Association Between Family Functioning and Health-related Quality of Life in Stroke Survivor-Informal Family Caregiver Dyads.

PURPOSE: Stroke survivors and their informal family caregivers may share the impact of the disease, which may affect family functioning and quality of life (QoL) for both. This study compared the perceptions of stroke survivors and informal family caregivers regarding family functioning and QoL and examined the QoL of those reporting effective versus ineffective family functioning. METHODS: A cross-sectional study design and convenience sampling were used. Stroke survivor-informal family caregiver dyads were recruited from a medical university hospital. We assessed participants' demographic and clinical variables, including disease severity, family functioning, and QoL. Independent t-test, paired t-test, Wilcoxon signed-rank test, and Mann-Whitney U test were used to analyze the data. RESULTS: Seventy-one stroke survivor-informal family caregiver dyads participated in the current study. Most stroke survivors and informal family caregivers reported effective family functioning, with no significant differences. However, significant differences existed in the seven domains (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, and role-emotional) of QoL, except emotional health. Stroke survivors reporting ineffective family functioning had a significantly lower mental component summary score, unlike informal family caregivers. CONCLUSION: Our findings suggest that family functioning is crucial to ensure stroke survivors' QoL, particularly regarding their mental health. Health professionals should prioritize mental health assessments and provide appropriate care interventions for stroke survivors in the first 1-6 months after stroke onset.

The effect of action modules on resilience and psychological health of stroke patients: A pilot non-randomised control trial.

AIMS AND OBJECTIVES: To determine whether interventions that use the Specific Thematic Nursing Care Action Modules (STNC-AM) platform improve patients' psychological health over a two-month period. BACKGROUND: Stroke survivors often are left with a disability after a stroke, which can have an impact on their physical and mental health. Therefore, it is necessary for stroke patients to have tailored programmes in the face of post-stroke mental health concerns and the need for care information. DESIGN: A non-randomised controlled pilot study was conducted. METHODS: Participants included 44 post-stroke patients at a medical university hospital, between 1 August 2019-28 February 2021, of whom 24 were assigned to the control group and 20 were assigned to the intervention (STNC-AM). Data were analysed on an intention-to-treat basis. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist (case-control studies) for this study. RESULTS: There were no statistical differences between the two groups at baseline. At the end of two months, however, the scores for resilience, depression and positive factors illness representation were statistically different between the two groups (p < .05). The results of the generalised estimating equation model analysis indicated that resilience and anxiety remained more significant in decreasing depression in the intervention group than in the control group. CONCLUSION: This preliminary trial suggests that, although action modules may be associated with a decrease in depression post-stroke, part of this effect was likely associated with an increase in resilience and a decrease in anxiety of the patients. RELEVANCE TO CLINICAL PRACTICE: The STNC-AM platform provides a coaching platform that helps patients and caregivers to be effective and accessible.

Minimal Clinically Important Differences and Changes in Stroke Disease-Specific Quality of Life in Stroke Survivors: A Prospective Cohort Study.

The aims of the present study were to investigate changes in QOL in post-stroke patients during the first 3 months of rehabilitation treatment. We estimate minimal detectable changes (MDCs) and minimal clinically important differences (MCIDs) of the eight dimensions of QOL and assess the proportion of patients' change scores that exceed MDCs and MCIDs in stroke survivors who receive rehabilitation in a hospital ward. This prospective cohort study enrolled 40 stroke survivors (57.5% male; Mage = 58.3 years) who received in-hospital rehabilitation for a total of 3 months. The Stroke Impact Scale 3.0, which has eight subscales-strength, activities of daily living (ADLs)/instrumental ADLs (IADLs), mobility, hand function, communication, memory and thinking, emotion, and social participation-was used for assessment on the third day of rehabilitation (Time 1), 1 month later (Time 2), and 3 months later (Time 3). Our findings indicated that the MDC95 and MCID proportions varied from 7.5% to 30% and 7.5% to 65%, respectively, of individuals who exhibited change based on individual change scores. The findings show compliance with MDC and MCID values in physical function, with the lowest proportion in hand function.

Polytomous Testlet Response Models for Technology-Enhanced Innovative Items: Implications on Model Fit and Trait Inference.

The development of technology-enhanced innovative items calls for practical models that can describe polytomous testlet items. In this study, we evaluate four measurement models that can characterize polytomous items administered in testlets: (a) generalized partial credit model (GPCM), (b) testlet-as-a-polytomous-item model (TPIM), (c) random-effect testlet model (RTM), and (d) fixed-effect testlet model (FTM). Using data from GPCM, FTM, and RTM, we examine performance of the scoring models in multiple aspects: relative model fit, absolute item fit, significance of testlet effects, parameter recovery, and classification accuracy. The empirical analysis suggests that relative performance of the models varies substantially depending on the testlet-effect type, effect size, and trait estimator. When testlets had no or fixed effects, GPCM and FTM led to most desirable measurement outcomes. When testlets had random interaction effects, RTM demonstrated best model fit and yet showed substantially different performance in the trait recovery depending on the estimator. In particular, the advantage of RTM as a scoring model was discernable only when there existed strong random effects and the trait levels were estimated with Bayes priors. In other settings, the simpler models (i.e., GPCM, FTM) performed better or comparably. The study also revealed that polytomous scoring of testlet items has limited prospect as a functional scoring method. Based on the outcomes of the empirical evaluation, we provide practical guidelines for choosing a measurement model for polytomous innovative items that are administered in testlets.

Evaluating Different Scoring Methods for Multiple Response Items Providing Partial Credit.

The multiple response structure can underlie several different technology-enhanced item types. With the increased use of computer-based testing, multiple response items are becoming more common. This response type holds the potential for being scored polytomously for partial credit. However, there are several possible methods for computing raw scores. This research will evaluate several approaches found in the literature using an approach that evaluates how the inclusion of scoring related to the selection/nonselection of both relevant and irrelevant information is incorporated extending Wilson's approach. Results indicated all methods have potential, but the plus/minus and true/false methods seemed the most promising for items using the "select all that apply" instruction set. Additionally, these methods showed a large increase in information per time unit over the dichotomous method.

Illness Representation and Self-Efficacy: An Exploration of Fatigue Factors in Middle-Aged Stroke Survivors.

The purpose of this study is twofold: to examine the relationship between illness representation and self-efficacy and to test the determinants and the effect of self-efficacy, resilience, and stroke impact on fatigue in middle-aged stroke survivors. This study used a cross-sectional and quantitative approach. The instruments included the Chronic Disease Self-Efficacy Scale, Stroke Impact Scale, Resilience Scale, and Fatigue Impact Scale. Structural equation modeling (SEM) was performed to analyze the data. A total of 63 patients with stroke (39 male and 24 female) were recruited form a medical university hospital. The results showed that patients' illness representation had a significantly effect on self-efficacy for managing disease. In addition, SEM analysis demonstrated that self-efficacy, resilience and stroke impact influenced fatigue, explaining 20.6% of the variance in fatigue. It was concluded that to improve patient fatigue, we believe it is imperative to design interventions that improve patients' self-efficacy, promote patients' resilience, and better function.

Type I Choledochal Cyst Complicated With Acute Hemorrhagic Pancreatitis: A Case Report.

Choledochal cysts rarely present with acute pancreatitis. We report a patient with type I choledochal cyst(s) who had concomitant acute frank hemorrhagic pancreatitis. A 14-year-old male noted with a history of recurrent abdominal pain, fever and jaundice. Ultrasonography (US) of abdomen at the Emergency Department depicted distended gall bladder with wall thickening. Apparently dilated intrahepatic ducts (IHDs) and fusiform dilatation of the common bile duct (CBD), and mild dilatation of the pancreatic duct were also noted, suggesting a type I choledochal cyst( ). Computed tomography (CT) demonstrated calcifications in the uncinate process of the pancreas in addition to the similar findings on US. He subsequently underwent choledochal cyst excision with a Roux-en-Y hepaticojejunostomy. After surgical treatment, he has been doing well for 3 years.