The influence of participation on health-related quality of life in stroke patients

Purpose.?Limitations in participation may have independent influences on health-related quality of life (HRQOL) at early and late phases of stroke recovery.

Methods.?Consecutive stroke patients were interviewed at months 3 and 12 after stroke for modified Barthel Index (MBI), geriatric depression scale (GDS) and WHO QOL questionnaire (abbreviated Hong Kong version). London handicap scale (LHS) was used to measure limitations in participation. The influence of the six LHS domains on the four HRQOL domains, adjusted for MBI and GDS was analysed by structural equation modelling with a two-component analysis.

Results.?Complete data were collected in 500 and 433 subjects at months 3 and 12, respectively. On multivariate analysis, after adjustment for MBI and GDS, the independence and social integration domains of LHS had significant influence on physical and social HRQOL, respectively, at both 3 and 12 months post-stroke. The occupation domain was a significant factor of physical and environmental HRQOL at month 12, but not at month 3. Economic sufficiency had more influence on HRQOL at month 3 than at month 12. The mobility and orientation domains had no significant negative influence on HRQOL.

Conclusions.?In stroke patients, participation had significant independent influences on HRQOL.     

Impact of Anxiety on Health-Related Quality of Life After Stroke: A Cross-Sectional Study

Objective

To examine the impact of anxiety on health-related quality of life (HRQOL) of stroke survivors.

Design

Cross-sectional study.

Setting

Acute stroke unit in a regional hospital.

Participants

Patients (N=374) from an acute stroke unit.

Interventions

Not applicable.

Main Outcome Measures

The presence of anxiety was defined as a score of ≥8 on the anxiety subscale of the Hospital Anxiety Depression Scale. HRQOL was measured by the total score and 12 domain scores of the Stroke Specific Quality of Life (SSQOL) scale. Demographic characteristics and history of medical conditions were also recorded. Clinical characteristics were obtained using the following scales: National Institutes of Health Stroke Scale, Barthel Index, Mini-Mental State Examination, and Geriatric Depression Scale (GDS).

Results

Eighty-six (23%) stroke survivors had anxiety. The anxiety group had significantly more women (62.8% vs 35.1%), higher GDS scores (7.5±4.5 vs 3.5±3.6), and lower scores for total SSQOL (3.9±0.6 vs 4.5±0.6) and SSQOL domains of energy (2.0±1.2 vs 3.4±1.4), mood (3.6±1.5 vs 4.6±0.9), personality (3.4±1.7 vs 4.4±1.1), and thinking (2.4±1.2 vs 3.5±1.4), after adjustment for sex and GDS score. In subsequent multivariate regression analysis, the Hospital Anxiety Depression Scale anxiety score was negatively associated with the SSQOL total score (r=−.154) and 5 of the 12 domain scores, namely energy (r=−.29), mood (r=−.102), personality (r=−.195), thinking (r=−.136), and work/productivity (r=−.096).

Conclusions

Anxiety has a negative effect on HRQOL of stroke survivors, independent from depression. Interventions for anxiety should improve stroke survivors' quality of life.     

Apathy and Health-Related Quality of Life in Stroke

Objective

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

Design

Cross-sectional study.

Setting

Acute stroke unit in a regional hospital.

Participants

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

Interventions

Not applicable.

Main Outcome Measures

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

Results

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

Conclusions

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

A randomized trial to evaluate an education programme for patients and carers after stroke

OBJECTIVES: To evaluate the effectiveness of an education programme for patients and carers recovering from stroke. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: One hundred and seventy patients admitted to a stroke rehabilitation unit and 97 carers of these patients. INTERVENTIONS: The intervention group received a specifically designed stroke information manual and were invited to attend education meetings every two weeks with members of their multidisciplinary team. The control group received usual practice. MEASURES: Primary outcome was knowledge of stroke and stroke services. Secondary outcomes were handicap (London Handicap Scale), physical function (Barthel Index), social function (Frenchay Activities Index), mood (Hospital Anxiety and Depression Scale) and satisfaction (Pound Scale). Carer mood was measured by the General Health Questionnaire-28. RESULTS: There was no statistical evidence for a treatment effect on knowledge but there were trends that favoured the intervention. The education programme was associated with a significantly greater reduction in patient anxiety score at both three months (p =0.034) and six months (p =0.021) and consequently fewer 'cases' (Hospital Anxiety and Depression Scale anxiety subscale score > or =11). There were no other significant statistical differences between the patient or carer groups for other outcomes, although there were trends in favour of the education programme. CONCLUSION: An education programme delivered within a stroke unit did not result in improved knowledge about stroke and stroke services but there was a significant reduction in patient anxiety at six months post stroke onset.     

Predictors of the depressive symptomatology of the family caregivers of Chinese stroke patients in Hong Kong

The aim of this cross-sectional study was to determine the socio-demographic and clinical factors associated with depressive symptoms in the family caregivers of Hong Kong Chinese stroke patients. One hundred and twenty-three patients at a stroke clinic and their family caregivers formed the study sample. The depressive symptoms of both the patients and their family caregivers were rated with the Chinese version of the 15-item Geriatric Depression Scale (GDS). Participants' socio-demographic data and clinical characteristics served as the independent variables in relation to the caregivers' GDS scores. Patients' and caregivers' somatic and psychological conditions were measured with 10 scales. In univariate analysis, caregivers' GDS scores were significantly correlated with certain of their characteristics [Modified Life Event Scale (MLES), Cumulative Illness Rating Scale (CIRS) and Lubben Social Network Scale (LSNS) scores, sex and being a housewife] and those of the patients (GDS score and being a housewife). Multiple regression analysis showed caregivers' MLES and CIRS scores and patients' GDS scores to be independent correlates of caregivers' GDS scores. Adverse events encountered by caregivers in the past 6 months, their current health problems and patients' depressive symptoms were found to be the principal factors associated with caregivers' depressive symptoms.     

Postadmission function best predicts acute hospital outcomes after stroke

OBJECTIVE: This study was conducted to determine the relative value of selected variables for predicting three acute hospital outcomes (length of stay, charges, discharge destination) after stroke. DESIGN: Data were obtained prospectively from 92 patients admitted with ischemic stroke to an acute care hospital. The relationship between five independent variables (age, sex, National Institutes of Health Stroke Scale [NIHSS] scores, prestroke Barthel Index scores, and postadmission Barthel Index scores) and the three outcome variables (hospital length of stay, hospital charges, and hospital discharge destination) were examined. RESULTS: Significant bivariate correlations were found between two predictors (NIHSS scores and Barthel Index scores) and all three outcome variables. Regression analysis showed that once postadmission Barthel Index scores were accounted for, no other variable added to the prediction of hospital length of stay or discharge destination. The NIHSS score added to the explanation of hospital charges provided by postadmission Barthel Index scores. CONCLUSIONS: Postadmission Barthel Index scores were the best predictor of the three outcomes measured in this study.     

Burden of Chinese stroke family caregivers: the Hong Kong experience

Tang W-K, Lau CG, Mok V, Ungvari GS, Wong K-S. Burden of Chinese stroke family caregivers: the Hong Kong experience.

Objective

To ascertain the clinical and sociodemographic factors associated with family caregivers' burden in Chinese patients with stroke in Hong Kong.

Design

Cross-sectional design.

Setting

Stroke Clinic.

Participants

Patients (N=123) from a stroke clinic and their family caregivers.

Interventions

Not applicable.

Main Outcome Measures

Predictive factors of family caregivers' burden in Chinese stroke patients in Hong Kong. Caregivers' burden was assessed with the Caregiving Burden Scale (CBS). Patients' and caregivers' sociodemographic data and clinical characteristics were recorded. Physical and psychological conditions were measured and rated with the following instruments: Cumulative Illness Rating Scale, Geriatric Depression Scale (GDS), Barthel Index, Instrumental Activities of Daily Living, Mini-Mental State Examination, Lubben Social Network Scale, Modified Life Event Scale (MLES), Hospital Anxiety and Depression Scale (HADS), and a single question about fatigue.

Results

In the univariate analysis, the CBS score had significant correlations with certain characteristics of caregivers (sex, GDS, HADS, depressive symptoms, fatigue, and MLES) and those of patients' (sex, age, education, GDS). Regression analysis revealed that caregivers' GDS and patients' education were the independent correlates of the CBS.

Conclusions

The severity of depressive symptoms in Chinese stroke caregivers and patients' education are independent factors associated with the caregivers' burden. Further studies evaluating interventions on caregivers' burden should include the assessment and management of mood disorders.     

医患互动模式对偏瘫康复效果的影响

目的探讨医患互动模式对急性脑卒中后中重度偏瘫患者康复效果的影响。方法200例中重度偏瘫患者按家庭是否支持康复分为治疗组和对照组各100例,治疗组给以互动模式治疗。两组于康复前,康复后1个月、3个月、6个月、12个月时用美国卫生研究院卒中量表(NIHSS)、Fugl-Meyer评定(FMA)、Barthel指数(BI)进行评分,1年后采用老年抑郁量表(GDS)评定抑郁。结果两组间比较,治疗组各项指标3个月时改善最大(P<0.01),BI于6个月、1年后仍有非常显著性差异(P<0.01),抑郁发生率明显低于对照组(P<0.01)。结论医患互动模式可改善中重度偏瘫康复效果。     

Prevalence of chronic pain and its impact on health-related quality of life in stroke survivors

OBJECTIVES: To document the prevalence of chronic pain and to evaluate the effect of pain on quality of life (QOL) in patients 6 months or more after a stroke. DESIGN: Cross-sectional survey. SETTING: Outpatient clinic of a rehabilitation center. PARTICIPANTS: One hundred seven stroke patients (68 men, 39 women; mean age, 60.9 y) attending the outpatient clinic of a rehabilitation center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients were interviewed on pain, QOL, mood, and functional status by using the short form of the Brief Pain Inventory (BPI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Beck Depression Inventory, and Modified Barthel Index (MBI), respectively. RESULTS: Self-reported chronic pain was present in 45 patients (42%), with 32 having musculoskeletal pain and 13 central poststroke pain. It was significantly more common in patients with a shorter poststroke duration (P=.025), but was not related to the nature of stroke (infarct or bleed), age, gender, presence of depression, and MBI score. There was no difference in the SF-36 scores between patients with and without pain except for the domain of bodily pain. When compared with patients with musculoskeletal pain, patients with central poststroke pain were more likely to have sensory impairments (P=.009), higher pain scores on the question "least pain in the past 24 hours" of the BPI (P=.036), and lower scores on the vitality domain of the SF-36 (P=.042). CONCLUSION: Pain is common in chronic stroke patients, and it does not appear to have a significant effect on patients' QOL.     

Validation of the Stroke Specific Quality of Life Scale (SS-QOL): test of reliability and validity of the Danish version (SS-QOL-DK)

OBJECTIVE: To test the reliability and validity of the Danish version of the Stroke Specific Quality of Life Scale version 2.0 (SS-QOL-DK), an instrument for evaluation of health-related quality of life. DESIGN: A correlational study. SETTING: A stroke unit that provides acute care and rehabilitation for stroke patients in Frederiksborg County, Denmark. SUBJECTS: One hundred and fifty-two stroke survivors participated; 24 of these performed test-retest. INTERVENTION: Questionnaires were sent out and returned by mail. A subsequent telephone interview assessed functional level and missing items. MAIN OUTCOME MEASURES : Test-retest was measured using Spearman's r, internal consistency was estimated using Cronbach's alpha, and evaluation of floor and ceiling values in proportion of minimum and maximum scores. Construct validity was assessed by comparing patients' scores on the SS-QOL-DK with those obtained by other test methods: Beck's Depression Index, the General Health Survey Short Form 36 (SF-36), the Barthel Index and the National Institutes of Health Stroke Scale, evaluating shared variance using coefficient of determination, r2. Comparing groups with known scores assessed known-group validity. Convergent and discriminant validity were assessed. RESULTS: Test-retest of SS-QOL-DK showed excellent stability, Spearman's r = 0.65-0.99. Internal consistency for all domains showed Cronbach's alpha = 0.81-0.94. Missing items rate was 1.0%. Most SS-QOL-DK domains showed moderately shared variance with similar domains of other test methods, r2 = 0.03-0.62. Groups with known differences showed statistically significant difference in scores. Item-to-scale correlation coefficients of 0.37-0.88 supported convergent validity. CONCLUSIONS: SS-QOL-DK is a reliable and valid instrument for measuring self-reported health-related quality of life on group level among people with mild to moderate stroke.     

脑卒中偏瘫恢复期患者健康教育路径研究设计

目的 提高脑卒中偏瘫恢复期患者的健康教育效果和最大程度地促进患者康复。方法 借鉴国外应用临床护理路径的经验，将临床护理路径用于脑卒中偏瘫恢复期患者的健康教育。56例脑卒中偏瘫恢复期患者分为实验组和对照组，实验组实施规范化康复护理，应用健康教育路径．对照组实施传统护理，传统健康教育方法。入选时、干预1、2个月后进行Barthel指数、简化Fugl—Meyer运动功能评分量表、脑卒中后抑郁多模式方法诊断、焦虑自评量表、并发症发生率评定。结果 2组患者Barthel指数、简化Fugl-Meyer运动功能评分均较前一阶段提高（P〈0．01）；1月后．实验组提高分高于对照组．但无显著性差异，2月后．实验组提高分高于对照组．有显著性差异（P〈0．01）。2组脑卒中后抑郁多模式方法诊断、焦虑自评分均较前一阶段显著性降低（P〈0．01）；焦虑自评分：1，2月后实验组降低分均显著大于对照组（P〈0．01），脑卒中后抑郁多模式方法诊断评分：1月后，实验组降低分大于对照组（P〈0．05）．2月后．试验组降低分显著大于对照组（P〈0．01）。实验组的并发症发生率低于对照组（P〈0．05）。结论 健康教育路径可提高健康教育质量，有助于患者整体康复。     

Prevalence of post-stroke depression in an Irish sample and its relationship with disability and outcome following inpatient rehabilitation

PURPOSE: (1). To examine the prevalence of depressive symptoms and operationally defined depressive disorder (major depression) in an Irish sample of subjects undergoing inpatient rehabilitation following their first stroke. (2). To investigate factors predictive of depression following stroke. (3). To examine the relationship between post-stroke depression and outcome following inpatient rehabilitation. METHODS: Fifty consecutive patients meeting inclusion criteria who were admitted for inpatient rehabilitation to a specialised unit following their first stroke were prospectively studied. Inclusion criteria: first stroke 3 - 12 months previously, lesion identified on CT or MRI, age 18 - 65 years, at least some sensory/motor impairment, no pre-existing disabling condition and Barthel Index score > 14 prior to stroke. Mood (Center for Epidemiologic Studies Depression scale, Hamilton Depression Rating Scale, DSM-IV diagnostic criteria for Major Depressive Disorder), Cognition (Mini-Mental State Examination) and Disability (Barthel Index, Rankin Disability Scale) were assessed one week after admission (baseline) and again after 2 months of rehabilitation. Outcome was measured as effectiveness of rehabilitation (Shah et al., 1990) and length of inpatient stay (LOS). RESULTS: 10/50 (20%) of the sample met criteria for major depressive disorder on admission. The best predictor of depression was gender, with females having a two-fold higher rate of both subjectively reported and objectively rated depressive symptoms. Depression was unrelated to baseline Barthel Disability, side of lesion or previous psychiatric history. The best predictor of effectiveness of rehabilitation was baseline Barthel Disability score. Depression did not predict either effectiveness or LOS. CONCLUSION: (1). Major depression is common in subjects undergoing rehabilitation following their first stroke. (2). Females appear to be especially at risk, possibly reflecting an increased general risk of depression. (3). Depression in our sample was not related to functional disability following stroke or early functional outcome following rehabilitation.     

Activities, participation and satisfaction one-year post stroke

Purpose. To evaluate the chronic consequences of stroke in terms of activity limitations, restricted participation and dissatisfaction from life, and the relationship between these variables, in stroke survivors living in the community one-year post onset.

Method. A total of 56 stroke patients (mean age: 57.7) who completed an in-patient rehabilitation programme, were evaluated one-year post onset in their homes, using the following instruments: Functional Independence Measure (FIM), Instrumental Activities of Daily Living Questionnaire (IADLq), Activity Card Sort (ACS), a work questionnaire, Life-Satisfaction Questionnaire (Li-Sat 9) and the Geriatric Depression Scale (GDS).

Results. One year post stroke onset the mean FIM motor score was 75.88 (max score: 91), yet more than 50% of the sample still required assistance (usually mild to moderate) in dressing, bathing and use of stairs. The majority of the sample required full assistance in some IADL domains, notably meal preparation (77%), housekeeping (70%) and laundry (82%). Only one subject returned to paid employment and the mean activity level (ACS), representing the percentage of leisure and IADL activities retained from before stroke, was 42.8%. Satisfaction ratings were generally low but varied between domains. Only 39% were satisfied from 'life as a whole'. The lowest satisfaction rates were noted for 'vocational situation' (14%), 'leisure situation' (34%) and 'ability in self-care' (43%), whereas the satisfaction rate from family life was high (84%). Significant correlations were found between overall life satisfaction scores and the overall FIM motor, IADLq, and ACS scores (Pearson r values: 0.32, 0.48 and 0.57, respectively). Activity level was found to be a significant predictor of satisfaction (p = 0.007) beyond that accounted for by demographic variables and depression.

Conclusions. Stroke survivors dwelling in the community demonstrate long-standing dissatisfaction one-year post onset, correlating with activity limitation and restricted participation. The findings present a compelling need for rehabilitation services with a focus on participation in IADL and leisure activities, in order to improve the satisfaction of this population.     

Psychometric evaluation of the original and Canadian French version of the activities-specific balance confidence scale among people with stroke

OBJECTIVE: To evaluate the internal and absolute reliability and construct validity of the Activities-Specific Balance Confidence (ABC) scale and a new Canadian French version (ABC-CF) of it among people with stroke. DESIGN: Cross-sectional data from a randomized controlled trial. SETTING: Community. PARTICIPANTS: Ninety-one people with a residual walking deficit between 57 and 386 days poststroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The ABC and ABC-CF scales, Berg Balance Scale (BBS), comfortable and maximum gait speeds, Timed Up & Go (TUG) test, 6-minute walk test (6MWT), Barthel Index, physical function scale of the Medical Outcomes Study 36-Item Short-Form Health Survey, Geriatric Depression Scale (GDS), and the EQ-5D visual analog scale (EQ VAS). RESULTS: Internal consistency (Cronbach alpha) was .94 and .93 and the standard error of measurement was 5.05 and 5.13 for the ABC (n=51) and the ABC-CF (n=35) scales, respectively. Spearman rho values ranged from .30 to .60 for the ABC scale and from .45 to .68 on the ABC-CF scale for associations with scores on the BBS, comfortable and maximum gait speeds, TUG, 6MWT, Barthel Index, physical function scale, GDS, and EQ VAS. CONCLUSIONS: Evidence of internal and absolute reliability and of construct validity of the ABC and the ABC-CF scales supports their use for cross-sectional measurements of balance self-efficacy among community-dwelling people in the first year poststroke.     

Caregiver characteristics predict stroke survivor quality of life at 4 months and 1 year

Evaluating factors that reduce stroke survivors' (SS) health‐related quality of life (HRQOL) is important for developing interventions to improve HRQOL after stroke. The influence of baseline caregiver and family characteristics (physical health, depressive symptoms, family communication) on five domains of SS HRQOL (physical function, memory/thinking, social activities, communication, and mood) was examined. Data were collected on 132 SS‐caregiver dyads at baseline, 4 months, and 12 months. Baseline caregiver depressive symptoms predicted lower scores for SS physical function and communication at 4 months and social participation and mood at 12 months. Male caregiver gender was negatively associated with SS HRQOL (communication and mood) at 12 months. Early intervention targeting these family characteristics, especially caregiver depressive symptoms, may improve survivors' HRQOL. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:592–605, 2009     

Speed of finger tapping as a predictor of functional outcome after unilateral stroke

OBJECTIVES: To determine (1) if the speed of finger tapping of the hand ipsilateral to the lesion (ie, unaffected hand) remains stable during the first 6 months after stroke and (2) if the speed of finger tapping of the unaffected hand is related to functional outcome after neurorehabilitation, which is of relevance to clinical practice. DESIGN: Prospective cohort study with measurements at admission to inpatient rehabilitation (t0), 4 weeks after admission (t1), at discharge (t2), and 3 months after discharge (t3). SETTING: Neurorehabilitation unit of a Dutch rehabilitation center. PARTICIPANTS: Fifty-seven patients with a unilateral first-ever stroke and 42 spouses (controls) of stroke patients without history of neurologic disorders were administered the finger-tapping test to generate normative scores. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Finger-tapping speed of the ipsilateral hand from the Amsterdam Neuropsychological Test battery. The Barthel Index, Frenchay Activities Index (FAI), and Sickness Impact Profile-68 (SIP-68) were also used as outcome measures. RESULTS: The speed of finger tapping of the ipsilateral hand improved significantly from t0 (mean, 44.13) to t1 (mean, 47.30, P=.02) but consecutively remained stable until 3 months after discharge. Four weeks after admission, the speed of finger tapping was comparable to the scores of the controls. The speed of finger tapping at admission was significantly correlated with the Barthel Index score at discharge (r=.39) and the FAI score at discharge (r=.32) and follow-up (r=.37) but not with the SIP-68 score (r=.28). Regression analyses showed that the Barthel Index score at discharge could be predicted by the initial Barthel Index score and finger tapping at admission (R(2)=.49); the variance of FAI score at discharge and follow-up was largely explained by the initial Barthel Index score. CONCLUSIONS: The speed of finger tapping improved over the first 4 weeks postadmission until normative speeds were reached and remained stable during the next 4 months. The speed of finger tapping correlated with functional outcome but not with quality of life; it was a predictor of activity of daily living functioning, although not a strong one. These findings suggest that the speed of finger tapping of the ipsilateral hand is a useful measure of recovery, although other variables such as the initial level of independent functioning are of more importance.     

老年髋部骨折术后病人抑郁及康复状况的研究

目的调查老年髋部骨折病人术后的抑郁状况,并探讨抑郁对其康复状况及生活质量的影响。方法选取北京市某三级甲等医院7l例髋部骨折术后复查的老年病人,应用老年抑郁量表调查病人的抑郁情况,应用Barthel指数、Harris髋关节功能评分评价病人的身体康复状况,应用健康状况问卷调查病人的生活质量状况。结果髋部骨折术后老年病人的抑郁发生率为39．44％。抑郁组的Barthel指数、Harris髋关节功能评分和健康状况评分（除外躯体疼痛和情感职能）均低于非抑郁组（P〈0．0l或P〈0．05）。结论老年髋部骨折术后病人抑郁发生率较高,抑郁会影响病人的术后康复状况。     

Activities,participation and satisfaction one-year post stroke

Purpose. To evaluate the chronic consequences of stroke in terms of activity limitations, restricted participation and dissatisfaction from life, and the relationship between these variables, in stroke survivors living in the community one-year post onset.

Method. A total of 56 stroke patients (mean age: 57.7) who completed an in-patient rehabilitation programme, were evaluated one-year post onset in their homes, using the following instruments: Functional Independence Measure (FIM), Instrumental Activities of Daily Living Questionnaire (IADLq), Activity Card Sort (ACS), a work questionnaire, Life-Satisfaction Questionnaire (Li-Sat 9) and the Geriatric Depression Scale (GDS).

Results. One year post stroke onset the mean FIM motor score was 75.88 (max score: 91), yet more than 50% of the sample still required assistance (usually mild to moderate) in dressing, bathing and use of stairs. The majority of the sample required full assistance in some IADL domains, notably meal preparation (77%), housekeeping (70%) and laundry (82%). Only one subject returned to paid employment and the mean activity level (ACS), representing the percentage of leisure and IADL activities retained from before stroke, was 42.8%. Satisfaction ratings were generally low but varied between domains. Only 39% were satisfied from ‘life as a whole’. The lowest satisfaction rates were noted for ‘vocational situation’ (14%), ‘leisure situation’ (34%) and ‘ability in self-care’ (43%), whereas the satisfaction rate from family life was high (84%). Significant correlations were found between overall life satisfaction scores and the overall FIM motor, IADLq, and ACS scores (Pearson r values: 0.32, 0.48 and 0.57, respectively). Activity level was found to be a significant predictor of satisfaction (p = 0.007) beyond that accounted for by demographic variables and depression.

Conclusions. Stroke survivors dwelling in the community demonstrate long-standing dissatisfaction one-year post onset, correlating with activity limitation and restricted participation. The findings present a compelling need for rehabilitation services with a focus on participation in IADL and leisure activities, in order to improve the satisfaction of this population.     

Lesion characteristics, NIH stroke scale, and functional recovery after stroke

OBJECTIVE: We examined the relationships between the National Institute of Health Stroke Scale (NIHSS) and physical, cognitive, and social participation outcomes across subpopulations of stroke survivors on the basis of cortical involvement and lesion lateralization. DESIGN: Families in Recovery from Stroke Trial participants were classified with respect to lesion lateralization (n = 274) and cortical involvement (n = 158). NIHSS scores (average 13 days after stroke) were used to predict Physical Performance Test times (PPT), limitations in activities of daily living (Augmented Barthel Index (ABI)), Instrumental Activities of Daily Living (IADL), cognitive function, depressive symptoms (Center for Epidemiologic Studies Depression scale [CES-D]), and productive, recreational, self-care, and social role activities 3 and 6 mos later. We compared the relationship between NIHSS and each outcome in stroke subgroups classified by lesion lateralization and cortical involvement. RESULTS: NIHSS predicted physical performance, activities of daily living, and IADL independence. The association between NIHSS and both PPT and IADLs was less steep for patients with cortical lesions than for patients with exclusively subcortical lesions. NIHSS predicted physical performance, activities of daily living, or IADLs similarly for right- and left-hemisphere strokes, but hemisphere modified the association between NIHSS and CES-D and cognitive measures. CONCLUSIONS: The NIHSS may predict outcomes in subpopulations of stroke survivors with subcortical lesions better than in patients with cortical involvement. NIHSS predicted CES-D in patients with right-sided lesions but not in those with left-sided lesions. In contrast, NIHSS had little association with cognitive outcomes among patients without left-side involvement.     

Prevalence of post-stroke depression in an Irish sample and its relationship with disability and outcome following inpatient rehabilitation

Purpose:?(1) To examine the prevalence of depressive symptoms and operationally defined depressive disorder (major depression) in an Irish sample of subjects undergoing inpatient rehabilitation following their first stroke. (2) To investigate factors predictive of depression following stroke. (3) To examine the relationship between post-stroke depression and outcome following inpatient rehabilitation.

Methods:?Fifty consecutive patients meeting inclusion criteria who were admitted for inpatient rehabilitation to a specialised unit following their first stroke were prospectively studied. Inclusion criteria: first stroke 3?–?12 months previously, lesion identified on CT or MRI, age 18?–?65 years, at least some sensory/motor impairment, no pre-existing disabling condition and Barthel Index score >?14 prior to stroke. Mood (Center for Epidemiologic Studies Depression scale, Hamilton Depression Rating Scale, DSM-IV diagnostic criteria for Major Depressive Disorder), Cognition (Mini-Mental State Examination) and Disability (Barthel Index, Rankin Disability Scale) were assessed one week after admission (baseline) and again after 2 months of rehabilitation. Outcome was measured as effectiveness of rehabilitation (Shah et al., 1990) and length of inpatient stay (LOS).

Results:?10/50 (20%) of the sample met criteria for major depressive disorder on admission. The best predictor of depression was gender, with females having a two-fold higher rate of both subjectively reported and objectively rated depressive symptoms. Depression was unrelated to baseline Barthel Disability, side of lesion or previous psychiatric history. The best predictor of effectiveness of rehabilitation was baseline Barthel Disability score. Depression did not predict either effectiveness or LOS.

Conclusion:?(1) Major depression is common in subjects undergoing rehabilitation following their first stroke. (2) Females appear to be especially at risk, possibly reflecting an increased general risk of depression. (3) Depression in our sample was not related to functional disability following stroke or early functional outcome following rehabilitation.