To be on sick-leave due to heart failure: a qualitative perspective

Abstract

Purpose: The aim of the present study was to explore and describe meanings of being on sick leave due to heart failure. Methods: The study was conducted in Sweden during 2011–2012. Five men and one woman, aged 46 to 62, were interviewed. A reflective life-world research approach based on phenomenological philosophy was used. The result of the analysis is presented in three themes. Results: To be on sick leave due to heart failure implies a life situation characterized by anxiety, insecurity and uncertainty. When rehabilitation professionals do not take on their professional responsibility, sick listed people with heart failure perceive they are dismissed and abandoned. If rehabilitation professionals take on their professional responsibility it can be experienced as supportive. Conclusions: People who are on sick leave due to heart failure are abandoned by rehabilitation professionals and they lack opportunities to participate in their own sick leave/rehabilitation processes. Rehabilitation professionals need to take more responsibility and allow the patients to participate by connecting and recognizing patients as equal human beings. The present results can be used by rehabilitation professionals to reflect on and discuss the needs of people on sick leave due to heart failure.

• Implications for Rehabilitation

• Heart failure is a chronic condition implying a complicated life-situation.

• People with heart failure experience abandonment by rehabilitation professionals and lack participation in their own rehabilitation process.

• In order to support people on sick leave due to heart failure collaboration and coordination between rehabilitation professionals are needed.

     

The effects of multimodal rehabilitation on pain-related sickness absence – an observational study

Purpose: The aim of the current study was to examine the effects on sickness absence of multimodal rehabilitation delivered within the framework of a national implementation of evidence based rehabilitation, the rehabilitation guarantee for nonspecific musculoskeletal pain.

Method: This was an observational matched controlled study of all persons receiving multimodal rehabilitation from the last quarter of 2009 until the end of 2010. The matching was based on age, sex, sickness absence the quarter before intervention start and pain-related diagnosis. The participants were followed by register data for 6 or 12 months. The matched controls received rehabilitation in accordance with treatment-as-usual.

Results: Of the participants, 54% (N?=?3636) were on registered sickness absence at baseline and the quarter before rehabilitation. The average difference in number of days of sickness absence between the participants who received multimodal rehabilitation and the matched controls was to the advantage of the matched controls, 14.7 days (CI 11.7; 17.7, p?≤?0.001) at 6-month follow-up and 9.5 days (CI 6.7; 12.3, p?≤?0.001) at 12-month follow-up. A significant difference in newly granted disability pensions was found in favor of the intervention.

Conclusions: When implemented nationwide, multimodal rehabilitation appears not to reduce sickness absence compared to treatment-as-usual.

• Implications for Rehabilitation

• A nationwide implementation of multimodal rehabilitation was not effective in reducing sickness absence compared to treatment-as-usual for persons with nonspecific musculoskeletal pain.

• Multimodal rehabilitation was effective in reducing the risk of future disability pension for persons with nonspecific musculoskeletal pain compared to treatment-as-usual.

• To be effective in reducing sick leave multimodal rehabilitation must be started within 60 days of sick leave.

• The evidence for positive effect of multimodal rehabilitation is mainly for sick listed patients. Prevention of sick leave for persons not being on sick leave should not be extrapolated from evidence for multimodal rehabilitation.

     

A crossover trial comparing wide dynamic range compression and frequency compression in hearing aids for tinnitus therapy

Purpose: It has been suggested that frequency lowering may be a superior tinnitus reducing digital signal processing (DSP) strategy in hearing aids than conventional amplification. A crossover trial was undertaken to determine if frequency compression (FC) was superior to wide dynamic range compression (WDRC) in reducing tinnitus. Method: A 6–8-week crossover trial of two digital signal-processing techniques (WDRC and 2 WDRC with FC) was undertaken in 16 persons with high-frequency sensorineural hearing loss and chronic tinnitus. Results: WDRC resulted in larger improvements in Tinnitus Functional Index and rating scale scores than WDRC with FC. The tinnitus improvements obtained with both processing types appear to be due to reduced hearing handicap and possibly decreased tinnitus audibility. Conclusions: Hearing aids are useful assistive devices in the rehabilitation of tinnitus. FC was very successful in a few individuals but was not superior to WDRC across the sample. It is recommended that WDRC remain as the default first choice tinnitus hearing aid processing strategy for tinnitus. FC should be considered as one of the many other options for selection based on individual hearing needs.

• Implications of Rehabilitation

• Hearing aids can significantly reduce the effects of tinnitus after 6–8 weeks of use.

• Addition of frequency compression digital signal processing does not appear superior to standard amplitude compression alone.

• Improvements in tinnitus were correlated with reductions in hearing handicap.

     

Associations between socio-demographic factors,encounters with healthcare professionals and perceived ability to return to work in people sick-listed due to heart failure in Sweden: a cross-sectional study

Purpose: The aim of this study was to investigate associations between socio-demographic factors, experiences of positive/negative encounters with healthcare professionals, and the encounters' impact on the ability to return to work in a population of people on sick leave due to heart failure. Methods: This was a cross-sectional study. Data were collected from two official registries in Sweden and from a postal questionnaire. In all, 590 people with heart failure responded to the questionnaire. Associations between variables were calculated with bivariate correlation analyses and logistic regression analyses. Results: For people on sick leave due to heart failure, positive encounters with healthcare professionals are associated with being Swedish-born, female gender, and high income. People with high income are more likely to be supported back to work by positive encounters with healthcare professionals. To perceive that healthcare professionals believe in person's ability to return to work can be facilitating. Conclusions: Women, people who are not foreign-born, and people with high income are more likely to perceive encounters with healthcare professionals as positive. Healthcare professionals who work with rehabilitation for people with heart failure need to be aware of social inequalities and that being on sick leave is a process of change.

• Implications for Rehabilitation

• A failing heart limits everyday life implying risk for long-term sick leave. Even though there are rehabilitation programs for people with heart failure, vocational rehabilitation is often over-looked. The knowledge about factors associated with sick leave due to heart failure is scarce.

• Experiences of positive encounters with healthcare professionals were associated with being Swedish-born, female gender, and high income. People with high income were more likely to be supported back to work by positive encounters with healthcare professionals.

• Healthcare professionals who work with rehabilitation for people with heart failure can support patients with heart failure by showing them confidence and trust. However, they need to be aware that sick leave implies a process of change.

     

Higher social distress and lower psycho-social wellbeing: examining the coping capacity and health of people with hearing impairment

Abstract

Purpose: The objectives of this paper are as follows: (1) propose an explanatory model as to how hearing disability may impact on health and (2) examine the model’s utility. Methods: Data were collected on the psycho-social wellbeing, disability and physical health of farmers (n?=?56) participating in an intervention to manage the social impacts of hearing disability. Two models were proposed and examined using multiple hierarchical linear regression. Model 1 used self-rated quality of life and model 2 used capacity to manage hearing and listening impairments, as dependent variables. Results: The analyses found that physical measures of hearing impairment (audiograms) were not correlated with physical or mental health outcomes. However, in model 1, self-confidence and self-rated ability to manage hearing impairment were most closely associated with reduced quality of life (anxiety and diastolic blood pressure were positively associated with quality of life). In model 2, higher anxiety and reduced self-confidence were associated with decreasing ability to successfully manage one’s hearing impairment. Conclusions: The findings support the explanatory model that stress is higher and wellbeing lower when the fit between the person’s coping capacity and environmental demands is poor.

• Implications for Rehabilitation

• This paper demonstrates that anxiety is associated with coping with the psycho-social aspects of hearing disability.

• This finding has important implications for the many hearing services, which only provide assessment and devices.

• To negate anxiety and its long-term impacts, rehabilitation providers need to ensure people with hearing disability have the capacity to manage the psycho-social aspects of communication breakdown.

     

Comorbid insomnia in patients with chronic pain: a study based on the Swedish quality registry for pain rehabilitation (SQRP)

Abstract

Purpose: This study investigates the prevalence of insomnia and its relationship to other symptoms and health aspects in patients with chronic pain. Methods: Patients with chronic pain conditions (n?=?845) referred to a multidisciplinary pain centre completed surveys provided by the Swedish quality registry for pain rehabilitation (SQRP). The SQRP collects data on socio-demographics, health status, symptoms of pain, mood and insomnia and life satisfaction. Results: The majority of patients (65.3%) had clinical insomnia according to the insomnia severity index (ISI). Insomnia correlated significantly but weakly with pain, depression, anxiety and coping; the strongest multivariate correlations were found with depression and anxiety followed by pain interference and pain severity. Pain intensity, depression and anxiety correlated stronger than ISI with respect to the two investigated aspects of health. Conclusions: The prevalence of insomnia is high in patients with chronic pain conditions, but the level of importance in relation to other symptoms for health aspects is low, and the associations with other important symptoms are relatively weak. One way to increase the effects of multimodal rehabilitation programs may be to provide interventions directed specifically at insomnia rather than focusing only on interventions that address pain, depression and anxiety.

• Implications for Rehabilitation

• The prevalence of insomnia is high in patients with complex chronic pain conditions.

• Relatively low correlations existed between insomnia and pain intensity, depression, anxiety and other psychological aspects.

• Pain intensity, anxiety and depression were more important for perceived health aspects than insomnia.

• One way to increase the effects of multimodal rehabilitation programs may be to also include interventions directed directly to insomnia.

     

Important elements in farm animal-assisted interventions for persons with clinical depression: a qualitative interview study

Purpose: The main aim of this study was to obtain participants’ own experience of a farm animal-assisted intervention, and what they perceived as important elements in relation to their mental health. Method: A qualitative study, inspired by a phenomenological-hermeneutical perspective was conducted. Eight persons with clinical depression who had completed a 12-week farm animal-assisted intervention at a dairy farm participated in thematic interviews between May and June 2009. Results: The intervention was regarded as a positive experience for the participants. The analyses revealed that central elements in the intervention were the possibility to experience an ordinary work life, but also the importance of a distraction to their illness. Furthermore, the flexibility of the intervention made it possible to adjust the intervention to the participants’ shifting reality and was thereby a key element in farm animal-assisted intervention. The flexibility and adapted work tasks were important elements that the participants associated with their experience of coping. A model showing the interaction between the different elements reported as important by the participants was constructed. Conclusions: This study shows that a farm animal-assisted intervention could be a supplement in mental health rehabilitation. All the elements in our model could possibly influence positively on mental health.

Implications for Rehabilitation

• Depression causes decreased quality of life and impairment, and in Western countries depression represents a major cause for sick leave and work disability.

• During rehabilitation, farm animal-assisted interventions may be beneficial for persons with depression.

• The possibility to experience an ordinary work setting was important for the participants, but also that the intervention acted as a distraction to their illness.

• The participants described the flexibility and possibility to experience coping as central elements in the intervention.

     

Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction

Purpose: This study examined the role of anxiety and upper limb dysfunction, amongst other variables, as predictors of health related quality of life (HRQOL) 6 months after stroke. Method: Participants: Stroke survivors (n = 85) who had previously participated in a randomised controlled trial of a physiotherapy intervention. Dependent variable: HRQOL – Nottingham Health Profile (NHP). Predictor variables: Mood – Hospital Depression and Anxiety Scale; Upper Limb Functioning - Action Research Arm Test; Rivermead Motor Assessment; Activities of Daily Living – Modified Barthel Index; Clinical and demographic factors. Results: Anxiety and depression significantly predicted 49% of variance in overall HRQOL (p < 0.05), but only anxiety significantly predicted NHP pain (13% variance, p < 0.001), emotional reactions (41% variance, p < 0.001), sleep (19% variance, p = 0.02) and social isolation (23% variance, p = 0.02). Depression and anxiety together significantly predicted 30% variance in energy level (p < 0.001). UL motor impairment and activities of daily living predicted 36% of variance in NHP physical activity score (p < 0.001). Conclusions: This study indicates that where anxiety is assessed, it appears more important in determining HRQOL than depression. UL impairment and ADL independence predicted perceived physical activity. Management strategies for anxiety and therapy for UL recovery long after stroke onset are likely to benefit perceived HRQOL.

Implications for Rehabilitation

• Anxiety is a major predictor of quality of life six months after stroke.

• Post-stroke anxiety should be routinely assessed in rehabilitation.

• Appropriate management strategies for anxiety should occur during rehabilitation with follow-up into the chronic post-stroke period.

• Upper limb impairment is a stronger predictor of perceptions of physical activity than independence in activities daily living six months after stroke.

• Rehabilitation of the upper limb should continue into the chronic post-stroke period.

     

The actions of the social insurance agency regarding long-term sickness absentees before and after a medical assessment – a study of 384 case files

Abstract

Purpose: The purpose of this article is to investigate actions taken by the Social Insurance Agency (SIA) for long-term sickness absentees and possible associations of this with future sick leave or disability pension. Method: For 384 long-term sickness absentees who had had a multidisciplinary medical assessment (MMA) during 2001–2006, three types of data were obtained: (1) case file information about SIA actions, (2) suggested rehabilitation measures from the MMA and (3) sickness absence and disability pension data. Results: Most individuals had been subject to a range of actions by the SIA. Sixty percent had been invited to a coordination meeting, and half of those who assessed by the MMA for vocational rehabilitation were approved to get it by the SIA. Few SIA actions were associated with full or partial return to work. Conclusions: Although the studied individuals had been on sick leave for a long time, the number of SIA actions related to vocational rehabilitation was limited and came late in the sick-leave spell. The information from the MMA was often not used as a basis for further SIA action and seldom resulted in return to work. The positive MMA views on the potential of vocational rehabilitation were not met by SIA actions.

• Implications for Rehabilitation

• Suggestions on vocational rehabilitation from a medical assessment was in many cases not used by the social insurance agency in relationship to long-term sickness absentees.

• Active rehabilitation measures by the social insurance agency were few and came late in the sickness absence process.

• Few of the activities taken by the social insurance agency enhanced return to work.

     

The quality of the sickness certificate. A case control study of patients with symptom and disease specific diagnoses in primary health care in Sweden

Abstract

Objective: To compare information in sickness certificates and rehabilitation activities for patients with symptom diagnoses vs patients with disease specific diagnoses.

Design: Retrospective case control study 2013–2014.

Setting: Primary health care, Sweden.

Subjects. Patients with new onset sickness certificates with symptom diagnoses n?=?222, and disease specific diagnoses (controls), n?=?222.

Main outcome measures: Main parameters assessed were: information about body function and activity limitation in certificates, duration of sick leave, certificate renewals by telephone, diagnostic investigations, health care utilisation, contacts between patients, rehabilitation coordinators, social insurance officers, employers and occurrence of rehabilitation plans.

Results: Information about body function and activity limitation was sufficient according to guidelines in half of all certificates, less in patients with symptom diagnoses compared to controls (44% vs. 56%, p?=?0.008). Patients with symptom diagnoses had shorter sick leave than controls (116 vs. 151 days p?=?0.018) and more certificates issued by telephone (23% vs. 15% p?=?0.038). Furthermore, they underwent more diagnostic investigations (32% vs. 18%, p?<?0.001) and the year preceding sick leave they had more visits to health care (82% vs. 68%, p?<?0.001), but less follow-up (16% vs. 26%, p?<?0.008). In both groups contacts related to rehabilitation and with employers were scarce.

Conclusion: Certificates with symptom diagnoses compared to disease specific diagnoses could be used as markers for insufficient certificate quality and for patients with higher health care utilisation. Overall, the information in half of the certificates was insufficient and early contacts with employers and rehabilitation activities were in practice missing.

• KEY POINTS

• Symptom diagnoses are proposed as markers of sickness certification quality. We investigated this by comparing certificates with and without symptom diagnoses.

• Certificates with symptom diagnoses lacked information to a higher degree compared to certificates with disease specific diagnoses.

• Regardless of diagnoses, early contacts between patients, rehabilitation coordinators and social insurance officers were rare and contacts with employers were absent.

     

The effect of ice skating on psychological well-being and sleep quality of children with visual or hearing impairment

Abstract

Purpose: Physical exercise and sports have a key role in preventing physical and psychiatric problems in children. However, children with a disability often experience difficulty participating in physical activity due to a lack of suitable opportunities. Participation in an accessible sport is particularly important for these children, but studies examining which sports are beneficial for which disability groups are rare. In this study, we assessed the effects of ice skating on the psychological well-being, self-concept, and sleep quality of children with hearing or visual impairment. Method: Forty students (20 visually impaired and 20 hearing impaired) aged 8–16 were included in a regular ice skating programme for three months. We examined the sleep quality, self-concept, and behavioural and emotional states of the children before and after participating in the programme. Results: There was a significant improvement in self-concept, behavioural and emotional problems, and sleep quality (p?<?0.05 for each) of the children with hearing impairment. Although the sleep quality (p?=?0.019) and emotional problem scores (p?=?0.000) of the visually impaired children improved; self-concept, peer relations and hyperactivity scores of these children worsened (p?<?0.05 for each). Conclusion: Ice skating is one of the popular sport alternatives that gives children the opportunity to exercise and have fun together. The results of this study revealed that regular ice skating programmes may have positive effects on the psychological well-being of children with hearing impairment. Despite some positive effects, caution must be use when including visually impaired children in ice skating programmes. Generalization of the study's outcomes is limited as the study group were residential students enrolled in special education institutions for children who are blind or deaf.

• Implications for Rehabilitation

• Ice skating is a community-based sport and a popular leisure activity that can also have benefits for people with disabilities.

• Ice skating and children with hearing impairment:

• Self-concept, behavioural and emotional problems, and sleep quality of the children with hearing impairment significantly improved after ice skating.

• Ice skating programmes may be considered as a rehabilitation alternative for children with hearing impairment.

• Ice skating and children with visual impairment:

• Caution must be use when including children with visual impairment in ice skating programmes because of possible negative psychological outcomes.

• Balance exercises before starting the practices on ice should be considered for preventing some possible negative outcomes in children with visual impairment.

     

World Health Organization. Regional Office for the Eastern Mediterranean (EMRO)

Purpose: The aim of this study was to evaluate the potential interaction between treatment content and subgroups according to the Swedish version of the Multidimensional Pain Inventory (MPI-S) on the effect on sickness absence during a 10-year follow-up in a population with chronic neck pain (NP) and/or low back pain (LBP). Methods: This study is based on a randomized controlled multicentre trial with a 10-year follow-up using the MPI-S and included 214 participants. The interventions consisted of Behavioural-oriented Physiotherapy (PT), Cognitive Behavioural Therapy (CBT), Behavioural Medicine Rehabilitation (BM), and a “treatment-as-usual” control group (CG). Results: There appears to be a difference in the development of sickness absence after rehabilitation for the adaptive coper (AC) group even though the result did not reach statistical significance. AC seems to respond most favourably to the multidisciplinary programme compared to the CG. The development of sickness absence after intervention among interpersonally distressed (ID) and dysfunctional (DYS) patients were similar across all three treatment alternatives as well as CG. Conclusion: In terms of long-term follow-up of sickness absence, the multidisciplinary programme appears to be most beneficial for DYS and AC patients. In contrast, the CBT and PT interventions failed to benefit any patient group.

Implications for Rehabilitation

• There may be subgroups of patients with neck/back pain that benefit differently from different treatments.

• This study indicates that patients with less psychosocial problems (adaptive copers) benefit most from behavioural medicine rehabilitation with regard to sick leave 10 year after rehabilitation.

• Additional studies with larger study groups are needed to further investigate these findings.

     

Situationally influenced tinnitus coping strategies: a mixed methods approach

Abstract

Purpose: The primary aim of this study was to identify coping strategies used to manage problematic tinnitus situations. A secondary aim was to determine whether different approaches were related to the level of tinnitus distress, anxiety, depression, and insomnia experienced.

Materials and methods: A cross-sectional survey design was implemented. The study sample was adults interested in undertaking an Internet-based intervention for tinnitus. Self-reported measures assessed the level of tinnitus distress, depression, anxiety, and insomnia. An open-ended question was used to obtain information about how problematic tinnitus situations were dealt with. Responses were investigated using qualitative content analysis to identify problematic situations. Further data analysis comprised of both qualitative and quantitative methods.

Results: There were 240 participants (137 males, 103 females), with an average age of 48.16 years (SD: 22.70). Qualitative content analysis identified eight problematic tinnitus situations. Participants had either habituated to their tinnitus (7.9%), used active (63.3%), or passive (28.8%) coping styles to manage these situations. Those who had habituated to tinnitus or used active coping strategies had lower levels of tinnitus distress, anxiety, and depression.

Conclusions: The main problematic tinnitus situations for this cohort were identified. Both active and passive coping styles were applied to approach these situations. The coping strategies used most frequently and utilised in the widest range of problematic situations were using sound enrichment and diverting attention.

• Implications for Rehabilitation

• The main problematic tinnitus situations for this group of participants were identified.

• Overall, a limited range of strategies were used to deal with individual problematic situations. The use of sound enrichment and diverting attention was applied in the widest range of problematic situations.

• The use of both active and passive coping styles was evident to approach these situations. The use of passive strategies in certain situations was associated with higher levels of tinnitus distress, depression, and anxiety over the last week as measured by self-reported questionnaires.

     

Fatigue in the mothers of children with cerebral palsy

Purpose: To evaluate fatigue in the mothers of children with cerebral palsy (CP), and to determine its associations with clinical parameters of CP, depression and quality of life (QoL). Method: Ninety children (50 girls and 40 boys) with spastic CP and their mothers were included. Control group comprised mothers of healthy children. Gross motor function classification system (GMFCS) was used for determining functional status. Spasticity was evaluated by using modified Ashworth scale. Fatigue symptom inventory (FSI) was used for assessing maternal fatigue, Nottingham health profile (NHP) for maternal QoL, and Beck Depression Scale (BDS) for maternal depression. Results: Mothers of children with CP scored significantly higher in all FSI subgroups (intensity of fatigue, duration of fatigue and interference with QoL), all NHP subgroups and BDS (p?p?< 0.01). No association was found between FSI and clinical parameters of children with CP including age, gender, type of CP, tonus and functional impairment (p?>?0.05). Conclusions: Our findings indicate that fatigue levels of mothers with CP children are higher than those with healthy children and associated with depression and deterioration in QoL in terms of physical, social and emotional functioning. This should be considered while designing a family centred rehabilitation programme for children with CP.

• Implications for Rehabilitation

• Caring for a child with cerebral palsy has psychological, social and financial impacts on familiesand is associated with increased levels of fatigue among mothers.

• The capacity of current programs and services needs to be strengthened to accommodate theneeds of children with CP and their mothers in order to reduce fatigue of mothers.

• New programs need to be developed to provide psychosocial support for the mothers andto reduce their fatigue as they continue to care for their children.

• Provision of assistive technology devices (particularly suitable wheelchairs) will be useful inreduction of fatigue levels of mothers.

     

Screening for depression and anxiety after stroke: developing protocols for use in the community

Purpose: To develop screening protocols to detect depression and anxiety after stroke in a community setting and train therapists to administer them. Method: Psychologists and a community therapist met to design a system suitable for screening for anxiety and depression in all those with stroke, including people with cognitive and/or communication problems. Other therapists and a local user group were also consulted. Therapists were then trained in the use of the protocols. The ability to enact the protocols was assessed via case vignettes and staff experience, over a month-long trial. Results: It was considered appropriate for community therapists to screen patients and to do this within 4 weeks of first contact. Two protocols were designed, one for patients without significant communication/cognitive deficits and one for patients with these difficulties. Therapists applied the protocols with accuracy to the case vignettes and rated the training highly. No challenges in applying the protocols in the clinical setting were reported over an initial 1-month trial. Conclusion: Two protocols to screen for depression and anxiety after stroke have been developed. These appear feasible for use when trialled via case vignette and in clinical practice. Further research might consider the usefulness of the screens in detecting actual clinical disorder and developing better screens to identify anxiety after stroke, particularly in those with a cognitive and/or communication disorder.

Implications for Rehabilitation

• Depression and anxiety are common after stroke and likely affect rehabilitation outcomes.

• These problems can be identified via screening protocols that include measures appropriate for use with those patients having significant cognitive and/or communication disabilities.

• Rehabilitation therapists can enact these protocols.

     

Anxiety and depression after stroke: a 5 year follow-up

Purpose: The aim was to document the prevalence and predictors of anxiety and depression 5 years after stroke, across four European centres. Method: A cohort of 220 stroke patients was assessed at 2, 4 and 6 months and 5 years after stroke. Patients were assessed on the Hospital Anxiety and Depression Scale and measures of motor function and independence in activities of daily living. Results: At 5 years, the prevalence of anxiety was 29% and depression 33%, with no significant differences between centres. The severity of anxiety and depression increased significantly between 6 months and 5 years. Higher anxiety at 6 months and centre were significantly associated with anxiety at 5 years, but not measures of functional recovery. Higher depression scores at 6 months, older age and centre, but not measures of functional recovery, were associated with depression at 5 years. Conclusions: Anxiety and depression were more frequent at 5 years after stroke than at 6 months. There were significant differences between four European centres in the severity of anxiety and depression. Although the main determinant of anxiety or depression scores at 5 years was the level of anxiety or depression at 6 months, this accounted for little of the variance. Centre was also a significant predictor of mood at 5 years. There needs to be greater recognition of the development of mood disorders late after stroke and evaluation of variation in management policies across centres.

Implications for Rehabilitation

• Depression and anxiety persisted up to 5 years after stroke in about a third of patients.

• Variation in the rates of anxiety and depression between different European centres suggest management policies rather than stroke related factors may determine their persistence.

• The effect of variations in stroke management policies should be investigated.

• Patients’ mood should be monitored over time in order to detect those with late onset mood disorders after stroke.

     

Quality of life in older Chinese-speaking adults with hearing impairment

Purpose: General and hearing-specific health-related quality of life (HRQoL) was examined in elderly Chinese with hearing impairment. Methods: Sixty-four Chinese speakers aged ≥65 years and did not use hearing aids were evaluated using Chinese versions of the Short-Form 36 health survey (SF-36) and the Hearing Handicap Inventory for the Elderly (Screening Version) (HHIE-S). Results on the SF-36 were compared to norms obtained in a general elderly Chinese population. The relationships between HRQoL and degree of hearing impairment, and between SF-36 and HHIE-S were also evaluated. Results: Elderly Chinese speakers with hearing impairment rated six of the eight scales of the SF-36 poorer, compared to a general elderly Chinese population. When average hearing impairment in the better ear exceeded 40 dB HL, SF-36 ratings were poorer than those with better hearing. Poorer better ear hearing was significantly related to poorer ratings on the Vitality scale of the SF-36 and the three scales of the HHIE-S, after controlling for age, gender and number of coexisting chronic health problems. Ratings on SF-36 and HHIE-S did not correlate. Conclusion: Elderly Chinese who are hearing impaired experienced poorer general and hearing-specific HRQoL, and HRQoL is reduced further among those with greater hearing impairment.

Implications for Rehabilitation

• Hearing impairment adversely affects communication and is associated with social isolation.

• Older Chinese with hearing impairment report poorer physical functioning, role limitations due to physical problems, vitality, social functioning, role limitations due to emotional problems and general mental health than the general population.

• Degree of hearing impairment seems to exhibit lesser differential effects on self-reported quality of life among older Chinese, compared to those reported in Western societies.

• Treatment to improve communication should be evaluated for its impact on disease-specific and health-related quality of life.

     

A dynamic view of comorbid depression and generalized anxiety disorder symptom change in chronic heart failure: the discrete effects of cognitive behavioral therapy,exercise, and psychotropic medication

Abstract

Purpose: No previous study has reported upon comorbid depression and anxiety disorders and their treatment in heart failure (HF), which the current study has sought to document. Materials and methods: Total 29 HF patients under psychiatric management underwent primary depression cognitive behavioral therapy (CBT; n?=?15) or primary generalized anxiety disorder (GAD) CBT (n?=?14), and participated in a community exercise program and standard physician care. Repeated measures analysis of variance assessed Patient Health Questionnaire (PHQ-9) and GAD-7 symptom change pre- and post-CBT treatment, and assessed the interaction effects of treatment type, exercise, anti-depressant and anxiolytic. Results: There was a significant time and treatment interaction effect that favored the primary GAD CBT group for reduction in PHQ symptoms (F(1, 24)?=?4.52, p?=?0.04). Analysis of PHQ-somatic symptoms also showed a significant main effect for participation in the exercise program (F(1, 24)?=?4.21, p?=?0.05) and a significant time and anxiolytic interaction (F(1, 24)?=?3.98, p?=?0.05). The average number of cardiac hospital readmissions favored the primary GAD CBT group (p?=?0.05). Conclusion: The findings support the use of multifaceted interventions in the rehabilitation of HF patients with comorbid psychiatric needs.

• Implications for Rehabilitation

• Comorbid depression and anxiety disorders are a clinical and research focus that deserves more attention in the treatment of heart failure patients.

• Cognitive behavioral therapy, exercise, and anxiolytic use was associated with significant changes in depression and anxiety though discrete effects were evident.

• Multifaceted interventions are most likely to be successful in the rehabilitation of HF patients with psychiatric needs.