ICF, quality of life, and depression in breast cancer: perceived disability in disease-free women 6 months after mastectomy.

GOAL OF WORK: Aim of the present observational study is to focus on health-related quality of life (HRQL), mood and everyday life of breast cancer affected women disease-free 6 months after mastectomy, paying particular attention to the International Classification of Functioning, Disability and Health (ICF) framework contribution. MATERIALS AND METHODS: Sixty-five breast cancer-affected women disease-free 6 months after mastectomy hospitalized for reconstructive surgery (mean age 46.3 ± 7.3) were enrolled. Their depressive symptoms (Beck Depression Inventory-BDI-II), HRQL, and every day life functioning/barriers and facilitators (ICF) were assessed. RESULTS: At the BDI-II, 6 patients (9.2 %) reported mild depression and 6 (9.2 %) severe depression; when the subscales were considered, 7 (10.8%) resulted depressed at the somatic-affective factor and 16 (24.6 %) at the cognitive factor. Compared to normative data no differences emerged at the HRQL Physical Component Summary (46.4 ± 9.3 vs 49.1 ± 10.1), whereas patients reported lower scores at the Mental HRQL Component Summary (45.9 ± 10.1 vs 51.5 ± 9.1; p = 0.00001 t = -4.3). As for the activity and participation domain, 11 of the 42 categories investigated were compromised in at least 20% of the sample: lifting and carrying objects (d430), acquisition of goods and services (d620), doing housework (d640), remunerative employment (d850), and many categories relating to interpersonal relationships; moreover the caregiver seems to be perceived as an important and positive modulator of disability. CONCLUSIONS: The addition of the ICF evaluation to the usual psychological assessment gives a more complete picture, enabling a broader perspective of the psychological-clinical implications. Mainly, the women that we have evaluated continue to function in their everyday lives, thanks in part to their ability to accept help from their own families. However, they inevitably carry signs of their disease which some translating into problems with interpersonal relationships, depressive thoughts and negative ideation. Only the synergistic use of all these assessment instruments can one truly perceive all the nuances relating to the social and psychological conditions of the assessed patients' life, overcoming a binomial vision of well-being and ill-being.

[Neuropsychological evaluation and psychological intervention on patients with Parkinson's disease in physical rehabilitation]. / Valutazione neuropsicologica e intervento psicologico nei pazienti con malattia di Parkinson in riabilitazione motoria.

OBJECTIVE: Parkinson's Disease (PD) is characterized by a wide range of motor and non-motor symptoms. In the last years the evaluation of cognitive functioning, emotional aspects and health status of PD patients has became ever-growing important. METHODS: In this article a neuropsychological and psychological assessment model, by means of tests and interviews, and a clinical approach to the narrative themes are described. Areas of clinical investigation: cognitive processing, emotional acceptance and behavioural adaptation to the disease, motivation to rehabilitation treatment, expectations regarding functional recovery, adherence, social and family perceived support, mood, awareness of possible cognitive deficits. Tests assessment (based on specific cognitive deficits related to PD): MMSE, FAB, TMTA-B, Phonological verbal fluency test, Stroop test, Geriatric Depression Scale (GDS) or Beck Depression Inventory- BDI-II and Parkinson's Disease Questionnaire-8 (PDQ-8). The psychological approach, which is part of an interdisciplinary rehabilitative intervention, is based on Cognitive Behavioural Therapy and it is focused on disease management even in the absence, sometimes, of a significant general emotional status modification and it is aimed at improving patient's adaptability, self-management and empowerment. In order to describe the model, the clinical and test data of two PD patients are illustrated. CONCLUSIONS: The added value of this psychological approach lies in the clinical data integration of the test evaluation, the narrative aspects and the information mediated by the inter-professional team. This model allows a deeper and more personalized identification of the patient's subjective adjustment process according to his/her personal needs and resources.

[Presentation of the Psycho-Cardiological schedule and convergence levels analyses among the psycho-cardiological screening and the psychological assessment]. / Presentazione della Scheda Psico-Cardiologica (SPC) e analisi dei livelli di convergenza tra screening psico-cardiologico e valutazione psicologica.

UNLABELLED: In Cardiovascular Rehabilitation the increasing inpatients complexity suggests the necessity to develop screening methods which allow to identify those patients that require a psychological intervention. MATERIAL AND METHODS: A Psycho-Cardiological Schedule (PCS) was developed with the aim of detecting the critical situation indicators or the presence of psychological, social and cognitive problems. The PCS, compiled by a nurse or cardiologist in collaboration with a psychologist, allows to assess the need for a deeper psychological examination, clinical and/or with tests. Aim of the present study is to identify the convergence levels among the observational and anamnestic data of the PCS collected by a nurse and the clinical and/or test data of the psychological deeper assessment. RESULTS: Among the 87 patients recruited in January-February 2010, 28 (aged 53.5 +/- 12.6, M = 20, F = 8) fulfilled the criteria for a deeper psychological examination: age < or = 50, manifestation of psychological/behavioural problems, neuropsychological disorders, low adherence to prescriptions, inadequate disease knowledge/representation. From data comparisons emerged convergence levels with 100% concordance as to smoke habits and problems in social-family support. High convergence levels also resulted as to emotional and/or behavioural problems (92.8%) and inadequate adherence to prescriptions (89.3%). Lower levels of concordance (82.1%) emerged when considering disease knowledge/representation, issues specifically linked to cognition and subjective illness experience, not directly detectable from behaviour. CONCLUSIONS: our data confirm the synergic efficacy of the two evaluations: the Psycho-Cardiological Schedule reliably identifies the problematic macro-categories, mainly if they are characterized by behavioural indicators, which facilitate the detection. The psychological approach appears more suitable for better specifing macro-categories characteristics and for detecting critical aspects not overt but not less important, providing therefore advice for a therapeutic psychological management.

[Perception of illness and dispositional optimism in a sample of patients with chronic heart failure]. / Percezione di malattia e ottimismo disposizionale in un campione di pazienti con scompenso cardiaco cronico.

UNLABELLED: INTRODUCTION. Psychological research on Chronic Heart Failure has mainly focused on the patient's emotional status, particularly on anxiety and depression. AIM: To describe the psychological characteristics of a sample of hospitalized CHF inpatients and to assess their illness perception and their dispositional optimism and pessimism, and the mutual relations among these variables. METHOD: 77 CHF inpatients of a Department of Cardiovascular Rehabilitation (aged 57.4 +/- 10.0) were consecutively enrolled. The following psychological constructs were assessed: anxiety (HADS-A), depression (BDI-II: total score, Cognitive and Affective Factors), illness perception (Brief IPQ) and dispositional optimism and pessimism (LOT-R). Correlations between Brief IPQ and LOT-R data were calculated and subsequently ANOVAs were performed on Brief IPQ and LOT-R data divided by sex, anxiety and depression. RESULTS. As to anxiety, 57 (74.0%) patients resulted not anxious, whereas 10 (13.0%) reported light anxious symptomatology, 8 (10.4%) moderate and 2 (2.6%) severe. Thirty nine patients (50.7%) resulted not depressed, whereas 19 (24.7%) resulted severely depressed. Significant correlations emerged among dispositional pessimism (LOT-R) and the following Brief IPQ variables: Treatment Control (r = - 0.40 p < 0.0001) and Coherence (r = -0.35 p = 0.002). Anxiety and depression differentiated the sample considering illness perception but not dispositional optimism and pessimism. CONCLUSIONS. As to anxiety and depression our data enlighten the presence of emotional disorders in CHF patients. Moreover illness perception differentiates the sample when analysed considering the emotional status. Interesting are the relationships among illness representations and dispositional pessimism, which deserve further studies. In our sample pessimism seems not to be opposed, in a bipolar construct, to optimism and results not related to depression; besides pessimism might have a predictive role in patient's disease management in a not yet explored direction. Finally our data confirm what usually qualitatively observed in clinical practice during the psychological intervention in rehabilitation cardiology. They also provide scientific information on the utility of an accurate psychological screening and a consequent specific intervention aimed at both providing psychological support and cognitive restructuring.

Additive prognostic value of subjective assessment with respect to clinical cardiological data in patients with chronic heart failure.

BACKGROUND: Health-related quality of life tools that better reflect the unique subjective perception of heart failure (HF) are needed for patients with this disorder. The aim of this study was to explore whether subjective satisfaction of HF patients about daily life may provide additional prognostic information with respect to clinical cardiological data. METHODS: One hundred and seventy-eight patients (age 51 ± 9 years) with moderate to severe HF [New York Heart Association (NYHA) class 2.0 ± 0.7; left ventricular ejection fraction (LVEF) 29 ± 8%] in stable clinical condition underwent a standard clinical evaluation and compiled the Satisfaction Profile (SAT-P) questionnaire focusing on subjective satisfaction with daily life. Cox regression analysis was used to assess whether SAT-P factors (psychological functioning, physical functioning, work, sleep/eating/leisure, social functioning) had any prognostic value. RESULTS: Forty-six cardiac deaths occurred during a median of 30 months. Patients who died had higher NYHA class, more depressed left ventricular function, reduced systolic blood pressure (SBP), increased heart rate (HR), and worse biochemistry (all p < 0.05). Among the SAT-P factors, only physical functioning (PF) was significantly reduced in the patients who died (p = 0.003). Using the best subset selection procedure, resistance to physical fatigue (RPF) was selected from among the items of the PF factor. RPF showed independent predictive value when entered into a prognostic model including NYHA class, LVEF, SBP, and HR with an adjusted hazard ratio of 0.86 per 10 units increase (95% CI 0.75-0.98, p = 0.02). CONCLUSIONS: Patients' dissatisfaction with physical functioning is associated with reduced long-term survival, after adjustment for known risk factors in HF. Given its user-friendly structure, simplicity, and significant prognostic value, the RPF score may represent a useful instrument in clinical practice.

Positive psychology in psychological interventions in rehabilitation medicine.

Human beings have always tackled their problems and the adversities of life by drawing on their own resources, resilience, and values, and yet the focus on pathology has effectively long dominated the cognitive approach of psychologists to ill-being. Psychological interventions in rehabilitation medicine were formed around the codification and containment of the ill-being, in an almost surgical or antibiotic sense of "correcting" the negativity: identifying and removing or combating the ill-being, or, if possible, its sources; the distance to be covered was from negativity to zero: absence of ill-being as a synonym for well-being. But what makes a 20-year-old tetraplegic look to the future? Where does someone who has been waiting for heart transplant for one, two or three years find the strength to carry on while living on 18 drugs and no more than two little bottles of water a day? In its use in the context of health care, positive psychology is that part of psychology that takes on the task--among others--of deciphering the mechanisms through which it becomes possible to adapt to a chronic illness. But not only. Positive psychology also offers the opportunity to systematise knowledge concerning the possibility of overreaching the distance from negativity to zero, of going beyond, of nourishing positivity, enriching and improving oneself, despite the presence of an organic disease or a disability. Positive psychotherapy does not negate painful or unpleasant experiences, but encourages the use of resources to understand weaknesses and it is contributing substantially to drawing our attention back to optimism, courage, positive emotions, flexibility, creativity, faith, hopes, honesty, perseverance, flourishing and on their relationships with physical health. A different language from the one that years of pragmatism have accustomed us to. If positive psychology can help our patients to see, through the pain, anger and fear, something that makes their life still worth living, it only remains to add it to the tools of our trade.

Psychological adjustment to a chronic illness: the contribution from cognitive behavioural treatment in a rehabilitation setting.

Patients with a chronic illness must continuously revise their lifestyle, adapting it to the behavioural limitations imposed by their state of health. These incessant adjustments of behaviour dictated by the patients' need to adapt to their clinical condition also cause profound psychological changes. The experience of a patient with a chronic illness often leads to a reformulation of self, which the patient may or may not be aware of, but which helps to facilitate successful behavioural adaptation. During the course of their disease, which spans from diagnosis to treatment, some patients have the opportunity to meet a psychologist, who has various tasks: understanding what stage of adaptation the chronically ill patients have reached, evaluating the patients' emotional state, facilitating their acceptance of their clinical condition, stimulating them to redefine their aims, if there are the presuppositions, and supporting their coping capacities and internal and external resources. This article is neither a review nor original research, but rather a "clinical exposition" with educational suggestions. The purpose of this article is to give a voice to the patients' internal dialogue, to what they say to themselves, to their narration of the illness, but also to explain the typical components of cognitive behavioural treatment in the setting of cardiological, respiratory and neuromotor rehabilitation.

Adherence self report assessment in solid-organ pre and post transplant recipients.

OBJECTIVE: There is strong evidence that many patients with chronic diseases have difficulties to adhere to the medical regimens. As to transplantation, nonadherence to the prescribed medical regimen has repeatedly been found to predict morbidity and mortality, both in adults and in children. Many instruments are available in order to assess nonadherence to immunosuppressive medication, whereas only few are available on behavioural components. Aim of the study was to present the Adherence Schedule in Transplantation (ASiT, in its three versions: ASiT-A, Adults; ASiT-PA, Proxy Adult and ASiT-PC, Proxy Child) that evaluates the Cognitive Relational Antecedents of adherence to treatment and the Self-efficacy in disease management in patients before and after transplantation. METHOD: (1) Review and construct analysis of the already existing adherence Schedules, on the basis of literature review and clinical experience; (2) Construction of the ASiT in its three versions from an adaptation of the already existing adherence Schedules; (3) Administration of the ASiT to pre and post transplant recipients followed by a semi-structured interview in order to discuss with the patients pros and cons; (4) ASiT correction on the basis of patients' comments; (5) Translation in English by a bilingual English mother tongue. RESULTS: On the whole 56 Schedules were administered to pre and post transplant (liver, heart, lung and kidney) recipients and their proxy and resulted to have good construct validity, were easily administered and were well accepted by patients. CONCLUSIONS: As to research the ASiT could cover a wide range of nonadherence sources. Within a clinical context our Schedule could be a not time consuming tool useful in favouring the communication about adherence and able to enhance patients' personal limits and resources.

[International Classification of Functioning, Disability and Health (ICF) and quality of life in cancer patients in a terminal condition]. / International Classification of Functioning, Disability and Health (ICF) e qualità della vita nel paziente oncologico in fase avanzata di malattia.

INTRODUCTION: Quality of life (QoL) preservation for the patient with cancer in a terminal condition is a central goal in palliative care. Aim of the present study is to assess QoL and to verify the additive value of the ICF in a sample of cancer inpatients of a palliative care unit. Method. 32 terminal palliative care inpatients were evaluated by means of traditional assessment tools: Karnofsky Performance Status (KPS), Palliative Prognostic Index (PPI), Barthel Index (BI), SF-12, EuroQol VAS (today and last 30 days) and ICF checklist. Results. Among the 32 patients (age 70.4 +/- 10.2), 17 male (53.1%) and 15 female (49.6%), 8 were alive at the end of the study (24 deceased: survival days 41.0 +/- 46.4). As to the traditional assessment instruments, patients resulted severely impaired: KPS 30.0 +/- 10.4; PPI 5.7 +/- 2.7; BI 35.6 +/- 22.2; EuroQol-VAS today 46.5 +/- 19.7; EuroQol-VAS last 30 days 29.0 +/- 22.5; SF-12: PCS 29.2 +/- 8.1 e MCS 39.7 +/- 11.8. As to the ICF Activity and Participation categories 21 out of 42 (with equipment aids only) and 12 out of 42 (with equipment aids and with a person's help) resulted at least mildly impaired in > or =50% of patients. Delta values of the former scores (caregiver's impact) were calculated: in 10 categories the median value was > or =1 (caregiver as a positive disability modulator) and in 32 the median value was 0 (neutral role of the caregiver). Environmental Factors were mainly facilitators. Conclusions. Traditional QoL assessment highlights the severity of this condition. Whereas the ICF Checklist shows a more diversified situation, where some aspects of daily life are maintained, safeguarding personal dignity and family role. An integrated use of these instruments may grant an overall assessment, showing both difficulties and resources, confirming the importance of a unique interdisciplinary approach with patients at end of life.

A multidimensional assessment of obese patients with obstructive sleep apnoea syndrome (OSAS): a study of psychological, neuropsychological and clinical relationships in a disabling multifaceted disease.

BACKGROUND: Rare are the studies that focus on OSAS (obstructive sleep apnoea syndrome) obese patient assessing neuropsychological, psychological and clinical aspects simultaneously. METHODS: One hundred and fifty-seven obese patients with OSAS were psychologically and neuropsychologically assessed by a standardized battery of validated tests in a cross-sectional study. RESULTS: Patients reported with higher frequency, compared to the normal distribution, the presence of an extrovert personality trait and depressive behaviours: 15.9% of the patients minimized symptoms and denied distress, whereas 28.0% presented psychological disorders. Compared to the normative group, patients' results were characterized as impaired with a higher percentage in short-term verbal memory (30.6%) and in short-term visual spatial memory (20.5%). Moreover 30.6% of patients were impaired in one cognitive function, 11.5% in two, 8.9% in three, and 8.2% in four or more cognitive functions. No significant relations between psychological-neuropsychological data and clinical variables emerged. CONCLUSIONS: The results of our obese patients with OSAS were significantly different from the normative data as for psychological and neuropsychological variables (extroversion, depression, short-term verbal and visual spatial memory, logical ability). Further studies are needed in order to investigate the eventual dose effect on psychological and neuropsychological variables of OSAS and obesity severity and treatment efficacy.

The positive role of caregivers in terminal cancer patients' abilities: usefulness of the ICF framework.

BACKGROUND: Among the purposes of palliative care, reducing perceived disability during the terminal stages of illness is of paramount importance. AIM: The aim of this study was to shed light on the possible role of the caregiver as a modulator of disability in patients with advanced cancer receiving end-of-life palliative care by means of the WHO International Classification of Functioning, Disability and Health (ICF). DESIGN: Observational prospective cross-sectional study. SETTING: Inpatients of a Palliative Care Unit. POPULATION: Fifty consecutively-enrolled inpatients (aged 69.9±10.6), in bed on average for more than 50% of daily hours (Karnofsky Performance Status Scale: 31.2±10.0) and functionally severely compromised (Barthel Index: 45.3±19.7); the average estimated survival was 6 weeks or more (Palliative Prognostic Index: 5.5±2.4). METHODS: Inpatients compiled a self-report questionnaire on quality of life (SF-12) and were interviewed on the ICF checklist. RESULTS: Patients reported significantly lower quality of life scores (SF-12) than the normative sample for both the Physical Component Summary Score (29.2±8.1 vs. 50.0±9.4; Student's t-test P=0.00001) and the Mental Component Summary Score (39.7±11.8 vs. 50.0±9.9; P=0.01). As to ICF Activity and Participation delta (Δ) values, describing caregiver's impact on patient's life: 26 domains had a median Δ=0 (neutral caregiver's role), 10 domains had a median Δ>0 (caregiver as a positive modulator of the patient's disability); no negative Δ values were reported (caregiver never considered as a barrier). Environmental Factors were mainly facilitators. CONCLUSIONS: Even if patients were mostly confined to bed, with reduced functional autonomy and marked dependency on others, their disability was reduced thanks to the caregiver's modulator role. CLINICAL REHABILITATION IMPACT: The ICF framework could also be extended to palliative care, because by integrating the standard functional assessment, it allows to identify two levels of intervention: one directly affecting patients' activity and participation, and one related to barriers and facilitators (i.e., caregivers, environmental factors).

Prevalence of job-related distress and satisfaction in a nationwide cardiology setting: The IANUS - itAliaN cardiologists' Undetected distress Study.

INTRODUCTION AND OBJECTIVES: Cardiologists' work distress has been seldom studied. The ItAliaN cardiologists' Undetected distress Study survey was designed to assess prevalence of work distress and satisfaction, and to gain insight into associations among these constructs and socio-demographics and job description. METHODS: We invited members of our national cardiological society (Associazione Nazionale Medici Cardiologi Ospedalieri) to participate in an anonymous, self-report, exclusively web-based survey, posted on the Associazione Nazionale Medici Cardiologi Ospedalieri website. ItAliaN cardiologists' Undetected distress Study included socio-demographics, job description and a 15-item questionnaire on job-related distress and work satisfaction. RESULTS: Of 7393 invited cardiologists, 1064 completed the survey. Organizational problems and worries about medico-legal controversies were reported by 71% and 49% of participants, respectively; over one-third reported loss of enthusiasm, helplessness, work-life imbalance and lack of control over work. Conversely, 86% felt competent at work, 67% rewarded by the moral/human meaning of their work and 52% satisfied with their professional fulfilment. Factor analysis revealed a meaningful underlying structure including four factors: job strain, positive meaning, emotional fatigue and relational difficulties. Relational difficulties were more frequent in cardiologists working in primary-level than in secondary and tertiary care hospitals (P = 0.017 and P = 0.013, respectively). Interventional cardiologists reported higher positive meaning than those in the clinical inpatients area and outpatient diagnostic settings (P = 0.007 and P = 0.025, respectively) and lower emotional fatigue than subjects in the clinical inpatients area (P = 0.0005). CONCLUSION: Cardiologists' work distress should be interpreted integrating job-related negative aspects with a reappraisal of protective personal and relational resources, which should be fostered to promote physicians' wellbeing at the individual, collective and organizational levels.

Subjective impact of osteoarthritis flare-ups on patients' quality of life.

BACKGROUND: Clinical trials on osteoarthritis (OA) flare-ups treatment usually focus only on objective measures of health status, albeit recent literature suggestions on the importance of patients' subjectivity. Aim of the study was to evaluate the effects of OA and of its different types of medical treatment(s) on Health Related Quality of Life (HRQoL) in terms of both subjective satisfaction and functional status. METHODS: An observational study on prospective data collected from the Evaluation of Quality of life in OA (EQuO) clinical trial (April 1999-November 2000) was conducted; outpatients from 70 participating centers (Orthopedy or Rheumatology Departments in Italy) with a diagnosis of OA of the hip or knee were consecutively enrolled. Patients were observed at OA flare-ups (baseline) and at follow up 4 weeks after treatment. Patients' objective and subjective HRQoL were assessed by means of the SF-36 and the Satisfaction Profile (SAT-P, which focuses on subjective satisfaction); Present Pain at baseline and Pain Relief at follow up were also evaluated. RESULTS: Among the 1323 patients, 1138 (86%) were prescribed one drug/treatment of osteoarthritis, 169 (13%) 2 drugs/treatments, and 16 (1%) 3 drugs/treatments; most of treatments involved the prescription of NSAIDs; non-coxib, COX2 selective NSAIDs were prescribed in about 50% of patients. Follow-up visits were performed after 29.0 days on average (+/- 7.69 SD). For all SF-36 domains, all SAT-P items and factors, the differences between baseline and follow up scores resulted statistically significant (p < 0.001), enlighting an improvement both in health status and in subjective HRQoL. CONCLUSION: Besides the classic health status measures, the assessment of patients' subjective satisfaction provides important clues on treatments efficacy of OA within the patient-centered medicine model. In clinical practice this could lead to a better doctor-patient communication and to higher levels of treatment adherence.

[End-of-life care in elderly heart failure patients]. / L'assistenza al paziente anziano con scompenso cardiaco terminale: quanto c'è di "cardiologico"? e quanto di "psicologico"?

Even if improved, the prognosis of chronic heart failure is still malignant, survival rate being similar to that of cancer. Due to the relevant epidemiology of the disease in the elderly, the terminal care of heart failure has a significant impact. Improving end-of-life care (by improving quality of life, quality of cure and care at the end of life and quality of dying and death) is a major challenge for health providers involved in heart failure care.

Current perspectives. Heart failure woman: does she make any difference?

Significant differences between sexes may influence the prevalence, incidence and severity of the heart failure syndrome. These differences may also interfere with treatment and management. In this review sex differences and similarities have been analyzed focusing on epidemiology, drug therapy and psychological implications. Pathophysiological differences but also a selection bias are evident; such differences bear an influence on clinical management. Gender differences exist even in the health-related quality of life, depression and coping ability. No studies have been specifically designed to investigate gender differences and the exclusion of elderly persons (mainly women) from large trials may compromise the quality of their care.

[Health care quality in terminal cardiac decompensation: a "multidisciplinary" reflexion]. / Qualità dell'assistenza nello scompenso cardiaco terminale: una riflessione "multidisciplinare".

Although improved, the prognosis of chronic heart failure is still malignant, the survival rate being similar to that of cancer. Due to the relevant epidemiology of this disease, the terminal care of heart failure has a significant impact, searching for the best quality of cure and care.

Disexecutive functions and depression in patients with Parkinson disease: the impact on rehabilitation outcome.

BACKGROUND: Studies relating to patients with Parkinson disease that assess neuropsychologic, psychologic, and clinical aspects are very uncommon. OBJECTIVE: The aim of this study was to analyze the impact of executive functioning (impaired vs. not impaired) or depression (depressed vs. nondepressed) on the outcome of rehabilitation treatment in patients with Parkinson disease without dementia at the medium stage of disease. METHODS: Forty consecutive inpatients affected by Parkinson disease were psychologically and neuropsychologically assessed by means of standardized tests during the first week of admission and at discharge after undergoing an intensive rehabilitation training. RESULTS: At baseline, the patients (mean [SD] age, 70.1 [8.0]; Mini-Mental State Examination [MMSE], ≥24) showed impairment in the following executive functions: frontal functions (32.5%), selective and divided attention (55.0% and 41.9%, respectively), and word fluency (17.5%). Depressive symptoms reported using the Geriatric Depression Scale were distributed as follows: mild (n = 13), 32.5%; moderate (n = 4), 10.0%; and severe (n = 5), 12.5%. As for the outcome of the intensive rehabilitation treatment, a general improvement in the Unified Parkinson's Disease Rating Scale, the Berg's scale, the 6-min walking test, and the Timed Up and Go test was observed (P < 0.0001). The improvement was homogeneous for all groupings of the patients for all of the considered variables, indicating that the changes in performance as a result of treatment were unaffected by the presence of executive function deficits or moderate-to-severe depression. CONCLUSIONS: The patients' executive function impairment or moderate-to-severe depressive symptoms did not seem to interfere with the outcome of the intensive physical and occupational rehabilitation. Therefore, these aspects in patients without dementia should not be considered a contraindication to an intensive rehabilitation program. Furthermore, despite the presence of impaired executive functions and/or of depressive symptoms, the 4-wk multidisciplinary rehabilitation program resulted to be highly effective.

Physical and emotional symptom burden of patients with end-stage heart failure: what to measure, how and why.

OBJECTIVE: Much of our understanding about symptom burden near the end of life is based on studies of cancer patients. The aim of this study was to explore physical and emotional symptom experience among end-stage chronic heart failure patients, looking for those symptoms mostly related to their global health status. METHODS: Forty-six patients with end-stage heart failure compiled the following: Edmonton Symptom Assessment Scale (ESAS) and Kansas City Cardiomyopathy Questionnaire (KCCQ). RESULTS: End-stage heart failure patients have many complaints and poor global health status. The most distressing symptoms reported were general discomfort and tiredness followed by anorexia and dyspnea. The KCCQ summary scores were highly correlated with ESAS (r = -0.78; P = 0.0001). Among the domains explored by the KCCQ, social functioning and self-efficacy showed the lowest correlation coefficients with ESAS (r = -0.50; P = 0.001 and r = -0.31; P = 0.003, respectively); concerning the physical limitation domain, the symptom score and the quality-of-life domain, the correlation coefficients were as follows: r = -0.71 (P = 0.0001), r = -0.75 (P = 0.0001) and r = -0.74 (P = 0.0001), respectively. In the multiple regression analysis of ESAS and KCCQ scores, general discomfort, depression and anxiety were the symptoms that mostly related with the results in the domains explored by the KCCQ. No independent predictor was found among symptoms and quality of life. CONCLUSION: General discomfort together with depression and anxiety were the symptoms that were mostly related with the physical limitation domain of global health status, but did not influence the social functioning and the self-efficacy domains. When ESAS is used together with KCCQ, comprehensive and quantitative information on a patient's physical, emotional and social distress is provided.