Rehabilitation of the Elbow Extension With Motor Imagery in a Patient With Quadriplegia After Tendon Transfer

Grangeon M, Guillot A, Sancho P-O, Picot M, Revol P, Rode G, Collet C. Rehabilitation of the elbow extension with motor imagery in a patient with quadriplegia after tendon transfer.

Objective

To test the effect of a postsurgical motor imagery program in the rehabilitation of a patient with quadriplegia.

Design

Crossover design with kinematic analysis.

Setting

Rehabilitation Hospital of Lyon. Study approved by the local Human Research Ethics Committee.

Participants

C6-level injured patient (American Spinal Injury Association Impairment Scale grade A) with no voluntary elbow extension (triceps brachialis score 1).

Intervention

The surgical procedure was to transfer the distal insertion of the biceps brachii onto the triceps tendon of both arms. The postsurgical intervention on the left arm included 10 sessions of physical rehabilitation followed by 10 motor imagery sessions of 30 minutes each. The patient underwent 5 sessions a week during 2 consecutive weeks. The motor imagery content included mental representations based on elbow extension involved in goal-directed movements. The rehabilitation period of the right arm was reversed, with motor imagery performed first, followed by physical therapy.

Main Outcome Measures

The kinematics of upper-limb movements was recorded (movement time and variability) before and after each type of rehabilitation period. A long-term retention test was performed 1 month later.

Results

Motor imagery training enhanced motor recovery by reducing hand trajectory variability—that is, improving smoothness. Motor performance then remained stable over 1 month.

Conclusions

Motor imagery improved motor recovery when associated with physical therapy, with motor performance remaining stable over the 1-month period. We concluded that motor imagery should be successfully associated with classic rehabilitation procedure after tendon transfer. Physical sessions may thus be shortened if too stressful or painful.     

The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients

Objectives

To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.

Design

Cross-sectional, correlation study.

Setting

Orthopaedic outpatient setting in a tertiary hospital.

Participants

One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.

Measures

Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.

Results

The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.

Conclusions

This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.     

Lowering of Sensory, Motor, and Pain-Tolerance Thresholds With Burst Duration Using Kilohertz-Frequency Alternating Current Electric Stimulation: Part II

Ward AR, Lee Hung Chuen WL. Lowering of sensory, motor, and pain-tolerance thresholds with burst duration using kilohertz-frequency alternating current electric stimulation: part II.

Objective

To determine the optimum burst duration for discrimination between sensory, motor, and pain tolerance thresholds using 20-Hz bursts of kilohertz-frequency sinusoidal alternating current (AC) applied transcutaneously to human participants.

Design

A within-subject, repeated-measures trial.

Setting

A research laboratory.

Participants

Healthy young adults (N=20).

Interventions

Bursts of AC electric stimulation at frequencies of 1 and 4kHz. The burst frequency was 20Hz. Burst durations ranged from 250 microseconds (for 1 cycle of 4-kHz AC) and 1 millisecond (for 1 cycle of 1-kHz AC) to 50 milliseconds (continuous AC).

Main Outcome Measures

Measurement of sensory, motor, and pain-tolerance thresholds.

Results

Thresholds decreased to a minimum with increasing burst duration. The minimum threshold identified the utilization time over which summation of subthreshold stimuli occurs. Utilization times were different for sensory (∼20ms), motor (∼30ms), and pain (>50ms) and were much higher than found in a previous study that used a higher burst frequency (50Hz). As with the previous study, relative thresholds were found to vary with burst duration. Despite the very different utilization times, maximum separation between sensory, motor, and pain thresholds was found to occur with bursts in the range of 1 to 4 milliseconds, the same range found in the previous study.

Conclusions

Our conclusions concur with those reported previously and support the contention that short-duration kilohertz-frequency AC bursts (1-4ms) have a more useful role in rehabilitation than the long-duration kilohertz-frequency bursts that characterize Russian and interferential currents.     

Use of Sheng-Hua-Tang and health-related quality of life in postpartum women: A population-based cohort study in Taiwan

Background

Although Sheng-Hua-Tang (comprising Radix Angelicae Sinensis, Ligustici Rhizoma, Semen Persicae, Zingiberis Rhizoma and Glycyrrhizae Radix) use during the postpartum has been popular in Chinese communities over a long period, its benefits have not been evaluated in terms of its effects on the health-related quality of life of postpartum women.

Objectives

This study aims to explore the relation between different patterns of Sheng-Hua-Tang use and the health-related quality of life in postpartum women.

Design

A longitudinal birth cohort follow-up study.

Settings and participants

We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. A structured questionnaire was successfully administered to 87.8% of the sampled population.

Methods

Subjects underwent a home interview 6 months after their deliveries between June 2005 and July 2006. The Medical Outcomes Study 36-item Short-Form (SF-36) was used to measure the quality of life of the women with different patterns of Sheng-Hua-Tang use.

Results

Compared with those who never used after delivery, the scores of role limitations due to physical health and emotional problems significantly increased in women who used Sheng-Hua-Tang within 1 month only but decreased in those who continuously used within 1 month and later. In addition, the scores of role limitations due to physical health and emotional problems significantly increased in women who used Sheng-Hua-Tang regardless of the frequency.

Conclusions

Sheng-Hua-Tang use during the first month of the postpartum period may have a positive effect on women's health-related quality of life especially in terms of role limitations due to physical health and emotional problems. However, continuous use after the first month of the postpartum period might have a negative effect on women's quality of life. Further studies are needed to replicate the results and elucidate the causal relations.     

Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: A questionnaire survey

Background

Previous studies about the prevalence and impact of lower urinary tract symptoms (LUTS) were focused on urinary incontinence or overactive bladder in the general population. Little research has been focused on the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL).

Objectives

To estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS.

Design

This study was a cross-sectional, questionnaire survey.

Settings

Three medical centers and five regional hospitals in Taipei were selected randomly.

Participants

In the selected hospitals, 1065 female nurses were selected randomly. Data analyses were based on 907 usable surveys. All participants were native Taiwanese; most of the female nurses were 26-35 years of age (mean = 31.02, SD = 6.32), had normal body mass index, and had never given birth. Most nurses’ bladder habits were poor or very poor and their personal habits of fluid consumption at work were inadequate.

Methods

Data were collected using the Taiwan Nurse Bladder Survey and the Short Form 36 Taiwan version. Chi-square tests were used to compare the prevalence rates of different LUTS for nurses in different age groups. Student's t-tests were conducted to compare the mean scores of HRQL for nurses with and without LUTS.

Results

Based on 907 usable surveys, 590 (65.0%) experienced at least one type of LUTS. The prevalence for different LUTS ranged from 8.0% to 46.5%. Nurses who reported LUTS also reported lower HRQL, more so on physical health than mental health, than nurses who did not report LUTS.

Conclusions

Although most of the nurses in this study were young (≦35 years) and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to concerns about nurses’ possible dysfunctional voiding patterns and possible effects of working environment and poor bladder and personal habits on LUTS. Study results showed a possible negative impact of LUTS on nurses’ physical health. Designing a continence-related education program for this group is essential for delivering information about LUTS prevention and management.     

Assessment of the anal sphincter muscle: Comparison of a digital and a manometric technique

Objectives

To determine if there is a relationship between digital anal use of the modified Oxford Scale for assessment of anal sphincter muscle strength and anal manometric assessment.

Design

A prospective, correlational, within-subject design, using two different techniques, in random order, at the same session.

Setting

The physiotherapy outpatient department of a district general hospital.

Participants

Seventy subjects (57 females) with a mean age of 56.3 years. All were attending for physiotherapy treatment of pelvic floor dysfunction.

Interventions

Subjects carried out three consecutive pelvic floor muscle contractions each, for digital assessment and for manometric assessment.

Main outcome measures

The relationship between the median of the three digital and the mean of the three manometric measurements was examined using the Spearman rank correlation coefficient.

Results

There was a low, positive correlation between the median of the digital scores and the mean of the manometric pressures (r_s = 0.33, P < 0.005).

Conclusions

This study poses questions about the use of the modified Oxford Scale for assessment of the anal sphincter muscle. Issues include the subject's body mass index and the probe design. The quality of anal resting tone, though crucial to its function, is not addressed by the modified Oxford Scale. Further work is needed to develop a robust method of anal sphincter assessment.     

Differential Performance of SF-36 Items in Healthy Adults With and Without Functional Limitations

Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations.

Objective

To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations.

Design

Survey responses were analyzed by using partial correlations.

Setting

General community.

Participants

Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems.

Interventions

Not applicable.

Main Outcome Measure

SF-36.

Results

Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions.

Conclusions

Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.     

Accelerometer monitoring of home- and community-based ambulatory activity after stroke

Haeuber E, Shaughnessy M, Forrester LW, Coleman KL, Macko RF. Accelerometer monitoring of home- and community-based ambulatory activity after stroke. Arch Phys Med Rehabil 2004;85:1997-2001.

Objectives

To investigate the utility of a novel microprocessor-linked Step Watch Activity Monitor (SAM) to quantify ambulatory activity after stroke and to evaluate the validity and reliability of conventional accelerometers to measure free-living physical activity in this population.

Design

Cross-sectional with repeated measures of 2 separate 48-hour recordings in 17 persons wearing an ankle-mounted SAM and Caltrac, a hip-mounted mechanical accelerometer.

Setting

Home and community.

Participants

Seventeen subjects with chronic hemiparetic gait after stroke.

Interventions

Not applicable.

Main outcome measures

The SAM derived stride counts per day and Caltrac estimated the daily caloric expenditure of physical activity.

Results

SAM data revealed that stroke patients had a mean strides per day ± standard deviation of 3035±1944 and demonstrated a broad range of daily activity profiles (400-6472 strides). SAM test-retest reliability was high across separate monitoring periods (r=.96, P<.001). Although Caltrac also revealed a broad range of daily activity calories (346±217kcal/d; range, 83-1222kcal/d), reliability was poor (r=.044, P=not significant) and Caltrac accounted for only 64% of the ambulatory activity quantified by the SAM.

Conclusions

Microprocessor-linked accelerometer monitoring, but not conventional accelerometers, are accurate and highly reliable for quantifying ambulatory activity levels in stroke patients. These findings support the utility of personal status monitoring of ambulatory activity as an outcomes instrument and metric in programs to increase physical activity and cardiovascular health after stroke.     

Baseline Comorbidity Associated With the Short-Term Effects of Exercise Intervention on Quality of Life in the Japanese Older Population: An Observational Study

Tamari K. Baseline comorbidity associated with the short-term effects of exercise intervention on quality of life in the Japanese older population: an observational study.

Objective

To investigate predictors of responses to a class-based exercise program in terms of health-related quality of life (HRQOL).

Design

A 3-month prospective cohort study.

Setting

General community.

Participants

A sample of community-dwelling Japanese volunteers (N=137; aged ≥65y) initially was included in the study. More than three fourths (76.6%) completed the follow-up examination.

Interventions

Not applicable.

Main Outcome Measures

Eight domains of the Medical Outcomes Study 36-Item Short-Form Health Survey, version 2, were used as main outcome measures. Candidate predictors included demographic variables, medical history of chronic diseases, and results of a set of physical performance tests at the baseline examination. Logistic regression models were used to detect predictors.

Results

Bodily pain, vitality, social functioning, and mental health domains improved after the intervention (P<.01 vs baseline). The absence of diabetes mellitus showed an association with a good response in the identified domains, with an adjusted odds ratio (OR) of 2.88 (confidence interval [CI], .90-9.25). More than 20% of participants had negative changes in the physical functioning, physical role, general health, and emotional role domains at follow-up. The presence of osteoarthritis significantly predicted a poor response in these domains, with an adjusted OR of 6.75 (CI, 1.58-28.83).

Conclusions

Three months of class-based exercise is effective in alleviating bodily pain and the mental components of HRQOL; however, the effect of exercise on the physical domains of HRQOL may be limited. The presence of osteoarthritis may moderate the effects of exercise on HRQOL physical components.     

How Reproducible Is Home-Based 24-Hour Ambulatory Monitoring of Motor Activity in Patients With Multiple Sclerosis?

Rietberg MB, van Wegen EE, Uitdehaag BM, de Vet HC, Kwakkel G. How reproducible is home-based 24-hour ambulatory monitoring of motor activity in patients with multiple sclerosis?

Objective

To determine the reproducibility of 24-hour monitoring of motor activity in patients with multiple sclerosis (MS).

Design

Test-retest design; 6 research assistants visited the participants twice within 1 week in the home situation.

Setting

General community.

Participants

A convenience sample of ambulatory patients (N=43; mean age ± SD, 48.7±7.0y; 30 women; median Expanded Disability Status Scale scores, 3.5; interquartile range, 2.5) were recruited from the outpatient clinic of a university medical center.

Interventions

Not applicable.

Main Outcome Measures

Dynamic activity and static activity parameters were recorded by using a portable data logger and classified continuously for 24 hours. Reproducibility was determined by calculating intraclass correlation coefficients (ICCs) for test-retest reliability and by applying the Bland-Altman method for agreement between the 2 measurements. The smallest detectable change (SDC) was calculated based on the standard error of measurement.

Results

Test-retest reliability expressed by the ICC_agreement was .72 for dynamic activity, .74 for transitions, .77 for walking, .71 for static activity, .67 for sitting, .62 for standing, and .55 for lying. Bland and Altman analysis indicated no systematic differences between the first and second assessment for dynamic and static activity. Measurement error expressed by the SDC was 1.23 for dynamic activity, 66 for transitions, .99 for walking, 1.52 for static activity, 4.68 for lying, 3.95 for sitting, and 3.34 for standing.

Conclusions

The current study shows that with 24-hour monitoring, a reproducible estimate of physical activity can be obtained in ambulatory patients with MS.     

A meta-analytic study of predictors of maternal-fetal attachment

Objectives

To identify predictors of maternal-fetal attachment (MFA) through a comprehensive review of the literature, and to use quantitative meta-analysis to determine the magnitude of the relationship between each predictor and MFA.

Design

The literature reviewed included 183 studies of MFA, published and unpublished, between 1981 and 2006.

Methods

Seventy-two studies met the inclusion criteria and yielded 14 predictors of MFA. A meta-analysis was performed on each of the 14 predictors in relation to MFA.

Results

The results indicated that gestational age had a moderate to substantial effect size. Two predictors (social support and prenatal testing) had moderate effect sizes; 10 predictors (anxiety, self-esteem, depression, planned pregnancy, age, parity, ethnicity, marital status, income, and education) had low effect sizes. High-risk pregnancy had a trivial effect size.

Conclusions

The most powerful predictors of MFA using meta-analysis were identified to direct future research and evidence-based practice.     

Is surgical airway necessary for airway management in deep neck infections and Ludwig angina?

Background

Deep neck infections are potentially life-threatening conditions because of airway compromise. Management requires early recognition, antibiotics, surgical drainage, and effective airway control. The Surgical Education and Self-Assessment Program 12 states that awake tracheostomy is the treatment of choice for these patients.

Hypothesis

With advanced airway control techniques such as retrograde intubation, GlideScope, and fiberoptic intubation, surgical airway is not required.

Design

A retrospective analysis of all deep neck abscesses treated from December1999 to July 2006 was performed.

Methods

All patients who underwent urgent or emergent surgery for Ludwig angina and submental, submandibular, sublingual, and parapharyngeal abscesses (Current Procedural Terminology codes 41015, 41016, 41017, 42320, and 42725) were included in our review. Charts were studied for age, presence of true Ludwig angina, presence of airway compromise, airway management, morbidity/mortality, and the requirement for surgical airway.

Results

Of 29 patients, 6 (20%) had symptoms consistent with true Ludwig angina. Nineteen (65.5%) had evidence of airway compromise. Eight (42%) of these 19 patients required advanced airway control techniques. No patient required a surgical airway, and no mortality resulted from airway compromise. Advance airway control techniques were required more often in patients with airway compromise (P < .05).

Conclusion

Treatment of Ludwig angina and deep neck abscesses requires good clinical judgment. Patients with deep neck infections and symptoms of airway compromise may be safely managed with advanced airway control techniques.     

Life-Space Mobility of Middle-Aged and Older Adults at Various Stages of Usage of Power Mobility Devices

Auger C, Demers L, Gélinas I, Miller WC, Jutai JW, Noreau L. Life-space mobility of middle-aged and older adults at various stages of usage of power mobility devices.

Objective

To examine whether the impact of power mobility devices (PMDs) varies as a function of stage of usage and to explore key factors associated with greater life-space mobility for middle-aged and older adults.

Design

Multicohort study with respondents grouped as a function of stage of PMD usage (reference group with mobility impairments, n=42; initial users, 1-6mo, n=35; long-term users, 12-18mo, n=39). Cohorts were compared with respect to life-space mobility in a continuum of environments ranging from home to outside town, using analysis of variance and chi-square tests. Baseline personal, assistive device, intervention, and environmental factors associated with life-space mobility were explored with age-adjusted linear regression models.

Setting

Four Canadian rehabilitation centers.

Participants

Random sample of middle-aged and older adults (N=116; 50-89y) living in the community or residential care.

Intervention

Procurement of a powered wheelchair or scooter.

Main Outcome Measure

Life-Space Assessment composite score.

Results

Cohort comparisons showed higher frequency of outings for PMD users in the neighborhood (P<.001) and around home (P<.05) and significantly greater Life-Space Assessment composite scores for initial and long-term users than for the reference group (P<.05). Factors such as sex, the nature of activities, and device type explained variances in Life-Space Assessment composite score ranging from 15.9% to 18.0% (P<.006).

Conclusions

Life-space mobility increases after PMD use and remains stable across the stages of initial and long-term use. To appreciate the impact of PMDs, clinicians should consider the environment and a combination of personal and device factors that are associated with the range of life-space mobility in the first 18 months after procurement.     

Black-white disparities in motor function outcomes taking into account patient characteristics, nontherapy ancillaries, therapy activities, and therapy interventions

Deutscher D, Horn SD, Smout RJ, DeJong G, Putman K. Black-white disparities in motor function outcomes taking into account patient characteristics, nontherapy ancillaries, therapy activities, and therapy interventions.

Objective

To assess black-white differences in functional outcomes, controlling for patient characteristics, use of nontherapy ancillaries (NTAs), and use of physical (PT) and occupational therapy (OT) activities and interventions.

Design

Multicenter prospective observational cohort study of poststroke rehabilitation.

Setting

Six U.S. inpatient rehabilitation facilities.

Participants

Patients (N=732) subdivided into case-mix subgroups (CMGs; CMGs 104-107 for moderate strokes [n=397], CMGs 108-114 for severe strokes [n=335]).

Interventions

Not applicable.

Main Outcome Measure

Discharge Motor FIM.

Results

Taking into account patient characteristics, NTAs, and therapy activities, multivariate regressions explained (R²) 54% and 69% of variation in outcomes between patients with moderate and severe stroke, respectively. Black race was associated with lower outcomes than white race in the severe group. However, race was no longer associated with outcomes after including interventions used within PT and OT activities. Including interventions within therapy activities increased R² to 64% and 74% for moderate and severe strokes, respectively. Some PT and OT activities were provided more to blacks than whites and vice versa. Greater intensity sometimes was associated with better and sometimes with poorer functional outcomes.

Conclusions

After controlling for interventions within activities, no racial differences were found in functional outcomes at discharge despite racial differences in rehabilitation care, possibly because each racial group received a mixture of interventions that were negatively and positively associated with outcome. Clinicians should provide therapies associated with better outcomes with high and similar intensities for black and white patients poststroke.     

Health of community-dwelling adults with mobility limitations in the United States: incidence of secondary health conditions. Part II

Rasch EK, Magder L, Hochberg MC, Magaziner J, Altman BM. Health of community-dwelling adults with mobility limitations in the United States: incidence of secondary health conditions. Part II.

Objective

To compare incident health conditions that occurred over a 2-year period in nationally representative groups of adults with mobility, nonmobility, and no limitations.

Design

Data were collected prospectively from a probability subsample of households that represent the civilian, noninstitutionalized U.S. population.

Setting

Five rounds of household interviews were conducted over 2 years.

Participants

Data were analyzed on the same respondents from the 1996−1997 Medical Expenditure Panel Survey (MEPS) and the 1995 National Health Interview Survey Disability Supplement. Respondents were categorized into 3 groups for analysis; those with mobility limitations, nonmobility limitations, and no limitations. The analytic sample included 12,302 MEPS adults (≥18y).

Interventions

Not applicable.

Main Outcome Measures

Number, types, and 2-year incidence of self-reported health conditions compared across groups.

Results

The mean number of incident conditions (95% confidence intervals [CIs]) over the 2-year period was greatest in adults with mobility limitations (mean, 4.7; 95% CI, 4.4−4.9) compared with those with nonmobility limitations (mean, 3.9; 95% CI, 3.7−4.2) or no limitations (mean, 2.6; 95% CI, 2.5−2.7). Incident conditions affected most major body systems.

Conclusions

Because secondary conditions are potentially preventable, determining factors that influence their occurrence is an important public health issue requiring specific action.     

Apathy and Health-Related Quality of Life in Stroke

Objective

To examine differences in health-related quality of life (HRQOL) in stroke survivors with and without apathy.

Design

Cross-sectional study.

Setting

Acute stroke unit in a regional hospital.

Participants

Stroke survivors (N=391) recruited from the acute stroke unit.

Interventions

Not applicable.

Main Outcome Measures

Participants were divided into apathy and nonapathy groups. Participants who scored ≥36 on the Apathy Evaluation Scale, clinician's version formed the apathy group. HRQOL was measured with the 2 component scores, mental component summary (MCS) and physical component summary (PCS), of the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12). Demographic and clinical information were obtained with the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS).

Results

Thirty-six (9%) participants had apathy. The apathy group had significantly lower MCS and PCS scores. After adjusting for sex, education, diabetes mellitus, and NIHSS, MMSE, GDS, and BI scores, the MCS score in the apathy group remained significantly lower.

Conclusions

Apathy has a significant negative effect on HRQOL in stroke survivors, particularly on their mental health. Interventions for apathy could improve the HRQOL of stroke survivors.     

Managing uncertainty in life after stroke: A qualitative study of the experiences of established and new informal carers in the first 3 months after discharge

Background

Caring for stroke survivors at home can have an enormous impact on informal carers and past research has tended to focus on the negative emotional consequences of caring, with few identifying any positive outcomes. Despite an awareness that the experiences of these carers change over time, there is a dearth of qualitative studies investigating carers’ experiences over time.

Objectives

To investigate the experiences of informal carers of stroke survivors over time.

Design

Qualitative study.

Setting

Carers of stroke survivors from one acute and two rehabilitation units in South-West London.

Participants

A purposive sample of 31 informal carers of stroke survivors discharged from inpatient treatment and rehabilitation returning home were interviewed. The majority of participants’ were spouses but they also included adult sons and daughters. Most participants were post-retirement age.

Methods

Audio-taped in-depth interviews of 30-90 min duration were undertaken at three time points—close to discharge, 1 month and 3 months post-discharge. Interviews were transcribed immediately after each interview. Analysis was an ongoing process starting during data collection and ending with themes. As themes emerged they were identified and discussed with other members of the team so that any patterns across the interviews were noted. Themes were followed up at subsequent interviews. This process enabled progressive focusing of ideas and also validated respondents’ accounts.

Results

There were a total of 81 interviews and these carers were similar demographically to other carers in stroke research. A central theme of uncertainty with a number of other interconnected themes were identified. Other themes including adopting routines and strategies, absolute and relative positives and questioning the future could be seen to both influence and be influenced by uncertainty. These themes can all be related to the changes in carers’ lives or the management of uncertainty around stroke. Differences in experiences and coping strategies were identified between new carers and those with prior caring experience.

Conclusions

Carers experience considerable uncertainty when caring for stroke survivors. Living with uncertainty is central to these carers’ experiences and this should be acknowledged by clinicians when supporting stroke survivors and carers. Encouraging the identification of the positive aspects of caring may help carers manage the challenges and uncertainties created by stroke.     

Use of the Continuous Scale Physical Functional Performance Test in Stroke Survivors

Manns PJ, Tomczak CR, Jelani A, Cress ME, Haennel R. Use of the continuous scale physical functional performance test in stroke survivors.

Objective

To (1) determine the feasibility of the continuous scale physical functional performance 10-item test (CS-PFP10) for the measurement of physical function in stroke survivors, (2) characterize physical functional performance of stroke survivors and their matched controls, and (3) explore the associations among physical functional performance, ambulatory activity, and peak oxygen uptake (Vo₂peak).

Design

Case control.

Setting

University research setting.

Participants

Ten participants with stroke and 10 healthy controls matched for age, sex, and physical activity.

Interventions

Not applicable.

Main Outcome Measures

The CS-PFP10 test was used to measure functional ability. The test requires performance of 10 serial tasks that range from low to high difficulty. The step activity monitor was used to measure absolute ambulatory activity and was reported as the average number of steps a day over a 4-day period. Vo₂peak was determined using a metabolic cart and a recumbent cycle ergometer.

Results

Stroke survivors scored lower than healthy controls on all individual tasks, domains, and the total score on the CS-PFP10. Higher Vo₂peak was associated with higher total scores on the CS-PFP10 in both stroke survivors and controls. In stroke survivors, lower levels of impairment (as indicated by the Chedoke-McMaster stroke assessment) were associated with higher total CS-PFP10 scores.

Conclusions

The CS-PFP10 is a measure of physical performance that is feasible to use with ambulatory participants with stroke. Future investigations with people with stroke should explore the ability of the CS-PFP10 to provide meaningful information about change in CS-PFP10 subscales with interventions that target items on the subscales, such as balance or upper extremity strength.     

Health-related quality of life in women with coronary artery disease

Background

Women with coronary artery disease (CAD) have reported worse health-related quality of life (HRQOL) than men.

Objectives

The purpose of this study was to explore HRQOL in women with CAD undergoing coronary angiography. Specifically, the effects of age and depressive symptoms on HRQOL were examined.

Method

Data were obtained from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. A total of 1034 women underwent coronary angiography between February, 2004 and January, 2005. Questionnaires measuring HRQOL and depressive symptoms were mailed within 1 week of index cardiac catheterization.

Results

There were 437 women (42.3%) who responded to the questionnaires. After adjusting HRQOL scores for sociodemographic and clinical variables, depressive symptoms were the strongest predictor of HRQOL; increased age was associated with worse physical functioning and positive disease perception; higher BMI with anginal stability; revascularization with anginal stability and treatment satisfaction.

Conclusion

Overall, the variables measured accounted for a small proportion of the variance in HRQOL. Further research is needed to understand the complex relationship among age, depressive symptoms, and HRQOL in women with CAD.