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Lieb A, Zrenner B, Zrenner C, Kozák G, Martus P, Grefkes C, Ziemann U. Brain-oscillation-synchronized stimulation to enhance motor recovery in early subacute stroke: a randomized controlled double-blind three- arm parallel-group exploratory trial comparing personalized, non- personalized and sham repetitive transcranial magnetic stimulation (Acronym: BOSS-STROKE). BMC Neurol 2023; 23:204. [PMID: 37231390 PMCID: PMC10210305 DOI: 10.1186/s12883-023-03235-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Stroke is a major cause of death and the most frequent cause of permanent disability in western countries. Repetitive transcranial brain stimulation (rTMS) has been used to enhance neuronal plasticity after stroke, yet with only moderate effect sizes. Here we will apply a highly innovative technology that synchronizes rTMS to specific brain states identified by real-time analysis of electroencephalography. METHODS One hundred forty-four patients with early subacute ischemic motor stroke will be included in a multicenter 3-arm parallel, randomized, double-blind, standard rTMS and sham rTMS-controlled exploratory trial in Germany. In the experimental condition, rTMS will be synchronized to the trough of the sensorimotor µ-oscillation, a high-excitability state, over ipsilesional motor cortex. In the standard rTMS control condition the identical protocol will be applied, but non-synchronized to the ongoing µ-oscillation. In the sham condition, the same µ-oscillation-synchronized protocol as in experimental condition will be applied, but with ineffective rTMS, using the sham side of an active/placebo TMS coil. The treatment will be performed over five consecutive work days (1,200 pulses per day, 6,000 pulses total). The primary endpoint will be motor performance after the last treatment session as measured by the Fugl-Meyer Assessment Upper Extremity. DISCUSSION This study investigates, for the first time, the therapeutic efficacy of personalized, brain-state-dependent rTMS. We hypothesize that synchronization of rTMS with a high-excitability state will lead to significantly stronger improvement of paretic upper extremity motor function than standard or sham rTMS. Positive results may catalyze a paradigm-shift towards personalized brain-state-dependent stimulation therapies. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov (NCT05600374) on 10-21-2022.
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Affiliation(s)
- Anne Lieb
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Brigitte Zrenner
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute for Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Christoph Zrenner
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute for Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Gábor Kozák
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Statistics, University of Tübingen, Tübingen, Germany
| | - Christian Grefkes
- Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
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Wayessa DI, Chala MB, Demissie SF, Abebe AB, Janakiraman B, Deme S, Gashaw M. Cross-cultural translation, adaptation, and validation of the stroke-specific quality of life (SSQOL) scale 2.0 into Amharic language. Health Qual Life Outcomes 2023; 21:7. [PMID: 36691045 PMCID: PMC9869570 DOI: 10.1186/s12955-023-02092-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 01/14/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The stroke-specific quality of life 2.0 (SSQOL 2.0) scale is a valid, reliable instrument which has been widely used as a patients reported outcome measure among stroke survivors. However, the SSQOL scale has not been validated and used in any Ethiopian language. This study aimed to translate, culturally adapt, and test the psychometric properties of the SSQOL scale 2.0 in Amharic, which is the official and working language with about 34 million (23%) speakers in Ethiopia. METHODS The adapted English version of the SSQOL 2.0 scale was translated into Amharic and then back-translated to English. An expert committee translated and created a final Amharic version of SSQOL (SSQOL-AM) scale. Pre-field testing (pilot and cognitive debriefing) was conducted with 15 post-stroke subjects. The SSQOL-Am was administered to 245 stroke survivors from four referral hospitals to determine the psychometric properties. Cronbach's alpha and Intra-class correlation coefficient were used to calculate the internal consistency and test-retest reliability, spearman's correlation for the convergent validity of the SSQOL-Am scale. The Standard Error of Measurement (SEM), Minimum Detectable Change (MDC), Bland Altman Limit of Agreement (LOA), Confirmatory Factor Analysis, and Exploratory Factor Analysis were also determined. RESULTS The SSQOL-Am demonstrated excellent test-retest reliability (ICC = 0.93), internal consistency (Cronbach's alpha = 0.96), SEM 0.857, MDC 1.94, and good LOA. As postulated, the mobility domain of the tool demonstrated a significantly strong correlation with the physical function domain of the SF-36 (rho = 0.70, p < 0.001). CONCLUSIONS The SSQOL-Am is a valid and reliable outcome measure. The tool can be used in both clinical practice and research purposes with Amharic speaking post-stroke survivors.
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Affiliation(s)
- Dechasa Imiru Wayessa
- grid.59547.3a0000 0000 8539 4635Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Mulugeta Bayisa Chala
- grid.59547.3a0000 0000 8539 4635Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia ,grid.17063.330000 0001 2157 2938Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Solomon Fasika Demissie
- grid.59547.3a0000 0000 8539 4635Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Abey Bekele Abebe
- grid.59547.3a0000 0000 8539 4635Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia ,grid.17063.330000 0001 2157 2938Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Balamurugan Janakiraman
- grid.444359.b0000 0004 1756 0397Department of Research and Faculty of Physiotherapy, Meenakshi Academy of Higher Education and Research (MAHER), Chennai, Tamil Nadu India
| | - Sisay Deme
- grid.411903.e0000 0001 2034 9160Department of Physiotherapy, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Moges Gashaw
- grid.59547.3a0000 0000 8539 4635Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
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Kumar V, Malhotra V, Sinha V. Evaluation of Individual Quality of Life (QOL) Among Patients with Tracheostomy Using WHO-QOL BREF Questionnaire. Indian J Otolaryngol Head Neck Surg 2022; 74:5207-5216. [PMID: 36742676 PMCID: PMC9895232 DOI: 10.1007/s12070-020-02052-z] [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: 03/25/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Tracheostomy is one of the most frequently performed surgical procedures worldwide. The placement of tracheostomy in a patient is associated with significant morbidities as apart from the physical impact of the procedure, a profound and persistent effect on psychosocial, financial, environmental and other aspects of global health of the patient becomes inevitable. However, there is a surprising paucity of literature assessing the Quality of Life (QOL) in patients with tracheostomy tube placement. This study was undertaken with the objective to assess the effect of tracheostomy on Quality of Life (QOL) of patients in an urban tertiary health care setup in India. Patients who underwent tracheostomy tube placement irrespective of the indication were included in the study and followed up for a period of up to 3 months to determine the effect of tracheostomy tube placement on the Quality of Life. A questionnaire based on World Health Organisation (WHO) QOL BREF scheme was utilized to evaluate QOL in the immediate post operative period and again appraised after a period of 3 months. The results were statistically analyzed, tabulated and compared using paired t test to evaluate the 'p' value in every domain i.e., physical, social, psychological and environmental, of the WHO QOL-BREF evaluation tool. 63 patients were enrolled in the study after excluding the patients not fulfilling the selection criteria. The majority of patients were male over the age of 50 years (mean age 57 years). There was a noteworthy depreciation in QOL score in patients as WHO-QOL-BREF scores in all the 4 domains were significantly lower after 3 months. The most affected were the Environmental domain (p value 5E-15) whereas the domain of Psychological showed least depreciation of mean QOL score (p value 7.7E-5). Insertion of a tracheostomy tube has a significant impact on the quality of life of the patient and the amount of burden increases with worsening quality of life. A holistic and scientific approach to assess and manage tracheostomy induced morbidity on the patient is necessary. The patients' views of the aspects of life should be used by health policy makers, clinicians, and caregivers as a reliable guide to the most important priorities for treatment and medical interventions. Large prospective multicenter studies may be undertaken for the developement of a standardized and internationally accepted tracheostomy specific quality of life evaluation tool.
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Affiliation(s)
- Vivek Kumar
- Department of ENT, PMCH, Ashok Rajpath, Patna, 800004 India
| | | | - Vineet Sinha
- Department of ENT, PMCH, Ashok Rajpath, Patna, 800004 India
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Quality of Life in the First Year after Ischemic Stroke Treated with Acute Revascularization Therapy. J Clin Med 2022; 11:jcm11113240. [PMID: 35683624 PMCID: PMC9181285 DOI: 10.3390/jcm11113240] [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: 04/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: we aimed to describe the disease-specific quality of life (QoL) of ischemic stroke patients treated with acute revascularization therapy, its evolution from 6 months to 12 months, and associated factors. (2) Methods: QoL was assessed with the SS-QoL in consecutive patients treated with either intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT). Variables associated with QoL scores and its evolution were studied using multivariate mixed models, and interaction with time. Analyses were performed in four domains of SS-QoL: self-care, mobility, mood, and social roles. (3) Results: Among the 501 included patients (mean (sd) age 68.9 (14.5), 49% women), lower post-stroke QoL was independently related to lower level of school education, prestroke mRS > 2, and 24 h NIHSS score > 4. Independent predictors of unfavorable evolution of QoL over time were age <75 years (Mobility p = 0.0194 and Mood p = 0.0015), NIHSS score ≤ 4, (Self-care p = 0.0053 and Mood p = 0.0048), and modified Rankin Scale score ≤ 2 (Social roles, p = 0.0006). Revascularization therapy had no significant effect on the QoL scores, but patients treated with MT (alone or as bridging therapy) had significantly greater improvement in mobility score between 6 and 12 months than patients treated with IVT alone (p = 0.0072). (4) Conclusion: QoL evolution over one year had only slight variation and was associated with the modalities of acute treatment, age, and stroke severity.
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Abba MA, Olaleye OA, Hamzat TK. Effects of over-ground walking and cognitive rehabilitation on cognition, brain-derived neurotrophic factor, participation and quality of life among stroke survivors: a study protocol. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1808056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Muhammad Aliyu Abba
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, Kano, Nigeria
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olubukola A. Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Talhatu K. Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Moliterno AH, Bezerra FV, Pires LA, Roncolato SS, da Silva TD, Massetti T, Fernani DCGL, Magalhães FH, de Mello Monteiro CB, Dantas MTAP. Effect of Contextual Interference in the Practicing of a Computer Task in Individuals Poststroke. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2937285. [PMID: 32775414 PMCID: PMC7396124 DOI: 10.1155/2020/2937285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Sensory and motor alterations resulting from stroke often impair the performance and learning of motor skills. The present study is aimed at investigating whether and how poststroke individuals and age- and sex-matched healthy controls benefit from a contextual interference effect on the practice of a maze task (i.e., constant vs. random practice) performed on the computer. METHODS Participants included 21 poststroke individuals and 21 healthy controls, matched by sex and age (30 to 80 years). Both groups were divided according to the type of the practice (constant or random) presented in the acquisition phase of the learning protocol. For comparison between the groups, types of practice, and blocks of attempts, the analysis of variance with Tukey's post hoc test (p < 0.05) was used. RESULTS Poststroke individuals presented longer movement times as compared with the control group. In addition, only poststroke individuals who performed the task with random practice showed improved performance at the transfer phase. Moreover, randomized practice enabled poststroke individuals to perform the transfer task similarly to individuals without any neurological impairment. CONCLUSION The present findings indicated a significant effect of contextual interference of practice in poststroke individuals, suggesting that applying randomized training must be considered when designing rehabilitation protocols for this population.
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Affiliation(s)
- Alice Haniuda Moliterno
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- São Paulo State University (Unesp) "Júlio de Mesquita Filho"-Presidente Prudente, SP, Brazil
| | - Fernanda Vieira Bezerra
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- São Paulo State University (Unesp) "Júlio de Mesquita Filho"-Presidente Prudente, SP, Brazil
| | | | | | - Talita Dias da Silva
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
| | - Thais Massetti
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
| | - Deborah Cristina Gonçalves Luiz Fernani
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
- Laboratory Design and Scientific Writing. Department of Basic Sciences, ABC Faculty of Medicine-Santo André, SP, Brazil
| | - Fernando Henrique Magalhães
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
| | - Carlos Bandeira de Mello Monteiro
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
- Laboratory Design and Scientific Writing. Department of Basic Sciences, ABC Faculty of Medicine-Santo André, SP, Brazil
| | - Maria Tereza Artero Prado Dantas
- University of West Paulista-UNOESTE-Presidente Prudente, SP, Brazil
- Grupo de Pesquisa em Aplicações Tecnológicas em Reabilitação School of Arts, Sciences and Humanities-EACH-University of São Paulo, São Paulo, SP, Brazil
- Laboratory Design and Scientific Writing. Department of Basic Sciences, ABC Faculty of Medicine-Santo André, SP, Brazil
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Uddin MN, Amirul Islam FM. Psychometric evaluation of the modified 19-item Bengali version of WHOQOL scale using Rasch analysis: a cross-sectional study of a rural district in Bangladesh. BMC Psychol 2020; 8:44. [PMID: 32357921 PMCID: PMC7195788 DOI: 10.1186/s40359-020-00411-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This investigation aims to validate the psychometric properties of the modified 19-item Bengali version World Health Organization Quality of Life (WHOQOL) instrument in a typical healthy rural population in Bangladesh. METHOD The cross-sectional investigation collected 300 adults aged 18-85 years from Narail, a rural district of Bangladesh using a multi-stage cluster random sampling technique. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application CommCare. SPSS version 25; IBM. and a Rasch analysis software RUMM2030 were used for analyses. RESULTS Results showed good overall fit, as indicated by a significant item-trait interaction with Bonferroni corrected p values, for physical ([Formula: see text] =32.13, p = 0.041), psychological ([Formula: see text] =14.93, p = 0.529), social ([Formula: see text] =12.62, p = 0.397), and environmental ([Formula: see text] =22.01, p = 0.339) domains. Item fit residual (IFR) values for all domains were within the desired limits, indicating no deviation from the expected relationship between the individual items and the rest of the items of the scale. Person fit residual (PFR) values also showed no person misfit among the samples, indicating item threshold are suitable for Rasch analysis. Reliability of the three domains of the 19-item WHOQOL scale was very good as indicated by a person separation index (PSI) = 0.873 and Cronbach's Alpha (CA) = 0.881 for physical domain, PSI = 0.739 and CA = 0.746 for psychological domain, and PSI = 0.753 and CA = 0.781 for environmental domain. The social domain (PSI = 0.650 and CA = 0.669) had below acceptable reliability. All items in each domain had ordered thresholds except one item of the environmental domain. All four domains of the 19-item WHOQOL scale showed unidimensionality and was free from local dependency. Each domain also showed similar functioning for adults and older adults, males and females, no education and at least primary level of education, low and high socio-economic conditions. CONCLUSION The 19-item modified WHOQOL scale is confirmed as an efficient screening tool for measuring QoL among healthy rural Bangladeshi people. The scale could be implemented more widely. In particular, validations are required for diseases-specific population in Bangladesh to measure the Health Related Quality of life (HR-QoL) assessments for people suffering from chronic or other diseases.
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Affiliation(s)
- Mohammed Nazim Uddin
- Department of Statistics, Data Science and Epidemiology; Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122 Australia
| | - Fakir M. Amirul Islam
- Department of Statistics, Data Science and Epidemiology; Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122 Australia
- Organisation for Rural Community Development (ORCD), Dariapur, Narail Bangladesh
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Silva SM, Corrêa FI, de Morais Faria CDC, Corrêa JCF. Discriminatory power of Stroke Specific Quality of Life questionnaire items to evaluate the participation component of the International Classification of Functioning, Disability and Health. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2018.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims This study aimed to estimate the discriminatory power of 26 items on the Stroke Specific Quality of Life Scale questionnaire to evaluate the participation component of the International Classification of Functioning, Disability and Health. Methods A prospective study was conducted using accuracy procedures based on the Standards for Reporting Diagnostic Accuracy Studies to evaluate individuals with hemiparesis stemming from a stroke. Discriminatory power was estimated based on the area under the receiver operating characteristic curve with a 95% confidence interval. Two groups were defined for the analysis: community-dwelling and institutionalised individuals. A 5% level of significance (α=0.05) was considered for all analyses. Results The area under the receiver operating characteristic curve was 0.888 (95% confidence interval: 0.794–0.949; P=0.001). Analysis indicated a cut-off point of ≥80 with 73.9% sensitivity and 100% specificity. Conclusions The 26 items of the Stroke Specific Quality of Life questionnaire that evaluate the participation component of the International Classification of Functioning, Disability and Health demonstrate adequate discriminatory power. A cut-off point of ≥80 seems to best discriminate the perception of participation between community-dwelling and institutionalised stroke survivors.
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Affiliation(s)
- Soraia Micaela Silva
- Postgraduate Programme in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil
| | - Fernanda Ishida Corrêa
- Postgraduate Programme in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil
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Uddin MN, Islam FMA. Psychometric evaluation of an interview-administered version of the WHOQOL-BREF questionnaire for use in a cross-sectional study of a rural district in Bangladesh: an application of Rasch analysis. BMC Health Serv Res 2019; 19:216. [PMID: 30953506 PMCID: PMC6451264 DOI: 10.1186/s12913-019-4026-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to validate the psychometric properties of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire for use in a rural district of Bangladesh. METHODS This cross-sectional study recruited a multi-stage cluster random sample of 2425 participants from the rural district Narail of Bangladesh in May-July 2017. Rasch analysis was carried out using the sampled participants, as well as multiple validation random sub-samples of 300 participants, to validate four domains of the WHOQOL-BREF questionnaire: physical, psychological, social and environmental. RESULTS The original WHOQOL-BREF appeared to be a poor fit for both sampled and sub-sampled group of participants in Narail district in all underlying domains: physical, psychological, social and environmental. Two items (sleep and work capacity) from the physical domain, two items (personal belief and negative feelings) from the psychological domain and three items (home environment, health care and transport) from the environment domain were excluded for goodness of fit of the Rasch model. The social domain exhibited reasonably reliable fitness while fulfilling all the assumptions of the Rasch model. A modified version of the WHOQOL-BREF questionnaire using five-items for the physical ([Formula: see text] = 36.47, p = 0.013, Person Separation Index (PSI) = 0.773), four-items for the psychological ([Formula: see text] = 28.30, p = 0.029, PSI = 0.708) and five-items for the environmental ([Formula: see text] = 36.97, p = 0.011, PSI = 0.804) domain was applied, which showed adequate internal consistency, reliability, unidimensionality, and similar functioning for different age-sex distributions. CONCLUSIONS The modified WHOQOL-BREF questionnaire translated into Bengali language appeared to be a valid tool for measuring quality of life in a typical rural district in Bangladesh. Despite some limitations of the modified WHOQOL-BREF questionnaire, further application of Rasch analysis using this version or an improved one in other representative rural areas of Bangladesh is recommended to assess the external validity of the outcomes of this study and to determine the efficacy of this tool to measure the quality of life at the national rural level.
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Affiliation(s)
- Mohammed Nazim Uddin
- Department of Statistics, Data Science and Epidemiology; Faculty of Health, Arts and Design; Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Fakir M Amirul Islam
- Department of Statistics, Data Science and Epidemiology; Faculty of Health, Arts and Design; Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.,Organisation for Rural Community Development (ORCD), Dariapur, Narail, Bangladesh
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Translation and Cross-Cultural Adaptation of SATIS-Stroke for Use in Brazil: A Satisfaction Measure of Activities and Participation in Stroke Survivors. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8054640. [PMID: 30906780 PMCID: PMC6398040 DOI: 10.1155/2019/8054640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/06/2019] [Accepted: 02/05/2019] [Indexed: 11/18/2022]
Abstract
Introduction SATIS-Stroke was developed to measure satisfaction regarding activities and participation among stroke survivors based on the concepts contained in the International Classification of Functioning, Disability, and Health. However, this measure is only available in English and French. Objective Perform the translation and cross-cultural adaptation of SATIS-Stroke to Brazilian Portuguese and test the preliminary reliability of this measure. Methods The translation process followed standardized guidelines and consisted of six phases: initial translation, back-translation, analysis of expert committee, test of final version, submission, and assessment of all written reports. To test the preliminary test-retest reliability, the measure was administered by a single observer on two occasions with an interval of 7 to 14 days for the determination of intraobserver agreement and administered again by a second observer for the determination of interobserver agreement. Reliability was analyzed using the intraclass correlation coefficient (ICC2,1) and respective 95% confidence intervals (CI). Results All stages of the cross-cultural adaptation process were respected and the final translated version of SATIS-Stroke exhibited semantic, idiomatic, cultural, and conceptual equivalence to the original version. The preliminary analysis revealed excellent intraobserver and interobserver reliability (ICC = 0.93; 95% CI: 0.83-0.97, p = 0.001 and ICC = 0.90; 95% CI: 0.74-0.96; p = 0.001, respectively). The items demonstrated adequate internal consistency, although ceiling and floor effects were considered beyond acceptable standards for some items. In the exploratory factor analysis, three factors were extracted that aggregated more than one construct to each component, but all were related to the “Activities and Participation” component of the International Classification of Functioning, Disability, and Health. Conclusion The final version of the SATIS-Stroke scale in Brazilian Portuguese proved to be adequate and reliable for use on the Brazilian population. Further studies are underway to give continuity to the validation process and analyze the others measurement properties of the scale in the Brazilian population.
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Jingwen J, Han J, Yu Z, Xiaojun H, Junpeng Z, Fanxia S, Jianrong L. Quality of life among patients during subacute phase following stroke during hospitalisation period in Shanghai. Int J Psychiatry Clin Pract 2018; 22:296-303. [PMID: 29457918 DOI: 10.1080/13651501.2018.1432763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: This study aimed to investigate the factors influencing the quality of life of in-hospital subacute stroke patients. Methods: The patients of subacute stroke (within four weeks) in our institution between 2015 and 2016 were recruited. Patients' characteristics and QOL were obtained from medical charts and stroke-specific quality of life scale (SS-QOL). Associations of each domain in SS-QOL with socio-demographic, clinical factors and patient satisfaction were investigated using the linear regression models. Results: Among the 203 subjects, 60 were diagnosed as large artery atherosclerosis (LAA), 80 were small-artery occlusion (SAO), 28 were cardioembolism (CE) and 35 were intracranial haemorrhage (ICH). The ICH group had the worst self-care ability and upper extremity function. Worse severity of stroke was associated with lower levels of language ability, mobility, mood status and upper-extremity function. Participants who had better satisfaction had high levels of capability of conducting family roles, positive emotions, personality consistency, self-care ability and capacity of conducting social roles. Conclusions: The level of patient satisfaction, duration of hospitalisation and the severity of stroke were found to be the three important factors associated with SS-QOL at hospital discharge, indicating doctors might assist patients adjust to the consequences of stroke and improve the QOL of subacute stroke.
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Affiliation(s)
- Jiang Jingwen
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Jin Han
- b Centre for Mental Health Research , The Australian National University , Canberra , Australia
| | - Zhang Yu
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Huang Xiaojun
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Zhuang Junpeng
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Shen Fanxia
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Liu Jianrong
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
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12
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Silva SM, Corrêa JCF, Pereira GS, Corrêa FI. Social participation following a stroke: an assessment in accordance with the international classification of functioning, disability and health. Disabil Rehabil 2017; 41:879-886. [DOI: 10.1080/09638288.2017.1413428] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Soraia Micaela Silva
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - João Carlos Ferrari Corrêa
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Gabriela Santos Pereira
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Fernanda Ishida Corrêa
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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13
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Uddin MN, Bhar S, Al Mahmud A, Islam FMA. Psychological distress and quality of life: rationale and protocol of a prospective cohort study in a rural district in Bangaladesh. BMJ Open 2017; 7:e016745. [PMID: 28864700 PMCID: PMC5588978 DOI: 10.1136/bmjopen-2017-016745] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/26/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A significant proportion of the global burden of disease has been attributed to mental and behavioural disorders. People with mental disorders (MDs) have lower levels of health-related quality of life than those without MDs. Several studies have shown that in low-resource countries, a range of social determinants including poor health literacy is critical in the epidemiological transition of disease outcome. There is a lack of evidence of MDs literacy, the prevalence and risk factors of common mental health conditions, or any validated instruments to measure psychological distress or evaluate the quality of life in rural areas of Bangladesh. AIMS The aims of this study are: (1) report the awareness, knowledge, attitudes and practice (KAP) of MDs; (2) estimate the prevalence of and risk factors for psychological distress; (3) measure association of psychological distress and other socio-demographic factors with quality of life and (4) test the feasibility to use Kessler 10-item (K10) and WHO Quality Of Life-BREF (WHOQOL-BREF) questionnaires in rural Bangladesh for measuring psychological distress and quality of life. METHODS AND ANALYSIS A sample of 1500 adults aged 18-59 years and 1200 older adults aged 60-90 years will be interviewed from a multistage cluster random sample. Each participant will go through a face-to-face interview to assess their awareness and KAP of MDs. Information about the participant's sociodemographic and socioeconomic status will be collected along with the psychological distress (K10) and quality of life (WHOQOL-BREF) questionnaires. Internal consistency, validity, reliability and item discrimination of K10 and WHOQOL-BREF instruments will be determined by using Rasch analysis and regression techniques. ETHICS AND DISSEMINATION Human Ethics Approval was received from the Swinburne University of Technology Human Ethics Committee. Results of this research will be disseminated via scientific forums including peer-reviewed publications and presentations at national and international conferences.
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Affiliation(s)
- Mohammed Nazim Uddin
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Abdullah Al Mahmud
- Centre for Design Innovation (CDI), School of Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Fakir M Amirul Islam
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Organisation for Rural Community Development (ORCD), Narail, Bangladesh
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Hall SS, MacMichael J, Turner A, Mills DS. A survey of the impact of owning a service dog on quality of life for individuals with physical and hearing disability: a pilot study. Health Qual Life Outcomes 2017; 15:59. [PMID: 28356121 PMCID: PMC5372266 DOI: 10.1186/s12955-017-0640-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/23/2017] [Indexed: 11/23/2022] Open
Abstract
Background Quality of life refers to a person’s experienced standard of health, comfort and happiness and is typically measured using subjective self-report scales. Despite increasing scientific interest in the value of dogs to human health and the growing demand for trained service dogs, to date no research has reported how service dogs may affect client perceptions of quality of life. Method We compared quality of life scores on the 16 item Flanagan quality of life scale from individuals who owned a trained service dog with those who were eligible to receive a dog, but did not yet have one (waiting list control). Data were analysed separately from two groups; those with a service dog trained for individuals with physical disabilities (with physical service dog: n = 72; waiting for a service dog: n = 24; recruited from Dogs for Good database) and those with a hearing service dog (with hearing service dog = 111; waiting for a service dog = 30; recruited from Hearing Dogs for Deaf People database). Results When controlling for age and gender individuals scored higher on total quality of life scores if they owned a service dog or a hearing service dog, but this was only statistically significant for those with a service dog. Both groups (physical service dog and hearing service dog) scored significantly higher on items relating to health, working, learning and independence if they owned a service dog, in comparison to those on the waiting list. Those with a physical service dog also scored significantly higher on items relating to recreational activities (including items relating to reading/listening to music, socialising, creative expression), and those involving social interactions (including items relating to participating in organisations, socialising, relationship with relatives). Additionally, those with a physical service dog scored higher on understanding yourself and material comforts than those on the waiting list control. In contrast, those with a hearing service dog appeared to receive fewer benefits on items relating to social activities. Conclusions Owning a service dog can bring significant specific and potentially general benefits to the quality of life of individuals with physical disabilities and hearing impairments. These benefits may have considerable implications for individuals with disabilities, society and the economy by promoting independence, learning and working abilities.
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Affiliation(s)
- Sophie S Hall
- University of Lincoln, School of Life Sciences, Lincoln, UK.
| | | | - Amy Turner
- University of Lincoln, School of Life Sciences, Lincoln, UK
| | - Daniel S Mills
- University of Lincoln, School of Life Sciences, Lincoln, UK
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15
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Silva SM, Corrêa FI, Pereira GS, Faria CDCDM, Corrêa JCF. Construct validity of the items on the Stroke Specific Quality of Life (SS-QOL) questionnaire that evaluate the participation component of the International Classification of Functioning, Disability and Health. Disabil Rehabil 2016; 40:225-231. [DOI: 10.1080/09638288.2016.1250117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Soraia Micaela Silva
- Postgraduate program in Rehabilitation Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Fernanda Ishida Corrêa
- Postgraduate program in Rehabilitation Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Gabriela Santos Pereira
- Postgraduate program in Rehabilitation Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
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16
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Santos GL, Alcântara CC, Silva-Couto MA, García-Salazar LF, Russo TL. Decreased Brain-Derived Neurotrophic Factor Serum Concentrations in Chronic Post-Stroke Subjects. J Stroke Cerebrovasc Dis 2016; 25:2968-2974. [PMID: 27593096 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/27/2016] [Accepted: 08/07/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) plays a critical role in sensorimotor recovery after a stroke. However, few studies have assessed the circulating BDNF levels in post-stroke humans to understand its changes. This study was conducted to measure BDNF serum concentrations in subjects with chronic hemiparesis, as well as to correlate serum concentrations with age, post-stroke time, total score of Stroke Specific Quality of Life Scale (SS-QOL), mobility subscale score, and motor function of SS-QOL. METHODS Seventeen chronic post-stroke subjects matched by age and gender with healthy controls took part in the study. Personal data (age, hemiparesis side, and post-stroke time) were collected, and a physical examination (weight, height, body mass index) and SS-QOL assessment were carried out. On the same day, after the initial evaluation, venous blood samples were collected from the chronic post-stroke subjects and the healthy subjects. The BDNF serum concentrations were measured blindly by enzyme-linked immunosorbent assay. RESULTS Subjects with chronic hemiparesis presented a decrease in BDNF serum compared with healthy subjects (P < .01). There was no correlation between BDNF serum levels with post-stroke time, age or quality of life, mobility, and the upper extremity motor function (P > .05). BDNF concentrations are related to structural and functional recovery after stroke; thus, this reduction is important to understand the rehabilitation process more clearly. However, more studies are needed considering the genetic variations and other tools to assess motor impairment and functional independence. CONCLUSION Chronic post-stroke subjects presented a decrease in BDNF serum concentrations, without a correlation with post-stroke time, age, and quality of life.
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Affiliation(s)
- Gabriela Lopes Santos
- Laboratory of Neurological Physical Therapy Research, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Carolina Carmona Alcântara
- Laboratory of Neurological Physical Therapy Research, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Marcela Abreu Silva-Couto
- Laboratory of Neurological Physical Therapy Research, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Luisa Fernanda García-Salazar
- Laboratory of Neurological Physical Therapy Research, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Thiago Luiz Russo
- Laboratory of Neurological Physical Therapy Research, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
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Silva SM, Corrêa FI, Faria CDCDM, Pereira GS, Attié EADA, Corrêa JCF. Reproducibility of the items on the Stroke Specific Quality of Life questionnaire that evaluate the participation component of the International Classification of Functioning, Disability and Health. Disabil Rehabil 2016; 38:2413-8. [DOI: 10.3109/09638288.2015.1130178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Soraia Micaela Silva
- Postgraduate Program in Rehabilitation Sciences, University Nove De Julho (UNINOVE), São Paulo, SP, Brazil
| | - Fernanda Ishida Corrêa
- Postgraduate Program in Rehabilitation Sciences, University Nove De Julho (UNINOVE), São Paulo, SP, Brazil
| | | | - Gabriela Santos Pereira
- Postgraduate Program in Rehabilitation Sciences, University Nove De Julho (UNINOVE), São Paulo, SP, Brazil
| | - Edna Alves dos Anjos Attié
- Postgraduate Program in Rehabilitation Sciences, University Nove De Julho (UNINOVE), São Paulo, SP, Brazil
| | - João Carlos Ferrari Corrêa
- Postgraduate Program in Rehabilitation Sciences, University Nove De Julho (UNINOVE), São Paulo, SP, Brazil
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Micaela Silva S, Carlos Ferrari Corrêa J, da Silva Mello T, Rodrigues Ferreira R, Fernanda da Costa Silva P, Ishida Corrêa F. Impact of depression following a stroke on the participation component of the International Classification of Functioning, Disability and Health. Disabil Rehabil 2016; 38:1830-5. [DOI: 10.3109/09638288.2015.1107774] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ahn S. Analysis approaches and interventions with occupational performance. J Phys Ther Sci 2016; 28:2681-2683. [PMID: 27799719 PMCID: PMC5080201 DOI: 10.1589/jpts.28.2681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/31/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to analyze approaches and interventions with
occupational performance in patients with stroke. [Subjects and Methods] In this study,
articles published in the past 10 years were searched. The key terms used were
“occupational performance AND stroke” and “occupational performance AND CVA”. A total 252
articles were identified, and 79 articles were selected. All interventions were classified
according to their approaches according to 6 theories. All interventions were analyzed for
frequency. [Results] Regarding the approaches, there were 25 articles for studies that
provided high frequency interventions aimed at improving biomechanical approaches (31.6%).
This included electrical stimulation therapy, robot therapy, and sensory stimulation
training, as well as others. Analysis of the frequency of interventions revealed that the
most commonly used interventions, which were used in 18 articles (22.8%), made use of the
concept of constraint-induced therapy. [Conclusion] The results of this study suggest an
approach for use in clinics for selecting an appropriate intervention for occupational
performance.
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Affiliation(s)
- Sinae Ahn
- Department of Occupational Therapy, Yeoju Institute of Technology: 338 Seajong-ro, Yeoju-si, Gyeonggi-do 469-705, Republic of Korea
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Ahn S. Measurement of balance function and community participation in stroke survivors. J Phys Ther Sci 2016; 28:2268-70. [PMID: 27630411 PMCID: PMC5011575 DOI: 10.1589/jpts.28.2268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/07/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the relationship between balance function and
community participation in stroke survivors. [Subjects and Methods] Sixty-three patients
diagnosed with hemiparetic stroke participated in this study (36 males, 27 females, aged
58.6 ± 15.2 years). The participants were assessed for balance function and their level of
participation in the community, using activity card sorting and the Berg Balance Scale. A
regression analysis was used to identify the influence of balance function on instrumental
activities of daily living and leisure and social activities. [Results] The results of the
regression analysis indicated that balance function measured by using the Berg Balance
Scale affected community participation of patients with hemiparetic stroke. Participation
in instrumental activities of daily living and leisure and social activities was affected
by balance function. [Conclusion] This study provides useful information for designing
efficient programs and identifying their effectiveness for enhancement of community
participation in stroke survivors.
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Affiliation(s)
- Sinae Ahn
- Department of Occupational Therapy, Yeoju Institute of Technology: 338 Seajong-ro, Yeoju-si, Gyeonggi-do 469-705, Republic of Korea
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Silva SM, Corrêa FI, Faria CDCDM, Buchalla CM, Silva PFDC, Corrêa JCF. Evaluation of post-stroke functionality based on the International Classification of Functioning, Disability, and Health: a proposal for use of assessment tools. J Phys Ther Sci 2015; 27:1665-70. [PMID: 26180294 PMCID: PMC4499957 DOI: 10.1589/jpts.27.1665] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/07/2015] [Indexed: 11/24/2022] Open
Abstract
This study aimed to identify the International Classification of Functioning, Disability, and Health categories addressed by the assessment tools commonly used in post-stroke rehabilitation and characterize patients based on its evaluation model. [Subjects and Methods] An exploratory, descriptive, cross-sectional study was conducted involving 35 individuals with chronic post-stroke hemiparesis. Handgrip strength was assessed to evaluate body functions and structures. The 10-meter gait speed test and Timed Up and Go test were administered to evaluate activity. The Stroke Specific Quality of Life scale was used to evaluate participation. Moreover, a systematic review of the literature was performed to identify studies that have associated these assessment tools with the International Classification of Functioning, Disability, and Health categories. [Results] The tools employed in this study for evaluating function addressed 63 International Classification of Functioning, Disability, and Health categories: 24 related to body functions and structures; 36 related to activity and participation; and 3 related to environmental factors. [Conclusion] The assessment tools employed in this study addressed 63 International Classification of Functioning, Disability, and Health categories and allowed a more complete evaluation of stroke survivors with hemiparesis. Use of this classification can therefore be more easily incorporated into clinical practice.
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Affiliation(s)
- Soraia Micaela Silva
- Postgraduate Program in Rehabilitation Sciences, University
Nove de Julho (UNINOVE),
Brazil
| | - Fernanda Ishida Corrêa
- Postgraduate Program in Rehabilitation Sciences, University
Nove de Julho (UNINOVE),
Brazil
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