Comparison of three scales to evaluate personality traits in Parkinson's disease: which one to use?

BACKGROUND: Personality traits have gained interest in the field of disability and stress, because they may either prompt or deny compliance. They can also foster motivation and influence outcome. Parkinson disease (PD) is a disabling and stressful condition that requires coping strategies and rehabilitation plans. Three constructs and their relative scales have been a matter of investigation, namely dispositional optimism (DO), locus-of-control (LOC), and sense-of-coherence (SOC). AIM: The present study compared the psychometric properties of three constructs in Parkinson's disease (PD). The health-related variables were: emotional distress (ED), quality of life (HR-QoL) and activities of daily living (ADL). The final objective was to provide guidance on scale selection to be implemented in clinical protocols. DESIGN: A cross sectional study. SETTING: Community-based general physicians. POPULATION: Participants with PD (N.=84) from community-based general physicians. METHODS: PD patients completed 3 self-report scales, namely Life Orientation Test-Revised (LOT-R, measuring Dispositional Optimism), Internal and External Locus Of Control (LOC-int. LOC-ext) and Sense of Coherence (SOC). All participants had magnetic resonance imaging. The MDS-UPDRS and the Barthel Scale were compiled by the investigator with the assistance of a caregiver. RESULTS: LOC-ext was the only scale to be associated with PD severity and disability (P<0.05). A higher level of LOC-ext was also associated with a higher level of ED (P<0.005). LOT-R was inversely associated with ED. Subjects in the highest tertile had a 41% lower ED (P<0.001). SOC was also inversely associated with degree of ED. Subjects in the highest tertile have a 44% lower ED (P<0.01). Moreover, HR-QoL is associated with several parameters, but LOT-R is the one with the strongest association (P<0.001). CONCLUSIONS: DO and SOC are predictive of important end-points, namely HR-QoL and ED. DO is even better under this respect. Conversely, those clinicians who are more interested in motor problems may find LOC more suitable. DO may be the most efficient construct to use in PD because of its favorable psychometric properties. CLINICAL REHABILITATION IMPACT: DO, LOC and SOC are constructs to be implemented in both research and clinical PD protocols. It is recommended to implement these, because they have predictive value especially when HR-QoL and ED are studied.

'Locus of control', health-related quality of life, emotional distress and disability in Parkinson's disease.

This cross-sectional study evaluated locus of control and its subscales in Parkinson's disease. A total of 50 consecutive Parkinson's disease participants and 50 healthy volunteers (control group) were enrolled. External locus of control was significantly higher in Parkinson's disease participants, whereas internal locus of control had no significant differences. External locus of control and internal locus of control were correlated in control group, but not in Parkinson's disease. In Parkinson's disease participants, external locus of control was negatively associated with health-related quality of life as well as positively associated with emotional distress and disease severity (but not with disability). After adjusting to confound variables, the associations remained. On the other hand, internal locus of control was negatively associated with depression.

Effects of dispositional optimism on quality of life, emotional distress and disability in Parkinson's disease outpatients under rehabilitation.

This study was performed with the aim of assessing dispositional optimism (DO) in a sample of Parkinson's disease (PD) patients, in order to evaluate its association with clinical outcomes and its impact on rehabilitation. Before entering an outpatient rehabilitation program, 58 participants suffering from idiopathic PD completed the Life Orientation Test-Revised (LOT-R) to evaluate their level of DO, the WHO-5 scale to evaluate their health-related quality of life (HR-QoL), the Hospital Anxiety and Depression Scale (HADS) to identify emotional distress, and the Barthel Index to evaluate their level of disability. All the measures were repeated four months later, at their discharge from the program. Disease stage and severity measures (Unified Parkinson's Disease Rating Scale) were also taken into consideration. Correlations and multivariate regression analyses compared DO with the health-related variables. On admission a high level of DO was found to be associated with less severe disease, a better quality of life (QoL) and lower emotional distress, but not with level of disability (Barthel Index). Consistent results were found at discharge. The level of DO di not change after rehabilitation, while anxiety was significantly reduced, especially in subjects with low LOT-R and high HADS scores. The Barthel Index values significantly improved. At discharge, participants with high DO showed the best improvements in disability and in QoL. Effects of dispositional optimism on quality of life, emotional distress and disability in Parkinson's disease outpatients under rehabilitation In conclusion, a high level of DO was associated with QoL, HADS and UPDRS both on admission and at discharge. The level of DO remained stable after rehabilitation, while disability and anxiety were reduced. Participants with high DO generally had better QoL, and better clinical and psychological performances.

The sense-of-coherence predicts health-related quality of life and emotional distress but not disability in Parkinson's disease.

BACKGROUND: Personality traits are deemed important in many fields of Medicine. The present study aimed at evaluating i) the presence of Sense-of-Coherence (SOC) in patients suffering from Parkinson's Disease (PD) in comparison with an age-matched general control population, ii) the influence of SOC on health-related variables, such as depression and anxiety, quality of life (Qol), and activities of daily living (ADL). METHODS: SOC was measured in 50 PD patients and in 50 matched controls enrolled in cross-sectional study. The other clinical measures included: Mini Mental State Examination (MMSE), Movement Disorder Society revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Well-being Index (WHO-5), Hospital Anxiety and Depression Scale (HADS) and the Barthel Index of ADL (BI). Data were analysed with univariate statistics and loglinear adjusted regression models. RESULTS: No difference emerged between PD and controls on socio-demographic and SOC. A statistically significant positive correlation was found between SOC and Qol (0.40, p < 0.004) and a negative significant correlation between SOC and emotional distress (-0.37, p < 0.008). The multivariate regression analysis confirmed the negative effect of SOC on total emotional distress (-3%, p = 0.01) and positive effect on Qol (2%, p = 0.01). SOC and BI were uncorrelated. CONCLUSIONS: SOC is predictive of QoL and emotional distress in PD, whereas no evidence of a predictive effect for disability could be found. These results support only partially, the Salutogenic Theory in PD, i.e. a strong SOC positively influences psychosocial health, but does not influence physical health.

Dispositional optimism, depression, disability and quality of life in Parkinson's disease.

Very little research on dispositional optimism (DO) has been carried out in the field of Parkinson's disease (PD). The present cross-sectional study, focusing on this personality trait, was performed with two main aims: i) to compare DO between patients with PD and a control group (CG); ii) to perform, in the PD group, a regression analysis including health-related variables, such as depression, anxiety, quality of life (QoL) and activities of daily living. Seventy PD participants and 70 healthy volunteers were enrolled in the study. The Mann-Whitney test was used to compare life orientation between the PD and CG groups. In the PD group, Pearson's correlation analysis was used to investigate the relationship between the measures of DO and the other variables. Means of log-linear regression were also used. Mean ratios adjusted for sex, age, education, and severity of disease were estimated, with relative 95% confidence intervals and p-values. The main results were as follows: i) no significant difference in DO was found between the PD participants and the CG; ii) DO was positively associated with QoL and emotional distress and inversely correlated with the Unified Parkinson's Disease Rating Scale; iii) DO was not correlated with disability. In conclusion, high DO predicts a satisfactory quality of life, low emotional distress and reduced disease severity in PD.

Rehabilitation in neuro-oncology: a meta-analysis of published data and a mono-institutional experience.

BACKGROUND: Rehabilitation for cancer patients with central nervous system (CNS) involvement is rarely considered and data on its use are limited. The purpose of the present study is to collect all available published data on neuro-oncology rehabilitation and perform a meta-analysis where results were presented in a comparable manner. Moreover, the authors report results on cancer patients with neurological disabilities undergoing rehabilitation at their unit. STUDY DESIGN: A PubMed search was performed to identify studies regarding cancer patients with CNS involvement undergoing inpatient physical rehabilitation. Studies with a complete functional evaluation at admission and discharge were selected. As the most common evaluation scales were Functional Independence Measure (FIM) and Barthel Index (BI), only articles with complete FIM and/or BI data were selected for the meta-analysis. Moreover, 23 cancer patients suffering from diverse neurological disabilities underwent standard rehabilitation program between April 2005 and December 2007 at the San Raffaele Pisana Rehabilitation Center. Patient demographics and relevant clinical data were collected. Motricity Index, Trunk Control Test score, and BI were monitored during rehabilitation to assess patient progresses. BI results of patients in this study were included in the meta-analysis. RESULTS: The meta-analysis included results of a total of 994 patients. A statistically significant (P < .05) improvement of both BI and FIM scores was demonstrated after rehabilitation (standardized mean difference = 0.60 and 0.75, respectively). Functional status determined by either FIM or BI improved on average by 36%. CONCLUSION: Published data demonstrate that patients with brain tumors undergoing inpatient rehabilitation appear to make functional gains in line with those seen in similar patients with nonneoplastic conditions.

Religious and spiritual beliefs in stroke rehabilitation.

Faith could dampen Post-Stroke Depression (PSD), which may negatively influence recovery. The present pilot study is an initial examination of the role of religion and spirituality on the functional recovery after a recent stroke. Data were analyzed from 112 consecutive stroke inpatients, who underwent a 2-month standard rehabilitation program. All participants received the Royal Free Interview (RFI), a semi-structured interview for religious and spiritual beliefs, and were assessed on their mood with the Hospital Anxiety and Depression Scale (HADS). Functional status was measured by means of the Functional Independence Measure (FIM). The relationship between religious beliefs, mood improvements, and functional recovery was explored by means of a multiple linear regression. No association between faith and recovery of functional independence could be verified, neither religiousness as a "coping strategy" was associated with functional recovery in this study. An explorative study of a larger size, which also takes into consideration the cultural background and religious beliefs of all patients, is warranted in the longterm.

Quality of life after stroke in a rehabilitation setting.

The perceived Quality of Life (QOL) was evaluated in one-hundred and eleven participants after a first-ever stroke, who were admitted in a rehabilitation center and completed a 2-month program. The World Health Organization (WHO) QOL-100 was applied. Two domains were correlated with the functional status at discharge, namely, the level of independence and the social relations. The study confirmed the strong correlation between the functional status at admission and at discharge. Other predictive parameters of outcome were age and depression. The functional improvement was highly significant (p < 0.0001) at Wilcoxon test (40 points at functional independence measure (FIM) scale). The gain was gender-independent. Nevertheless, among females, a significant correlation was found between the FIM score at discharge and either distress value at Hospital Anxiety and Depression Scale (HADS) or QOL. In conclusion, the perceived QOL should be considered by a stroke rehabilitative team.

A bio-psycho-social approach for treating sub-acute low back pain.

PURPOSE: This article examines the distinctive opportunities and challenges involved in treating sub-acute low back pain (LBP). Several risk factors have been identified. Thus, a multi-disciplinary design and a comprehensive bio-psycho-social approach seem to be the best modality of intervention to improve outcome. METHOD: The relevant literature on various factors that are supposed to improve outcome is summarised and discussed. RESULTS: A controversial on the rehabilitation benefits still exists. From one side, meta-analytic studies provide a small evidence of effectiveness. Most treatments for chronic LBP provide weak results and the benefits can be just transient. From the other side, comprehensive bio-psycho-social approaches seem to be the best modality of intervention to facilitate physical outcome and return to work. CONCLUSION: This article reflects the conviction that clinicians with a special knowledge on LBP problems and researchers with a special knowledge on health policy will better work together. Their targets are outcome and cost-benefit ratio by taking into account the economical and political milieu of the country where the research is carried out.

An electrophysiological contribution to the study of language lateralization and prognosis of aphasia.

The study is aimed at identifying hemispheric language dominance in both the right-handed and left-handed participants. Eighteen right-handed and 18 left-handed young volunteers were invited to listen for 80 times to a 720 ms duration Italian word. Signals from 16 electrodes were averaged and displayed both as traces and maps. When the word was delivered to the participant, a positive component at 340 ms was recorded, following the N100-P200 complex. The potential was significantly lateralized to the left hemisphere in 50% of the right-handers. The left-handed group was less homogeneous. Six out of 18 participants (33%) had a right lateralization, six participants (33%) had the positive potential shifted to the left hemisphere. Finally, the remaining participants had a bilateral representation. The maps show that there are no two participants alike, independently of either sex or handedness. A 300 Hz tone of the same duration failed to evoke the P340. Results indicate the utility of event-related potentials in studying the language processing. The possibility to identify cortical localization permits a better prognosis of acquired aphasia. The method is relatively cheap and noninvasive. Application is suggested in those participants who are at risk of stroke or in patients to be submitted to a neurosurgical intervention nearby possible language areas.

Slowing of event-related potentials in primary progressive aphasia. A case report.

Primary Progressive Aphasia (PPA) is a rare and insidious language impairment that worsens over time. It belongs to the group of fronto-temporal dementias. This study was aimed at assessing the role of speed of cognitive abilities, such as word recognition, in PPA. The design is a single-case, longitudinal study. A male patient suffering from PPA was enrolled and fifteen healthy older adults were the control group. An event-related electrical potential connected with word recognition, namely the N400, was delayed by 200 ms at baseline compared to healthy controls and progressively deteriorated. One year later, the delay was greater and two years later the potential had disappeared. Reduced speed of processing is an early pathological factor negatively affecting higher cognitive functions in APP. Event related electrical potentials are recommended in the field of aphasia and cognitive decline. They permit observation of a speed decline in higher cognitive abilities, when pathological changes at a central level begin and language comprehension seems to be unaffected.

Is there a scientific basis for pet therapy?

PURPOSE: Pet therapy is a non-pharmacological intervention, but its scientific value is still undefined. METHODS: The first step to identify the papers of interest was the access to the MEDLINE library from 1960 until June 2007 and the Cochrane controlled trials registry. RESULTS: At present there is consistent evidence of the protective effect against cardiovascular risk, mainly through the moderate exercise prompted by walking a dog. Indeed, walking a dog may contribute to a physically active lifestyle. Moreover, patients suffering from chronic illness are likely to benefit from pet companionship. CONCLUSIONS: There is a contrast between physical effects (for which the evidence is fairly clear) and the psychological benefits (for which the evidence is controversial). Further randomised researches are necessary to convey scientific dignity to the human - animal relationship.

Possible influence of spiritual and religious beliefs on hypertension.

Religious and spiritual beliefs are beneficial in stroke patients as coping strategies. This work has investigated the feeling of people about it by proposing to 174 volunteers aged 54.0 +/- 16.9 years the Royal Free Interview (RFI). Interviewed subjects considered the beliefs beneficial for health independently of their form. Ascertaining the pre-morbid understanding of life in subjects at risk of hypertension may be useful to verify self-confidence and coping possibilities against anger, fear, and stress, factors that may exert a negative effect.

Return to work following traumatic brain injury: trends and challenges.

PURPOSE: The aim of this paper is to present the current knowledge regarding return to work (RTW) following traumatic brain injury (TBI). METHOD: Based on a Medline search, the authors reviewed the current TBI rehabilitation literature regarding (a) predictive factors for successful RTW, and (b) current concepts in rehabilitative strategies for successful RTW. RESULTS: The functional consequences to the victim of traumatic brain injury (TBI) can be severe. Intensive rehabilitative efforts typically emphasize the early phase and address mainly the accompanying functional deficits in the realm of basic activities of daily living and mobility. An otherwise successful medical rehabilitation may end unsuccessfully because of the failure to return to work, with profound consequences to the individual and family, both economic and psychosocial. Even mild TBI may cause lasting problems in tasks calling for sustained attention. There appears to be a complex interaction between pre-morbid characteristics, injury factors, post injury impairments, personal and environmental factors in TBI patients, which influences RTW outcomes in ways that make prediction difficult. Injury severity and lack of self-awareness appear to be the most significant indicators of failure to RTW. Several medical, psychosocial and rehabilitative therapies are currently being implemented in rehabilitation settings which improve the chances of returning to work. CONCLUSION: Accurate prediction of whether a particular TBI patient will successfully return to work is not feasible, with RTW rates in the 12 - 70% range. A significant proportion of TBI patients, including those who are severely injured, are able to return to productive employment if sufficient and appropriate effort is invested. A comprehensive approach - medical and psychosocial - eventually entailing adequate vocational rehabilitation with supported employment can improve outcomes.

A polynomial function of gait performance.

A mathematical data processing method is presented that represents a further step in gait analysis. The proposed polynomial regression analysis is reliable in assessing differences in the same patient and even on the same day. The program also calculates the confidence interval of the whole curve. The procedure was applied to normal subjects in order to collect normative data. When a new subject is tested, the polynomial function obtained is graphically superimposed on control data. Should the new curve fall within the limits described by normative data, it is considered to be equivalent. The procedure can be applied to the same subject, either normal or pathological, for retesting kinematic characteristics. The gait cycle is analyzed as a whole, not point-by-point. Ten normal subjects and two patients, one with recent- and the other with late-onset hemiplegia, were tested. Multiple baseline evaluation is recommended before the start of a rehabilitation program.

Gait in the water: a comparison between young and elderly subjects.

PURPOSE: To find differences, if any, between young and elderly people who walked in a pool. METHOD: Twenty young subjects (mean age 23.8 years, SD 3.6) and 20 elderly subjects (mean age 66.8, SD 3.8) were enrolled in a cross-sectional design study. Gait parameters were assessed by means of underwater video recording. Analysis of the playback allowed the assessment of speed, stance and swing duration with the aid of a digital clock with a 0.04% resolution. Length of step was also measured. Two-tail Student's t-test and Pearson's correlation coefficient were applied. RESULTS: The mean speed was 1482 meters per hour (SD 207) in the younger population and 1366 meters per hour (SD 336) in the elderly. The mean stance duration was 1.60 s (SD 0.26) in the younger population and 1.59 s (SD 0.34) in the elderly. The mean swing duration was 1.16 s (0.22) in the younger population and 1.02 s (SD 0.26) in the elderly. The mean step length was 0.41 m (SD 0.05) in the younger population and 0.37 (SD 0.09) in the elderly. None of the differences was statistically significant. CONCLUSIONS: Gait in elderly people who walk in the water retains characteristics that are typical of younger participants. Hydrotherapy is therefore a suitable intervention for old people who are in a good state of fitness.

Gait in the early days after total knee and hip arthroplasty: a comparison.

PURPOSE: To evaluate whether gait after Total Knee Arthroplasty (TKA) is different from gait after Total Hip Arthroplasty (THA) in the early days following surgical intervention. METHOD: The gait was studied in water, thus exploiting its buoyancy force. Twenty consecutive patients underwent TKA and twenty consecutive patients underwent THA. The mean age was 70.2 years (SD 6.9). Twenty age-matched volunteers were the control group. RESULTS: At the beginning TKA and THA patients had the same speed and the same step length. At day 15 there was a speed difference in favour of THA patients (t = - 2.245, df 38, p = 0.031). Likewise, the step length was longer in THA patients (t = -2.293 df 38, p = 0.027). In contrast to TKA patients, THA patients were unbalanced, having a longer stance phase on the non-operated leg and a longer swing on the contralateral one. CONCLUSIONS: Gait strategies were completely different after TKA and THA interventions. TKA patients were balanced over their feet and they appeared more cautious and more concerned about gait quality than moving quickly. By contrast, THA patients were unbalanced, having a longer stance phase on the non-operated leg and a longer swing on the contralateral one. However, their speed gain was higher.

Gait during hydrokinesitherapy following total knee arthroplasty.

PURPOSE: To obtain gait parameters during hydrotherapy (HT) in patients who were referred for rehabilitation after primary total knee arthroplasty (TKA). METHOD: The study had a cohort prospective design. Patients who had undergone TKA followed a HT rehabilitation programme. Twenty-two consecutive patients were enrolled. Four of them dropped out for various reasons, independently of HT. Therefore 18 patients could be evaluated (5 men and 13 women). Eighteen age-matched healthy volunteers were the control subjects. Nine patients had a right TKA and nine a left TKA. On the average HT duration was 18.4 days (SD 1.4). RESULTS: The patients presented with a mean speed of 912 (SD 275) meters per hour (m/h) at the baseline. At the last session the mean speed was 1330 (SD 416) m/h. The mean stance duration was 1.75 s (SD 0.34) on the operated side and 1.83 s (SD 0.41) on the non-operated side. By contrast, the mean swing duration was 1.10 s (SD 0.25) on the operated side and 1.13 s (SD 0.34) on the non-operated side. The step duration was the same on both sides. At the beginning of HT the mean stance/swing ratio was 1.94 on the operated side, whereas it was 1.77 on the non-operated side. In the controls the ratio was 1.46. At the beginning the mean stride length was 0.526 m (SD 0.147) and the value became 0.556 (SD 0.138) after 18 training sessions. At the individual level, recovery occurred in a non-linear fashion (Best Fitting, 7th-grade Fourier finite series). CONCLUSIONS: The study design permits accurate definition of stride parameters during rehabilitation which allows optimization of the programme. Increase in speed and regain of balance are the main targets of a HT programme and are monitored on a daily basis.