Abstract Struyf PA, van Heugten CM, Hitters MW, Smeets RJ. The prevalence of osteoarthritis of the intact hip and knee among traumatic leg amputees. Objective To determine the prevalence of ...osteoarthritis (OA) in the knee and/or hip of the intact leg among traumatic leg amputees compared with the general population and its relationship with amputation level, time since amputation, age, and mobility. Design Cross-sectional observational study. Setting Outpatient population of 2 Dutch rehabilitation centers. Participants Patients (N=78) with a unilateral traumatic transtibial amputation, knee disarticulation, or transfemoral amputation of at least 5 years ago; ability to walk with a prosthesis; older than 18 years of age; and able to understand Dutch. Patients were excluded if they had bilateral amputations, other pathologies of the knee or hip, or central neurologic pathologies. Interventions Not applicable. Main Outcome Measure The prevalence of OA. Results The prevalence of knee OA was 27% (men 28.3%, women 22.2%) and hip OA was 14% (men 15.3%, women 11.1%). This was higher compared with the general population (knee OA men 1.58%, women 1.33%, hip OA men 1.13%, women 0.98%, age adjusted). No significant relationships between the prevalence of OA and level of amputation, time since amputation, mobility, and age were found. Conclusions The prevalence of OA is significantly greater for both the knee and hip in the traumatic leg amputee population. No specific risk factors were identified. Although no specific risk factors in this specific population could be identified, it might be relevant to apply commonly known strategies to prevent OA as soon as possible after the amputation.
To investigate changes in the frequency of participation 6 months poststroke compared with prestroke; and to establish whether the change is associated with participation restrictions and ...satisfaction with participation 6 months poststroke.
Inception cohort study. Prestroke frequency of participation was measured retrospectively in the first week poststroke. Frequency, participation restrictions, and satisfaction with participation were assessed 6 months poststroke.
General hospitals and home residences.
Patients with stroke (N=325; 65.5% men; mean age, 66.9±12.2y) admitted to 1 of 6 participating general hospitals.
Not applicable.
Utrecht Scale for Evaluation of Rehabilitation-Participation (0-100), which consists of 3 scales: frequency, restrictions, and satisfaction. The frequency scale consists of 2 parts: vocational activities (work, volunteer work, education, household activities) and leisure and social activities.
Vocational activities showed a large decrease (effect size: 0.6) poststroke; leisure and social activities showed a small decrease (effect size: 0.13) poststroke. In multiple regression analyses, both the frequency of participation in vocational activities 6 months poststroke and the decrease in vocational activities compared with before the stroke were significantly associated with the participation restrictions experienced and satisfaction with participation after controlling for age, sex, 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.
The frequency of participation decreased after a stroke, and this decrease was associated with 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.
To identify psychological factors related to poststroke depressive symptoms.
Cross-sectional study, with patients assessed at 2 months poststroke.
Patients with stroke from 6 general hospitals.
...Stroke patients (N=344; mean age ± SD, 66.9±12.3y).
Not applicable.
The presence of clinical depressive symptoms was determined with the depression subscale of the Hospital Anxiety and Depression Scale 2 months poststroke. Psychological factors assessed were extraversion, neuroticism, optimism, pessimism, self-efficacy, helplessness, acceptance, perceiving benefits, proactive coping, and passive coping.
Bivariate correlations and multivariate backward logistic regression were used to analyze associations between psychological factors and poststroke 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 (odds ratio OR=1.17) and passive coping (OR=1.19) and less acceptance (OR=.89) and perceived benefits (OR=.89) were independently significantly associated with the presence of poststroke depressive symptoms (Nagelkerke R(2)=.49).
We found a relationship between psychological variables and the presence of depressive symptoms 2 months poststroke. It is important to take these factors into account during poststroke rehabilitation.
Abstract Smeets SM, van Heugten CM, Geboers JF, Visser-Meily JM, Schepers VP. Respite care after acquired brain injury: the well-being of caregivers and patients. Objective To investigate ...satisfaction with respite care, the well-being of informal caregivers and patients with acquired brain injury (ABI) who receive respite care by day-care activity centers, and factors related to caregiver well-being. Design Cross-sectional cohort study. Setting Adult day-care activity centers. Participants A sample of caregivers and patients (N=108) with ABI (mean of 8y since injury) enrolled in 1 of 7 day-care activity centers. The sample consisted predominantly (70%) of stroke patients. Intervention Respite care by adult day-care activity centers. Main Outcome Measures Well-being was defined in terms of life satisfaction (Life Satisfaction Questionnaire LiSat-9), emotional functioning (Hospital Anxiety and Depression Scale HADS), and caregiver burden (Caregiver Strain Index CSI). Factors related to well-being were personal, injury related, and psychological. Results Satisfaction with day-care activity center care was high for caregivers (7.8) and patients (8.1). Caregiver satisfaction with care was unrelated to caregiver well-being. Most caregivers (61%) showed low life satisfaction and high subjective burden (69%), and 33% of caregivers and 42% of the patients reported depressive symptoms. Caregiver well-being was positively correlated with a high sense of mastery of caregivers and patients and low passive coping of the patient (LiSat-9 R2 =.32; HADS R2 =.55; CSI R2 =.35). Conclusions This study emphasizes the need for care for both caregivers and patients in the chronic phase after ABI. Although respite care is highly appreciated, it is not sufficient for caregivers to attain a healthy level of well-being. Results indicate that caregiver well-being might improve by targeting passive coping and mastery skills of caregivers and patients. Continuous support for both caregivers and patients is needed.
To examine the associations of proactive coping and self-efficacy with psychosocial outcomes in individuals after stroke.
Cross-sectional study. Regression analyses were performed.
Outpatient ...settings of hospitals and rehabilitation centers.
Individuals after stroke (N=112; mean age ± SD, 57.1±8.9y; mean time ± SD since stroke, 18.9±28.5mo).
Not applicable.
Proactive coping was measured using the Utrecht Proactive Coping Competence scale (UPCC), and self-efficacy was measured using the General Self-Efficacy Scale (GSES). Psychosocial outcomes were measured as (1) participation with the use of the restriction and satisfaction subscales of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation); (2) emotional problems with the use of the Hospital Anxiety and Depression Scale (HADS); (3) life satisfaction with the use of 2 questions (2LS); and (4) health-related quality of life (HRQOL) with the use of the Short Stroke-Specific Quality of Life scale (SS-QOL-12).
Higher UPCC scores were associated with lower HADS scores (β=-.55, P<.001) and with higher USER-Participation satisfaction (β=.31, P=.001), 2LS (β=.34, P<.001), and SS-QOL-12 scores (β=.44, P<.001). The influence of UPCC scores on HRQOL was indirect through self-efficacy. Higher GSES scores were associated with higher UPCC scores (β=.65, P<.001), which in turn were associated with lower HADS scores (β=-.51, P<.001). GSES scores were directly associated with higher SS-QOL-12 scores (β=.32, P=.002). GSES scores did not influence the association between UPCC scores and any of the psychosocial outcomes (all P>.0025).
Proactive coping and self-efficacy have different associations with each of the psychosocial outcomes. Therefore, outcome-specific models appear to be necessary to describe these associations.
Abstract Objective To examine psychometric properties of the Utrecht Proactive Coping Competence scale (UPCC) and explore relations of proactive coping with health-related quality of life (HRQOL) and ...characteristics of patients with stroke. Design Cross-sectional study. Reliability and convergent validity, and associations with HRQOL and characteristics of patients with stroke were examined. Setting Inpatient and outpatient settings of hospitals and rehabilitation centers in The Netherlands. Participants Patients with stroke (N=55; mean age, 58.7±12.8y; mean months since stroke, 25.0± 38.5). Interventions Not applicable. Main Outcome Measures UPCC, Utrecht Coping List (UCL), and the short Stroke Specific Quality of Life scale (SS-QOL-12). Results The UPCC showed excellent reliability (Cronbach's α=.95) without floor/ceiling effects or skewed score distribution. Convergent validity was shown by moderate positive relations with the UCL subscale active problem solving ( r =.38) and moderate negative relations with the UCL subscales passive reactions ( r =−.50), avoidance ( r =−.40), and expression of emotions ( r =−.42). Correlations between the UPCC and HRQOL domains were moderate to strong ( r =.48–.61) and stronger than those between UCL subscales and HRQOL domains. The only characteristic of patients with stroke associated with proactive coping was time after stroke ( r =−.52). Conclusions The UPCC appears reliable and valid for patients with stroke. Moreover, we found positive associations between proactive coping and HRQOL. Future research is recommended to confirm our results and to explore ways to enhance proactive coping in patients with stroke.
To evaluate the effectiveness of individually tailored cognitive behavioral therapy (CBT) for reducing depressive symptoms with or without anxiety poststroke.
Multicenter, assessor-blinded, ...randomized controlled trial.
Ambulatory rehabilitation setting.
Patients who had a Hospital Anxiety and Depression Scale-depression subscale (HADS-D) score >7 at least 3 months poststroke (N=61).
Participants were randomly allocated to either augmented CBT or computerized cognitive training (CCT). The CBT intervention was based on the principles of recognizing, registering, and altering negative thoughts and cognitions. CBT was augmented with goal-directed real-life activity training given by an occupational or movement therapist.
HADS-D was the primary outcome, and measures of participation and quality of life were secondary outcomes. Outcome measurements were performed at baseline, immediately posttreatment, and at 4- and 8-month follow-up. Analysis was performed with linear mixed models using group (CBT vs CCT) as the between-subjects factor and time (4 assessments) as the within-subjects factor.
Mixed model analyses showed a significant and persistent time effect for HADS-D (mean difference, -4.6; 95% confidence interval, -5.7 to -3.6; P<.001) and for participation and quality of life in both groups. There was no significant group × time effect for any of the outcome measures.
Our augmented CBT intervention was not superior to CCT for the treatment of mood disorders after stroke. Future studies should determine whether both interventions are better than natural history.
Abstract Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. Three-year follow-up results of a residential community reintegration program for patients with chronic acquired ...brain injury. Objective To evaluate outcomes of a residential community reintegration program 3 years after treatment on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. Design A follow-up assessment 3 years after treatment was compared with the 1-year follow-up assessment in a prospective cohort study. Setting A tertiary rehabilitation center for acquired brain injury. Participants Of the 67 patients assessed at the 1-year follow-up, 63 subjects (94%; 42 men; mean age at admission to treatment 24.7y; mean time postonset 5.1y) were available at the 3-year follow-up and taken into account in the analyses. Intervention A structured residential treatment program directed at improving independence in domestic life, work, leisure time, and social interactions. Main Outcome Measures Community Integration Questionnaire, Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies-Depression scale, and the World Health Organization Quality of Life Scale Abbreviated (5 scales). Results There were no significant differences for any of the outcome measures between the 1-year and 3-year follow-up assessment. Conclusions These results indicate that the established significant and clinically relevant improvements after a residential community reintegration program remain stable in the long term.
Abstract Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. A prospective study to evaluate a residential community reintegration program for patients with chronic acquired ...brain injury. Objective To examine the effects of a residential community reintegration program on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. Design A prospective cohort study with a 3-month waiting list control period and 1-year follow up. Setting A tertiary rehabilitation center for acquired brain injury. Participants Patients (N=70) with acquired brain injury (46 men; mean age, 25.1y; mean time postonset, 5.2y; at follow up n=67). Intervention A structured residential treatment program was offered directed at improving independence in domestic life, work, leisure time, and social interactions. Main Outcome Measures Community Integration Questionnaire (CIQ), Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies Depression Scale, EuroQOL quality of life scale (2 scales), World Health Organization Quality of Life Scale Abbreviated (WHOQOL-BREF; 5 scales), and the Global Assessment of Functioning (GAF) scale. Results There was an overall significant time effect for all outcome measures (multiple analysis of variance T2 =26.16; F36,557 134.9; P =.000). There was no spontaneous recovery during the waiting-list period. The effect sizes for the CIQ, Employability Rating Scale, work hours, and GAF were large (partial η2 =0.25, 0.35, 0.22, and 0.72, respectively). The effect sizes were moderate for 7 of the 8 emotional well-being and quality of life (sub)scales (partial η2 =0.11–0.20). The WHOQOL-BREF environment subscale showed a small effect size (partial η2 =0.05). Living independently rose from 25.4% before treatment to 72.4% after treatment and was still 65.7% at follow up. Conclusions This study shows that a residential community reintegration program leads to significant and relevant improvements of independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation.
Abstract Winkens I, Van Heugten CM, Wade DT, Habets EJ, Fasotti L. Efficacy of Time Pressure Management in stroke patients with slowed information processing: a randomized controlled trial. Objective ...To examine the effects of a Time Pressure Management (TPM) strategy taught to stroke patients with mental slowness, compared with the effects of care as usual. Design Randomized controlled trial with outcome assessments conducted at baseline, at the end of treatment (at 5–10wk), and at 3 months. Setting Eight Dutch rehabilitation centers. Participants Stroke patients (N=37; mean age ± SD, 51.5±9.7y) in rehabilitation programs who had a mean Barthel score ± SD at baseline of 19.6±1.1. Intervention Ten hours of treatment teaching patients a TPM strategy to compensate for mental slowness in real-life tasks. Main Outcome Measures Mental Slowness Observation Test and Mental Slowness Questionnaire. Results Patients were randomly assigned to the experimental treatment (n=20) and to care as usual (n=17). After 10 hours of treatment, both groups showed a significant decline in number of complaints on the Mental Slowness Questionnaire. This decline was still present at 3 months. At 3 months, the Mental Slowness Observation Test revealed significantly higher increases in speed of performance of the TPM group in comparison with the care-as-usual group ( t =–2.7, P =.01). Conclusions Although the TPM group and the care-as-usual group both showed fewer complaints after a 3-month follow-up period, only the TPM group showed improved speed of performance on everyday tasks. Use of TPM treatment therefore is recommended when treating stroke patients with mental slowness.
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