Caregiver strain and fatigue are independent determinants of anxiety among patients early after stroke.

Anxiety and depression are common mental health disorders in stroke patients, and often co-occur. However, in contrast to depression, there is limited research about anxiety after stroke, although impact of anxiety can be substantial. Therefore, this cross-sectional observational study investigated determinants of anxiety after stroke and compared them with determinants of depression after stroke. Stroke surviving patients (n = 284) were seen six weeks after discharge from the hospital or rehabilitation setting. Of these, 238 patients answered all questions of the Hospital Anxiety and Depression Scale measuring anxiety (HADS-a) and 239 patients answered all questions measuring depression (HADS-d). Step-wise regression was used to identify independent determinants of anxiety and depression after stroke. Higher levels of anxiety were associated with a higher caregiver strain (p < 0.01) and more fatigue (p < 0.05). In contrast, higher levels of depression were associated with lower life satisfaction (p < 0.001) and less daily activities (p < 0.05), but also more fatigue (p < 0.001). Hence, our results show that both fatigue and caregiver strain are associated with higher levels of anxiety, but of these only fatigue is also associated with higher levels of depression. Practitioners should therefore ask for both anxiety and depression symptoms in stroke patients.

A blended eHealth intervention for insomnia following acquired brain injury: a randomised controlled trial.

The high prevalence and severe consequences of poor sleep following acquired brain injury emphasises the need for an effective treatment. However, treatment studies are scarce. The present study evaluates the efficacy of blended online cognitive behavioural therapy for insomnia (eCBT-I) developed specifically for people with acquired brain injury. In a multicentre prospective, open-label, blinded end-point randomised clinical trial, 52 participants with insomnia and a history of a stroke or traumatic brain injury were randomised to 6 weeks of guided eCBT-I or treatment as usual, with a 6-week follow-up. The primary outcome measure was the change in insomnia severity between baseline and after treatment, measured with the Insomnia Severity Index. Results showed that insomnia severity improved significantly more with eCBT-I than with treatment as usual compared to baseline, both at post-treatment (mean [SEM] 4.0 [1.3] insomnia severity index points stronger decrease, d = 0.96, p < 0.003) and at follow-up (mean [SEM] 3.2 [1.5] insomnia severity index points, d = -0.78, p < 0.03). In conclusion, our randomised clinical trial shows that blended CBT is an effective treatment for insomnia, and feasible for people with acquired brain injury, regardless of cognitive and psychiatric complaints. Online treatment has major advantages in terms of availability and cost and may contribute to the successful implementation of insomnia treatment for people with acquired brain injuries.

The course of depressive symptoms in the first 12 months post-stroke and its association with unmet needs.

AIM: To describe the course of depressive symptoms during the first 12 months post-stroke and its association with unmet needs. METHODS: A prospective cohort study among stroke patients admitted to inpatient rehabilitation. Depressive symptoms were assessed 3, 6, and 12 months post-stroke using the Hospital Anxiety and Depression Scale, and categorized into three trajectories: no (all times <8), non-consistent (one or two times ≥8), or persistent (all times ≥8) depressive symptoms. Unmet needs were assessed using the Longer-Term Unmet Needs questionnaire. Multivariable logistic regression analyses were used to investigate the association between depressive symptoms and unmet needs. RESULTS: One hundred and fifty-one patients were included, of whom 95 (62.9%), 38 (25.2%), and 18 (11.9%) had no, non-consistent, or persistent depressive symptoms, respectively. Depressive symptoms three months post-stroke persisted in 43.9% and recurred in 19.5% of patients during the first 12 months post-stroke. Depressive symptoms were significantly associated with the occurrence and number of unmet needs (odds ratio 6.49; p = 0.003 and odds ratio 1.28; p = 0.005, respectively). CONCLUSIONS: Depressive symptoms three months post-stroke were likely to persist or recur during the first 12 months post-stroke. Depressive symptoms are associated with unmet needs. These results suggest that routine monitoring of depressive symptoms and unmet needs should be considered post-stroke.Implications for rehabilitationPatients with depressive symptoms three months post-stroke have a high risk of developing persistent or recurrent depressive symptoms during the first 12 months post-stroke.Unmet needs are associated with both non-consistent and persistent depressive symptoms post-stroke.These results suggest that health professionals should routinely screen for depressive symptoms and health care needs around three months post-stroke.In patients with depressive symptoms at three months post-stroke early treatment of depressive symptoms and addressing unmet needs should be considered and depressive symptoms should be routinely monitored during the first 12 months post-stroke.

Patients' outcome expectations and their fulfilment in multidisciplinary stroke rehabilitation.

BACKGROUND: Patients' expectations of the outcomes of rehabilitation may influence the outcomes and satisfaction with treatment. OBJECTIVES: For stroke patients in multidisciplinary rehabilitation, we aimed to explore patients' outcome expectations and their fulfilment as well as determinants. METHODS: The Stroke Cohort Outcomes of REhabilitation (SCORE) study included consecutive stroke patients admitted to an inpatient rehabilitation facility after hospitalisation. Outcome expectations were assessed at the start of rehabilitation (admission) by using the three-item Expectancy scale (sum score range 3-27) of the Credibility/Expectancy Questionnaire (CEQ). After rehabilitation, patients answered the same questions formulated in the past tense to assess fulfilment of expectations. Baseline patient characteristics were recorded and health-related quality of life (EQ-5D) was measured at baseline and after rehabilitation. The number of patients with expectations unfulfilled or fulfilled or exceeded was computed by subtracting the admission and discharge CEQ Expectancy scores. Multivariable regression analysis was used to determine the factors associated with outcome expectations and their fulfilment, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: We included 165 patients (96 males [58.2%], mean (SD) age 60.2 years [12.7]) who completed the CEQ Expectancy instrument at admission (median score 21.6, interquartile range [IQR] 17.0-24.0); 79 completed it both at admission (median score 20.6, IQR 16.6-24.4) and follow-up (median score 20.0, IQR 16.4-22.8). For 40 (50.6%) patients, expectations of therapy were fulfilled or exceeded. No patient characteristic at admission was associated with baseline CEQ Expectancy score. Odds of expectation fulfilment were associated with low expectations at admission (OR 0.70, 95% CI 0.60-0.83) and improved EQ-5D score (OR 1.35, 95% CI 1.04-0.75). CONCLUSIONS: In half of the stroke patients in multidisciplinary rehabilitation, expectations were fulfilled or exceeded, most likely in patients with low expectations at admission and with improved health-related quality of life. More research into the role of health professionals regarding the measurement, shaping and management of outcome expectations is needed.

Responsiveness of four participation measures to changes during and after outpatient rehabilitation.

OBJECTIVE: To assess the responsiveness of 4 participation measures. DESIGN: Longitudinal study with repeated measurements at the start (t1) and at the end (t2) of a multidisciplinary out-patient rehabilitation programme, and at 4 months follow-up (t3). SUBJECTS: Outpatients with different diagnoses (n=395) from 5 rehabilitation centres in The Netherlands. METHODS: Measures were the Frenchay Activities Index (FAI), the Participation subscale of the ICF Measure of Participation and Activities Screener (IMPACT-SP), the Participation Scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation). Responsiveness was analysed using the effect size and the standardized response mean. RESULTS: Comparing scores at t1 and t2, the standardized response mean was 0.54 for the USER-Participation Restriction scale, 0.41 for the FAI, 0.40 for the IMPACT-SP, 0.39 for the USER-Participation Satisfaction scale, -0.36 for the Participation Scale, and 0.21 for the USER-Participation Frequency scale. Effect size values were generally somewhat smaller than standardized response mean values. Effect size and standardized response mean values were negligible between t2 and t3. Responsiveness parameters varied between diagnostic groups, with participants with acquired brain injury showing the largest change and participants with neuro-muscular disease or chronic pain showing least change. CONCLUSION: Overall and across the different diagnostic groups, the USER-Participation Restriction scale showed the best responsiveness.