Maternal body mass index in pregnancy and offspring physical and psychosocial functioning in older age: findings from the Helsinki Birth Cohort Study (HBCS)

Introduction: Maternal obesity is associated with several adverse long-term health outcomes in the offspring. In this study, we examined the association between maternal body mass index (BMI) and offspring physical and psychosocial functioning in late adulthood. Methods: The study included 1759 men and women born during 1934–1944 and belonging to the Helsinki Birth Cohort Study. Data on maternal weight and height in late pregnancy and on offspring birth weight were retrieved from hospital birth records. Physical and psychosocial functioning was assessed using the Short Form 36 scale. Results: Maternal BMI was positively associated with poorer physical and psychosocial functioning among men, but not among women. This association was not mediated by birth weight. Discussion: The present study emphasizes the importance of preventing overweight and obesity among women of childbearing age.

• Key messages

• Maternal BMI is known to be associated with adverse health outcomes among adult offspring.

• We found that higher maternal BMI was associated with poorer physical and psychosocial functioning among male offspring in late adulthood.

• The association between maternal BMI and offspring physical and psychosocial functioning was not mediated by birth weight.

     

Long-term fatigue after perimesencephalic subarachnoid haemorrhage in relation to cognitive functioning,mood and comorbidity

Purpose: To study relationships between fatigue and objective and subjective cognitive functioning, mood and comorbidity in the long term after perimesencephalic subarachnoid haemorrhage (PM-SAH).

Methods: Cross-sectional study. Objective cognitive functioning was measured with: Trail Making Test; Symbol Substitution; D2; Verbal and Semantic Fluency; Tower Test; Digit Span; 15-Words Test; Rey Complex Figure. Subjective cognitive functioning: Cognitive Failure Questionnaire. Fatigue: Fatigue Severity Scale. Mood: Hospital Anxiety and Depression Scale.

Results: Forty-six patients, mean age 50.4 (SD?=?9.4), mean time after PM-SAH 4.7 (SD?=?1.6) years participated. Patients with fatigue (33%) had significantly lower scores than patients without fatigue on most objective cognitive functioning tests (p?Conclusions: This study supports our previous findings that a third of patients with PM-SAH experience fatigue and problems of cognitive functioning, also in the long term. Future research should investigate whether these patients would benefit from long-term follow-up and/or cognitive rehabilitation programmes.

• Implications for Rehabilitation

• Consequences for patients with PM-SAH are underestimated.

• One in every three patients suffered from fatigue in the long term after onset of PM-SAH.

• Patients with PM-SAH should be screened for problems of cognitive functioning, fatigue and mood in outpatient clinic just as patients with aneurysmal SAH.

     

Inclusion of populations at risk of advanced melanoma in an opportunistic targeted screening project involving general practitioners

Objective: The study objective was to measure the rates of inclusion of populations at risk of advanced melanoma in a pilot targeted screening project involving general practitioners.

Design: This cross-sectional database study compared the inclusion rates of patients who signed inclusion in a targeted screening project with those of patients who did not, during a period in which both groups of patients consulted investigators.

Setting: Data were extracted from the national healthcare insurance records in western France from 11 April to 30 October 2011.

Patients: Patients, older than 18, considered for the data extraction had consulted one of the 78 participating GPs during the study period, and were affiliated with the national healthcare insurance.

Main outcome measures: Inclusion in the screening was the main outcome measure. Patients at risk of advanced melanoma were characterized by male gender, age over 50, low income, rural residence, farmer, and presence of chronic disease.

Results: A total of 57,279 patients consulted GPs during the inclusion period and 2711 (4.73%) were included in the targeted screening. Populations at risk of advanced melanoma were less included: men (OR?=?0.67; 95%CI [0.61–0.73]; p?p?p?p?p?Conclusion: This study demonstrated inequalities in the inclusion of patients in a melanoma screening. Patients at risk of advanced cancer were screened less often. Further studies should focus on GPs ability to identify and screen these patients.

• KEY POINTS

• Advanced melanoma is more frequently diagnosed in men, older patients and socioeconomically disadvantaged populations, which leads to survival inequalities.

• ??Despite the involvement of general practitioners, the implementation of targeted melanoma screening did not avoid inclusion inequalities.

• ??Men, older patients, patients suffering from chronic diseases, and low-income patients were less likely to benefit from screening.

• ??The display of a conventional or an alarmist poster in the waiting room did not statistically reduce these inclusion inequalities.

     

Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial

Purpose: Chronic whiplash-associated disorders (WAD) incur both costs and suffering. Treatments that can relieve chronic WAD are therefore needed. Exercise therapy (ET) has been shown to provide pain relief. Another often used treatment for chronic pain in Scandinavia is basic body awareness therapy (BAT). We compared the effectiveness of 10 weeks of twice-weekly, 90-min sessions of either ET or BAT in a randomized comparative trial. Method: We recruited 113 patients suffering from chronic WAD grades I–III and several years’ duration of symptoms in a primary health care setting. 57 were allocated to ET and 56 to BAT. Primary outcome measures were Neck Disability Index and SF-36 v.2. Results: From baseline to post-treatment, the BAT group increased their physical functioning (median 5, IQR?=?15) more than the ET group (median?=?0, IQR?=?15), p?=?0.032, effect size ?0.54. Three months after the end of treatment, the BAT group had less bodily pain (m?=?17.5, 95% CI 6.9–17.6) than the ET group (m =?4.9, 95% CI ?0.1 to 9.8), p?=?0.044, effect size ?0.4. The BAT group had also increased their social functioning (m?=?13.3, 95% CI 6.6–19.9) more than the ET group (m?=?3.5, 95% CI ?3 to 9.9), p?=?0.037, effect size ?0.41. No statistically significant differences between groups were found for the change of other outcomes. No serious adverse effects were found in either groups. Conclusions: The present trial indicates that BAT led to greater improvements than ET for the patients with chronic WAD.

• Implications for Rehabilation

• Chronic whiplash-associated disorders are disabling and incur great costs to society often through inability to work.

• Exercise therapy (ET) may alleviate symptoms of chronic WAD.

• Basic body awareness therapy (BAT) is often a component of multimodal pain rehabilitation programs.

• In this randomized comparative trial, BAT increased physical functioning and led to greater pain reduction and social functioning 3 months after the end of treatment.

     

Associations between neighbourhood characteristics and community mobility in older adults with chronic health conditions

Purpose: To explore associations between perceptions of neighbourhood built and social characteristics and satisfaction with community mobility in older adults with chronic health conditions. Method: Two hundred and thirty-seven community-dwelling adults aged 60 years or more with one or more of arthritis (osteoarthritis or rheumatoid arthritis), chronic obstructive pulmonary disease, diabetes or heart disease completed a cross-sectional, mailed survey. The survey addressed community mobility and 11 neighbourhood characteristics: amenities (three types), problems (six), social cohesion and safety. Analysis involved logistic regression modeling for each neighbourhood characteristic. Results: Satisfaction with community mobility was associated with perception of no traffic problems (OR?=?3.0, 95% CI?=?1.4–6.2, p?≤?0.05) and neighbourhood safety (OR?=?3.4, 95% CI?=?1.2–9.8, p?≤?0.05), adjusted for age, ability to walk several blocks and depressive symptoms.

Conclusion: Satisfaction with community mobility is associated with neighbourhood safety and no traffic problems among older adults with chronic conditions. While further research is needed to explore these neighbourhood characteristics in more detail and to examine causation, addressing these neighbourhood characteristics in health services or community initiatives may help promote community mobility in this population.

• Implications for Rehabilitation

• Community mobility, or the ability to move about one’s community, is a key aspect of participation that enables other aspects of community participation.

• Good community mobility is associated with perception of no traffic problems and neighbourhood safety among older adults.

• Considering and addressing a broad range of environmental influences has the potential to improve community mobility in older adults, beyond traditional approaches.

• Health professionals can work with clients to develop strategies to avoid traffic and safety problems and can work with communities to develop safe spaces within neighbourhoods, to improve community mobility in older adults.

     

Physical functioning of low back pain patients: perceived physical functioning and functional capacity,but not physical activity is affected

Abstract

Purpose: Physical functioning is a multidimensional construct covering perceived functioning, functional capacity and actual physical activity. Currently, the assessment of physical functioning in low back pain (LBP) patients has been limited to only one or two of these aspects. This study evaluates physical functioning of LBP patients by assessing the three individual aspects using questionnaires and ambulant sensor-based measurements. Methods: Actual physical activity, functional capacity and perceived functioning were measured in 26 patients undergoing patient specific treatment before, direct and 3–4 weeks after the first treatment using, respectively, sensor-based activity monitoring, sensor-based motion analysis test and the Oswestry questionnaire. Patients were compared to a healthy control group. Results: Perceived functioning and functional capacity, but not actual physical activity is impaired in pre-treatment LBP patients. After treatment, patients improved in perceived physical functioning and functional capacity approaching healthy levels, however only slight (p?>?0.05) improvements in actual physical activity were found. Moreover, only few and weak correlations were found between the different aspects of physical functioning. Conclusion: Perceived functioning, actual physical activity and functional capacity are three independent outcome dimensions, being complementary but not redundant. Especially, perceived functioning and physical capacity need attention when evaluating LBP patients during rehabilitation.

• Implications for Rehabilitation

• Perceived physical functioning and physical capacity are negatively affected by low back pain and improve after treatment.

• Low back pain patients perform their daily activity independent of pain and complaints.

• Inertia sensor-based motion analysis can objectify treatment effects showing low back pain patients their progress in rehabilitation.

• New interventions can be justified with inertia sensor technology in low back pain patients.

     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Long-lasting improvements in health-related quality of life among women with chronic pain,following multidisciplinary rehabilitation

Purpose: To determine whether observed health-related quality-of-life improvements after four-week traditional multidisciplinary pain management program and additional neuroscience education and mindfulness-based cognitive therapy for chronic pain are sustained at six-month follow-up.

Method: This observational longitudinal follow-up study, with complete follow-up of 75 women, 61.5% of initial traditional approach group (treated 2001–2005) and 56 (62.2%) receiving the new approach (treated 2006–2009). Pain intensity and quality of life were measured at baseline and six months after interventions. Analysis of variance (ANOVA) and paired samples t-tests were used for statistical analysis.

Results: Both groups showed sustained improvements in pain intensity (traditional approach?=??10.6 [p?<?0.001]; new approach?=??14.5 [p?p?p?p?=?0.066]), whereas all other domains among both groups were sustained. Significant decline was observed from discharge to six month among both groups with the exception of the sleep domain among the traditional approach group, pain intensity among the new approach and financial status among both groups. No baseline differences were revealed between responders and nonresponders.

Conclusions: Multidisciplinary interventions for women with chronic pain conditions improved quality of life and pain intensity with lasting improvements observed half a year after treatment completion.

• Implications for rehabilitation

• Intensive multidisciplinary biopsychosocial rehabilitation is essential for chronic pain conditions.

• This follow-up study shows sustained improvement in health-related quality of life and pain intensity six months after such rehabilitation was completed.

• Emphasizing mindfulness-based cognitive therapy and neuroscience patient education may contribute to less decline in pain intensity from discharge to six-month follow-up compared with a more traditional approach.

     

Factors influencing the provision of oral hygiene care following stroke: an application of the Theory of Planned Behaviour

Objectives: This study aimed to examine “intention to” and “performance of” oral hygiene care to stroke patients using the Theory of Planned Behavior.

Materials and methods: A large scale survey of 13 centers in Malaysia was conducted involving 806 nurses in relation to oral hygiene care intentions and practices. In addition, information on personal and environmental factors was collected.

Results: The response rate was 95.6% (778/806). The domains of the Theory of Planned Behavior were significantly associated with general intention to perform oral hygiene care: attitudes (β?=?0.21, p?p?p?p?<0.01), controlling for other factors. Knowledge scores, training, access to oral hygiene guidelines and kits, as well as working ward type were identified as key factors associated with intention and practice of oral hygiene care.

Conclusion: The Theory of Planned Behavior provides understanding of “intention to” and “performance of” oral hygiene care to stroke patients. Several provider and environmental factors were also associated with intentions and practices. This has implications for understanding and improving the implementation of oral hygiene care in stroke rehabilitation.

• Implications for Rehabilitation

• Oral hygiene care is crucial for stroke patients as it can prevent oral health problems and potentially life threatening events (such as aspiration pneumonia).

• Despite oral hygiene care being relative simple to perform, it is often neglected during stroke rehabilitation.

• A large-scale national survey was conducted to understand “intentions to” and “performance of” oral hygiene care to stroke patients using the Theory of Planned Behavior social cognition model.

• These study findings may have implications and use in promoting oral hygiene care to stroke patients:i) by understanding the pathways and influences to perform oral hygiene care.ii) to conduct health promotion and health education based on behavioral models such as Theory of Planned Behavior.

     

Executive functioning deficits in young adult survivors of bronchopulmonary dysplasia

Abstract

Purpose: To assess long-term impairments of executive functioning in adult survivors of bronchopulmonary dysplasia (BPD). Method: Participants were assessed on measures of executive functioning, health-related quality of life (HRQoL) and social functioning. Survivors of BPD (n?=?63; 34 males; mean age 24.2 years) were compared with groups comprising preterm (without BPD) (<1500?g; n?=?45) and full-term controls (n?=?63). Analysis of variance was used to explore differences among groups for outcome measures. Multiple regression analyzes were performed to identify factors predictive of long-term outcomes. Results: Significantly more BPD adults, compared with preterm and term controls, showed deficits in executive functioning relating to problem solving (OR: 5.1, CI: 1.4–19.3), awareness of behavior (OR: 12.7, CI: 1.5–106.4) and organization of their environment (OR: 13.0, CI: 1.6–107.1). Birth weight, HRQoL and social functioning were predictive of deficits in executive functioning. Conclusions: This study represents the largest sample of survivors into adulthood of BPD and is the first to show that deficits in executive functioning persist. Children with BPD should be assessed to identify cognitive impairments and allow early intervention aimed at ameliorating their effects.

• Implications for Rehabilitation

• Adults born preterm with very-low birth weight, and particularly those who develop BPD, are at increased risk of exhibiting defects in executive functioning.

• Clinicians and educators should be made aware of the impact that BPD can have on the long-term development of executive functions.

• Children and young adults identified as having BPD should be periodically monitored to identify the need for possible intervention.

     

Predictors of referral uptake in children with disabilities in Bangladesh – Exploring barriers as a first step to improving referral provision

Purpose: Making services available to children with disabilities in low- and middle-income countries does not guarantee their use. This study aims to identify factors associated with the uptake of referrals in order to investigate barriers to service use. Methods: Children with impairments identified in two districts of Bangladesh were invited to attend screening camps where their condition was confirmed; they were provided with referrals for rehabilitation and treatment services. Predictors of referral uptake were identified using logistic regression. Results: Overall referral uptake was 47%, 32% in Sirajganj and 61% in Natore. There was no association between age or gender and referral uptake. Factors predictive of referral uptake were higher income in Sirajganj (OR?=?2.6 95%CI 1.4–5.0), and the districts combined (OR?=?1.6 95%CI 1.1–2.1); maternal literacy in Natore (OR?=?1.6 95%CI 1.0–2.5); and epilepsy in all three models (Sirajganj: OR?=?2.6 95%CI 1.7–4.0; Natore: OR?=?13.5 95%CI 6.5–28.3; Combined: OR?=?4.6 95%CI 3.3–6.5). Physical impairment was associated with increased odds of uptake in Sirajganj and in the combined model (OR?=?2.7 95%CI 1.8–4.1; OR?=?3.34 95%CI 2.2–5.2). Conclusions: Even when some logistical and financial assistance is available, children with impairment from low-income families may require additional support to take up referrals. There may be greater willingness to accept treatment that is locally provided, such as medication for epilepsy or therapy at village level.

Implications for Rehabilitation

• Providing a referral for treatment or rehabilitation is often not enough to ensure access to service for children with disabilities in low and middle income countries.

• Uptake of referral can be influenced by many factors, and individuals face different types of barriers.

• Financial and logistical support can help increase referral uptake.

• Low monthly income and maternal illiteracy is associated with lower uptake even when assistance is provided.

     

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.

     

Support group programme for siblings of children with special needs: predictors of improved emotional and behavioural functioning

Purpose: A pilot study to identify the predictors of improvement in emotional and behavioural functioning of siblings of children with special needs following participation in SibworkS, a six-week manual-based, cognitive–behavioural group programme.

Method: Data from 36 participants from a recent evaluation of the SibworkS programme was used. Measures were administered pre-intervention, immediately post-intervention and three months post-intervention. Treatment effects were measured using change scores for siblings on the Strengths and Difficulties Questionnaire – Parent Version (SDQ). Seven predictors were analysed: symptom severity of the child with special needs, participant age and gender, sibling birth order, family socio-economic status, participant baseline SDQ score and participant use of additional support services.

Results: The overall model significantly predicted change in SDQ scores at post-intervention and follow-up (adjusted R²?=?0.41 and 0.40). At both evaluation points, SDQ change scores were significantly predicted by baseline SDQ score. Furthermore, symptom severity of the child with special needs was a significant predictor at three months post-intervention.

Conclusions: Poorer emotional and behavioural functioning among participants and symptom severity of the child with special needs were associated with greater intervention effects. These results indicate that SibworkS is likely to be beneficial for siblings who have difficulties adjusting, and siblings of children with more severe special needs.

• Implications for Rehabilitation

• Siblings of children with disability are at increased risk of emotional and behavioural difficulties.

• Sibworks is a manualised group-based intervention for the siblings of children with a disability.

• Poorer emotional and behavioural functioning among participants and symptom severity of the child with special needs were associated with greater intervention effects.

• SibworkS is likely to be beneficial for siblings who have difficulties adjusting and siblings of children with more severe disabilities.

     

Agreements and disagreements between children and their parents in health-related assessments

Purpose: To systematically review research concerning parent–child agreement in health-related assessments to reveal overall agreement, directions of agreement, and the factors that affect agreement in ratings.

Method: The Uni-Search and five additional databases were searched. Children’s health issues were grouped into psychosocial issues including autism and ADHD, and physical and performance issues including pain. Measures used for comparison were those addressing (a) psychosocial functioning, (b) physical and performance functioning, and (c) health-related quality of life.

Results: Totally, 39 studies met the inclusion criteria, comprising 44 analyses in all since four studies contained more than one analyses. Moderate child–parent agreement was demonstrated in 23 analyses and poor agreement in 20 analyses. Several analyses found more agreement on observable/external than on non-observable/internal domains. Overall, parents considered their children had more difficulties than did the children themselves, although there were indications that for children with physical performance issues, parents may underreport their children’s difficulties in emotional functioning and pain. There were no consistencies in differences between children’s and parent’s ratings on levels of agreement with respect to the children’s health issue, age or gender.

Conclusions: Discrepancies between child and parent reports seem to reflect their different perspectives and not merely inaccuracy or bias.

• Implications for Rehabilitation

• In general, parents consider their children to have more difficulties – or more extensive difficulties – than the children themselves think they have.

• The perspectives of the child and his or her parents should be sought whenever possible since both constitute important information concerning the child´s health and well-being.

• Children with physical and performance issues reported more difficulties than their parents concerning the children’s emotional functioning and pain.

• Clinicians should prioritize obtaining children’s views on subjective aspects such as emotional issues as well as on pain.

     

Forgiveness and health among people in outpatient physical therapy

Purpose: Forgiveness is associated with a variety of health-related outcomes; however much of this work has been in the context of forgiveness of others, direct associations and otherwise healthy samples. This study examined associations involving multiple dimensions of forgiveness, including indirect effects through health behavior, among outpatients receiving physical therapy. Methods: Participants from southern Appalachia (n?=?141) completed cross-sectional self-report measures of forgiveness, lifetime religiousness, health behavior, health status and pain. Mediation analysis was employed to examine the direct and indirect relationships between forgiveness and health. Results: Forgiveness of self was associated with: (i) overall health status, physical health status and current pain in an indirect-only fashion and (ii) mental health status and chronic pain in a direct-only fashion. Feeling forgiven by God was associated with health-related social functioning in a direct-only fashion. Forgiveness of others was not associated with the health-related outcomes. Conclusions: Forgiveness of self appears to be the most important to health, yet the most difficult to achieve. Religious culture may influence whether feeling forgiven by God is also important. Forgiveness-based intervention may be useful in the context of rehabilitation, in general, and physical therapy, in particular.

Implications for Rehabilitation

• Forgiveness may be particularly helpful for people seeking physical therapy and its effect may be direct and/or operate through association with better health behavior or self-care.

• Direct associations were observed for forgiveness of self with mental health status and chronic pain and for feeling forgiven by God with health-related social functioning.

• Forgiveness of self was indirectly associated with overall health status, physical health status and current pain through its association with health behavior.

• Clinicians may be able to facilitate the benefits of forgiveness through explicit forgiveness-based interventions.

     

Predictors of quality of life in people with Parkinson’s disease: evidence for both domain specific and general relationships

Abstract

Purpose: To assess the determinants of health-related quality of life (HrQoL) in people with Parkinson’s disease (PD). Method: Eighty-one people with a diagnosis of idiopathic PD took part in a cross-sectional questionnaire-based study. Measures were collected in a community setting and included established determinants of HrQoL (demographic, clinical and cognitive variables) but also included a wide range of mental health variables (depression, anxiety and stress) and, for the first time, positive psychological functioning (optimism and self-esteem). HrQoL was measured by the full version of the Parkinson’s Disease Questionnaire (PDQ-39) which includes eight domains of functioning. Results: Mental health measures (depression, anxiety and stress) were more influential than any other block of determinants and influenced a broader array of HrQoL domains including physical ones. There was some evidence of domain-specific relationships, e.g. between physical determinants and the more physically-oriented HrQoL domains, and between mental health determinants and emotional well-being. However, cognitive ability did not influence the HrQoL domain of cognitive impairment. Conclusions: The contribution of a multi-disciplinary approach is crucial given the many variables which affect HrQoL; in particular, significant overall improvements on HrQoL are unlikely if only physical rehabilitation is offered. Rehabilitation is likely to be beneficial in terms of HrQoL only if it is planned and delivered holistically.

• Implications for Rehabilitation

• Interventions to improve physical function may have only limited impact on quality of life and might be limited to more physical HrQoL domains.

• Psychological interventions have the potential to improve quality of life over a wider range of both emotional and physical HrQoL domains.

• Clinician-measured level of functioning does not necessarily translate into patient-perceived levels of functional ability and relatively small objective decreases in ability can be appraised much more significantly disabling by people with PD.

     

Needs,priorities, and desired rehabilitation outcomes of family members of young adults who have had a stroke: findings from a phenomenological study

Purpose: This study explored the experience of stroke from the perspective of family members of young adults who have had a stroke. Gaining understanding of the short, medium and long-term needs and desired rehabilitation outcomes of family members assisted identification of appropriate family-centred multidisciplinary rehabilitation interventions. Method: A qualitative approach based on Merleau-Ponty’s existential phenomenology enabled exploration of family members’ experience of stroke. Eleven family members, including parents, spouses, children and siblings, participated in 24 interviews over 2 years. A subsequent iterative process of critical reflection was used to identify family-centred needs, priorities and associated rehabilitation outcomes. Results: Within a thematic framework, family members’ experience was conceptualised as Disruption of Temporal Being. Against this overarching theme or (back)ground, figural themes were identified: Uncertainty, Disrupted and Altered Relationships, and Situatedness. In addition, sixteen short, medium and long-term effects of stroke were identified along with associated family-centred needs and rehabilitation outcomes. Conclusion: An empathetic understanding of the experience of stroke from the perspective of family members, combined with research evidence and professional expertise enables the multidisciplinary rehabilitation team to deliver tailored interventions based on identified needs and priorities, and negotiation of mutually agreed goals.

Implications for Rehabilitation

• Following stroke in a young adult, families’ needs, priorities and associated rehabilitation outcomes change over time; rehabilitation services should reflect this dynamic process.

• To deliver family-centred care, rehabilitation professionals need to develop a deeper understanding of the experience of families affected by stroke, gained from qualitative research findings and from their own reflective practice.

• Gaining understanding of the experience of family members of young adults who have had a stroke will enable health professionals to consider how they may improve practice and enhance service provision to ensure delivery of effective, family-centred interventions.

• The table of family-centred needs and outcomes can be used by members of the multidisciplinary stroke rehabilitation team in conjunction with their own knowledge, experience and resources to inform family-centred practice.