Falls self-efficacy and falls incidence in community-dwelling older people: the mediating role of coping

Background: A cognitive behavioural model predicts that coping responses mediate the relationship between falls related psychological concerns and falls incidence, in community-dwelling older people. If empirical support could be found for this pathway then interventions could be developed to reduce falls risk by targeting coping strategies. Therefore, this study aimed to begin the process of testing whether coping responses mediate the association between falls self-efficacy (a principal element of falls related psychological concerns) and falls incidence, in community-dwelling older people. Method: In a cross-sectional design, 160 community–dwelling older people (31 male, 129 female; mean age 83.47 years) completed the Falls Efficacy Scale–International, the Revised-Ways of Coping Questionnaire, the Turning to Religion subscale of the COPE, and a falls questionnaire. Data were analysed via mediation analysis using a bootstrapping approach. Results: Lower falls self-efficacy was associated with higher falls incidence, and more self-controlling coping was found to be a partial mediator of this association, with a confidence interval for the indirect effect of (.003, .021) and an effect size of κ2 = .035. The association was not mediated by the other measured coping responses; namely, turning to religion, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem-solving and positive reappraisal. Conclusions: Self-controlling coping may mediate the association between falls self-efficacy and falling. If longitudinal studies confirm this finding then coping could be targeted in interventions to reduce falls

The factor structure of the Center for Epidemiological Study - Depression Scale in people with multiple sclerosis

Background: Depression is common in multiple sclerosis (MS); however, its assessment is complicated by biological processes. In this context it is important to consider the performance of depression screening measures including that their factor structure is consistent with expectation. This study sought to identify the factor structure of the Center for Epidemiological Study - Depression Scale (CES-D) in people with MS (PwMS). Methods: Participants (N = 493) were those who had consented to take part in a large three-phase longitudinal study of depression in PwMS. CES-D questionnaires completed at phase 1 of the study were utilised. An error in the questionnaire meant it was most appropriate to consider data for 19 of the 20 CES-D questionnaire items. The data was split into two samples by a random selection process to create an exploratory, model development sample and a validation sample. The first sample was subject to confirmatory factor analysis. Following examination of model fit and specification errors, the original model was modified. The revised model was tested in the confirmation sample to assess reproducibility. Results: The analysis results supported the original four factor solution for the CES-D, that is: Depressed Affect, Positive Affect, Somatic Complaints/Activity Inhibition, and Interpersonal Difficulties. Conclusions: The CES-D appears to have a coherent structure with which to examine depression in PwMS

Screening depression and suicidality in post stroke aphasia: A theory of planned behaviour study

Background: Clinical guidelines recommend screening for post-stroke depression, which is particularly important for people with post-stroke aphasia, due to increased risk of depression and suicidality. The Theory of Planned Behaviour (TPB) suggests that behavioural intentions are influenced by three factors: attitudes, normative beliefs, and perceived behavioural control. It has been used to investigate staff intentions to perform post-stroke screening, but little is known about staff intentions to screen people with aphasia for depression or suicidality. Aims We examined how UK stroke professionals describe screening for depression and suicidality with people with aphasia and whether the TPB predicts intent to screen depression with this population. Methods & Procedures: We conducted a cross-sectional online survey and used multiple regression to test whether attitudes, normative beliefs, and perceived behavioural control predicted intent to screen people with aphasia for depression and suicidality. To assess response stability over time we asked respondents to repeat the survey over a fortnight later. Results: One hundred and eighteen UK stroke professionals completed the survey between May and September 2020. Intent to screen people with aphasia for depression was high (M = 71.6%, SD = 34.7) but much lower for suicidality (M = 42.4%, SD = 39). Approximately half the variance in intent to screen for depression was predicted by the TPB, R2 = .48, F (3,101) = 30.60, p < .001, with normative beliefs identified as a significant predictor, β = .62, p < .001. Responses were stable over time for those who repeated the survey (N = 13). Conclusions: More support is needed to help stroke professionals screen for depression and suicidality in people with post-stroke aphasia. Screening rates may be improved by communicating clear expectations that staff should screen all stroke survivors for depression and suicidality, developing aphasia-accessible screening tools and providing training to all stroke professionals

A study of the validity and the reliability of the Geriatric Anxiety Inventory in screening for anxiety after stroke in older inpatients

Objectives: To investigate the validity and reliability of the Geriatric Anxiety Inventory in screening for anxiety in older inpatients post-stroke. Design: Longitudinal. Subjects: A total of 81 inpatients with stroke aged 65 years or older were recruited at four centres in England. Main measures: At phase 1 the Geriatric Anxiety Inventory and the Hospital Anxiety and Depression Scale were administered and then the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders 4th edition (phase 2). The Geriatric Anxiety Inventory was repeated a median of seven days later (phase 3). Results: Internal reliability of the Geriatric Anxiety Inventory was high (α = 0.95) and test-retest reliability acceptable (τB = 0.53). Construct validity of the Geriatric Anxiety Inventory was evident with respect to the Hospital Anxiety and Depression Scale -Anxiety subscale (τB = 0.61). At a cut off of 6/7, the sensitivity of the Geriatric Anxiety Inventory was 0.88 and specificity 0.84, with respect to Structured Clinical Interview diagnosis of anxiety. Hospital Anxiety and Depression Scale -Anxiety subscale sensitivity was 0.88, specificity 0.54 at the optimum cut off of 5/6. A comparison the areas under the curve of the Receiver Operating Characteristics for the two instruments indicated that the area under the curve of the Geriatric Anxiety Inventory was significantly larger than that of the Hospital Anxiety and Depression Scale –Anxiety subscale, supporting its superiority. Conclusions: The Geriatric Anxiety Inventory is an internally consistent, reliable (stable) and valid instrument with acceptable sensitivity and specificity to screen for anxiety in older inpatients with stroke

Everyday memory measures in multiple sclerosis: a systematic review

Everyday memory is one of the most affected cognitive functions in Multiple Sclerosis (MS). Assessing everyday memory problems is crucial for monitoring the impact of memory deficits on individuals’ day-to-day lives and evaluating the effectiveness of interventions that aim to improve cognitive functions. The aim of this systematic review was to identify the research literature on everyday memory measures used with people with MS, describe the types of measures used, and summarise their psychometric properties. Empirical studies of cognitive function in MS using standardised everyday memory measures were included. Online databases (MEDLINE, PsycINFO, PsycARTICLES, Embase) and Google Scholar were searched. Forty-four studies met the inclusion criteria. A total of twelve measures were identified, with varied uses and administration methods. The majority of papers did not report any psychometric properties for MS populations. The few papers that did, reported that the measures have good reliability and appear to have good face, concurrent and ecological validity, but these need to be evaluated further. This review presents researchers and clinicians with an overview of the various everyday memory measures used in studies with people with MS, to help them choose the appropriate measure for their evaluations

Graduan harus tingkatkan nilai kemanusiaan sejagat demi keamanan - Sultan Sharafuddin

Emotional disorders are common after stroke, but lacking is a complete framework to inform their treatment with cognitive behavioral therapy (CBT). This paper describes such a framework. It considers modification of CBT in light of cognitive and communication disability, and the involvement of carers in treatment, and presents brief case studies to illustrate the different elements of the framework. The development of a modified CBT should form the foundation for randomized controlled trials (RCT) to support treatment in this population. Service delivery issues include pathways to treatment, therapist confidence, and the overall positioning of CBT within stroke care

A mixed-methods feasibility study of a new digital health support package for people after stroke : The Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention

Background Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. Methods We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. Results Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. Conclusion The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-723

Fear of falling : psychological management after stroke

Background: Falls are common after stroke, occurring in up to 39% of survivors. Fear of falling ‘a lasting concern about falling that leads to an individual avoiding activities’ can arise in up to 88% and while associated with the experience of falls, can occur independently of a falls history. Fear of falling predicts poorer physical function and an increases the risk of falls. Research supports the usefulness of cognitive behavioural strategies to manage fear of falling after stroke, as an adjunct to physical therapy. Content: A cognitive behavioural approach, specifically designed to be accessible to non-psychological therapists will be outlined. The workshop will include video and the opportunity to role play a patient rehabilitation practitioner interaction. Outcomes: Participants will be expected to have an improved understanding of fear of falling after stroke and be able to apply this to their professional practice, to the benefit of their patients

Stepped psychological care after stroke

Emotional problems occur regularly after stroke and are distressing, but also impact on functional outcome. The UK experience is that there are not insufficient resources for psychologist to review every patient, nor is it felt this is necessary. On this account a stepped approach to psychological care has been developed, encompassing prevention and intervention, stepped according to need. Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Ian Kneebone as an IJS/SmartStrokes collaboration

Stepped psychological care after stroke

Background: Emotional problems occur regularly after stroke and are distressing, but also impact on functional outcome. The UK experience is that there are insufficient resources for psychologist to review every patient, nor is it felt this is necessary. On this account a stepped approach to psychological care has been developed, encompassing prevention and intervention, stepped according to need. Content: The UK stepped approach to psychological care after stroke will be described including attention to appropriate interventions at various levels and when to refer on. Outcome: Attendees will be expected to gain an understanding of a stepped approach to psychological care after stroke and be able to consider its potential for application within their own service setting