric properties of coping measures used in studies assessing patients with stroke. Four databases (Medline, CINAHL, PsychINFO and Cochrane Systematic Reviews) were searched to identify studies that used a coping measure in stroke. 14 studies assessed coping strategies in patients after stroke. Ten different coping measures were used, and the studies reviewed had many limitations. Few studies provided definitions of "coping" and the psychometric properties of the coping measures were under-reported. The need for future studies to more clearly define the coping process and to present data on the reliability and validity of the measures used is emphasised.
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Affiliation(s)
- C Donnellan
- Department of Medical Gerontology, Trinity College Dublin, Ireland.
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Kuroda A, Kanda T, Sakai F. Gender differences in health-related quality of life among stroke patients. Geriatr Gerontol Int 2006. [DOI: 10.1111/j.1447-0594.2006.00338.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rabelo DF, Néri AL. Bem-estar subjetivo e senso de ajustamento psicológico em idosos que sofreram acidente vascular cerebral: uma revisão. ESTUDOS DE PSICOLOGIA (NATAL) 2006. [DOI: 10.1590/s1413-294x2006000200006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Foi feito um levantamento dos estudos brasileiros e estrangeiros publicados entre 1996 e 2005 que relacionavam bem-estar subjetivo, senso de ajustamento psicológico e acidente vascular cerebral, com o objetivo de identificar variáveis mediadoras dessa relação em idosos. Estudos transversais e prospectivos indicaram que os afetados por acidente vascular cerebral apresentam menor bem-estar subjetivo quando comparados com a população geral. Boa capacidade cognitiva, suporte social efetivo, continuidade de uma ocupação produtiva, manutenção da competência em atividades instrumentais de vida diária e humor positivo são fatores que podem melhorar o bem-estar subjetivo e psicológico. Variáveis que podem piorar o bem-estar subjetivo e psicológico são incapacidade funcional, déficits cognitivos, depressão, dificuldade em restabelecer a identidade e restrição à possibilidade de desempenhar atividades e papéis que contribuem para a auto-definição. O conhecimento das implicações psicológicas de sofrer acidente vascular cerebral pode beneficiar pacientes, familiares e profissionais no gerenciamento do evento.
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Secrest J, Zeller R. Replication and Extension of the Continuity and Discontinuity of Self Scale (CDSS). J Nurs Scholarsh 2006; 38:154-8. [PMID: 16773919 DOI: 10.1111/j.1547-5069.2006.00093.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To replicate and extend development of an instrument to measure continuity and discontinuity of self after stroke. DESIGN The conceptual basis for the instrument was derived from an existential phenomenologic study of stroke survivors, which showed that life after stroke included both continuity and discontinuity of self, experienced as control, independence, and connections with others. METHODS A 45-item instrument with a three-point response set was designed with standard instrument techniques. Study instruments included the Barthel Index (measure of functional abilities), and a pre- and poststroke QoL Cantril Ladder. The sample size for the initial study was 55, and for the replication study was 50. Principal components analysis was used in both studies. Data analysis was done with both the sample of 50 and with the combined samples, N = 105. FINDINGS The sample in the replication study had lower functional ability scores than did that of the original study; demographic characteristics were not significantly different. Factor analysis of the 50 cases robustly replicated the two-factor solution. When the samples were combined, however, a subtle pattern was detected in the "continuity" dimension, resulting in two factors for continuity and one factor for discontinuity, for an overall three-factor solution. CONCLUSIONS Continuity appears two-dimensional, including control and independence as one dimension, and connections with others as the second. Discontinuity factored as a single dimension, indicating that perhaps loss permeates the components of discontinuity. Further study is in progress.
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Affiliation(s)
- Janet Secrest
- University of Tennessee at Chattanooga, 1051 School of Nursing, 615 McCallie Avenue, Chattanooga, TN 37403, USA.
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Baune BT, Aljeesh Y. The association of psychological stress and health related quality of life among patients with stroke and hypertension in Gaza Strip. Ann Gen Psychiatry 2006; 5:6. [PMID: 16712716 PMCID: PMC1475857 DOI: 10.1186/1744-859x-5-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 05/19/2006] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The study was performed to investigate the association of psychological stress and quality of life (QOL) among patients with the cardiovascular disease (CVD) of hypertension plus stroke or hypertension only. METHODS The WHOQOL-BREF questionnaire was applied to 112 hypertensive patients with hypertension plus stroke and 224 hypertensive patients without stroke. Psychological stress was assessed with SCL-90. Means scale scores were compared using student-t-test and predictors of QOL were calculated with covariance analysis. RESULTS Patients with stroke had a significant lower QOL than patients without stroke and a significantly higher level of stress (p < 0.01). In analyses of covariance psychological stress was significantly correlated to all domains of QOL among non-stroke patients. The same psychological and sociodemographic factors showed little impact on the stroke patients in these multivariable analyses. In these models psychological stress had a significant impact on the global domain of QOL among stroke patients. Income and gender were the only sociodemographic factors being significantly associated with the physical (education) and social (gender) domains of QOL in stroke patients. CONCLUSION Psychological stress was strongly correlated with all domains of QOL in patients without stroke and was only partly associated with QOL among patients with stroke. Future studies should investigate if psychological stress is a factor suitable for educational and psychological interventions aiming at stress reduction in CVD patients which might substantially contribute to better health related quality of life in these patients.
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Affiliation(s)
- BT Baune
- Department of Psychiatry, School of Medicine, James Cook University, Australia
- Department of Psychiatry and Psychotherapy, University of Munster, Germany
| | - Y Aljeesh
- Islamic University, Gaza, Palestinian Authority
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Moon YS, Kim SJ, Kim HC, Won MH, Kim DH. Correlates of quality of life after stroke. J Neurol Sci 2004; 224:37-41. [PMID: 15450769 DOI: 10.1016/j.jns.2004.05.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Accepted: 05/28/2004] [Indexed: 11/16/2022]
Abstract
The relationship between lesion location and quality of life (QOL) in stroke patients has not yet been clearly revealed. The present study was undertaken to investigate the clinical and anatomical correlates which can predict future QOL in stroke patients. The study subjects consisted of 69 consecutive patients with ischemic stroke who were followed up 2 months after the stroke event at the stroke unit. Quality of life was evaluated during the 2-month follow up period after the stroke. Baseline information or data including clinical and anatomical correlates (Beck Depression Inventory, Beck Anxiety Inventory, Barthel's Index, MRI data) at the time of the stroke event were collected by performing a review of each patient's chart and research data files. Severe subcortical gray matter lesion and depressive symptoms in the acute phase of stroke were of importance in predicting low QOL 2 months after stroke.
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Affiliation(s)
- Yoo-Sun Moon
- Department of Family Medicine, Hallym University College of Medicine, Chunchon, South Korea
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Hillen T, Davies S, Rudd AG, Kieselbach T, Wolfe CD. Self ratings of health predict functional outcome and recurrence free survival after stroke. J Epidemiol Community Health 2004; 57:960-6. [PMID: 14652262 PMCID: PMC1732360 DOI: 10.1136/jech.57.12.960] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE To measure stroke victims' self rated health (SRH) status and SRH transition, and to compare how the two are prospectively associated with disability and recurrence free survival. DESIGN Prospective case registry study with face to face follow up interviews at three months, one, two, and three years. Ascertained were SRH status and SRH transition using single question assessments, Barthel Index (BI), Frenchay Activities Index (FAI), and Mini Mental State Examination (MMSE). SETTING A multiethnic inner city population of 234 533. PARTICIPANTS Patients surviving the initial three months after a first in a lifetime stroke in 1995 to 1998. RESULTS Of 690 stroke survivors 561 (81.3%) could complete the self report items. Answers to the item on SRH status did not vary significantly between the four follow up interviews. However, responses to the item on SRH transition changed significantly during follow up with three months ratings being more negative than all subsequent ratings. SRH transition, but not SRH status, showed a prospective association with long term outcome in multivariate analyses controlling for the BI, FAI, and MMSE. Compared with all other patients, patients reporting "Much worse health" at three months were more likely to be disabled ( = BI<20) at one year (OR 6.29, 95% CI 2.26 to 17.52) and their combined risk of stroke recurrence and death was increased over five years (HR 1.72, 95% CI 1.25 to 2.38). CONCLUSIONS Items on SRH should be used with caution in populations with high rates of disability and language problems, as many participants are unable to complete them. SRH transition may be a better predictor of disability and recurrence free survival after major medical events than SRH status.
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Affiliation(s)
- T Hillen
- Division of Primary Care and Public Health Sciences, Guy's, King's and St Thomas' School of Medicine, King's College, London, UK
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Affiliation(s)
- A Courtney DeVries
- Department of Psychology, The Ohio State University, Columbus 43210, USA.
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Ben-Shlomo Y, Camfield L, Warner T. What are the determinants of quality of life in people with cervical dystonia? J Neurol Neurosurg Psychiatry 2002; 72:608-14. [PMID: 11971047 PMCID: PMC1737851 DOI: 10.1136/jnnp.72.5.608] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about the quality of life in patients with cervical dystonia, although pain and depression are relatively common. OBJECTIVE To test the hypothesis that an individual's ability to cope with the disease will modify the association of intrinsic, extrinsic, and disease related factors with quality of life. METHODS Patients with cervical dystonia diagnosed by a movement disorder specialist were recruited from seven European countries. Data on quality of life (SF-36), measures of coping, and intrinsic, extrinsic, and disease related factors were collected by a self completed postal questionnaire. RESULTS 289 patients (101 men and 188 women), mean age 55 years, completed the questionnaire. Both physical and mental quality of life scores were predicted by self esteem and self deprecation, educational level, employment status, social support, response to botulinum toxin, disease severity, social participation, stigma, acceptance of illness, anxiety, and depression. In multivariable analyses, the strongest predictors were anxiety and depression. Severe depression was associated with a 19.1 point decrement in the physical summary score (95% confidence interval, -31.7 to -6.6; p = 0.003); however, disease duration and severity remained predictors. CONCLUSIONS Care for patients with cervical dystonia must not only focus on reducing the severity of the dystonia but also on the psychological wellbeing of the patient. Interventions aimed at treating depression or anxiety, especially of a cognitive nature, may have a large impact on improving quality of life.
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Affiliation(s)
- Y Ben-Shlomo
- Department of Social Medicine, MRC Health Services Collaboration, University of Bristol, Bristol, UK.
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Nilsson I, Axelsson K, Gustafson Y, Lundman B, Norberg A. Well-being, sense of coherence, and burnout in stroke victims and spouses during the first few months after stroke. Scand J Caring Sci 2002; 15:203-14. [PMID: 11564227 DOI: 10.1046/j.1471-6712.2001.00008.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ten stroke victims, who had recently suffered their first manifest stroke with lasting neurological symptoms, participated, together with their spouses, in a study aimed at elucidating the well-being, sense of coherence (SOC), and burnout during the first few months after discharge. The stroke victims had no substantial speech disturbances, and showed no evidence of significant cognitive impairment, signifying they were mildly to moderately impaired by their stroke. All subjects were investigated at 1 and 3 months after homecoming. The methods used in this study were open-ended interviews with all research participants, performed at two different appointments, and three self-reporting questionnaires: the well-being measure (WM), the SOC scale, and the burnout measure (BM). The instruments suit each other well, broaden the picture of living with stroke and give an attuned comprehensive understanding. The most striking finding was the substantial differences in the results, both regarding the stroke victims and their spouses, clearly indicating the limited value current generalizations have. The results also pointed to considerable distress both in stroke victims and spouses, although individuals with a weak SOC clearly displayed more difficulties in coping with the situation and risk of burnout, than did those with a strong SOC.
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Affiliation(s)
- I Nilsson
- Department of Nursing, Umeå University, Boden, Sweden. imenin
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Smout S, Koudstaal PJ, Ribbers GM, Janssen WG, Passchier J. Struck by stroke: a pilot study exploring quality of life and coping patterns in younger patients and spouses. Int J Rehabil Res 2001; 24:261-8. [PMID: 11775030 DOI: 10.1097/00004356-200112000-00002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
So far, research on quality of life after stroke has focused mainly on elderly patients. This study is targeted at younger stroke patients and their partners, aiming to evaluate stroke impact, as related to coping strategy. For our pilot study, eight patients who had suffered a stroke and four partners completed the Impact of Event Scale questionnaire. The mean age was 47.6 years in patients and 44.5 years in partners. The patients' level of activities of daily life was assessed using the Barthel Index. They were then interviewed to obtain information with respect to stroke impact and coping. The Schedule for the Evaluation of Individual Quality of Life procedure was carried out to measure quality of life, and stroke impact was quantified using Visual Analogue Scales. On average, patients scored 19.25 on the Barthel Index. Quality of life had deteriorated by 20.1% in patients, whereas partners did not show a decline in quality of life. However, well-being was inversely correlated among patients and partners. Accommodative coping was positively correlated with quality of life in both patients and partners. Conversely, assimilation was negatively related to quality of life in patients.
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Affiliation(s)
- S Smout
- Erasmus University Rotterdam, Department of Medical Psychology and Psychotherapy, The Netherlands
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