Purpose: This study examined the role of anxiety and upper limb dysfunction, amongst other variables, as predictors of health related quality of life (HRQOL) 6 months after stroke. Method: ...Participants: Stroke survivors (n = 85) who had previously participated in a randomised controlled trial of a physiotherapy intervention. Dependent variable: HRQOL - Nottingham Health Profile (NHP). Predictor variables: Mood - Hospital Depression and Anxiety Scale; Upper Limb Functioning - Action Research Arm Test; Rivermead Motor Assessment; Activities of Daily Living - Modified Barthel Index; Clinical and demographic factors. Results: Anxiety and depression significantly predicted 49% of variance in overall HRQOL (p < 0.05), but only anxiety significantly predicted NHP pain (13% variance, p < 0.001), emotional reactions (41% variance, p < 0.001), sleep (19% variance, p = 0.02) and social isolation (23% variance, p = 0.02). Depression and anxiety together significantly predicted 30% variance in energy level (p < 0.001). UL motor impairment and activities of daily living predicted 36% of variance in NHP physical activity score (p < 0.001). Conclusions: This study indicates that where anxiety is assessed, it appears more important in determining HRQOL than depression. UL impairment and ADL independence predicted perceived physical activity. Management strategies for anxiety and therapy for UL recovery long after stroke onset are likely to benefit perceived HRQOL.
Implications for Rehabilitation
Anxiety is a major predictor of quality of life six months after stroke.
Post-stroke anxiety should be routinely assessed in rehabilitation.
Appropriate management strategies for anxiety should occur during rehabilitation with follow-up into the chronic post-stroke period.
Upper limb impairment is a stronger predictor of perceptions of physical activity than independence in activities daily living six months after stroke.
Rehabilitation of the upper limb should continue into the chronic post-stroke period.
Cross-sectional, observational study.
To determine whether changes in essential care during the COVID-19 pandemic impacted satisfaction with activities, participation, and relationships among ...individuals with spinal cord injury (SCI).
Data were collected online between December 31, 2020 and February 14, 2021 among community dwelling adults with SCI (N = 123).
The primary outcome variables were satisfaction with the ability to complete activities of daily living (ADLs) (mobility, dressing, feeding, and toileting), as well as satisfaction with participation in household and recreational activities, and satisfaction with relationships among friends, family, and with the status of one's relationship measured with the International Spinal Cord Injury Data Sets Activities and Participation Basic Data Set. Primary predictors were age, gender, time since injury, completeness of injury, injury level, access to mental health, access to medications, access to medical supplies, and access to personal care assistants (PCAs).
Impact on access to mental health and impact on access to supplies were the most common factors affecting satisfaction with activities, participation, and relationships for individuals with SCI during the COVID-19 pandemic. Impact on access to PCAs/homecare was also found to impact certain outcomes including feeding and participation in household activities.
Future supply chain disruptions from pandemics or natural disasters could have wide-reaching effects for individuals with SCIs. Thus, further research and advocacy is needed to improve mental health care planning and supply chain access during subsequent natural disasters.
The COVID‐19 outbreak imposed to Italian families many changes in their daily life increasing the risk of developing psychological problems. The present study explored risk factors associated with ...parenting stress and implications for children’s emotion regulation in families with different socioeconomic risks. Parents of 2–14 years old children completed a survey reporting difficulties experienced due to the lockdown, level of household chaos, parenting stress, parent involvement in the child’s daily life, and children emotion regulation competences. The general mean levels of parenting stress and children emotion regulation abilities were not at clinical level compared with Italian norms. Household chaos predicted higher levels of parenting stress, which, in turn, was associated with less effective emotion regulation in children through the mediating role of parental involvement. More stressed parents were less involved in their children’s activities, decreasing children’s effective emotion regulation. Only for SES no‐risk families, the lockdown constraints increased parenting stress. For SES at‐risk families, the impact of parenting stress and involvement on children regulation strategies was stronger, with a protective role played by parental involvement on children’s negativity not evident for SES no‐risk families. Dealing with the lockdown is a stressful experience for parents who have to balance personal life, work, and children upbringing, without other help. This situation potentially impairs their ability to be supportive caregivers and is consequently detrimental for children well‐being. Policies should take into consideration the implications of the lockdown for families’ mental health and tailor supportive interventions according to family’s risk factors.
Resumen
El brote de la COVID‐19 impuso a las familias italianas muchos cambios en su vida cotidiana, los cuales aumentaron el riesgo de desarrollar problemas psicológicos. El presente estudio analizó los factores de riesgo asociados con el estrés de la crianza y las consecuencias para la regulación emocional de los hijos en familias con diferentes riesgos socioeconómicos. Un grupo de padres de niños de entre dos y 14 años contestó una encuesta donde informó las dificultades vividas debido al confinamiento, el nivel de caos en el hogar, el estrés en la crianza, la participación de los padres en la vida diaria de los hijos y las competencias de los hijos para regular sus emociones. Los niveles promedio generales de estrés en la crianza y las habilidades de regulación emocional en los niños no estuvieron a nivel clínico en comparación con las normas italianas. El caos en el hogar predijo niveles más altos de estrés en la crianza, el cual, a su vez, estuvo asociado con una menor regulación emocional eficaz en los niños mediante el rol mediador de la participación de los padres. Los padres más estresados participaron menos en las actividades de sus hijos, lo cual disminuyó la regulación emocional eficaz en los niños. Solo en los casos de las familias sin riesgo socioeconómico las limitaciones del confinamiento aumentaron el estrés en la crianza. Para las familias de riesgo socioeconómico, el efecto del estrés en la crianza y la participación en las estrategias de regulación emocional de los niños fue más profundo, y en el caso de las familias sin riesgo socioeconómico, no se evidenció el papel protector desempeñado por la participación de los padres en la negatividad de los niños.
Lidiar con el confinamiento es una experiencia estresante para los padres que tienen que compatibilizar la vida personal, el trabajo y la educación de los niños sin ninguna otra ayuda. Esta situación puede deteriorar su capacidad de ser cuidadores comprensivos y, como consecuencia, ser perjudicial para el bienestar de los niños. Las políticas deberían tener en cuenta las consecuencias del confinamiento en la salud mental de las familias y adaptar intervenciones de apoyo de acuerdo con los factores de riesgo de las familias.
摘要
新冠肺炎疫情给意大利家庭的日常生活带来许多变化，增加了出现心理问题的风险。本研究探讨不同社会经济风险家庭中，与父母压力相关的风险因素及它们对儿童情绪调节的影响。2至14岁儿童的父母完成了一项调查，报告了由于禁闭、家庭混乱程度、父母压力、父母参与儿童日常生活和儿童情绪调节能力所经历的困境。与意大利标准相比，养育压力和儿童情绪调节能力的一般平均水平没有达到临床水平。家庭混乱预示着更高程度的父母压力，反过来，通过父母参与的中介作用，孩子的情绪调节能力更低。父母压力越大，参与孩子活动就越少，孩子有效情绪调节能力就越弱。只有对没有社会经济地位风险的家庭来说，禁闭才会增加养育子女的压力。在有社会经济地位风险的家庭中，父母的压力和参与对儿童调节策略的影响更大，而父母参与对儿童消极情绪的保护作用在没有社会经济地位风险的家庭中并不明显。
对于那些不得不在没有其他帮助的情况下平衡个人生活、工作和抚养孩子的父母来说，应对禁闭是一件很有压力的事情。这种情况可能损害他们成为支持性照顾者的能力，因此对儿童的福祉有害。政策应考虑到封锁对家庭心理健康的影响，并根据家庭的风险因素制定支持性干预措施。
Background:
There is increasing interest in defining meaningful improvement in patient-reported outcomes. Knowledge of the thresholds and determinants for successful femoroacetabular impingement ...(FAI) outcomes is evolving.
Purpose:
To define preoperative outcome score thresholds and determine clinical/demographic patient factors predictive for achieving the minimal clinically important difference (MCID) after arthroscopic FAI surgery.
Study Design:
Cohort study (diagnosis); Level of evidence, 2.
Methods:
A prospective institutional hip preservation registry was reviewed to identify patients undergoing arthroscopic FAI surgery. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered at baseline and 1 year postoperatively. The MCID was calculated using a distribution-based method. Receiver operating characteristic (ROC) analysis was used to calculate cohort-based threshold values predictive of achieving the MCID. The area under the curve (AUC) was used to define predictive ability, with AUC >0.7 considered acceptably predictive. Multivariable analysis identified patient factors associated with achieving the MCID. Sensitivity analysis was performed to derive the MCID by an alternative anchor-based method.
Results:
There were 364 patients (mean ±SD age, 32.5 ± 10.3 years), and 57.1% were female. The MCID for the mHHS, HOS–Activities of Daily Living (HOS-ADL), HOS-Sports, and iHOT-33 was 8.2, 8.3, 14.5, and 12.1, respectively. ROC analysis findings (threshold, percentage achieving the MCID, and strength of association) for these tools were as follows: mHHS (60.5, 77.2%, and 0.68, respectively), HOS-ADL (83.3, 68.1%, and 0.85, respectively), HOS-Sports (58.3, 65.9%, and 0.76, respectively), and iHOT-33 (53.9, 81.9%, and 0.65, respectively). The likelihood for achieving the MCID significantly declined above these thresholds. In multivariable analysis, a higher sagittal center-edge angle (CEA) (odds ratio OR, 1.04; 95% CI, 1.01-1.08) was a positive predictor of achieving the MCID on the iHOT-33, while a higher Outerbridge grade for the acetabulum was a negative predictor (OR, 0.56; 95% CI, 0.32-0.99) on the mHHS. Sensitivity analysis confirmed these variables and identified relative femoral retroversion as another negative predictor (OR, 0.40; 95% CI, 0.17-0.94).
Conclusion:
The HOS had excellent predictive ability for identifying patient thresholds of achieving the MCID; patients with preoperative scores below identified thresholds were most likely to achieve the MCID. Additionally, anterior acetabular undercoverage, chondral injuries, and relative femoral retroversion were clinically significant negative modifiers of outcomes. These findings have implications for managing preoperative expectations of FAI surgery.
Introduction:
This study explored the strategies used by people with systemic sclerosis to perform valued obligatory (self-care), committed (home management, care of others, productivity), and ...discretionary (leisure and socialization) activities.
Method:
This cross-sectional study included a convenience sample of 92 people with systemic sclerosis who completed the Valued Life Activities Scale (VLA). The VLA categorizes activities into three main domains: obligatory, committed, and discretionary. Participants indicated the type of adaptive strategy used for each activity (assistive devices, personal assistance, limited frequency, and taking more time). Participants also completed a demographic questionnaire and measures of pain, fatigue, depression, and daily activity performance. Frequency counts were calculated for strategies used for each activity. One-way analyses of variance compared the mean use of strategies across the three domains (obligatory, committed, and discretionary). Pearson correlation coefficients calculated relationships between strategy use and pain, fatigue, depression, and daily activity performance.
Results:
Significantly, more strategies were used for committed activities compared to obligatory activities. Limiting the frequency of performing an activity was used significantly more for committed and discretionary activities than for obligatory activities. The least used strategies were assistive devices and assistance from another person. Fatigue and depression were related to strategy use, whereas pain and daily activity performance were not.
Conclusion:
People with systemic sclerosis use adaptive strategies to perform VLA. However, the strategies, most frequently used, such as taking more time or limiting the frequency of performing some activities, may result in relinquishing other valued activities.
ObjectivesTo assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and ...clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence.DesignStructural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence.SettingsCommunity, United Kingdom.Participants2560 eligible participants aged over 60 years.Main outcome measuresActivities of daily living (ADL) and instrumental activities of daily living (IADL).ResultsOne general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and ‘vitality’. This structure is consistent with biological theory and the model had a good fit for the data (χ2=71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome—root mean square error of approximation (RMSEA)=0.02 (90% CI 0.001 to 0.05) and RMSEA=0.008 (90% CI0.001 to 0.03) respectively—and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity.ConclusionsThe WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual’s subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.
Symptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied.
The objectives of this study were to identify prototypical ...presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time.
Women with newly diagnosed nonmetastatic breast cancer (n = 319) and matched noncancer controls (n = 347) aged 60+ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancer–specific QOL) by group, controlling for covariates.
Nearly one-fifth of older survivors were classified as having high pretherapy symptoms (n = 51; 16%); the remainder had low symptoms (n = 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancer–specific QOL at all time points (all P < 0.05).
Nearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention.
The slow and continuous loss of muscle mass that progresses with aging is defined as “sarcopenia”. Sarcopenia represents an important public health problem, being closely linked to a condition of ...frailty and, therefore, of disability. According to the European Working Group on Sarcopenia in Older People, the diagnosis of sarcopenia requires the presence of low muscle mass, along with either low grip strength or low physical performance. However, age-related changes in skeletal muscle can be largely attributed to the complex interactions among factors including alterations of the neuromuscular junction, endocrine system, growth factors, and muscle proteins turnover, behavior-related and disease-related factors. Accordingly, the identification of a single biomarker of sarcopenia is unreliable, due to its “multifactorial” pathogenesis with the involvement of a multitude of pathways. Thus, in order to characterize pathophysiological mechanisms and to make a correct assessment of elderly patient with sarcopenia, a panel of biomarkers of all pathways involved should be assessed.
•Sarcopenia is defined as a progressive loss of muscle mass and strength with aging.•Sarcopenia is a syndrome characterized by several pathophysiological mechanisms.•Sarcopenia cannot be assessed by the use of a single biomarker.•Biomarkers for each pathophysiological mechanism should be assessed.
The activities of daily living (ADL) ability level of an elderly patient is an important indicator in determining the patient’s degree of degenerative brain disease and is mainly evaluated through ...face-to-face interviews with doctors and patients in hospitals. It is impossible to determine the exact ADL ability of a patient through such a temporary interview, and the pursuit of accurate ADL ability evaluation technology is a very important research task worldwide. In this paper, in order to overcome the limitations of the existing ADL evaluation method mentioned above, first of all, a self-organized IoT architecture in which IoT devices autonomously and non-invasively measure a patient’s ADL ability within the context of the patient’s daily living place was designed and implemented. Second, a remote rehabilitation treatment concept for enhancing the patient’s ADL ability we call an “e-coaching framework”, in which a doctor remotely gives an instruction in a specific ADL scenario, and the patient’s ability to understand and perform the instruction can be measured on-line and in real time, was additionally developed on top of the self-organized IoT architecture. In order to verify the possibility of remote rehabilitation treatment through the proposed architecture, various remotely directed ADL scenarios were performed and the accuracy of the measurements was verified.
For both clinical and economic reasons, the increasing number of persons living with chronic conditions represents a public health issue of growing importance. Emphasizing patient responsibility, and ...acting in concert with the provider community, self-management represents a promising strategy for treating chronic conditions-moving beyond education to teaching individuals to actively identify challenges and solve problems associated with their illness. Self-management also shows potential as an effective paradigm across the prevention spectrum (primary, secondary, and tertiary) by establishing a pattern for health early in life and providing strategies for mitigating illness and managing it in later life. We suggest ways to advance research methods and practical applications of self-management as steps in its future development and implementation.
PDF
