Intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression and life satisfaction in patient-partner couples after stroke.

Many stroke patients and partners suffer from anxiety, depression, and low life satisfaction. Psychological factors such as coping style and self-efficacy can be protective factors within individuals. The close relationship between stroke patients and partners suggests that there may be interdependence in psychological functioning. The aim of this study was to examine intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression, and life satisfaction in patient-partners couples. In this prospective cohort study, pro-active coping (UPCC), general self-efficacy (GSES), anxiety (HADS-A), depression (HADS-D), and life satisfaction (1-6 scale) were assessed in 215 couples at 2 and 12 months post-stroke. Effects within couples were assessed using structural equation modelling. Several intra- and interpersonal effects of coping style and self-efficacy at 2 months post-stroke were related to emotional health at 12 months post-stroke. Most effects were intrapersonal effects. The interpersonal effects were small but showed that pro-active coping by the patient was associated with lower anxiety of the partner. Higher self-efficacy of the partner was associated with lower depression scores and higher life satisfaction of the patient. This study underscores the importance of a dyadic approach to post-stroke functioning. It supports a family-based approach for treating post-stroke emotional problems.

Which approach to measure cognitive functioning should be preferred when exploring the association between cognitive functioning and participation after stroke?

A variety of approaches are currently used to explore the relationship between cognitive functioning and participation after stroke. We aimed to gain insight into the preferred approach to measure cognitive functioning when exploring the association between cognitive functioning and participation in the long term after stroke. In this inception cohort study 128 individuals with stroke participated and were assessed at a single time point three to four years after the event. Participation was measured using the Restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation. Subjective cognitive complaints were assessed using the Cognition subscale of the Checklist for Cognitive and Emotional Consequences (CLCE-24-C). Objective cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) and a neuropsychological test battery (NTB) testing multiple cognitive domains. Participation showed a strong correlation (r = 0.51) with the CLCE-24-C and moderate correlations with the domains of visuospatial perception (r = 0.37) and mental speed (r = 0.36). Backward linear regression analyses showed that participation restrictions were best explained by the combination of the CLCE-24-C and a test for visuospatial perception (R2 = 0.31). Our findings suggest the use of a combination of subjective cognitive complaints and objective cognitive performance to explore the relationship between cognitive functioning and participation after stroke.

The influence of psychological factors and mood on the course of participation up to four years after stroke.

PURPOSE: (1) To explore the course of participation from two months up to four years after stroke, and (2) to examine if adaptive and maladaptive psychological factors and mood measured at two months after stroke are determinants of the course of participation during this period. MATERIALS AND METHODS: Prospective cohort study in which 369 individuals with stroke were assessed at stroke onset, two months, six months, one year, two years and three to four years after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) restrictions subscale was used to measure participation. Psychological factors were clustered into adaptive (proactive coping, self-efficacy, extraversion and optimism) and maladaptive (passive coping, neuroticism and pessimism) psychological factors. The Hospital Anxiety and Depression Scale was used to assess mood. RESULTS: Although improvements in participation were observed up to one year after stroke, considerable long-term restrictions in social and physical domains persisted. More mood problems and less adaptive psychological factors were independent determinants of worse participation up to four years after stroke. CONCLUSIONS: Participation improves in the first 12 months after stroke and stabilizes afterwards. Mood problems and less adaptive psychological factors negatively influence the course of participation over time up to four years after stroke.Implications for rehabilitationFollow-up assessments after stroke should not only focus on cognitive and motor impairment, but also encompass screening on mood problems and adaptive psychological factors.Implementation of a routine follow-up assessment one year after stroke can be beneficial as restrictions in participation are unlikely to diminish spontaneously from then onwards.

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.

Comparing contents of functional outcome measures in stroke rehabilitation using the International Classification of Functioning, Disability and Health.

PURPOSE: To examine the content of outcome measures that are frequently used in stroke rehabilitation and focus on activities and participation, by linking them to the International Classification of Functioning, Disability and Health (ICF). Method. Constructs of the following instruments were linked to the ICF: Barthel Index, Berg Balance Scale, Chedoke McMaster Stroke Assessment Scale, Euroqol-5D, Functional Independence Measure, Frenchay Activities Index, Nottingham Health Profile, Rankin Scale, Rivermead Motor Assessment, Rivermead Mobility Index, Stroke Adapted Sickness Impact Profile 30, Medical Outcomes Study Short Form 36, Stroke Impact Scale, Stroke Specific Quality of Life Scale and Timed Up and Go test. Results. It proved possible to link most constructs to the ICF. Most constructs fitted into the activities and participation component, with mobility being the category most frequently covered in the instruments. Although instruments were selected on the basis of their focus on activities and participation, 27% of the constructs addressed categories of body functions. Approximately 10% of the constructs could not be linked. CONCLUSIONS: The ICF is a useful tool to examine and compare contents of instruments in stroke rehabilitation. This content comparison should enable clinicians and researchers to choose the measure that best matches the area of their interest.

[There are also suitable treatments during the chronic phase following a stroke]. / Ook de chronische fase na een beroerte kent behandelmogelijkheden.

In contrast to the chronic phase, for the acute and rehabilitation phases following a stroke it is sufficiently clear what care is adequate care. Most stroke patients no longer have contact with healthcare professionals in the chronic phase. In this phase, new psychosocial problems may develop. Long (3, 5, 12 and 29 years) post stroke, 4 patients (aged 38-67 years) presented at an outpatient rehabilitation clinic with new complaints: social problems, emotional changes and cognitive impairments. Their relatives (spouses and children) perceived a substantial burden. A short-term outpatient, multidisciplinary rehabilitation programme was offered to them. The International Classification of Functioning, Disability and Health model was used to evaluate the health problems in relation to the environmental and personal factors. Psycho-education, learning cognitive strategies, supporting the family, and starting new leisure activities were important parts of the rehabilitation programme to increase participation and quality of life. The chronic phase following a stroke is not a stable phase and in this phase, rehabilitation interventions can be helpful too and should therefore be offered.

Responsiveness of functional health status measures frequently used in stroke research.

PURPOSE: To compare the responsiveness of several functional health status measures frequently used in stroke research, namely the Barthel Index (BI), Functional Independence Measure (FIM), Frenchay Activities Index (FAI) and Stroke-Adapted Sickness Impact Profile 30 (SA-SIP 30). METHOD: Patients with a first-ever supratentorial stroke admitted for inpatient rehabilitation were included. Complete datasets for 163 patients were available for analysis. Floor/ceiling effects and responsiveness, quantified by effect sizes, were studied for the periods between rehabilitation admission and six months post stroke (subacute phase) and between six and 12 months post stroke (chronic phase). RESULTS: Effect sizes in the subacute phase were similar and were classified as large for the BI, FIM total and FIM motor score. The FIM cognitive score showed a considerable ceiling effect and had the smallest effect size in the subacute phase. In the chronic phase, the FAI and SA-SIP 30 detected the most changes and had moderate effect sizes. CONCLUSIONS: BI, FIM total and FIM motor score, FAI and SA-SIP 30 were responsive measures. We recommend the use of the BI in the subacute phase and the use of the FAI and SA-SIP 30 in the chronic phase, especially for the stroke rehabilitation population.

Monitoring the functional health status of stroke patients: the value of the Stroke-Adapted Sickness Impact Profile-30.

PURPOSE: To further validate the Stroke-Adapted Sickness Impact Profile-30 (SA-SIP30) and to determine its responsiveness in a stroke rehabilitation population. METHOD: Data of 122 communicative stroke patients (mean age 57 years), selected for an inpatient rehabilitation programme, were available. All had suffered different types of stroke. Six months and one year post-stroke, the patients completed the SIP68 plus nine stroke-specific questions from the SIP136, enabling us to derive the SA-SIP30 from the questionnaire. We determined internal consistency, construct and clinical validity and responsiveness of the SA-SIP30. Total, physical and psychosocial dimension scores were calculated. RESULTS: Internal consistency was moderate to good (alpha>0.68) and correlation between the SIP68 and the SA-SIP30 was high (r>0.85), indicating good construct validity for total score and both dimension scores. Clinical validity assessment showed that total and psychosocial dimensions scores were significantly higher for patients with a cortical infarction compared to respectively subarachnoid haemorrhage and subcortical infarction (p<0.05). Effect sizes for the SA-SIP30 were moderate (between 0.56 and 0.65). CONCLUSIONS: The SA-SIP30 proved valid and responsive in our stroke rehabilitation population. The major advantages of the SA-SIP30 are the lesser number of items and, therefore, the shorter completion time and the fact that it is a stroke-specific scale to determine health-related functional status.

Is fatigue an independent factor associated with activities of daily living, instrumental activities of daily living and health-related quality of life in chronic stroke?

BACKGROUND: To determine the longitudinal association of poststroke fatigue with activities of daily living (ADL), instrumental ADL (IADL) and perceived health-related quality of life (HRQoL) and to establish whether this relationship is confounded by other determinants. METHODS: A prospective cohort study of stroke patients consecutively admitted for inpatient rehabilitation was conducted. ADL, IADL and HRQoL were assessed in 223 patients at 6, 12 and 36 months after stroke. Fatigue was determined by the Fatigue Severity Scale. Random coefficient analysis was used to analyze the impact of fatigue on ADL, IADL and HRQoL. The association between fatigue and outcome was corrected for potential confounders, i.e. age, gender, comorbidity, executive function, severity of paresis and depression. The covariate was considered to be a confounder if the regression coefficient of fatigue on outcome changed by >15%. RESULTS: Fatigue was significantly related to IADL and HRQoL but not to ADL. The relation between fatigue and IADL was confounded by depression and motor impairment. Depression biased the relation between fatigue and HRQoL, but fatigue remained independently related to HRQoL. CONCLUSIONS: Fatigue is longitudinally spuriously associated with IADL and independently with HRQoL. These findings suggest that in examining the impact of poststroke fatigue on outcome, one should control for confounders such as depression.