The Lancashire Quality of Life Profile: modification and psychometric evaluation

  Background: Although widely used in Europe, the conceptual and psychometric qualities of the Lancashire Quality of Life Profile (LQoLP) have not been thoroughly examined. Four issues need attention: coverage, scale construction, systematic missing data, and psychometric properties. Method: Concept mapping was used to examine the coverage, and exploratory factor analysis to examine the empirical scale structure of the LQoLP. Data of 518 long-term patients from ten different mental health care settings were used. Modifications to the LQoLP were proposed on the basis of these findings, and its psychometric properties were tested. Thirty-one respondents participated in a test-retest reliability study (T1–T2: 2 weeks). Results: The modified LQoLP covers the quality of life-concept in a more comprehensive manner. Internal consistency, test-retest reliability and validity are good. Conclusions: The modified version of the LQoLP now covers ten domains, paying specific attention to patients' definition of quality of life (autonomy, coping, self-worth). Domains are now based on factor analysis. The problem of systematic missing data is solved. Psychometric properties are good. Because of moderate alphas, two domains need further investigation. Accepted: 11 April 2000     

Effects of Mindfulness-Based Stress Reduction Intervention on Psychological Well-being and Quality of Life: Is Increased Mindfulness Indeed the Mechanism?

Background  Although several studies have reported positive effects of mindfulness-based stress reduction (MBSR) intervention on psychological well-being, it is not known whether these effects are attributable to a change in mindfulness. Purpose  The aim of this study is to compare the effects of MBSR to a waiting-list control condition in a randomized controlled trial while examining potentially mediating effects of mindfulness. Methods  Forty women and 20 men from the community with symptoms of distress (mean age 43.6 years, SD = 10.1) were randomized into a group receiving MBSR or a waiting-list control group. Before and after the intervention period, questionnaires were completed on psychological well-being, quality of life, and mindfulness. Results  Repeated measures multiple analysis of variance (MANCOVAs) showed that, compared with the control group, the intervention resulted in significantly stronger reductions of perceived stress (p = 0.016) and vital exhaustion (p = 0.001) and stronger elevations of positive affect (p = 0.006), quality of life (p = .009), as well as mindfulness (p = 0.001). When mindfulness was included as a covariate in the MANCOVA, the group effects on perceived stress and quality of life were reduced to nonsignificance. Conclusion  Increased mindfulness may, at least partially, mediate the positive effects of mindfulness-based stress reduction intervention.     

The Psychiatric Care Satisfaction Questionnaire: a reliability and validity study

Patient satisfaction can be a useful marker in evaluating the quality of psychiatric care. However, this form of measurement has been hampered by the lack of attention paid to the psychometric properties of instruments devised. The Psychiatric Care Satisfaction Questionnaire (PCSQ) was developed and tests of acceptability, validity and reliability were undertaken using 52 inpatients. Content validity was assessed by surveying psychiatrists, other mental health professionals, MIND workers and patient groups. Thirty-six (67.9%) of all mental health professionals felt that the questionnaire was a useful measure of patients' satisfaction with their care, and many comments also suggested high consensual validity. In terms of content validity, responses from patient groups indicated that the majority (63.6%) felt it to be a useful measure of patient satisfaction and 70.5% felt all the areas covered were important. Concurrent and criterion validity were also good, with high correlations with existing scales and with those on a section being significantly less satisfied on the PCSQ (F = 13.3, P = 0.0004). Test-retest reliability was adequate (Cohen's κ 0.48–0.80) and the internal consistency of the PCSQ was good, at 0.82 (Cronbach's α). The PCSQ performed well in all aspects of validity and reliability, indicating that it has good psychometric properties and can be a useful tool for measuring patient satisfaction. However, there remains the need to analyse more closely the concept of satisfaction and its determinants. Accepted: 4 June 1998     

Analyzing Theoretical Mechanisms of Physical Activity Behavior Change in Breast Cancer Survivors: Results from the Activity Promotion (ACTION) Trial

Background We previously reported that a physical activity (PA) behavior change intervention based on the theory of planned behavior (TPB) increased PA and quality of life in breast cancer survivors. Purpose To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks. Methods Breast cancer survivors (N = 377) were randomly assigned to receive either a standard public health recommendation for PA (SR group), a step pedometer alone, or one of two TPB-based behavior change interventions consisting of print materials (alone or combined with a step pedometer). For the purpose of this study, we compared the two TPB-based intervention groups (INT group) to the SR group. Results Compared to the SR group, the INT group reported more favorable changes in instrumental attitude (mean difference = 0.13; 95% CI = −0.01 to 0.23; d = 0.19; p = 0.077), intention (mean difference = 0.33; 95% CI = 0.10 to 0.56; d = 0.33; p = 0.006), and planning (mean difference = 0.39; 95% CI = 0.04 to 0.73; d = 0.26; p = 0.027). Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks. Conclusions Our TPB-based behavior change intervention resulted in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior. Additional research with the TPB is warranted.     

根据Brunnstrom分期制定针对性康复方案对脑卒中患者康复效果的影响

目的探讨Brunnstrom分期制定针对性康复方案对脑卒中患者康复效果的影响作用。方法选取90例脑卒中患者采用随机数字表法分为实验组和对照组各45例,实验组依据Brunnstrom分期制定针对性康复方案,对照组给予常规康复治疗方法。结果康复治疗前实验组和对照组的Fugl-Meyer运动功能评分法(FAM)、改良Barthel指数(MBI)、运动功能评估量表(MAS)、美国国立卫生研究院神经功能缺损量表(NIHSS)评分和脑卒中专用生存质量量表(SS-QOL)评分差异均不具有统计学意义(P0.05)。康复治疗后实验组的FAM评分(48.2±7.6)分、MBI评分(58.2±11.6)分、MAS评分(33.7±6.2)分和SS-QOL评分(44.8±5.3)分均高于对照组的(29.6±5.7)分、(53.6±9.8)分、(29.6±5.7)分和(40.2±5.0)分,差异均具有统计学意义(P0.05);实验组NIHSS评分(13.5±3.8)分显著低于对照组的(15.7±4.0)分,差异具有统计学意义(P0.05)。结论 Brunnstrom分期制定针对性康复方案较常规康复治疗对脑卒中患者具有更加显著的康复效果,具有提高患者生活质量的作用。     

The Dynamics of Quality of Life in ALS Patients and Caregivers

Background  Quality of life (QOL) in people with amyotrophic lateral sclerosis (ALS) and their caregivers may depend on disease progression, premorbid characteristics (e.g., personality or demographics), or idiosyncratic effects (e.g., life events unrelated to the disease). Furthermore, effects may differ for patients and caregivers; physical decline may impact the caregiver more than the patient. Purpose  The present study examined QOL in ALS patients and their caregivers over the course of the illness. Methods  Longitudinal data from ALS patients (N = 55) and caregivers (N = 53) yielded estimates of the sources of and changes over time in total QOL as well as individual domains (psychological existential, physical, and social) as measured by the McGill Quality of Life Questionnaire. Results  For both patients and caregivers, about half of QOL variance emerged from stable individual differences. Passage of time did not affect QOL in patients, but total QOL and particularly QOL related to physical symptoms declined over time in caregivers. Gender was mostly unrelated to QOL in patients and caregivers, but younger caregivers had lower QOL across a number of domains. Conclusions  Low QOL among ALS patients is likely due to pre-existing individual differences, whereas both individual differences such as demographics (e.g., age) and disease progression are likely to affect QOL among caregivers.     

Effectiveness of a low intensity outpatient cognitive rehabilitation programme for patients in the chronic phase after acquired brain injury

The aim of this prospective cohort study was to examine the effectiveness of a low intensity outpatient cognitive rehabilitation programme for patients with acquired brain injury in the chronic phase. Twenty-seven patients with acquired brain injury (i.e., stroke, traumatic brain injury, subarachnoid haemorrhage; 52% male) with a mean age of 49.5 (SD 9.2) years and 25 relatives with a mean age of 48.8 (SD 8.8) years were recruited to the study. Mean time since injury in the patient group was 1.9 years (SD 2.0). The group programme consisted of 15 weekly sessions of 2.5 hours and included cognitive strategy training, social skills training, and psycho-education. Patients also received homework. Relatives were invited to attend twice. Repeated measurements were taken: prior to treatment (baseline, T0); directly after treatment (T1, 21 weeks); and at follow-up (T2, 45 weeks). Primary outcome measures were individualised goals (GAS), cognitive failures (CFQ), and quality of life (SA-SIP). Patients did improve significantly on individual goals (p?<?.05) between T0 and T1 and the level of attainment remained stable between T1 and T2. Goals were mostly set in the cognitive and behavioural domains. There were no significant differences between the measurements (T0–T1–T2) on the CFQ and the SA-SIP. The programme had a positive effect on the individual goals set by the patients. However, this did not result in a higher participation level or a better quality of life. This may be due to the low intensity and short duration of the programme.     

Life events, ethnicity and perceptions of discrimination in patients with severe mental illness

  Background: Whilst it is commonly believed that black and ethnic minority (B&EM) people living in the UK experience social disadvantage compared with the white British (WB) population, no study has specifically addressed this issue in patients with severe mental illness. We sought to test the hypothesis that B&EM patients experience more negative life events than their WB counterparts, and to examine the extent to which they attribute these events to discrimination. Method: Thirty-four WB, 78 African Caribbean (AC) and 35 other ethnic minority patients with psychotic illnesses, defined using Research Diagnostic Criteria, were asked to complete a Racial Life Event Questionnaire examining life events and perceptions of discrimination at baseline and 12 and 24 months later. Results: African Caribbean patients experienced more `Financial' life events across the study period, otherwise there were no significant differences between patient groups in number of life events experienced. The B&EM group collectively (n = 113), however, were significantly more likely than the WB group (n = 34) to attribute `Assault', and `Legal' life events to discrimination. The AC patient group were significantly more likely than the other two ethnic groups to attribute the `Financial' and `Health' life events they experienced to discrimination. The B&EM group was also significantly more likely, and particularly the AC patient group, to report that members of their own ethnic group are adversely affected by discrimination. Further analyses showed skin colour rather than ethnicity or nationality to be the major contributing factor to perception of discrimination; thus, the Irish (n = 11) had similar scores to the WB while Africans (n = 16) scored like the ACs. Conclusion: Our study shows that B&EM patients do not experience significantly more life events than WB patients; however, their perception of these events is clearly different, and significantly more often attributed to racism. It is reasonable to suppose that patients may be disinclined to utilise services they believe to be prejudiced against them on the basis of their skin colour, and service providers need to be aware of this in order to create health care services that B&EM patients feel confident to use. Accepted: 3 September 1999     

Further evidence for a low body weight in male children and adolescents with Asperger's disorder

The study explores the common clinical impression and previously reported finding by Hebebrand et al. (7) of reduced body weight in male children and adolescents with Asperger's disorder (AD). Body weight and height of 36 consecutively admitted male patients with AD were retrospectively assessed for the calculation of body mass indices (BMI, kg/m²). The BMIs were transformed to percentile ranks and plotted into BMI-centiles representative for the German population. In addition, comorbid psychopathology was assessed to explore a possible relationship between associated psychopathology and body weight. The mean BMI-centile of all patients was 34.7 ± 31.8 and, thus, differed significantly from the mean centile of an age- and gender-matched psychiatric control group, which was 52.7 ± 28.3. Thirteen patients had a BMI below the 10th centile and five even below the third. Three of the latter presented with disturbed eating behaviour. Altogether four patients showed disturbed eating behaviour. They had a significantly lower mean BMI-centile than the rest of the group. The BMI-centiles of patients with other additional psychopathology did not differ significantly from the mean percentile of the whole cohort. The results clearly show an increased risk for underweight and disturbed eating behaviour in patients with Asperger's disorder which should be evaluated in further studies. Accepted: 26 January 1999     

Teachers’ assessments of children aged eight predict life satisfaction in adolescence

The objective was to investigate how teachers’ assessments of children predict life satisfaction in adolescence. This is a prospective cohort study on the population-based Northern Finland Birth Cohort 1986 (n = 8,959). Information was gathered from parents, teachers and adolescents using questionnaires at the age of 7, 8 and 15. Response rates were 80–90%. Emotional and behavioural problems were assessed with Rutter Children’s Behavioural Questionnaires for teachers (RB2) and parents (RA2) during the first grade at age 8. At adolescence, self-reported life satisfaction was measured with a question including five response alternatives. According to teachers’ assessments, 13.9% of the children had high emotional or behavioural problems (RB2 ≥9). These assessments predicted life dissatisfaction in adolescence (OR_crude = 1.77; 95% CI 1.43–2.20) in several models including also health behaviour and use of psychotropic medicine. However, introducing all the significant variables in the same model, RB2 lost its significance (OR = 1.28; 0.96–1.70), but good school achievement assessed by teachers was still a significant predictor. Life satisfaction in adolescence was associated with a variety of favourable concurrent factors. In conclusion teachers’ assessments of children during the first school year predicted life satisfaction in adolescence. In mental health promotion, teachers’ early assessments should be utilized for the benefit of children.     

The effects of Nintendo WiiTM-based balance and upper extremity training on activities of daily living and quality of life in patients with sub-acute stroke: a randomized controlled study

Objective: The aim of this study was to investigate the effects of Nintendo Wii^TM-based balance and upper extremity training on activities of daily living and quality of life in patients with subacute stroke. Methods: 42 adults with stroke (mean age (SD) = 58.04 (16.56) years and mean time since stroke (SD) = (55.2 ± 22.02 days (～8 weeks)) were included in the study. Participants were enrolled from the rehabilitation department of a medical center (a single inpatient rehabilitation facility). Participants were randomly assigned to Nintendo Wii group (n = 20) or Bobath neurodevelopmental treatment (NDT) (n = 22). The treatments were applied for 10 weeks (45–60 minutes/day, 3 days/week) for both of two groups. Nintendo Wii group used five games selected from the Wii sports and Wii Fit packages for upper limb and balance training, respectively. The patients in Bobath NDT group were applied a therapy program included upper extremity activites, strength, balance gait and functional training. The functional independence in daily life activities and health-related quality of life was assessed with Functional Independence Measure (FIM) and Nottingham Health Profile (NHP), respectively. Participant's treatment satisfaction was recorded by using Visual Analogue Scale. A second evaluation (FIM and NHP) occurred after 10 weeks at the end of rehabilitative treatment (post-training). Treatment satisfaction was measured after 10 sessions. Results: There were significant difference between FIM and NHP values in NDT and Nintendo Wii group (p < 0.05). However, a significant difference was not found between the groups with regard to FIM and NHP (p > 0.05). The patients in Nintendo Wii group were detected to be better satisfied from the therapy (p < 0.05). A significant difference was found between subparameters and total FIM score, all subparameters and total NHP score in both groups (p < 0.05). Conclusion: These findings suggested that the Nintendo Wii training was as effective as Bobath NDT on daily living functions and quality of life in subacute stroke patients.     

Surgical treatment of spasticity in children: comparison of selective dorsal rhizotomy and intrathecal baclofen pump implantation

Introduction Neurosurgical treatments for spasticity in children include the traditional selective dorsal rhizotomy (SDR) and intrathecal baclofen pumps (ITBPs), which have been widely used in the past decade as an attractive alternative. The purpose of the study was to examine and compare the outcomes of these two procedures in the treatment of children with severe spasticity. Materials and methods A consecutive series of 71 children who underwent SDR for treatment of spasticity was compared with a group of 71 children matched by age and preoperative score on the Gross Motor Function Classification System (GMFCS) who underwent ITBP placement. Change in GMFCS score, lower-extremity tone (based on the Modified Ashworth–Bohannon Scale), and lower-extremity passive range of movement (PROM) at 1 year as well as the need for subsequent orthopedic procedures and parents’ satisfaction were selected as outcome measures. Results At 1 year, both SDR and ITBP decreased tone, increased PROM, and improved function. Both procedures resulted in a high degree of patient satisfaction. Compared with ITBP, SDR provided a larger magnitude of improvement in tone (−2.52 vs −1.23, p < 0.0001), PROM (−0.77 vs −0.39, p = 0.0138), and gross motor function (−0.66 vs −0.08, p < 0.0001). In addition, fewer patients in the SDR group required subsequent orthopedic procedures (19.1 vs 40.8%, p = 0.0106). Conclusions For children with moderate to severe spasticity, SDR and ITBP are both effective surgical treatments. Our results indicate SDR is more effective in reducing the degree of spasticity and improving function than ITBP is in this group of patients.     

Subjective quality of life of recently discharged Nigerian psychiatric patients

Abstract. Objectives: The objectives of the study were to examine the perceptions of recently recovered psychiatric patients on their feeling of well-being, their satisfaction with domains of living experience, and the correlates of subjective quality of life (QOL). Method: Patients (n = 118, aged 18–60) with schizophrenia and major affective disorders were assessed with the 26- item WHOQOL instrument, 2 weeks after discharge. Satisfaction with the items was graded as follows: dissatisfaction (< 50% positive appreciation), bare satisfaction (50–65 %), moderate (66–74 %), and highest satisfaction ( 75 %). In the six domains of QOL, patients were categorized as high, average or poor, based on domain mean score plus/minus 1 SD. Results: Items of highest satisfaction included overall sense of well-being and satisfaction with self; satisfaction with personal relationships and ability to work were moderate; while there was dissatisfaction with adequacy of money to meet needs, dependence on treatment and sex life. At least two-thirds of the subjects were categorized as having average QOL in each of the six domains of living experience. There were no significant associations between psychiatric diagnosis, socio-demographic characteristics and QOL. Conclusion: Our data support the impression that effective medical treatment is the first step to ensure QOL. Subjective QOL ratings realistically reflect the strengths and weaknesses of socio-cultural circumstances and patients perceived personal qualities. High subjective sense of well-being should be a tool in public mental health education to dispel the gloom of psychiatric outcome and combat stigma.     

Subject and observer-rated quality of life in schizophrenia

OBJECTIVE: We aimed to explore the relationship between objectively rated quality of life and subjective measures of social functioning and life satisfaction. Method: Participants of the Schizophrenia Care and Assessment Program (SCAP) study at Dandenong in Australia were included in this analysis. Subjective ratings of several domains of social functioning and life satisfaction were taken from the SCAP instrument and comparisons made with data from the Quality of Life scale rated by research staff as well as several psychopathology measures. RESULTS: Subjectively reported life satisfaction was not related to positive or negative symptoms of schizophrenia but did correlate with depressive symptoms. Quality of Life scale measures correlated with negative symptoms on most domains. There was very limited overlap in domain items between the life satisfaction and quality of life measures. CONCLUSION: Life satisfaction and objectively rated quality of life are not closely related and appear to have different determinants in patients with schizophrenia.     

A Comparison of Voxel-Based Morphometry and Volumetry Methods in the Context of the Neural Basis of Aggression

The assumption that voxel-based morphometry (VBM) offers an automated substitution for manually-traced volumetry was subjected to empirical evaluation. Data available from a previous volumetry study (Gansler et al. Psychiatry Research: Neuroimaging 171:145–154, 2009) provided the basis for the current study, which assessed for convergence between the methods. Optimized modulated VBM was used to preprocess images (N = 40). Gray matter volume and self-reported aggression associations were tested. Results indicate convergence, as both methods revealed significant negative associations of the left orbitofrontal cortex (OFC) and aggression. VBM detected an additional positive left OFC result not revealed with volumetry, suggesting that VBM may allow greater within-region localization than volumetry. However, the methods differentially deal with error rates and power demands and as such are better conceptualized as complementary than interchangeable.     

Spouses' quality of life 1 year after stroke: prediction at the start of clinical rehabilitation

BACKGROUND AND PURPOSE: The purpose of this prospective study was to identify early predictors of spouses' quality of life at 1 year after stroke. METHODS: At the start of clinical rehabilitation patient and caregiver characteristics, psychological factors, harmony in the relationship and social support were assessed. One year after stroke, caregiver burden (Caregiver Strain Index), life satisfaction (Life Satisfaction Checklist) and depressive symptoms (Goldberg Depression Scale) were assessed in 187 participants. Multiple regression analyses were performed. RESULTS: About 80% of the spouses reported low quality of life on one or more of the measures; 52% reported depressive symptoms, 54% significant strain and only 50% was satisfied with life as a whole. The regression analysis identified 'passive coping strategy of the caregiver' as the most important predictor. ADL dependency was the only baseline patient characteristic significantly related to burden and life satisfaction, but explained just 0-4% of the variance. CONCLUSIONS: A large proportion of caregivers perceive impaired quality of life 1 year after stroke. Caregivers at risk should be identified at the start of rehabilitation by means of coping measurement instruments or selected anamneses on coping.     

Aphasia LIFT: Exploratory investigation of an intensive comprehensive aphasia programme

Background: Intensive comprehensive aphasia programs (ICAPs) are gaining popularity in the international aphasia rehabilitation community. ICAPs comprise at least three hours of treatment per day over at least two weeks, have definable start and end dates for one cohort and use a variety of formats including individual treatment, group therapy, education and technology to improve language and communication. While intensive treatment approaches have demonstrated equivocal results on impairment-based measures, positive changes on activity/participation measures provide support for ICAPs in rehabilitation of chronic aphasia. Aphasia Language Impairment and Functional Therapy (LIFT) is a research-based ICAP developed for the purpose of evaluating treatment outcomes across the International Classification of Functioning, Disability and Health (ICF) domains.

Aims: The aim of this study was to estimate the magnitude of treatment effects yielded by Aphasia Aphasia LIFT in the domains of language impairment, functional communication and communication-related quality of life (QOL).

Methods & Procedures: Eleven individuals with chronic post-stroke aphasia (mean = 26.9 months) completed Aphasia LIFT. The programme comprised individual impairment-based and functional treatment, group therapy, and computer-based treatment for 40 hours over two weeks (n = 4, LIFT 1) or 100 hours over four weeks (n = 7, LIFT 2). Assessments of confrontation naming, discourse production, functional communication and communication-related quality of life were completed at pre-treatment, immediately post-treatment and six to eight weeks following treatment termination.

Outcomes & Results: Group-level analyses revealed acquisition and maintenance of treatment effects, as evidenced by significant improvement on at least one outcome measure at follow-up in all domains. The most consistent pattern of improvement at an individual level was observed on measures of functional communication and communication-related QOL.

Conclusions: Aphasia LIFT yielded positive outcomes across ICF domains, and in many cases the treatment effect was enduring. These results demonstrate that Aphasia LIFT was successful in meeting the overarching goal of ICAPs, to maximise communication and enhance life participation in individuals with aphasia. Further research into ICAPs is warranted.