The development and preliminary validation of a Preference-Based Stroke Index (PBSI)

BACKGROUND: Health-related quality of life (HRQL) is a key issue in disabling conditions like stroke. Unfortunately, HRQL is often difficult to quantify in a comprehensive measure that can be used in cost analyses. Preference-based HRQL measures meet this challenge. To date, there are no existing preference-based HRQL measure for stroke that could be used as an outcome in clinical and economic studies of stroke. The aim of this study was to develop the first stroke-specific health index, the Preference-based Stroke Index (PBSI). METHODS: The PBSI includes 10 items; walking, climbing stairs, physical activities/sports, recreational activities, work, driving, speech, memory, coping and self-esteem. Each item has a 3-point response scale. Items known to be impacted by a stroke were selected. Scaling properties and preference-weights obtained from individuals with stroke and their caregivers were used to develop a cumulative score. RESULTS: Compared to the EQ-5D, the PBSI showed no ceiling effect in a high-functioning stroke population. Moderately high correlations were found between the physical function (r = 0.78), vitality (r = 0.67), social functioning (r = 0.64) scales of the SF-36 and the PBSI. The lowest correlation was with the role emotional scale of the SF-36 (r = 0.32). Our results indicated that the PBSI can differentiate patients by severity of stroke (p < 0.05) and level of functional independence (p < 0.0001). CONCLUSIONS: Content validity and preliminary evidence of construct validity has been demonstrated. Further work is needed to develop a multiattribute utility function to gather information on psychometric properties of the PBSI

Impairment, disability and fatigue in multiple sclerosis

Background: Identifying the predictors of pain is important for both health professionals and researchers, because pain has repeatedly been found to be a strong predictor of activity limitations and participation restrictions. The objective of this study was to determine the predictors of pain presence and severity in a large, well-designed sample of community dwelling individuals with multiple sclerosis (MS). Methods: This was a cross-sectional study. A center-stratified random sample including 188 persons with MS were recruited from three major MS clinics in the Greater Montreal, Canada. Main outcomes included pain prevalence and severity. Predictor variables included depression, anxiety, perceived health status, fatigue, sleep problems, and perceived cognitive deficits. Participants completed three questionnaires: the first asked about the socio-demographic and clinical information of the subjects, the second assessed the pain characteristics of the subjects, and the third covered the predictor variables. Results: The prevalence of pain in our sample was 42%. MS- related disability was found to be in the main predictor for both pain presence and intensity. Fatigue also was a main contributor to pain presence. The results of this study also showed that pain was associated with higher levels of depression, anxiety, sleep problems, and perceived cognitive deficits, and diminished perceived health status. Conclusions: The results of this study indicated that pain is a common symptom among people with MS. Pain presence was predicted by MS-related disability and fatigue, while pain intensity was only predicted by MS severity

Professional barriers and facilitators to using stratified care approaches for managing non-specific low back pain: a qualitative study with Canadian physiotherapists and chiropractors

Background: Recent clinical practice guidelines for the management of non-specific low back pain (LBP) recommend using stratified care approaches. To date, no study has assessed barriers and facilitators for health professionals in using stratified care approaches for managing non-specific LBP in the Canadian primary care setting. This study aimed to identify and contrast barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors. Methods: Individual telephone interviews, underpinned by the Theoretical Domains Framework (TDF), explored beliefs and attitudes about, and identified barriers and facilitators to the use of stratified care approaches for managing non-specific LBP in a purposive sample of 13 chiropractors and 14 physiotherapists between September 2015 and June 2016. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using directed content analysis. Results: Three and seven TDF domains were identified as likely relevant for physiotherapists and chiropractors, respectively. Shared key beliefs (and relevant domains of the TDF) for both physiotherapists and chiropractors included: lack of time, cost, and expertise (Environmental Context and Resources); and consulting more experienced colleagues and chronic patients with important psychological overlay (Social Influences). Unique key domains were identified among physiotherapists: incompatibility with achieving other objectives (Goals), and chiropractors: confidence in using stratified care approaches (Beliefs about Capabilities); intention to use stratified care approaches (Intentions); awareness and agreement with stratified care approaches (Knowledge); assessment of readiness for change and intentional planning behaviour (Behavioural Regulation); and improving the management of non-specific LBP patients and the uptake of evidence-based practice (Beliefs about Consequences). Conclusions: Several shared and unique barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors were identified. Findings may help inform the design of tailored theory-based knowledge translation interventions to increase the uptake of stratified care approaches in clinical practice. © The Author(s). 2019

Understanding the Determinants of Weight-Related Quality of Life among Bariatric Surgery Candidates

Obesity and its relation to quality of life are multifaceted. The purpose of this paper was to contribute evidence to support a framework for understanding the impact of obesity on quality of life in 42 morbidly obese subjects considering a wide number of potential determinants. A model of weight-related quality of life (WRQL) was developed based on the Wilson-Cleary model, considering subjects' weight characteristics, arterial oxygen pressure (PaO2), walking capacity (6-minute walk test, 6MWT), health-related quality of life (HRQL; Physical and Mental Component Summaries of the SF-36 PCS/MCS), and WRQL. The model of WRQL was tested with linear regressions and a path analysis, which showed that as PaO2 at rest increased 6MWT increased. 6MWT was positively associated with the PCS, which in turn was positively related to WRQL along with the MCS. The model showed good fit and explained 38% of the variance in WRQL

Factors associated with participation in life situations for adults with stroke: a systematic review

Objectives: To identify biopsychosocial factors associated with participation outcomes for adults with stroke and to investigate factors associated with participation at different time points post stroke. Data sources: Medline, CINAHL, AMED, PyschINFO and Web of Science were systematically searched using key words “stroke”, “participation” and “outcomes” and their synonyms on 15th May 2017. Study selection: Observational studies reporting on biopsychosocial factors and participation outcomes for community dwelling adults with stroke were selected. Studies were eligible for inclusion if participation outcomes were measured using indices that mapped to the participation domain of the ICF. Intervention studies were excluded. A second reviewer checked all studies against eligibility criteria at each stage. Data extraction: Data were extracted on any statistically determined association between biopsychosocial factors and participation outcomes. Data synthesis: The proportion of studies reporting significant associations with variables were classified according to the ICF. The exact binomial test was used to determine the probability that the proportion of studies reporting significant associations was due to chance alone. Qualitative descriptive summaries of each study allowed consideration of interactions between variables and changes in participation over time points. Conclusions: Whilst depressive symptoms, cognitive functioning and mobility were found to have the strongest associations with participation, we found that other frequently occurring factors (such as fatigue and environmental factors) were less extensively considered. The diversity of outcome measures encountered within the review highlight the need for a consensus on a core set of outcome measures to evaluate long term participation in life situations after stroke

The role of exercise in modifying outcomes for people with multiple sclerosis: a randomized trial

Abstract Background: Despite the commonly known benefits of exercise and physical activity evidence shows that persons Multiple Sclerosis (MS) are relatively inactive yet physical activity may be even more important in a population facing functional deterioration. No exercise is effective if it is not done and people with MS face unique barriers to exercise engagement which need to be overcome. We have developed and pilot tested a Multiple Sclerosis Tailored Exercise Program (MSTEP) and it is ready to be tested against general guidelines for superiority and ultimately for its impact on MS relevant outcomes. The primary research question is to what extent does an MS Tailored Exercise Program (MSTEP) result in greater improvements in exercise capacity and related outcomes over a one year period in comparison to a program based on general guidelines for exercise among people with MS who are sedentary and wish to engage in exercise as part of MS self-management. Methods/Design: The proposed study is an assessor-blind, parallel-group, randomized controlled trial (RCT). The duration of the intervention will be one year with follow-up to year two. The targeted outcomes are exercise capacity, functional ambulation, strength, and components of quality of life including frequency and intensity of fatigue symptoms, mood, global physical function, health perception, and objective measures of activity level. Logistic regression will be used to test the main hypothesis related to the superiority of the MSTEP program based on a greater proportion of people making a clinically relevant gain in exercise capacity at 1 year and at 2 years, using an intention-to-treat approach. Sample size will be 240 (120 per group). Discussion: The MS community is clearly looking for interventions to help alleviate the disabling sequelae of MS and promote health. Exercise is a well-known intervention which has known benefits to all, yet few exercise regularly. For people with MS, the role of exercise in MS management needs to be rigorously assessed to inform people as to how best to use exercise to reduce disability and promote health

Chronic Diarrhea and Pancolitis Caused by Paracoccidioidomycosis: A Case Report

South American blastomycosis is a systemic micosis caused by infection with Paracoccidioides brasiliensis. The most frequently affected sites are the lower lip buccal mucous membrane, palate, tongue, sublingual region, lymph glands, and lungs. However, colonic involvement is not a common expression of Paracoccidioidomycosis. We report a case of chronic diarrhea and pancolitis caused by Paracoccidioidomycosis with fatal outcome

Cognitive performance, quality and quantity of movement reflect unhealthy psychological symptoms in adolescents

Purpose: The presentation of unhealthy psychological symptoms are rising sharply in adolescents. Detrimental lifestyle behaviours are proposed as both possible causes and consequences. This study set out to compare selected measures of quality and quantity of movement between adolescents with and without unhealthy psychological symptoms.   Methods: Using a cross sectional design, 96 participants completed the study from a whole year group of 166, age (13.36 ± 0.48) male 50.6% from a secondary school in Oxfordshire, England as a part of a larger study (EPIC) between January and April 2017. Measures were taken of quality and quantity of movement: reaction/movement time, gait pattern & physical activity, alongside psychological symptoms. Differences in movement behaviour in relation to psychological symptom and emotional problem presentation were determined using ANOVA. In the event of a significant result for the main factor of each parameter, a Bonferroni -corrected post hoc test was conducted to show the difference between categories in each group. Results for both unhealthy psychological symptoms and emotional problems were grouped into four categories (‘Close to average’, ‘slightly raised’, ‘high’ and ‘very high’).  Results: Early adolescents with very high unhealthy psychological symptoms had 16.79% slower reaction times (p = .003, ηp2 = .170), 13.43% smaller walk ratio (p = .007, ηp2 = .152), 7.13% faster cadence (p = .005, ηp2 = .149), 6.95% less step time (p = .007, ηp2 = .153) and 1.4% less vigorous physical activity (p = .04, ηp2 = .102) than children with close to average psychological symptoms. Early adolescents with very high emotional problems had 12.25% slower reaction times (p = .05, ηp2 = .081), 10.61% smaller walk ratio (p = .02, ηp2 = .108), 6.03% faster cadence (p = .01, ηp2 = .134), 6.07% shorter step time (p = .007, ηp2 = .141) and 1.78% less vigorous physical activity (p = .009, ηp2 = .136) than children with close to average emotional problems.    Conclusions:  Different movement quality and quantity of was present in adolescents with unhealthy psychological symptoms and emotional problems. We propose movement may be used to both monitor symptoms, and as a novel therapeutic behavioural approach. Further studies are required to confirm our findings.