Translation and validation of the stroke self-efficacy questionnaire to a Portuguese version in stroke survivors

ABSTRACT

Background

Stroke Self-efficacy Questionnaire (SSEQ) is not available to Portuguese-Brazil.Objective: To translate, perform cross-cultural adaptation, and validate the Stroke Self-efficacy Questionnaire (SSEQ) to Portuguese-Brazil (SSEQ-B).Methods: It is a cross sectional study: 1) translation and cross-cultural adaptation of SSEQ – a five stage process, 2) validation and reliability study with 40 chronic stroke survivors. The outcomes were: Content Validity Index (CVI), Face validity index, Reliability, Internal consistency, Stability, Ceiling and floor effects Concurrent validity, Measurement error using Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC). Results: There was high agreement for the English to Portuguese-Brazil translation. Adjustments were made to improve semantic equivalence. Intra-examiner reliability was high (ICC 0.86) as was inter-examiner reliability (ICC 0.91). Internal consistency was acceptable for the total score, the activity subscale and self-management domain, Cronbach alphas are 0.82, 0.77, 0.68, respectively. The stability of the SSEQ-B was high and good (r = 0.77 p < .001). Ceiling effects were evident in 7.5% of the sample. For concurrent validity, there was an inverse relationship between BDI and SSEQ-B (r = ?0.43 p = .006), and a positive relationship between FIM (r = 0.52 p < .001), SIS (r = 0.64 p < .001) and SSEQ-B. SEM was 1.58 points of the SSEQ-B and the MDC was 4.38 points of SSEQ-B. Conclusion: SSEQ-B is a valid, reliable, and stable patient-reported outcome. It has concurrent validity with self-reported measures of depression, functional independence and a multi-dimensional measure of health status in chronic stroke survivors in Brazil.     

Assessment of anxiety in older adults: a systematic review of commonly used measures

Objectives: The authors set out to systematically review the research literature in order to identify the anxiety measures most commonly used in the assessment of older adults. Once identified, the literature was reviewed to determine the extent to which these instruments had age-relevant norms and psychometric data supporting their use with older adults.

Method: Literature searches were conducted in PsycINFO and PubMed to identify research articles in which anxiety measures were completed by older adults. After screening for suitability, a total of 213 articles were reviewed to determine the most commonly used anxiety measures with older adults to examine the psychometric properties of these instruments and to evaluate whether the instruments are appropriate for use with older adults.

Results: A total of 91 different anxiety measures were used in the 213 included articles. Twelve anxiety measures were most commonly used in the literature and of those three were specifically developed for older adults.

Conclusions: Of the most commonly used measures, the majority lacked sufficient evidence to warrant their use with older adults. Based on psychometric evidence, three measures (Beck Anxiety Inventory, Penn State Worry Questionnaire, and Geriatric Mental Status Examination) showed psychometric properties sufficient to justify the use of these instruments when assessing anxiety in older adults. In addition, two measures developed specifically for older adults (Worry Scale and Geriatric Anxiety Inventory) were also found to be appropriate for use with older adults.     

The effects of prism adaptation on daily life activities in patients with visuospatial neglect: a systematic review

Studies that have investigated prism adaptation (PA) effects on symptoms of visuospatial neglect have primarily used neuropsychological tests as outcome measures. An important question that remains to be answered is whether PA effects translate into improvements in patients’ daily life activities. In the present review, we examined systematically the evidence for the effect of PA treatment on daily life activities in patients with neglect. Two authors independently assessed the methodological quality of 25 intervention and 1 follow-up studies using validated scales. PA effects were evaluated for reading/writing, activities of daily living (ADL) direct tests, ADL questionnaires, and navigation tests. Studies were evaluated as being of excellent (n?=?1), good (n?=?12), fair (n?=?10), or poor (n?=?3) quality. Among the 26 articles, a total of 32 measurements showed significant PA effects (one measurement from a study of excellent quality, 17 from studies of good quality, 10 from studies of fair quality, four from studies of poor quality), whereas non-significant effects were found in 15 measurements (two from a study of excellent quality, three from studies of good quality, eight from studies of fair quality, two from studies of poor quality). There is some evidence suggesting that PA can improve daily functioning, particularly as measured by reading/writing and ADL direct tests. The impact of several variables on PA effects should be investigated further including sample heterogeneity and time since injury.     

Efficacy of RehaCom cognitive rehabilitation software in activities of daily living,attention and response control in chronic stroke patients

BackgroundOur world is unfortunately facing a huge number of stroke. Attention, response control and activities of daily living (ADL) are important cognitive functions affected by stroke. In line with this explanation, we aimed to investigate the effect of RehaCom rehabilitation software on ADL, attention and response control in chronic stroke patients with damage to middle and anterior cerebral arteries.MethodFor selecting participants, among chronic stroke patients who referred to our special rehabilitation clinic for patients with stroke, fifty patients selected. Participants were assigned to control (n = 25) and experimental (n = 25) groups. The experimental group was compared with the control group before and after using RehaCom (ten 45-min sessions in five weeks).ResultsThere is a significant enhancement in ADL, attention and response control scores in the experimental group compared with the control group. In fact, treatment with RehaCom significantly improved the score of all studied variables in chronic stroke patients.ConclusionsIn conclusion, RehaCom cognitive rehabilitation software has improvement effect on ADL, attention and response control in patients with chronic stroke. Our study reveals a new information about the efficacy of computerized training in the rehabilitation of stroke patients.     

The effects of computer-based cognitive rehabilitation in patients with visuospatial neglect following stroke: a systematic review

Objectives: To identify studies concerning the effects of computer based cognitive rehabilitation (CBCR) on visuospatial neglect (VN) after stroke to summarize the current state of knowledge in this research field and make recommendations for future research.

Methods: Four electronic databases were systematically searched. Authors of relevant studies were contacted to detect unpublished data or articles not found by searching databases. Data was extracted from included studies using predefined coding schemes and characteristics and results of individual studies were summarized qualitatively.

Selection criteria: Studies were included if at least 50% of the included patients had a stroke, if the studies explored the effects of CBCR as a primary intervention for rehabilitation of VN and if they included neuropsychological outcome measures for the presence of VN.

Results: Seven studies were included. Six of the seven studies suggested positive effects of CBCR on VN after stroke. However, the study that did not find these effects was also the study with the strongest methodological quality. All included studies consisted of small samples, varied greatly in design and had various methodological limitations.

Conclusion: Because the existing literature is very sparse and studies have various methodological limitations, it is currently not possible to either support or reject the effects of CBCR on VN after stroke. Future studies should aim to compare CBCR with active and passive control conditions and include larger samples in randomized and blinded designs.     

Instrumental activities of daily living in the screening of dementia in population studies: a systematic review and meta-analysis

BACKGROUND: Despite the fact that the current definitions of dementia in the DSM-IV and ICD-10 require functional deterioration for the diagnosis of dementia, it is not necessary a formal evaluation of functional capacity. OBJECTIVES: To examine the efficiency of functional assessment as a method of screening dementia in population studies. METHODS: This systematic review was based on information from MEDLINE, EMBASE, Index Médico Espa?ol (IME), and related articles. The studies included are population studies of patients over 65, in which normal and demented (established diagnosis) subjects are compared. In all of them, subjects were evaluated using the instrumental activities of daily living scale (IADL) as the method of screening for dementia. RESULTS: Two thousand three hundred and three abstracts and bibliographical references were reviewed. The authors of the selected studies were contacted and asked about other ongoing studies or indexes not included in our review in order to complete a meta-analysis. Finally, five studies were selected (n = 11.960). A meta-analysis was performed, with a statistical Q* value of 0.88 (SE 0.26). CONCLUSIONS: The functional assessment of the IADL showed an acceptable efficiency for the screening of dementia in the population studies included in this review, although few studies have verified this efficiency (sensitivity and specificity of the scales used). Further research is necessary in this field to be able to draw definitive conclusions.     

Everyday memory measures in multiple sclerosis: a systematic review

ABSTRACT

Everyday memory is one of the most affected cognitive functions in multiple sclerosis (MS). Assessing everyday memory problems is crucial for monitoring the impact of memory deficits on individuals’ day-to-day lives and evaluating the effectiveness of interventions that aim to improve cognitive functions. The aim of this systematic review was to identify the research literature on everyday memory measures used with people with MS, describe the types of measures used, and summarise their psychometric properties. Empirical studies of cognitive function in MS using standardised everyday memory measures were included. Online databases (MEDLINE, PsycINFO, PsycARTICLES, Embase) and Google Scholar were searched. Forty-four studies met the inclusion criteria. A total of 12 measures were identified, with varied uses and administration methods. The majority of papers did not report any psychometric properties for MS populations. The few papers that did, reported that the measures have good reliability and appear to have good face, concurrent, and ecological validity, but these need to be evaluated further. This review presents researchers and clinicians with an overview of the various everyday memory measures used in studies with people with MS, to help them choose the appropriate measure for their evaluations.     

Psychometric properties of an Arabic version of the fatigue severity scale in patients with stroke

Background: Post-stroke fatigue is a common symptom which needs to be assessed by a psychometrically sound tool.

Objectives: To investigate the psychometric properties of an Arabic version of the fatigue severity scale (FSS-A) in patients with stroke.

Methods: An observational, cross-sectional design was applied to 147 survivors of first-time stroke and 70 healthy participants. Internal consistency was measured by Cronbach’s α, while test-retest reliability was measured by intraclass correlation coefficients (ICCs). To assess validity, the FSS-A was correlated with the Fatigue Visual Analogue Scale (VAS-F), the Short Form 36 (SF-36) and its vitality domain (SF-36V), the stroke specific quality of life (SSQOL-A) and its energy domain (SSQOL-A-E), and the Beck Depression Inventory II (BDI-II).

Results: The FSS-A showed excellent internal consistency (Cronbach’s α = 0.934) and test-retest reliability (ICC = 0.920, 95% confidence interval (CI): 0.85–0.96). Exploratory factor analysis confirmed that the FSS-A is unidimensional. The FSS-A had high positive correlation with VAS-F, moderate positive correlation with BDI-II, high negative correlation with SSQOL-A-E and moderate negative correlations with SF-36, SF-36V, and SSQOL-A. It differentiated patients from healthy participants with a sensitivity of 78.4% and a specificity of 77.1%. The minimal detectable change with 95% CI was 1.02 (22.4%).

Conclusions: The FSS-A showed good psychometric properties suggesting its usefulness as a fatigue evaluation tool in patients diagnosed with stroke.     

Determining the potential benefits of yoga in chronic stroke care: a systematic review and meta-analysis

Background: Survivors of stroke have long-term physical and psychological consequences that impact their quality of life. Few interventions are available in the community to address these problems. Yoga, a type of mindfulness-based intervention, is shown to be effective in people with other chronic illnesses and may have the potential to address many of the problems reported by survivors of stroke.

Objectives: To date only narrative reviews have been published. We sought to perform, the first systematic review with meta-analyses of randomized controlled trials (RCTs) that investigated yoga for its potential benefit for chronic survivors of stroke.

Methods: Ovid Medline, CINHAL plus, AMED, PubMed, PsychINFO, PeDro, Cochrane database, Sport Discuss, and Google Scholar were searched for papers published between January 1950 and August 2016. Reference lists of included papers, review articles and OpenGrey for Grey literature were also searched. We used a modified Cochrane tool to evaluate risk of bias. The methodological quality of RCTs was assessed using the GRADE approach, results were collated, and random effects meta-analyses performed where appropriate.

Results: The search yielded five eligible papers from four RCTs with small sample sizes (n = 17–47). Quality of RCTs was rated as low to moderate. Yoga is beneficial in reducing state anxiety symptoms and depression in the intervention group compared to the control group (mean differences for state anxiety 6.05, 95% CI:?0.02 to 12.12; p = 0.05 and standardized mean differences for depression: 0.50, 95% CI:?0.01 to 1.02; p = 0.05). Consistent but nonsignificant improvements were demonstrated for balance, trait anxiety, and overall quality of life.

Conclusions: Yoga may be effective for ameliorating some of the long-term consequences of stroke. Large well-designed RCTs are needed to confirm these findings.     

Motor imagery as a complementary technique for functional recovery after stroke: a systematic review

Objective: To evaluate factors associated with 1-year mortality after discharge for acute stroke.

Methods: In this retrospective cohort study, we studied 305 patients with ischemic stroke or intracerebral hemorrhage discharged in 2010/2011. We linked Get With The Guidelines®-Stroke clinical data with New York State administrative data and used multivariate regression models to examine variables related to 1-year all-cause mortality poststroke.

Results: The mean age was 68.6 ± 14.8 years and 51.1% were women. A total of 146 (47.9%) were discharged directly home, 96 (31.5%) to inpatient rehabilitation facilities (IRFs), and 63 (20.7%) to skilled nursing facilities (SNFs). Overall, 24 (7.9%) patients died within 1-year post-discharge. Older age (adjusted odds ratio [OR] 1.05, 95% confidence interval [CI] 1.00–1.10), higher National Institutes of Health Stroke Scale (NIHSS) on admission (OR 1.10, 95% CI 1.03–1.17), and discharge destination (IRF vs. home, OR 0.10, 95% CI 0.01–0.94; and SNF vs. home, OR 2.22, 95% CI 0.71–6.95) were factors associated with 1-year all-cause mortality. When ambulation status at discharge was added to the model, ambulation with assistance and non-ambulation were significantly associated with mortality (ambulatory with assistance vs. ambulatory, OR 9.42, 95% CI 1.87–47.61; nonambulatory vs. ambulatory, OR 12.65, 95% CI 1.89–84.89).

Conclusions: While age and NIHSS on admission are important predictors of long-term outcomes, factors at discharge – ambulation status at discharge and discharge destination – are associated with 1-year mortality post-discharge for acute stroke and therefore could represent therapeutic targets to improve long-term survival in future studies.     

Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review

Objective: This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated.

Method: A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials.

Results: In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component.

Discussion: The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.     

C-反应蛋白水平对急性缺血性脑卒中预后影响的系统评价

目的 应用Meta分析,评价C-反应蛋白(C-reactive protein,CRP)水平对急性缺血性脑卒中预后的影响.方法 计算机检索PubMed、MEDLINE(1991-2006)、中国学术期刊全文数据库(1979-2006)等.搜集CRP水平对急性缺血性脑卒中预后影响非随机对照研究,逐篇评价纳入文献的质量,采用RevMan4.2版软件进行Meta分析.结果 共纳入7篇文献(外文4篇,中文3篇),涉及841例患者.在急性缺血性脑卒中患者中,3个月以上随访截尾时间的死亡率和再发血管事件与CRP水平相关,CRP增高组发生率比CRP正常组分别高2.71和1.81倍[OR合并分别为3.71和2.81,95%CI分别为(2.40,5.73)和(1.42,5.53)]均有统计学意义(P＜0.05);CRP测量值与缺血性脑卒中复发和死亡亦相关,在复发患者中,CRP测量值平均高于未复发者为3.52 mg/L[WMD=3.52,95%CI(-0.01,7.05)],具有一定的临床意义;在死亡患者中,CRP测量值平均高于生存者为8.02 mg/L[WMD=8.02,95%CI(5.68,10.37)],具有统计学意义(P＜0.05).结论 发病时CRP的水平可以初步评价急性缺血性脑卒中患者的预后.     

Botulinum neurotoxins for post‐stroke spasticity in adults: A systematic review

The aim of this systematic review was to determine whether botulinum neurotoxin (BoNT) reduce spasticity or improve function in adult patients after stroke. Eleven double‐blind randomized placebo‐controlled trials met inclusion criteria. They encompassed 782 patients, 767 (98%) of whom received BoNT/A, and 15 (2%) BoNT/B. Most studies used the Ashworth scale as primary outcome measure. Differences between treated and control groups were assessed as categorical or continuous comparisons. The overall effect on upper limb spasticity was in favor of BoNT/A. A significantly higher number of patients had a reduction of upper limb spasticity at 4‐week and 8‐week evaluations in the treatment group compared with placebo. Mean changes in joint spasticity revealed improvement 3 to 6 weeks and 9 to 12 weeks after treatment. There were insufficient data to establish BoNT/A efficacy on lower limb spasticity or the effect of BoNT/B on the upper and lower limbs. Because of inconsistency and heterogeneity of the available data, it was not possible to perform a meta‐analysis on disability and patients' reported outcomes. There was an overlapping safety profile between the treatment and the placebo groups. BoNT/A reduces upper limb spasticity in patients post‐stroke, but the improvement in functional ability remains to be established. This gap needs to be filled by new studies to assess the effect of BoNT in the context of multidisciplinary patient management. © 2009 Movement Disorder Society     

Psychosocial interventions for stroke survivors,carers and survivor-carer dyads: a systematic review and meta-analysis

Objective: To evaluate the effectiveness of psychosocial interventions on depressive symptoms, anxiety symptoms, quality of life, self-efficacy, coping, carer strain and carer satisfaction among stroke survivors, carers and survivor-carer dyads.

Data sources: MEDLINE, CINAHL, PsycINFO, SocINDEX, Cochrane Library, Web of Science and Scopus databases and the grey literature were searched up to September 2018.

Methods: A systematic review and meta-analysis of randomized controlled trials of psychosocial interventions for stroke survivors, carers and survivor-carer dyads, compared to usual care. Outcomes measured were depressive symptoms, anxiety symptoms, quality of life, coping, self-efficacy, carer strain, and carer satisfaction.

Results: Thirty-one randomized controlled trials (n = 5715) were included in the systematic review which found improvements in depressive symptoms, anxiety symptoms, quality of life and coping, though the number of trials assessing each outcome varied. A meta-analysis (11 trials; n = 1280) on depressive symptoms found that in seven trials psychosocial interventions reduced depressive symptoms in stroke survivors (SMD: ?0.36, 95% CI ?0.73 to 0.00; p = .05) and in six trials reduced depressive symptoms in carers (SMD: ?0.20, 95% CI ?.40 to 0.00; p = .05).

Conclusion: Psychosocial interventions reduced depressive symptoms in stroke survivors and their carers. There was limited evidence that such interventions reduced anxiety symptoms, or improved quality of life and coping for stroke survivors and carers and no evidence that they improved self-efficacy, carer strain or carer satisfaction.     

Effectiveness of acupuncture for stroke: a systematic review

Background Acupuncture has been suggested as a treatment for stroke rehabilitation, but the question whether it is effective has not been answered satisfactorily. Purpose To summarise and critically review all randomised controlled trials of the effectiveness of acupuncture as a treatment for stroke. Methods Four independent computerised literature searches (in MEDLINE, Cochrane Controlled Trials Register, Embase, and CISCOM data bases) were conducted in June 1999. All randomised-controlled trials that compared any form of needle insertion acupuncture to any form of non-acupuncture control intervention in the treatment of human stroke patients were included. Data were extracted independently by two authors and arbitrated by a third. The methodological quality of the included studies was assessed using the Jadad score. Results Nine randomised controlled trials with a total sample size of 538 patients were included. Two studies were assessor blind, one was subject blind, and one was assessor and subject blind. Two studies exclusively used manual acupuncture, five only electro-acupuncture, and two used both. Outcome measures used were Scandinavian Stroke Scale, Chinese Stroke Scale or Recovery Scale, Barthel index, Nottingham Health Profile, Motor function, balance, and days in hospital. Of the nine studies, six yielded a positive result suggesting that acupuncture is effective, and three produced a negative finding implying that acupuncture is not superior to control treatment. Only two studies obtained a Jadad score of more than 3. These methodologically best trials showed no significant effect of acupuncture. Conclusion Based on the evidence of rigorous randomised controlled trials, there is no compelling evidence to show that acupuncture is effective in stroke rehabilitation. Further, better-designed studies are warranted. Received: 20 September 2000 / Received in revised form: 16 February 2001 / Accepted: 13 February 2001     

Association of early-onset dementia with activities of daily living (ADL) in middle-aged adults with intellectual disabilities: The caregiver's perspective

Few studies have investigated in detail which factors influence activities of daily living (ADL) in adults with intellectual disabilities (ID) comorbid with/without dementia conditions. The objective of the present study was to describe the relation between early onset dementia conditions and progressive loss of ADL capabilities and to examine the influence of dementia conditions and other possible factors toward ADL scores in adults with ID. This study was part of the “Healthy Aging Initiatives for Persons with an Intellectual Disability in Taiwan: A Social Ecological Approach” project. We analyzed data from 459 adults aged 45 years or older with an ID regarding their early onset symptoms of dementia and their ADL profile based on the perspective of the primary caregivers. Results show that a significant negative correlation was found between dementia score and ADL score in a Pearson's correlation test (r = −0.28, p < 0.001). The multiple linear regression model reported that factors of male gender (β = 4.187, p < 0.05), marital status (β = 4.79, p < 0.05), education level (primary: β = 5.544, p < 0.05; junior high or more: β = 8.147, p < 0.01), Down's syndrome (β = −9.290, p < 0.05), severe or profound disability level (β = −6.725, p < 0.05; β = −15.773, p < 0.001), comorbid condition (β = −4.853, p < 0.05) and dementia conditions (β = −9.245, p < 0.001) were variables that were able to significantly predict the ADL score (R² = 0.241) after controlling for age. Disability level and comorbidity can explain 10% of the ADL score variation, whereas dementia conditions can only explain 3% of the ADL score variation in the study. The present study highlights that future studies should scrutinize in detail the reasons for the low explanatory power of dementia for ADL, particularly in examining the appropriateness of the measurement scales for dementia and ADL in aging adults with ID.