The added value of the artificial intelligence patient-reported experience measure (AI-PREM tool) in clinical practise: Deployment in a vestibular schwannoma care pathway.

Objectives: Patient-reported experience measures (PREMs) can be used for the improvement of quality of care. In this study, the outcome of an open-ended question PREM combined with computer-assisted analysis is compared to the outcome of a closed-ended PREM questionnaire. Methods: This survey study assessed the outcome of the open-ended questionnaire PREM and a close-ended question PREM of patients with unilateral vestibular schwannoma in a tertiary vestibular schwannoma expert centre. Results: The open-ended questions PREM, consisting of five questions, was completed by 507 participants and resulted in 1508 positive and 171 negative comments, categorised into 27 clusters. The close-ended questions PREM results were mainly positive (overall experience graded as 8/10), but did not identify specific action points. Patients who gave high overall scores (>8) on the close-ended question provided points for improvement in the open-ended question PREM, which would have been missed using the close-ended questions only. Conclusions: Compared to the close-ended question PREM, the open-ended question PREM provides more detailed and specific information about the patient experience in the vestibular schwannoma care pathway. Innovation: Automated analysis of feedback with the open-ended question PREM revealed relevant insights and identified topics for targeted quality improvement, whereas the close-ended PREM did not.

Exploring gender differences among couples with unexplained recurrent pregnancy loss regarding preferences for supportive care.

BACKGROUND: International guidelines recommend to offer supportive care during a next pregnancy to couples affected by recurrent pregnancy loss (RPL). In previous research, several options for supportive care have been identified and women's preferences have been quantified. Although it is known that RPL impacts the mental health of both partners, male preferences for supportive care have hardly been explored. METHODS: A cross-sectional study was conducted in couples who visited a specialized RPL clinic in the Netherlands between November 2018 and December 2019. Both members of the couples received a questionnaire that quantified their preferences for supportive care in a next pregnancy and they were asked to complete this independently from each other. Preferences for each supportive care option were analysed on a group level (by gender) and on a couple level, by comparing preferences of both partners. RESULTS: Ninety-two questionnaires (completed by 46 couples) were analysed. The overall need for supportive care indicated on a scale from 1 to 10 was 6.8 for men and 7.9 for women (P = 0.002). Both genders preferred to regularly see the same doctor with knowledge of their obstetric history, to make a plan for the first trimester and to have frequent ultrasound examinations. A lower proportion of men preferred a doctor that shows understanding (80% of men vs. 100% of women, P = 0.004) and a doctor that informs on wellbeing (72% vs. 100%, P = ≤0.000). Fewer men preferred support from friends (48% vs. 74%, P = 0.017). Thirty-seven percent of men requested more involvement of the male partner at the outpatient clinic, compared to 70% of women (P = 0.007). In 28% of couples, partners had opposing preferences regarding peer support. CONCLUSIONS: While both women and men affected by RPL are in need of supportive care, their preferences may differ. Current supportive care services may not entirely address the needs of men. Health care professionals should focus on both partners and development of novel supportive care programs with specific attention for men should be considered.

Predictors of health-related quality of life and participation after brain injury rehabilitation: The role of neuropsychological factors.

The aims of this longitudinal study were: (1) to assess associations between neuropsychological factors and health-related quality of life (HRQoL) and participation three months after discharge from inpatient acquired brain injury (ABI) rehabilitation; and (2) to determine the best neuropsychological predictor of HRQoL and participation after controlling for demographic and injury-related factors. Patients with ABI (n = 100) were assessed within approximately two weeks of enrolment in inpatient rehabilitation. Predictor variables included demographic and injury-related characteristics and the following neuropsychological factors: active and passive coping, attention, executive functioning, verbal memory, learning potential, depressive symptoms, motivation, extraversion, neuroticism and self-awareness. Bivariate analyses revealed that passive coping, executive functioning, depressive symptoms, extraversion, and neuroticism were significantly associated with HRQoL and/or participation. Neuropsychological factors significantly explained additional variance in HRQoL (18.1-21.6%) and participation (6.9-20.3%) after controlling for demographic and injury-related factors. However, a higher tendency towards passive coping was the only significant neuropsychological predictor (ß = -0.305 to -0.464) of lower HRQoL and participation. This study shows that neuropsychological functioning, and in particular passive coping, plays a role in predicting HRQoL and participation after inpatient ABI rehabilitation and emphasises the importance of addressing patients' coping styles in an early phase of ABI rehabilitation.

Awareness of memory functioning in patients with stroke who have a good functional outcome.

PRIMARY OBJECTIVE: To determine whether patients with stroke who have a good functional outcome show awareness of memory functioning and whether over- and under-estimation of memory performance are differentially related to neuropsychological performance. RESEARCH DESIGN: Prospective cohort study. METHODS AND PROCEDURES: The Barrow Neurological Institute Screen for Higher Cerebral Functions and a brief neuropsychological assessment were used to evaluate language, orientation, attention, visuospatial problem-solving, perception, reasoning, executive functioning, memory, affect and awareness of memory functioning. As for the latter, the patient's estimate of memory functioning was compared with his or her actual memory performance. Patients were divided into three groups: good-estimators (estimated performance = actual performance), over-estimators (estimated performance > actual performance) and under-estimators (estimated performance < actual performance). MAIN OUTCOMES AND RESULTS: In total, 54 patients with stroke were included, of whom 27 patients were classified as good-estimators, 19 as over-estimators and eight as under-estimators. Compared to good-estimators, over-estimators had significantly lower scores for all cognitive domains. Under-estimators had significantly poorer affect compared to good-estimators. CONCLUSIONS: These preliminary results suggest that over- and under-estimation of memory functioning can be observed in patients with stroke who have a good functional outcome and that they may reflect distinct underlying neuropsychological processes.

Clinicians' views on learning in brain injury rehabilitation.

PRIMARY OBJECTIVE: To determine clinicians' views on learning ability in brain injury rehabilitation. RESEARCH DESIGN: Online survey. METHODS AND PROCEDURES: An online survey was sent to physicians, psychologists and therapists of three Dutch organizations for neuropsychology or rehabilitation. The survey enquired (1) whether clinicians take learning ability into account; (2) about factors influencing learning ability; and (3) about assessment tools used to assess learning ability. MAIN OUTCOMES AND RESULTS: Thirty-seven physicians, 83 psychologists and 43 therapists completed the online survey. In total, 93% of respondents reported that they take learning ability into account when making a prognosis. The most frequently mentioned factors influencing learning ability were cognition, awareness of deficits and motivation. Learning ability was mainly determined by means of cognitive and memory tests and observations during therapy. CONCLUSIONS: This study demonstrates that a patient's learning ability may be influenced by not only cognition but also by motivation and awareness of deficits. Structured and standardized assessment of these factors may be suggested for standard use in clinical practice. More research is needed about the influence these factors have on the learning process.

Validity and feasibility of a learning style instrument for brain injury rehabilitation.

PURPOSE: Identifying learning styles of acquired brain injury (ABI) patients may aid the learning process by tailoring to the patient's learning needs and preferences. Currently, there is no learning style instrument for ABI patients. We therefore determined the validity and feasibility of the Adapted Learning Style Inventory (A-LSI) for patients with ABI. METHOD: We included 99 patients with ABI and 42 healthy controls. Learning styles were determined and subgroups were used to evaluate the validity of the A-LSI. Furthermore, rehabilitation professionals' perceptions on learning style and the A-LSI were evaluated. RESULTS: In the patient group, the A-LSI yielded the following learning styles: 4 doers, 54 observers, 2 deciders and 39 thinkers. A similar distribution was found for the control group (3, 28, 0 and 11, respectively). Spearman correlations revealed moderate internal validity. Content validity of the A-LSI was also moderate; 11 out of 19 patients recognized themselves in their A-LSI learning style. Furthermore, 12 rehabilitation professionals reported positive and negative aspects of the A-LSI and suggestions for using learning style in rehabilitation. CONCLUSIONS: Rehabilitation professionals were generally positive about using learning style in ABI rehabilitation. This study, however, raises doubts about the validity and feasibility of the A-LSI for this population. IMPLICATIONS FOR REHABILITATION: Rehabilitation professionals are generally positive about the assessment and implementation of learning style in rehabilitation. The A-LSI seems to be an inappropriate learning style instrument for individuals with ABI. There is a need for a more practical instrument to assess learning style directly at start of rehabilitation.

Exploring the relation between learning style and cognitive impairment in patients with acquired brain injury.

The way a patient prefers to approach or choose a learning situation represents the patient's learning style. The objective of this chart review study was to explore the relation between learning style and cognitive impairment in patients with acquired brain injury (ABI). We used data from files of 92 adult patients with ABI referred to inpatient rehabilitation, who completed the Adapted Learning Style Inventory (A-LSI) and at least one of the following neuropsychological tests: Trail Making Test, Rey Auditory Verbal Learning Test, WAIS-III Digit Span, Rey-Osterrieth Complex Figure Test-Copy, Stroop Color-Word Test, or the Brixton Spatial Anticipation Test. The A-LSI yielded the following distribution of learning styles: 4 doers, 48 observers, 2 deciders and 38 thinkers. No significant correlation coefficients were found between the neuropsychological tests and the A-LSI. Furthermore, Chi-square tests revealed no significant associations between learning style (observer, thinker) and cognitive impairment. The results of this exploratory study suggest that learning style and cognitive impairment are independent in patients with ABI.

Social activity contributes independently to life satisfaction three years post stroke.

OBJECTIVE: To determine social activity and life satisfaction three years post stroke and to investigate the contribution of social activity to life satisfaction controlled for the influence of demographic, physical and cognitive disabilities and social support. DESIGN: Cross-sectional study. SUBJECTS: One hundred and sixty-five patients with a stroke. MAIN MEASURES: The Life Satisfaction questionnaire (LiSat-9), the Social Support List - Interaction (SSL-12-I), the Barthel Index, the Mini-Mental State Examination (MMSE) and the Frenchay Activities Index. RESULTS: In total, 165 stroke patients participated, of whom 112 (67.9%) reported that they were satisfied with life as a whole. Socially inactive patients were significantly less often satisfied (50%, n = 26) than socially moderately (74.4%, n = 64) and socially highly active (81.5%, n = 22) patients. Lowest satisfaction ratings were found for sexual life (40.6%, n = 58). The socially inactive group was most satisfied with their partner relationship (85.1%, n = 40), the moderately and highly socially active group with their self-care ability (87.2%, n = 75 and 96.3%, n = 26, respectively). ADL and social activity were moderately correlated with life satisfaction. Social activity was found to explain an additional variance of the LiSat-9 total score (6.9%) and overall life satisfaction item (5.2%) after controlling for demographic variables, social support, ADL and cognitive functioning. CONCLUSIONS: Three years post stroke, many patients report ongoing dissatisfaction with various life domains. Social activity was related to life satisfaction.