Patients with Severe Poststroke Fatigue Show a Psychosocial Profile Comparable to Patients with Other Chronic Disease: Implications for Diagnosis and Treatment

Objective. To obtain a psychosocial profile of patients with poststroke fatigue (PSF), which could aid in optimizing treatment strategies. Methods. Eighty-eight outpatients with severe PSF measured with the Checklist Individual Strength-fatigue subscale (CIS-f) and the Fatigue Severity Scale (FSS) were selected. Depression and anxiety, psychological distress, coping, social support, and self-efficacy of this group were compared to reference groups of healthy controls and patients with other chronic diseases. Associations between psychosocial characteristics and fatigue were calculated. Results. Compared to healthy controls, patients with PSF reported more psychological distress, less problem-focused coping, and more positive social support. Minor or no differences were found in comparison with other chronic patients. The CIS-f correlated with somatic complaints and the FSS with cognitive complaints. Conclusion. Patients with PSF show a psychosocial profile comparable to patients with other chronic disease. Implications for diagnosis and treatment are discussed

Functional outcome and quality of life 5 and 12.5 years after aneurysmal subarachnoid haemorrhage

Patients who recover from aneurysmal subarachnoid haemorrhage (SAH) often remain disabled or have persisting symptoms with a reduced quality of life (QoL). We assessed functional outcome and QoL 5 and 12.5 years after SAH. In a consecutive series of 64 patients with mean age at SAH of 51 years, initial outcome assessments had been performed at 4 and 18 months after SAH. At the initial and current outcome assessments, functional outcome was measured with the modified Rankin Scale (mRS) and QoL with the SF-36 and a visual analogue scale (VAS). We studied the change in outcome measurements over time. We used the non-parametric Wilcoxon test to compare differences in mRS grades and calculated differences with corresponding 95% confidence intervals in the domain scores of the SF-36 and the VAS. After 5 years, seven patients had died and five patients had missing data. Compared with the 4-month follow-up, the mRS had improved in 29 of the 52 patients, remained similar in 19 patients. The overall QoL (SF-36 domains and VAS score) was better. At 12.5 years an additional six patients had died. Compared to the 4-month study, 25 of the 46 remaining patients had improved mRS, 12 had remained the same and in nine patients the mRS had worsened. Between the 5 and the 12.5 years follow-up, the improvement in mRS had decreased but patients reported overall a better QoL. Among long-time survivors, QoL may improve more than a decade after SAH

Verbetering van de kwaliteit van CVA-zorg; registratie kwaliteitsindicatoren is gezamenlijke verantwoordelijkheid

We streven voortdurend naar een betere zorgkwaliteit. Door routinematig een standaardset van uitkomsten te verzamelen (‘routine outcome measurements’) kunnen we bijvoorbeeld de kwaliteit van zorg van verschillende ziekenhuizen vergelijken om zo de zorg te kunnen verbeteren.1 Op basis van de overweging dat de uitkomsten van zorg uiteindelijk moeten worden afgemeten aan wat deze zorg de patiënt heeft gebracht, wordt daarbij tegenwoordig veel waarde gehecht aan patiëntgerapporteerde uitkomstmaten (‘patient-reported outcome measures’, PROM’s). Dit geldt ook binnen de zorg voor patiënten die een cerebrovasculair accident (CVA) hebben doorgemaakt. Wij hebben gezamenlijk kwaliteitsindicatoren vastgesteld, maar registratie hiervan in de CVA-ketens moet meer aandacht krijgen. Vanuit het buitenland worden interessante veranderingen voorgesteld, zoals onder andere beschreven in een recent artikel in Stroke.2 Maar in Nederland heeft het verbeteren van onze registratiediscipline prioriteit

Improving the quality of stroke care in the Netherlands; registration of quality indicators is a joint responsibility

We streven voortdurend naar een betere zorgkwaliteit. Door routinematig een standaardset van uitkomsten te verzamelen (‘routine outcome measurements’) kunnen we bijvoorbeeld de kwaliteit van zorg van verschillende ziekenhuizen vergelijken om zo de zorg te kunnen verbeteren.1 Op basis van de overweging dat de uitkomsten van zorg uiteindelijk moeten worden afgemeten aan wat deze zorg de patiënt heeft gebracht, wordt daarbij tegenwoordig veel waarde gehecht aan patiëntgerapporteerde uitkomstmaten (‘patient-reported outcome measures’, PROM’s).Dit geldt ook binnen de zorg voor patiënten die een cerebrovasculair accident (CVA) hebben doorgemaakt. Wij hebben gezamenlijk kwaliteitsindicatoren vastgesteld, maar registratie hiervan in de CVA-ketens moet meer aandacht krijgen. Vanuit het buitenland worden interessante veranderingen voorgesteld, zoals onder andere beschreven in een recent artikel in Stroke.2 Maar in Nederland heeft het verbeteren van onze registratiediscipline prioriteit.An article by the International Consortium of Health Outcomes Measurement, with the title 'An international standard set of patient-centered outcome measures after stroke', was published recently in the journal Stroke. In this article we reflect on this paper and its significance for the Netherlands. The authors report on an international consensus conference to establish recommendations for outcome measurement in stroke care. Indicators, measurement moments and measures were proposed, with a strong focus on patient-reported outcomes. The core measure advocated is use of the recently developed Patient Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS SF v1.1 Global Health; or PROMIS-10). We can appreciate this paper as support for current developments towards benchmarking in stroke rehabilitation in the Netherlands; however, we also have concerns about the administrative burden and the proposed time points and measures. Joining forces to strengthen the current efforts to establish benchmarking should be given priority in the Netherlands.</p

Further validation of the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q) in patients with acquired brain injury

The Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q) evaluates motivation for rehabilitation in four subscales: Interest in rehabilitation, Lack of anger, Lack of denial, and Reliance on professional help. The objective of this study was to further validate the MOT-Q in 122 inpatients and 92 outpatients with acquired brain injury (ABI). The main measures were motivation for rehabilitation (MOT-Q), self-awareness (Patient Competency Rating Scale), and treatment motivation (Visual Analogue Scale). The MOT-Q showed adequate feasibility in terms of few items with missing responses and few undecided responses. We found no floor or ceiling effects, and significant item-total MOT-Q correlations for 29 of 31 items. Internal consistency was good for the MOT-Q total and acceptable to good for the subscales. The MOT-Q scores were significantly intercorrelated except for the subscales Lack of denial and Reliance on professional help in the inpatient group. The MOT-Q total and subscales were significantly associated with treatment motivation. The Lack of denial subscale showed no significant association with treatment motivation and no to moderate significant associations with self-awareness. In conclusion, the overall MOT-Q is a valid instrument to assess motivation for rehabilitation in patients with ABI. Further research is needed to examine the validity of the subscales

Subjective hearing impairment after subarachnoid haemorrhage : Prevalence and risk factors

Background Sensorineural hearing impairment is a key symptom in patients with superficial siderosis of the central nervous system, a disease caused by chronic or intermittent haemorrhage into the subarachnoid space. We investigated the prevalence and risk factors of subjective hearing impairment after SAH. Methods We systematically interviewed all SAH patients admitted between June 2011 and December 2014, who were able to visit the SAH outpatient clinic six to eight weeks after hospital discharge. We calculated the proportion of patients with subjective hearing impairment noticed after SAH onset, and adjusted risk ratios (aRR) with 95% confidence intervals (CI) for potential risk factors with Poisson regression. Results We included 277 patients. Subjective hearing impairment was reported by 54/277 (19%) patients (aneurysmal SAH: 42/212 [20%;95%CI:15–26%]; perimesencephalic haemorrhage 8/36 [22%;95%CI:12–38%], non-aneurysmal non-perimesencephalic SAH: 4/29 [14%;95%CI:6–31%]). Hearing impairment was associated with a poor clinical condition on admission (defined as PAASH score 4–5) (aRR3.00;95%CI:1.43–6.28), aneurysm rupture at the middle cerebral artery (aRR2.72;95%CI:1.38–5.39), and moderate/severe disability 3 months after ictus (aRR2.25;95%CI:1.28–3.97), but not with large amounts of extravasated blood (highest vs. lowest tertile of Hijdra score) (aRR0.77;95%CI:0.33–1.81) or endovascular treatment (aRR1.19;95%CI:0.61–2.33). Conclusion Subjective hearing impairment occurs in 1 of every 5 SAH patients. It is related to the clinical condition on admission, aneurysm rupture at the middle cerebral artery, and functional outcome, but not to the amount of subarachnoid blood or the method of aneurysm occlusion. Audiometric tests, auditory cognitive assessments, and follow-up studies are needed to determine the cause and prognosis of hearing impairment after SAH