Cognitive and psychological recovery patterns across different care pathways 12 months after hospitalization for COVID-19: A multicenter cohort study (CO-FLOW).

BACKGROUND: The comparison of recovery patterns for different care pathways following COVID-19 is necessary for optimizing rehabilitation strategies. OBJECTIVES: To evaluate cognitive and psychological outcomes across different care pathways up to 12 months after hospitalization for COVID-19. METHODS: CO-FLOW is an ongoing multicenter prospective cohort study with assessments at 3, 6, and 12 months after hospitalization for COVID-19. The main outcomes are cognitive deficits (Montreal Cognitive Assessment, score <26), cognitive failure (Cognitive Failure Questionnaire, score >43), posttraumatic stress disorder (PTSD; Impact of Event Scale-Revised, score ≥33), and anxiety and depression (Hospital Anxiety and Depression Scale, subscale score ≥11). RESULTS: In total, data from 617 participants were analyzed. Mean age was 59.7 (SD 11.4) years and 188 (31%) were female. Significant recovery occurred within the first 6 months post-discharge (p ≤ 0.001). Cognitive deficits persisted in 21% (101/474), and psychological problems in 15% (74/482) of people at 12 months. Significantly improved cognition scores were reported for people who did not receive rehabilitation ('No-rehab'; 124/617, 20%; mean difference, MD 2.32, 95% CI 1.47 to 3.17; p<0.001), those who received community-based rehabilitation ('Com-rehab'; 327/617, 53%; MD 1.27, 95% CI 0.77 to 1.78; p<0.001), and those who received medical rehabilitation ('Med-rehab'; 86/617, 14%; MD 1.63, 95% CI 0.17 to 3.10; p = 0.029). Med-rehab participants experienced more cognitive failure from 3 to 6 months (MD 4.24, 95% 1.63 to 6.84; p = 0.001). Com-rehab showed recovery for PTSD (MD -2.43, 95% -3.50 to -1.37; p<0.001), anxiety (MD -0.67, 95% -1.02 to -0.32; p<0.001), and depression (MD -0.60, 95% -0.96 to -0.25; p<0.001), but symptoms persisted at 12 months. CONCLUSIONS: Survivors of COVID-19 showed cognitive and psychological recovery, especially within the first 6 months after hospitalization. Most persistent problems were related to cognitive functioning at 12 months. Recovery differed rehabilitation settings. Additional cognitive or psychological support might be warranted in people who medical or community-based rehabilitation.

Problem-Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life: Randomized Controlled Trial.

BACKGROUND AND PURPOSE: This study investigated whether problem-solving therapy (PST) is an effective group intervention for improving coping strategy and health-related quality of life (HRQoL) in patients with stroke. METHODS: In this multicenter randomized controlled trial, the intervention group received PST as add-on to standard outpatient rehabilitation, the control group received outpatient rehabilitation only. Measurements were performed at baseline, directly after the intervention, and 6 and 12 months later. Data were analyzed using linear-mixed models. Primary outcomes were task-oriented coping as measured by the Coping Inventory for Stressful Situations and psychosocial HRQoL as measured by the Stroke-Specific Quality of Life Scale. Secondary outcomes were the EuroQol EQ-5D-5L utility score, emotion-oriented and avoidant coping as measured by the Coping Inventory for Stressful Situations, problem-solving skills as measured by the Social Problem Solving Inventory-Revised, and depression as measured by the Center for Epidemiological Studies Depression Scale. RESULTS: Included were 166 patients with stroke, mean age 53.06 years (SD, 10.19), 53% men, median time poststroke 7.29 months (interquartile range, 4.90-10.61 months). Six months post intervention, the PST group showed significant improvement when compared with the control group in task-oriented coping (P=0.008), but not stroke-specific psychosocial HRQoL. Furthermore, avoidant coping (P=0.039) and the utility value for general HRQoL (P=0.034) improved more in the PST group than in the control after 6 months. CONCLUSIONS: PST seems to improve task-oriented coping but not disease-specific psychosocial HRQoL after stroke >6-month follow-up. Furthermore, we found indications that PST may improve generic HRQoL recovery and avoidant coping. CLINICAL TRIAL REGISTRATION: URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2509. Unique identifier: CNTR2509.

Coping, problem solving, depression, and health-related quality of life in patients receiving outpatient stroke rehabilitation.

OBJECTIVES: To investigate whether patients with high and low depression scores after stroke use different coping strategies and problem-solving skills and whether these variables are related to psychosocial health-related quality of life (HRQOL) independent of depression. DESIGN: Cross-sectional study. SETTING: Two rehabilitation centers. PARTICIPANTS: Patients participating in outpatient stroke rehabilitation (N=166; mean age, 53.06±10.19y; 53% men; median time poststroke, 7.29mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Coping strategy was measured using the Coping Inventory for Stressful Situations; problem-solving skills were measured using the Social Problem Solving Inventory-Revised: Short Form; depression was assessed using the Center for Epidemiologic Studies Depression Scale; and HRQOL was measured using the five-level EuroQol five-dimensional questionnaire and the Stroke-Specific Quality of Life Scale. Independent samples t tests and multivariable regression analyses, adjusted for patient characteristics, were performed. RESULTS: Compared with patients with low depression scores, patients with high depression scores used less positive problem orientation (P=.002) and emotion-oriented coping (P<.001) and more negative problem orientation (P<.001) and avoidance style (P<.001). Depression score was related to all domains of both general HRQOL (visual analog scale: ß=-.679; P<.001; utility: ß=-.009; P<.001) and stroke-specific HRQOL (physical HRQOL: ß=-.020; P=.001; psychosocial HRQOL: ß=-.054, P<.001; total HRQOL: ß=-.037; P<.001). Positive problem orientation was independently related to psychosocial HRQOL (ß=.086; P=.018) and total HRQOL (ß=.058; P=.031). CONCLUSIONS: Patients with high depression scores use different coping strategies and problem-solving skills than do patients with low depression scores. Independent of depression, positive problem-solving skills appear to be most significantly related to better HRQOL.

The relative effect of coping strategy and depression on health-related quality of life in patients in the chronic phase after stroke.

OBJECTIVE: To investigate the relative associations of coping strategy and depression on health-related quality of life in patients in the chronic phase after stroke. DESIGN: Cross-sectional study. SUBJECTS: A total of 213 patients after stroke (> 18 months post-onset), mean age 59 years (standard deviation (SD) 9.86 years), 56% men, mean time post-stroke 53 months (SD 37.8 months). METHODS: Coping strategy was measured using the assimilative-accommodative coping scale, depression using the Center for Epidemiologic Studies Depression Scale, and quality of life using the World Health Organization Quality of Life-BREF. Multivariable regression analyses were performed, adjusted for patient characteristics. RESULTS: Depression score was independently related to all domains of quality of life (Psychological Health (B = -0.924; p = 0.000), Physical Health (B = -0.832; p = 0.000), Social Relationships (B = -0.917; p = 0.000), Environment (B = -0.662, p = 0.000)). Accommodative coping (B = 0.305; p = 0.024) and assimilative coping (B = 0.235; p = 0.070) were independently related to the domain Psychological Health, adjusted for depression and education level. CONCLUSION: Coping strategies and depression score were independently associated with Psychological Health in patients in the chronic phase after stroke. Patients who prefer an accommodative coping strategy may show less symptoms of depression. Preferable coping strategies may be trained in order to improve both depression score and health-related quality of life in future research.

The effectiveness of problem solving therapy for stroke patients: study protocol for a pragmatic randomized controlled trial.

BACKGROUND: Coping style is one of the determinants of health-related quality of life after stroke. Stroke patients make less use of active problem-oriented coping styles than other brain damaged patients. Coping styles can be influenced by means of intervention. The primary aim of this study is to investigate if Problem Solving Therapy is an effective group intervention for improving coping style and health-related quality of life in stroke patients. The secondary aim is to determine the effect of Problem Solving Therapy on depression, social participation, health care consumption, and to determine the cost-effectiveness of the intervention. METHODS/DESIGN: We strive to include 200 stroke patients in the outpatient phase of rehabilitation treatment, using a multicenter pragmatic randomized controlled trial with one year follow-up. Patients in the intervention group will receive Problem Solving Therapy in addition to the standard rehabilitation program. The intervention will be provided in an open group design, with a continuous flow of patients. Primary outcome measures are coping style and health-related quality of life. Secondary outcome measures are depression, social participation, health care consumption, and the cost-effectiveness of the intervention. DISCUSSION: We designed our study as close to the implementation in practice as possible, using a pragmatic randomized trial and open group design, to represent a realistic estimate of the effectiveness of the intervention. If effective, Problem Solving Therapy is an inexpensive, deliverable and sustainable group intervention for stroke rehabilitation programs. TRIAL REGISTRATION: Nederlands Trial Register, NTR2509.

Memory complaints in chronic stroke patients are predicted by memory self-efficacy rather than memory capacity.

BACKGROUND: Memory self-efficacy (MSE) is the belief about one's mastery of memory functioning. In healthy elderly, memory complaints are related to MSE rather than to objectively measured memory capacity. MSE has scarcely been studied in patients that suffered a stroke. The aim of this study was twofold: (1) to examine whether memory capacity and MSE can predict the presence of memory complaints in stroke patients, and (2) to study which variables are the best predictors of MSE. METHODS: In a cross-sectional study, 136 stroke patients (>18 months after onset) were recruited from April 2008 to November 2009. MSE was measured using the Metamemory in Adulthood questionnaire. Depression, coping and personality were measured using validated questionnaires, and memory performance was measured using the Rivermead Behavioural Memory Test (RBMT) and the Auditory Verbal Learning Test (AVLT). Patients were divided into a 'complaints' and a 'no complaints' group. RESULTS: A lower MSE score was an independent predictor of having memory complaints (adjusted odds ratio: 0.422; p = 0.000), adjusted for age and depression. The RBMT and AVLT scores did not predict the presence of memory complaints (p > 0.263). Presence of memory complaints and depression were the strongest predictors of MSE (B = -1.748, p = 0.000; B = -0.054, p = 0.000), followed by word fluency, not having a partner and side of stroke (B = 0.038, p = 0.012; B = -0.517, p = 0.082; B = -0.479, p = 0.088). CONCLUSIONS: Memory complaints are predicted by MSE rather than memory capacity. MSE memory training might be an effective training strategy for reducing memory complaints in selected chronic stroke patients.