A longitudinal cohort study on quality of life in stroke patients and their partners: Restore4Stroke Cohort

BACKGROUND: Stroke is a major cause of disability in the Western world. Its long-term consequences have a negative impact on the quality of life of both the patients and their partners. AIM: The aim of the Restore4Stroke Cohort study is to investigate the changes in quality of life of stroke patients and their partners over time, and to determine factors predicting quality of life in several domains, especially personal and environmental factors. METHOD: Multicentre prospective longitudinal cohort study. Inclusion and the first assessment take place during hospital stay in the first week post-stroke. Follow-up assessments take place at two months, six months, one year, and two years post-stroke. Recruitment of 500 patients from stroke units in six participation hospitals is foreseen. If the patient has a partner, he or she is also asked to participate in the study. OUTCOMES: The main outcome is quality of life, considered from a health-related quality of life and domain-specific quality of life perspective. Factors predicting long-term quality of life will be determined by taking into account the health condition (pre-stroke health condition and stroke-related health condition), personal factors (e.g. coping and illness cognitions), and environmental factors (e.g. caregiver burden and social support). DISCUSSION: This study is expected to provide information about the changes in quality of life of stroke patients and their partners over time. Furthermore, the identification of factors predicting quality of life can be used to improve rehabilitation care and develop new interventions for stroke patients and their partners

Psychometric properties of FSS and CIS-20r for measuring post-stroke fatigue

FSW - Self-regulation models for health behavior and psychopathology - ou

The importance of psychological factores : The Restore4Stroke Patient Cohort study

Background: Stroke is a leading cause of mortality and disability in the Western world and can lead to limitations in the patient’s physical, psychological, and psychosocial functioning. To know how we can help these stroke patients to adapt to the consequences of their condition, we need to know which patients are vulnerable and at risk of poor long-term quality of life (QoL). It is hypothesized that psychological factors, such as personality and coping styles, play an important role in successful adaptation to the adverse consequences of stroke and regaining QoL, and these factors may be amendable to treatment. Aims: The aims of this thesis were to investigate the course of quality of life (QoL) in stroke patients and to determine factors predicting QoL with special interest in psychological factors. Methods: A multicenter longitudinal cohort study was conducted: the Restore4Stroke Patient Cohort study. In total, 395 stroke patients were included and 5 assessments were executed: in the acute phase, and at 2 months, 6 months, 12 months and 24 months post stroke. The main outcome was QoL, and this was investigated with generic measures of participation, emotional functioning and subjective well-being and with a measure of stroke-specific QoL. Results: With respect to the first aim it was found that most recovery of QoL takes place in the first six months post stroke. In the second year post stroke no significant changes in any QoL domain were found. The frequency of participation declines after a stroke in comparison with the pre-stroke situation. This decrease in frequency of participation was most apparent in vocational activities and less in leisure and social activities. Further analysis showed that not all patients experience the same degree of recovery of HRQoL. Four trajectories for both physical and psychosocial HRQoL post stroke were revealed: high, low, recovery and decline of HRQoL. Regards the second aim, we found that psychological factors were strongly related with QoL. Positive psychological factors, like acceptance and perceived benefits of the stroke and self-efficacy, were independently related with higher levels of QoL. Negative psychological factors, like neuroticism, passive coping, and hopelessness were independently related with lower levels of QoL. Conclusion: The findings in the present thesis have led to new insights regarding the long-term course of QoL post stroke and the significant influence of psychological factors on QoL. Professionals should become more aware of the role of psychological factors during rehabilitation and of the fact that patients differ from each other in terms of personality, illness cognitions and coping styles. We should shift towards personalized healthcare in which we tailor the management and treatment of each patient to his or her individual characteristics, instead of just following protocols. The results from the present thesis have led to the development of a course for paramedics in which professionals gain insight into the role of psychological factors on adaptation in terms of QoL and in how these factors could be taken into account during general stroke care without changing them

Associations between social support and stroke survivors' health-related quality of life : a systematic review

Objective: Social support to stroke survivors has been recognized as an important determinant of their health-related quality of life (HRQoL), but this relationship is not clarified to date. More insight in the relationships between various types (i.e. emotional, instrumental, or informational support) and sources (i.e. partner, children) of social support and HRQoL might target post-stroke educational and counseling interventions to strengthen patient's social networks and supportive relationships. Methods: Systematic review. Results: 11 original articles could be included. Most of these articles studied the overall perceived social support without further specification of type or source. They show a positive relation between perceived social support and stroke survivors' HRQoL. Relations between perceived social support and HRQoL seems to be more often significant and were stronger than relationships between specific social support types or sources and HRQoL. Conclusion: Due to the small number of studies and the heterogeneity in methods of assessing social support, a clear statement about the specific influence of social support source or type could not be made. Practice implications: Attention should be paid to promoting social support on the short and long term. Further research is needed to clarify the influence of social support type and source. (C) 2013 Elsevier Ireland Ltd. All rights reserved

Does the frequency of participation change after stroke and is this change associated with the subjective experience of participation?

OBJECTIVE: To investigate changes in the frequency of participation six months post stroke compared to the prestroke situation and establish whether such a change is associated with participation restrictions and satisfaction with participation six months post stroke. DESIGN: Inception cohort study. Prestroke frequency of participation was measured retrospectively in the first week post stroke. Frequency, participation restrictions and satisfaction with participation were assessed six months post stroke. SETTING: General hospitals and home residences in the Netherlands PARTICIPANTS: Patients with stroke (N = 325; 65.5% male; mean age 66.9 (SD 12.2) years) admitted to one of six participating general hospitals. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) [0-100], consisting of three scales: frequency, restrictions and satisfaction. The frequency scale consists of two parts: vocational activities (work, volunteer work, education and household activities) and leisure and social activities. RESULTS: Vocational activities showed a large decrease (effect size: 0.6) and leisure and social activities a small decrease (effect size: 0.13) post stroke. In multiple regression analyses, both the frequency of participation in vocational activities six months post stroke and the decrease in vocational activities compared to before the stroke were significantly associated with the participation restrictions experienced and satisfaction with participation after controlling for age, gender, level of education, dependency in activities of daily living, cognitive functioning, and presence of depressive symptoms. The presence of depressive symptoms showed the strongest association with the subjective experience of participation. CONCLUSIONS: The frequency of participation decreased after a stroke and this decrease was associated with the participation restrictions experienced and satisfaction with participation. Resuming vocational activities and screening and, if applicable, treatment of depressive symptoms should be priorities in stroke rehabilitation

Psychological factors determine depressive symptomatology after stroke

OBJECTIVE: To identify psychological factors related to post-stroke depressive symptoms. DESIGN: Cross-sectional study. Patients were assessed at two months post stroke. SETTING: Patients with stroke from six general hospitals in the Netherlands PARTICIPANTS: Stroke patients (N=344; mean age 66.9+/-12.3y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The presence of clinical depressive symptoms was determined with the Depression subscale of the Hospital Anxiety and Depression Scale two months post stroke. Psychological factors assessed were: extraversion, neuroticism, optimism, pessimism, self-efficacy, helplessness, acceptance, perceiving benefits, proactive coping, and passive coping. RESULTS: Bivariate correlations and multivariate backward logistic regression were used to analyse associations between psychological factors and post-stroke depressive symptoms, accounting for demographic and stroke-related factors. More neuroticism, pessimism, passive coping, and helplessness, and less extraversion, optimism, self-efficacy, acceptance, perceived benefits, and proactive coping were bivariately associated with the presence of depressive symptoms. Multivariate logistic regression analysis showed that more helplessness (OR 1.17) and passive coping (OR 1.19) and less acceptance (OR 0.89) and perceived benefits (OR 0.89) were independently significantly associated with the presence of post-stroke depressive symptoms (Nagelkerke R-Square 0.49). CONCLUSION: We found a relationship between psychological variables and the presence of depressive symptoms two months post stroke. It is important to take these factors into account during post-stroke rehabilitation

Life satisfaction post stroke: the role of illness cognitions

OBJECTIVE: To describe illness cognitions two months and two years post stroke and to investigate changes in illness cognitions over time. We also examined the associations between illness cognitions and life satisfaction at two months and two years post stroke and investigated if changes in illness cognitions predicted life satisfaction two years post stroke, taking demographic and stroke-related factors and emotional symptoms into account. METHODS: Prospective cohort study in which 287 patients were assessed at two months and two years post stroke. The illness cognitions helplessness (maladaptive), acceptance (adaptive) and perceiving benefits (adaptive) were measured with the Illness Cognition Questionnaire. Life satisfaction was assessed with two life satisfaction questions. Correlational and regression analyses were performed. RESULTS: Patients experienced both maladaptive and adaptive illness cognitions two months and two years post stroke. Only acceptance increased significantly from two months to two years post stroke (p</=0.01). Helplessness, acceptance and perceiving benefits were significantly associated with life satisfaction at two months (R2=0.42) and two years (R2=0.57) post stroke. Furthermore, illness cognitions two months post stroke and changes in illness cognitions predicted life satisfaction two years post stroke (R2=0.57). CONCLUSION: Illness cognitions and changes in illness cognitions were independently associated with life satisfaction two years post stroke. It is therefore important during rehabilitation to focus on reducing maladaptive behavior and feelings to promote life satisfaction, and on promoting adaptive illness cognitions

DISCHARGE HOME AFTER ACUTE STROKE: DIFFERENCES BETWEEN OLDER AND YOUNGER PATIENTS

Geriatrics in primary car