A study in persons later after stroke of the relationships between social participation, environmental factors and depression

Post-stroke emotionalism: Diagnosis, pathophysiology, and treatment

BACKGROUND

Post-stroke emotionalism affects one in five stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect.

AIM AND METHODS

This narrative review presents a summary of the post-stroke emotionalism literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment.

RESULTS

Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways and those related to serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. Testing for Emotionalism after Recent Stroke-Questionnaire (TEARS-Q) has recently been developed to allow standardized assessment. Treatment options are limited, and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomized-controlled trials of non-pharmacological interventions.

CONCLUSIONS

More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field.

Social participation, resilience, and coping tendency in a sample of stroke survivors: a multi-centre cross-sectional study in China

OBJECTIVES

To investigate the association between resilience and social participation and examine the mediation of resilience on coping strategies and social participation.

DESIGN

A multi-centre cross-sectional study performed from April to July 2022.

PARTICIPANTS

The study sample comprised 239 stroke survivors (53.1% male). The mean age of participants was 65.4 years.

METHODS

The study was conducted at 3 neurorehabilitation centres in Shanghai, China. The Utrecht Scale for Evaluation of Rehabilitation Participation (USER-P) was used to measure both objective and subjective social participation. Resilience was evaluated using the Connor-Davidson Resilience Scale (CD-RISC), while positive coping tendency was assessed using the Simplified Coping Style Questionnaire (SCSQ). Multivariate linear regression was employed, taking into account confounding factors. In cases where a significant interaction effect was observed, simple slope analysis was conducted to explore the relationship between positive coping tendency and social participation at different levels of resilience.

RESULTS

The mean scores of social participation frequency, restriction, and satisfaction were 21.80 ± 15.13, 38.92 ±  26.48, and 63.34  ± 22.35, respectively. Higher resilience level was independently associated with higher social participation frequency (B = 0.210, p < 0.001), less participation restriction (B = 0.584, p < 0.001), and higher participation satisfaction (B = 0.250, p < 0.001). Moreover, higher resilience was correlated with more positive coping tendency. More positive coping tendency was related to higher social participation frequency and less participation restriction, but not to social participation satisfaction. Furthermore, individuals at different resilience levels moderated the effect of positive coping tendency on social participation frequency.

CONCLUSION

This study underlines the importance of resilience as a potential intervention in enhancing both objective and subjective social participation in stroke survivors, and provides insights into increasing the efficacy of positive coping strategies on social participation.

Impact of Illness Perceptions on Poststroke Activity Engagement and the Moderating Role of Gender

IMPORTANCE

Beyond existing knowledge of demographic and performance skill factors, establishing relationships between poststroke activity engagement and illness perceptions sets the stage for the development of more effective intervention strategies.

OBJECTIVE

To describe the illness perceptions of community-dwelling people with stroke in the first 2 yr poststroke; specifically, to examine whether illness perceptions are associated with activity engagement and to explore the moderating role of gender in these relationships.

DESIGN

Cross-sectional study.

SETTING

Participants were recruited from eight rehabilitation settings in Beijing, China.

PARTICIPANTS

202 community dwellers with stroke.

OUTCOMES AND MEASURES

Activity engagement and illness perceptions were measured with the Mandarin version of the Assessment of Life Habits and the Chinese version of the Stroke-Specific Illness Perceptions Questionnaire-Revised, respectively. Participants' demographic information, cognitive status, and motor function were also collected.

RESULTS

Stronger perceptions of consequences and controllability were related to better performance in activity engagement at the personal level, and stronger perceptions of illness coherence were related to better performance in activity engagement at the societal level. In addition, gender differences in the relationship between illness perceptions and activity engagement were described.

CONCLUSIONS AND RELEVANCE

How people with stroke perceived their conditions dictated their levels of activity engagement in their community of residence. The findings suggest that understanding clients' illness perceptions may assist practitioners in developing comprehensive, targeted interventions to improve activity engagement and maximize recovery after stroke. Future studies are needed to explore the gender effect of illness perceptions on activity engagement in people with stroke. What This Article Adds: This study identified the relationships between illness perceptions and level of activity engagement in real-life environments in people with stroke. In addition to motor and cognitive interventions, providing opportunities for clients to gain a better understanding of stroke would facilitate their activity engagement in their real-life environment.

Predictors of post-stroke depression: the perspective from the social convoy model

BACKGROUND

Post-stroke depression (PSD) as one of the most common neuropsychiatric disorders after a stroke and is caused by many factors. However, the relationships among different factors and their potential contributions to PSD remain unclear.

METHODS

Two hundred and seventy-six patients were recruited into this study. The general information questionnaire, the Patient Health Questionnaire-9, the Perceived Social Support Scale, the Family Assessment Device, the General Well-Being Scale, the Barthel Index, and the modified Rankin Scale were used to assess the condition of patients. Subsequently, we identify the main causes associated with the PSD and then performed a path analysis to clarify the direct, indirect and total effects among the variables.

RESULTS

We found that age, stroke with coronary heart disease, neurological function, family function, social support, and general well-being had a significant impact on PSD (P < 0.05). Of these, neurological function had the largest total effect on PSD (β = 0.451), social support contributed the most as a direct effect (β = -0.306), and family function showed the largest indirect effect (β = -0.264).

CONCLUSION

Individual, disease, and social-psychological factors all contributed to the development of PSD. We should pay more attention to comprehensive assessment, especially for those with poor neurological function, and lacking family or social support. In addition, it would be preferable to provide them with necessary support and care strategies to reduce the incidence of PSD.

Intervention patterns and preliminary effectiveness on Social Participation following stroke: a scoping review

BACKGROUND

Stroke survivors suffer an overall loss of social participation. However, the interventions aiming at improving social participation have not yet been well-established. There is a need to synthesize existing knowledge on clinical interventions aiming at improving social participation among people with stroke.

OBJECTIVE

To describe the patterns of intervention that have been applied to stroke survivors to improve social participation and to determine the preliminary effects of these patterns.

METHODS

Eight online databases, including Cochrane Library, PubMed, Web of Science, Embase, Medline, CINAHL plus, PsycINFO, and Scoups were searched with predefined search terms from inception to September 22, 2022. References of included articles and previous reviews were also checked to identify additional studies. Two reviewers independently selected eligible studies and extracted data from the included articles.

RESULTS

A total of 98 studies were included, of which only 25 studies considered social participation as primary outcome of clinical interventions. The patterns of intervention were various, consisting of exercise-based intervention, occupational therapy, self-management program, and complex intervention. Of the 25 studies, eight studies found a positive effect of relative clinical intervention on social participation for stroke survivors. Of note, the same modality of intervention such as exercise-based intervention and self-management program produced paradoxical conclusion on social participation.

CONCLUSION

Exercised-based intervention, occupational therapy, self-management program, and complex intervention were important intervention modalities for the improvement of social participation among stroke survivors. Even though the preliminary effectiveness on social participation seems to be potentially positive, further high-quality researches are still required to reach a consensus to achieve optimal social participation among stroke survivors.

People with spinal cord injury in Morocco: results from the very first systematic data collection

PURPOSE

To report on the methodology, participant characteristics, and associations of four most frequent environmental barriers with health conditions, general health and quality of life (QoL) in the very first systematic data collection in people with spinal cord injury (SCI) in Morocco.

MATERIALS AND METHODS

We obtained data from 385 participants of the cross-sectional Moroccan SCI community survey (MorSCI). We used descriptive statistics to describe participant characteristics and regression models to investigate associations of the five most frequently reported environmental barriers with health conditions (secondary conditions, pain intensity, mental health), general health and QoL.

RESULTS

The most frequently reported environmental barriers were "lack of public services" (92.5%), "financial strain" (93.0%), restricted access to "public transportation" (85.5%), "public places" (83.9%) and "private places" (84.7%). People who perceived those factors as barriers also reported more secondary conditions, higher pain intensity, lower mental health, lower general health, and lower QoL.

CONCLUSIONS

This study on Moroccans with SCI found that environmental barriers detract from health and QoL. Given that environmental barriers are potentially modifiable, policy interventions present powerful tools to reduce barriers and potentially increase health and QoL in this vulnerable population.IMPLICATIONS FOR REHABILITATIONPublic policy on the construction of transportation and public places is important to make the physical environment accessible for wheelchair users to support their participation in society.The provision of adequate rehabilitation services and specialized post-acute rehabilitation units for people with SCI in Morocco is urgently needed, not only to contribute to health and QoL but also to contribute to their abilities to overcome environmental barriers.Adequate state services including universal health coverage and access to rehabilitation services and assistive devices or adapted tools must be a priority on the policy level to facilitate activities of daily living and reduce barriers.Improving the skills and knowledge of health professionals in SCI rehabilitation and guide policy makers to promote patient education and self-advocacy in the meantime, may help reduce the gap between needs of people with SCI and available support.

Factors associated with post-stroke social participation: A quantitative study based on the ICF framework

BACKGROUND

Post-stroke social participation is a major determinant of quality of life and life satisfaction. However, few data relating to participation determinants are available, especially the influence of psychological factors and factors related to the living environment.

OBJECTIVES

This study investigated determinants of post-stroke social participation within the International Classification of Functioning, Disability and Health framework.

METHODS

We contacted people with stroke who had been hospitalized in the Rhône County, included in a previous cohort study, were aged ≥18 years and were not institutionalized. The primary outcome was social participation measured with the Stroke Impact Scale (SIS) 2.0. We performed multiple hierarchical linear regressions to test the following predictors: clinical factors (stroke-related variables, limitations in Activities of Daily Living [ADL]/Instrumental ADL), personal factors (sociodemographic factors, coping strategies) and environmental factors (satisfaction with social relationships and living environment).

RESULTS

Among the 352 participants, 63% were men, and mean age was 68.7(SD 14.5) years. In the last multivariate model, variables associated with higher levels of social participation were the use of the positive thinking coping strategy (B (SD)=1.17(0.52), p = 0.03), higher perceived satisfaction with the living environment (B (SD)=0.17(0.07), p = 0.03) and fewer perceived activity limitations (B (SD)=0.55 (0.06), p < 0.001). Conversely, the seeking social support coping style (B (SD)= -1.98 (0.60), p = 0.001), and a higher number of stroke-related sequelae (B (SD)= -1.93(0.53), p = 0.001) were associated with lower social participation.

CONCLUSIONS

The identification of potentially modifiable personal and environmental factors that influence social participation provides elements to strengthen existing rehabilitation programs and opens the way for possible psychosocial interventions.

Association between participation self-efficacy and participation in stroke survivors

BACKGROUND

Most stroke survivors face restrictions in functional disability and social participation, which can impede their recovery and community reintegration. Participation self-efficacy refers to survivors' confidence in using strategies to manage participation in areas including community living and work engagement. This study aimed to assess the association between participation self-efficacy and participation among stroke survivors.

METHODS

This study adopted a cross-sectional correlational design with a convenience sample of 336 stroke survivors recruited from five hospitals in China. Participation self-efficacy was measured using the Chinese version of the Participation Strategies Self-Efficacy Scale (PS-SES-C) and participation measured using the Chinese version of the Reintegration to Normal Living Index (RNLI-C). The association between participation self-efficacy and participation was examined using multiple regression analysis with adjustment for potential confounders.

RESULTS

Participants had a mean age of 69.9 ± 11.5 years, with most (81.6%) having an ischaemic stroke, and more than half (61.6%) a first-ever stroke. After adjustment for potential confounders, every 10-point increase in the PS-SES-C total score was significantly associated with an average 1.3-point increase in the RNLI-C total score (B = 1.313, SE = 0.196, p < 0.001).

CONCLUSIONS

This study demonstrates that participation self-efficacy is significantly associated with participation among Chinese community-dwelling survivors of a mild or moderate stroke. This suggests that rehabilitation programmes for stroke survivors may be more effective if they incorporate participation-focused strategies designed to enhance self-efficacy. (229 words).

Perceived Community Participation and Associated Factors in People With Stroke

Objective

To examine individual- and environmental-level factors associated with perceived participation performance and satisfaction in people with chronic stroke.

Design

Cross-sectional study using secondary data analysis of baseline data from a randomized controlled trial.

Setting

Community-based setting.

Participants

Community-dwelling adults with mild to moderate stroke (N=113; mean age=57 years; 58 males).

Interventions

Not applicable.

Main Outcome Measures

Main outcomes were measured with the Reintegration to Normal Living Index (perceived participation performance) and Patient-Reported Outcome Measure Information System satisfaction with participation in social roles (perceived participation satisfaction). Other variables collected included personal (eg, age, perceived recovery), health-related (eg, time since stroke, number of comorbidities), body function–related (eg, Stroke Impact Scale, Center for Epidemiologic Studies Depression Scale), and environmental (eg, World Health Organization Quality of Life Short Form Environmental subscale) data.

Results

Depression, fatigue, mobility, and environmental support showed moderate to strong, statistically significant associations with participation performance and satisfaction in people with stroke. Perceived recovery was moderately associated with participation performance but not with participation satisfaction.

Conclusions

Returning to participation is a complex process after stroke. Results suggest that various personal, body function–related, and environmental factors are associated with participation performance and satisfaction.

The Impact of Social Pension Schemes on the Mental Health of the Chinese Elderly: A Mediating Effect Perspective of Two-Way Intergenerational Support

With the rapid decline in China’s fertility rate, the acceleration of aging, the continuous miniaturization and nucleation of China’s family structure, and the deterioration of the elderly’s living conditions and mental states, the elderly’s mental health has emerged as a major public health issue and a major social problem. Pensions are the elderly’s primary source of income, and they can help them meet their basic needs while also promoting family harmony and improving their mental health. Based on the data of the 2012, 2016, and 2018 Chinese Family Panel Studies (CFPS), we empirically examined the impact of pensions on the elderly’s mental health by using the fixed effects model, mediating effect model, and so on. The results show that receiving pension benefits can significantly reduce the level of depression and improve the mental health of the elderly. Receiving pension benefits causes reverse intergenerational economic transfer, which reduces the effect of pensions on the elderly’s mental health to some extent, but the life care and mental comfort provided by children increases when the elderly share pensions with their children. Overall, receiving pension benefits improves the mental health of the elderly. In addition, the effect of pensions on the elderly with different characteristics is heterogeneous. The older elderly, women, the elderly living with their children, and the elderly in rural areas all benefit more from receiving pension benefits. Moreover, the worse the mental health of the elderly is, the stronger the influence of pensions on their mental health is. Our discussion has important policy implications.

Poststroke activity engagement in community dwellers: Association with illness perceptions and perceived environment

OBJECTIVES

To investigate whether individuals' poststroke activity engagement is associated with their perceptions of stroke, as well as their perceptions of physical and social environment.

DESIGN

Cross-sectional study.

SETTING

Participants were recruited from eight rehabilitation settings in Beijing, China.

PARTICIPANTS

A total of 202 dyads of community dwellers with stroke and their primary caregivers.

MAIN MEASURES

Activity engagement measured by the Assessment of Life Habits; stroke individuals' and caregivers' illness perceptions measured by the Stroke-Specific Illness Perceptions Questionnaire - Revised; and stroke individuals' perceived social and physical environment measured by the Social Support Survey and abbreviated Neighborhood Environment Walkability Scale.

RESULTS

A total of 202 dyads of individuals with stroke and their caregivers participated in the study with mean ages of 61.3 (8.3) and 52.6 (11.6), respectively. On average, stroke individuals scored 7.61 (1.42) on the daily activities subscale, indicating that they completed personal level activities without assistance but with some difficulty. They scored 6.21 (2.21) on the social roles subscale, suggesting that individuals completed societal level activities with assistive devices and with some difficulty. Illness perceptions correlated significantly with personal level activity engagement (change in R-squared = 0.029; p = 0.049), and perceived accessibility and heterogeneity correlated significantly with societal level activity engagement (change in R-squared = 0.025; p = 0.011).

CONCLUSIONS

Poststroke activity engagement is associated not only with stroke individuals' performance skills but also with their perceptions of stroke, and how they perceive their physical environment. The findings may assist clinicians' decision making when developing comprehensive, targeted interventions for improving activity engagement and maximizing recovery after stroke.

The effect of self-management programs on post-stroke social participation: A systematic review and meta-analysis

OBJECTIVE

The aim of this study was to identify the effectiveness of self-management programs on the improvement of social participation among stroke survivors. Data Sources: Cochrane Library, PubMed, Web of Science database, EMBASE, Medline, CINAHL plus, and APA PsycArticles were searched from their inception to December 20, 2021.

METHODS

We considered randomized controlled trials and non-randomized controlled trials without language limits. Two reviewers independently screened the literature, evaluated risk of bias using the Cochrane's risk of bias tool, scored the methodological quality using criteria of the Australian Evidence-based Health Care Center, and extracted the data. The outcome was social participation. RevMan 5.3 was used, and intergroup differences were determined by calculating standardized mean difference (SMD) and 95% confidence intervals (CIs).

RESULTS

Of 1894 initial studies, totally 15 studies met the eligible criteria, consisting of six randomized controlled trials and nine non-randomized controlled trials. Four randomized controlled trials showed high methodological quality and two demonstrated medium quality. The randomized controlled trials involved a total of 430 stroke survivors and were published between 2007 and 2020. The meta-analysis from five randomized controlled trials demonstrates that the overall effect of self-management programs on social participation was not statistically significant (95% CI, -0.23 to 0.40; p = 0.61). Most of the non-randomized controlled trials were pre-/post-test design with an average sample size of 15.4. The effect of self-management program on social participation in most non-randomized controlled trials was insignificant as well.

CONCLUSION

The self-management programs seem not to be superior to usual care for the improvement on social participation in stroke survivors based on current evidence. Further well-designed investigation considering social participation as the primary outcome is still warranted.

A Chinese version of the Measure of Stroke Environment (MOSE): psychometric evaluation in stroke survivors

PURPOSE

To translate the MOSE from English to Chinese and investigate the psychometric properties of the Chinese-translated version of the Measure of Stroke Environment (MOSE).

MATERIALS AND METHODS

The MOSE was translated into Chinese using a cultural adaptation process. To validate this Chinese version, 311 stroke survivors were recruited to complete the questionnaire. The psychometric properties of the MOSE were evaluated by determining item analysis, test-retest reliability, internal consistency, content validity, construct validity, and floor/ceiling effects, respectively.

RESULTS

The MOSE was translated without any major difficulties. Regarding psychometric performances, a moderate level of correlation between the items and the domains (r > 0.4), and the significant differences in items between the high group and the low group were tested by independent sample t-tests (p < 0.05). The test-retest reliability was excellent (Intraclass Coefficient Correlation = 0.938). Very high internal consistency was also observed (Cronbach's α = 0.945, split-half reliability = 0.778). An acceptable I-CVI ranged from 0.714 to 1.000 and a high S-CVI of 0.973. Correlations with the subscales of the WHODAS 2.0 were significant in similar domains reflecting good convergent validity. No floor or ceiling effects were observed.

CONCLUSION

This study provides psychometric evidence supporting the use of the Chinese version of the MOSE among stroke survivors.IMPLICATIONS FOR REHABILITATIONThe Measure of Stroke Environment was translated into Chinese through a rigorous cultural adaptation process.MOSE-C is now a reliable and valid tool for Chinese-speaking survivors who have suffered from a stroke.It is necessary to assess the perceived environmental barriers of stroke survivors and develop targeted intervention programs in China.

The effect of stigma on social participation in community-dwelling Chinese patients with stroke sequelae: A cross-sectional study

OBJECTIVE

To explore the effect of stigma on social participation in community-dwelling Chinese patients with stroke sequelae.

DESIGN

A cross-sectional survey study.

SETTING

The study was conducted in two community centres in Tianjin, China.

SUBJECTS

Community-dwelling Chinese patients with stroke sequelae.

MEASURES

Chinese version of Stigma Scale for Chronic Illness, Chinese version of Impact on Participation and Autonomy, Modified Barthel index, Self-Rating Depression Scale, Social Support Rating Scale, Medical Coping Modes Questionnaire, background and disease-related questions. Pearson's correlation coefficients were computed between stigma and social participation. The impact of stigma on social participation was estimated by hierarchical multiple regression analysis after controlling for demographic, physical and psychosocial characteristics.

RESULTS

In total, 136 patients with stroke sequelae were included in this study, with a mean age of 67.8 years. The Chinese version of the Stigma Scale for Chronic Illness had a mean score of 48.4 (SD 16.9), and the Chinese version of the Impact on Participation and Autonomy was 67.1 (SD 21.1). Significant correlations were found between stigma and social participation. Pearson's correlation coefficient ranged from 0.354 to 0.605 (P < 0.01). Enacted stigma provided a significant explanation for the variance of social participation by 1.1% (P < 0.05). Felt stigma provided a significant explanation for the variance of social participation by 2.9% (P < 0.001).

CONCLUSION

Felt stigma and enacted stigma have independent associations with social participation. Patients with stroke sequelae who reported higher stigma experienced a lower level of social participation.

Depressive Symptoms Moderate the Relationship Among Physical Capacity, Balance Self-Efficacy, and Participation in People After Stroke

OBJECTIVE

It was previously found that balance self-efficacy mediated the relationship between physical capacity and participation after stroke. The effect of other factors that influence participation, such as depression, on this relationship has not been explored. This study examined the effect of symptoms of depression on the mediated relationship between physical capacity and participation by balance self-efficacy in individuals after stroke.

METHODS

In this cross-sectional study, 282 persons with chronic stroke (>6 months) were classified as having either low or high Geriatric Depression Scale scores. This study used a multiple group structural equation model to test moderated mediation by comparing a constrained model (indicating no effect of depression on the mediation) and an unconstrained model (indicating an effect of depression on the mediation). The models were compared using a chi-squared difference test.

RESULTS

The chi-squared difference test suggested that the unconstrained model was a better fit, indicating that depressive symptoms moderated the mediated relationship between physical capacity and participation (χ2(3, N = 282) = 9.0). In the Low Depression group, a significant indirect effect indicated that balance self-efficacy did mediate the relationship between physical capacity and participation. There was no significant indirect effect in the High Depression group.

CONCLUSION

The results suggest the relationship between physical capacity and participation appears to be mediated by balance self-efficacy in individuals after stroke with low reports of depressive symptoms, but in those with high reports of depressive symptoms, physical capacity and balance self-efficacy are unrelated to participation.

IMPACT

Targeting balance self-efficacy to improve post-stroke participation may be beneficial only for individuals with low reports of depression. In individuals after stroke with high reports of depression, treatment should include and emphasize the treatment of those depressive symptoms. Additional work further examining these complex relationships is warranted.

Exploring the Impact of Illness Perceptions, Self-efficacy, Coping Strategies, and Psychological Distress on Quality of Life in a Post-stroke Cohort

This study evaluated the mediating role of self-efficacy, coping, depression and anxiety on the relationship between illness perceptions and quality of life in stroke survivors (n = 72; 32 females; mean [SD] age 65.09 [14.14] years; male mean [SD] age 69.83 [11.81]). Illness perceptions (Brief Illness Perceptions Questionnaire; BIPQ), coping styles (Carver Brief-COPE scale; B-COPE), depression/anxiety (Hospital Anxiety and Depression Scale; HADS), self-efficacy (General Self-Efficacy Scale; GSE) and quality of life (Assessment of quality of life; AQOL-6D) were analysed. Correlation analyses showed illness perception, maladaptive coping, self-efficacy, depression and anxiety to have a significant negative relationship with quality of life. Mediation analyses showed that while maladaptive coping and self-efficacy did not mediate the relationship between illness perception and quality of life, depression and anxiety did. The final model explained 76.74% of the variance in quality of life. Although based on a relatively small sample size, these results provide evidence for the important role of psychosocial factors in quality of life in post-stroke cohorts.

Do Social Pension Schemes Promote the Mental Health of Rural Middle-Aged and Old Residents? Evidence From China

As China experiences rapid aging, the mental health of older rural adults has become a major public health concern. Among other social insurance programs, the New Rural Social Pension (NRSP) scheme was established to replace part of the income for old-age rural residents in China. This article employs survey data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018 to investigate the impact of a pension on depression in middle-aged and old residents. Our results show that the pension scheme not only reduces the depressive symptoms of the rural residents but keeps down the prevalence rate of depression. Among the subscribers of the pension scheme, the pensioners benefit more from enrolling in the pension scheme than the contributors in terms of depression alleviation. The impact of pension on depression displays heterogeneity; female residents, residents in central China, and/or those from lower income households are found to be positively affected. It is also confirmed that a pension scheme contributes to easing depression via reduced labor supply, better family support, and more consumption expenditure.

JEL Classification: H55, I18, I38.

Does variety of social interactions associate with frequency of laughter among older people? The JAGES cross-sectional study

OBJECTIVE

Several studies have reported that laughter is associated with health benefits. In addition, social interactions, such as social relationships, social participation and so forth, have shown the association with not only health but also individual emotion. In this study, we conducted a cross-sectional study to examine the association between variety of social interactions and the frequency of laughter.

DESIGN

Cross-sectional study.

SETTING

Sampled from 30 municipalities in Japan.

PARTICIPANTS

Non-disabled Japanese men (n=11 439) and women (n=13 159) aged ≥65 years using data from the Japan Gerontological Evaluation Study, which was conducted during October to December in 2013.

PRIMARY OUTCOME MEASURES

Laughing almost every day by self-reported questionnaire.

RESULTS

Poisson regression analysis with robust error variance was used to calculate prevalence ratios (PRs) for laughing almost every day according to each social relationship and its potential community-level environmental determinants. The prevalence of laughing almost every day tended to increase with increased variety in each social interaction after adjusting, instrumental activities of daily living, number of living together, working status, depression, self-reported economic status and residence year. Among men and women, multivariate-adjusted PRs (95% CIs) by comparing participants with the highest and lowest categories were 1.18 (1.04 to 1.35) and 1.16 (1.04 to 1.29) in positive life events; 1.26 (1.10 to 1.45) and 1.09 (0.96 to 1.24) in perceived positive changes in the area; 1.15 (1.04 to 1.28) and 1.17 (1.07 to 1.28) in social participations; 2.23 (1.57 to 3.16) and 1.47 (1.02 to 2.12) in social relationships and 1.25 (1.08 to 1.45) and 1.29 (1.15 to 1.45) in positive built environments. These associations were also preserved after the restriction of participants who were not in depression.

CONCLUSIONS

This study shows that a greater variety of each social relationships and the potential community-level environmental determinants are associated with higher frequencies of laughter in Japan.

Disability assessment in stroke: Relationship among the pictorial-based Longshi Scale, the Barthel Index, and the modified Rankin Scale

OBJECTIVE

To explore the correlations among the Longshi Scale, the Barthel Index, and the modified Rankin Scale and the differentiate ability of the Longshi Scale and the modified Rankin Scale to Barthel Index scores.

DESIGN

Prospective study.

SETTING

The inpatient rehabilitation units of three teaching hospitals in China.

SUBJECTS

A total of 343 stroke inpatients were recruited through convenience sampling.

MAIN MEASURES

Pictorial-based Longshi Scale, Barthel Index, and modified Rankin Scale.

RESULTS

The Longshi Scale was highly and moderately correlated with the Barthel Index and modified Rankin Scale, respectively. The median frequency distribution of the Barthel Index was slightly overlapped between Longshi Scale grades 2 and 3 but was considerably overlapped among modified Rankin Scale grades 1, 2, and 3. The Kruskal-Wallis and multiple comparison tests showed that, among the modified Rankin Scale grades, the median Barthel Index scores did not differentiate between grades 1 and 2 (χ² = 20.643, P = 1.000), between grades 1 and 3 (χ² = 60.404, P = 0.070), and between grades 2 and 3 (χ² = 39.760, P = 0.232). Among the Longshi Scale grades, the median Barthel Index scores did not differentiate between grades 2 and 3 (χ² = 48.778, P = 1.000), between grades 3 and 4 (χ² = 57.094, P = 1.000), and between grades 5 and 6 (χ² = 24.709, P = 1.000).

CONCLUSION

Using the Barthel Index as reference, the proposed Longshi Scale has better ability than the modified Rankin Scale in differentiating stroke patients' disability, especially for those with higher level of activities of daily living.

Readiness to Change is Related to Real-World Walking and Depressive Symptoms in Chronic Stroke

BACKGROUND AND PURPOSE

The transtheoretical model is a health behavior model used to understand an individual's readiness to change their behavior. This study aims to apply the transtheoretical model in understanding a person with stroke's readiness to change their activity level, as it relates to physical capacity, physical health, depressive symptoms, self-efficacy, and daily stepping activity.

METHODS

This was a cross-sectional analysis of baseline data from a clinical trial. Participants' readiness to change their activity levels was measured via self-report and daily stepping activity was measured using a step activity monitor. Robust regression (M-estimation with robust standard errors) was used to test the relationship between readiness to change and measures of physical capacity (6-minute walk test, self-selected walking speed), physical health (body mass index, age-adjusted Charlson Comorbidity Index), depressive symptoms (Patient Health Questionnaire-9), self-efficacy (Activities-Specific Balance Confidence Scale), and daily stepping (steps per day).

RESULTS

A total of 274 individuals were included in the analysis. Adjusted for age, readiness to change was positively related to daily stepping (β = 0.29, P < 0.001) and negatively related to depressive symptoms (β = -0.13, P = 0.01). Readiness to change was not significantly associated with measures of physical capacity, physical health, or self-efficacy.

DISCUSSION

These results suggest that individuals with stroke in the later stages of change may demonstrate greater daily stepping activity and lower depressive symptoms compared with those in earlier stages.

CONCLUSIONS

Understanding the relationship between readiness to change, daily stepping, and depressive symptoms will help clinicians implement appropriate stage-specific intervention strategies and facilitate greater improvement in activity levels.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A333).

An iPad application-based intervention for improving post-stroke depression symptoms in a convalescent rehabilitation ward: A pilot randomized controlled clinical trial protocol

BACKGROUND

Post-stroke depression (PSD) is a neuropsychiatric sequela that causes serious adverse effects on the prognosis of stroke patients. Our developed iPad application is a very innovative approach designed to improve participants' depressive symptoms by presenting positive words stimuli in a video. Although this application has fewer side effects than existing pharmacological and non-pharmacological interventions and is likely less burdensome for patients and caregivers, its efficacy for PSD has not been investigated. Here we present a pilot randomized controlled trial (RCT) protocol to investigate the therapeutic potential of this application intervention for PSD patients.

METHODS

This study is designed as a 5-week, single-center, open-label, parallel-group, pilot RCT. Thirty-two patients with PSD will be randomly assigned to a combination of the iPad application and usual rehabilitation or usual rehabilitation alone (1:1 allocation ratio). The iPad application intervention lasts 3 min a day, and the usual rehabilitation lasts 3 h a day. The primary outcome is the change from baseline in The Center for Epidemiologic Studies Depression Scale score at the end of the 5-week intervention.

DISCUSSION

This pilot RCT is the first study to investigate the potential of iPad application interventions to reduce depressive symptoms in PSD patients. This pilot RCT determines whether this is a viable and effective intervention and informs the design for a full-scale trial. If our hypothesis is correct, this trial can provide evidence to augment the standard practice of iPad application interventions to improve depressive symptoms in patients with PSD.

Environmental Barriers Experienced by People With Spinal Cord Injury Across 22 Countries: Results From a Cross-Sectional Survey

OBJECTIVES

To investigate the experience of environmental barriers by people with spinal cord injury (SCI) across 22 countries. Specific aims were to describe and compare the prevalence of environmental barriers experienced across countries, and to analyze determinants of environmental barriers at individual and country level.

DESIGN

Cross-sectional community survey.

PARTICIPANTS

Individuals (N=12,591) living with SCI in the community.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Nottwil Environmental Factors Inventory-Short Form.

RESULTS

Most barriers were experienced in relation to accessibility, climate, transportation, finances, and state services. More severe barriers were experienced in settings with lower gross domestic product (GDP), which especially refers to medical supplies (gamma=-0.38; P<.001) and finances (gamma=-0.37; P<.001) in this study. However, in a multivariable negative binomial regression using within-between estimation of the number of barriers experienced on the selected predictors, the effect of GDP was reversed when it was adjusted for covariates. On the individual level, the number of experienced barriers decreased with better mental health and greater self-care ability. People with low income, with paraplegia, complete lesions, and more health problems reported more barriers. On the country level, fewer barriers were reported in countries with higher average age, better mental health, and greater self-care ability, as well as in those with a higher percentage of traumatic SCI, paraplegia, and complete lesions. More barriers were reported in countries with a higher percentage of married individuals, lower average household income, higher average time since injury, higher mean vitality scores, and greater income inequality.

CONCLUSIONS

Study participants reported a significant number of environmental barriers, many of which are modifiable. Complementary interventions are recommended. Within and between country effects of covariates sometimes pointed in different directions, suggesting that countries with a different composition of SCI population also differed in environmental contexts.

Contextual determinants of participation after stroke: a systematic review of quantitative and qualitative studies

PURPOSE

From a patient's perspective, participation is a major determinant of quality of life. We aimed to review contextual factors, both personal and environmental, potentially associated with post-stroke participation.

METHODS

PubMed, PsycINFO, and Web of Science were searched for original quantitative and qualitative studies that investigated contextual factors of post-stroke participation, measured participation as the primary outcome, and met inclusion criteria.

RESULTS

Socio-demographic determinants were mostly unrelated with participation or showed discordant and inconclusive results. Although less investigated, psychosocial/psychological factors, particularly self-esteem and acceptance, were associated with participation in most studies. Motivation was found in qualitative studies, but discordant in quantitative ones. Environmental factors were even less investigated and mainly in qualitative studies among patients with communication disabilities. Among these, social support and attitude of others appeared to be major determinants of participation as well as physical environment and societal environment (services and polices).

CONCLUSIONS

Personal factors, particularly psychological and psychosocial factors, were identified as positively associated with post-stroke participation. Environmental factors such as support, relationships, and positive attitudes towards patients were major facilitators of participation as well as physical environment and accessibility to appropriate services. Most of these factors are modifiable and should be addressed to improve patient participation.Implications for RehabilitationPsychosocial factors (motivational aspects, acceptance of a new condition, self-esteem) and environmental factors (social support, attitudes towards the patient, physical environment, access to health, social services and policies) were identified as determinants of post-stroke participation.A structured evaluation of determinants of participation may be used in clinical practice to propose appropriate support and then improve patients' recoveryPrograms to improve patients' psychosocial skills such as self-esteem, acceptance, motivation should be tested and implemented, and policies to develop appropriate services accessibility should be encouraged.

Social participation and depressive symptoms among Chinese older adults: A study on rural-urban differences

BACKGROUND

Although studies conducted in developed countries have reported a negative relationship between social participation and depressive symptoms, few studies have examined rural-urban differences in the relationship between participation in various types of social activities and depressive symptoms among Chinese older adults.

OBJECTIVES

This study examined the association between participation in paid work, political, and voluntary activities and depressive symptoms among Chinese older adults in urban and rural areas.

METHODS

Data were obtained from the China Longitudinal Ageing Social Survey conducted in 2014, and bivariate linear regression and multivariable linear regression analyses were conducted.

RESULTS

The prevalence of depressive symptoms was significantly higher among older adults residing in rural areas than among older adults in urban areas. Participation in paid work activities was significantly associated with fewer depressive symptoms among older adults in urban and rural areas, whereas participation in political or voluntary activities was negatively associated with depressive symptoms only among older adults in urban areas. Older adults who participated in two or three types of activities (paid work, political, and voluntary activities) tended to have fewer depressive symptoms both in urban and rural areas.

LIMITATIONS

Because this study comprised a cross-sectional design, causality could not be established between social participation and depressive symptoms.

CONCLUSIONS

Social participation plays a protective role against depressive symptoms among Chinese older adults, especially among those in urban areas. Urban-rural differences exist between participation in different types of social activities and depression symptoms.

Functional activities and social participation after stroke in rural China: a qualitative study of barriers and facilitators

Objective:

To explore the perspectives of stroke survivors in China’s rural areas, particularly with respect to environmental barriers and facilitators related to their functional activity and social participation.

Design:

Qualitative content analysis. A cross-sectional study.

Setting:

In-depth interviewing in the participants’ homes.

Subjects:

In total, 18 community-dwelling stroke survivors in the rural areas of China.

Results:

The sub-themes to functional activity and social participation were restricted life-space mobility, reduced daily activities, and shrunken social networks. The main environmental facilitator was family support, which positively affected all facets of the participants’ lives, including assistance in daily living, assistance in gaining access to healthcare, and performing environmental modifications. The main barriers involved were physical barriers (toilet barriers, lack of assistive devices, barriers to getting out) and vague and complex regulations.

Conclusion:

Stroke survivors in rural China experienced environmental barriers mainly including physical barriers and complex regulations. The nuclear family’s support is an important environmental facilitator.