Posts Tagged HRQOL
[ARTICLE] Does upper limb strength play a prominent role in health-related quality of life in stroke patients discharged from inpatient rehabilitation?
Background: Impairments in arm function are a common problem in stroke survivors and have a large impact on health-related quality of life (HRQoL). Little is known about the longitudinal relationship between recovery of upper limb strength and changes in HRQoL.
Objectives: This study aimed to determine to what extent changes in HRQoL are related to changes in upper limb strength after discharge from inpatient rehabilitation.
Methods: 250 patients from an RCT were assessed at discharge from inpatient rehabilitation (baseline) and at 12 weeks post-discharge (follow-up). The Stroke Impact Scale was used to measure HRQoL, and the Motricity Index Arm was used to measure upper limb strength. Hierarchical regression analysis was performed to determine the predictive value of upper limb strength on HRQoL, relative to demographic and clinical characteristics. Regression analysis was used to determine the relation between upper limb strength improvement and HRQoL improvement.
Results: Upper limb strength at baseline was a major predictor of HRQoL at follow-up, after accounting for demographic and clinical characteristics (p < .05). Improvement in HRQoL was positively related to improvement in upper limb strength (F(1, 240) = 18.351, p <.0005).
Conclusions: These findings highlight the importance of upper limb strength in HRQoL, as HRQoL is associated with improvement in upper limb strength recovery. Better monitoring of recovery and treatment of upper limb strength during the outpatient rehabilitation period and beyond, i.e. outside the typical time-window of recovery in the first 3 months post-stroke, might contribute to higher quality of life for stroke survivors.
Stroke is a major health problem across the world causing complex disability. 1 The impact of this common and serious condition on an individual’s life is considerable: physical, psychological, and social consequences can be experienced. 2 3–4 Upper limb paresis, a muscle weakness in the affected limb to one side of the body, is one of the most frequently occurring conditions (up to 85% of stroke survivors). 5,6 Improvement in upper extremity motor function occurs mainly in the first few months after stroke. 7 At 6 months post-stroke, estimates pointed out that some dexterity in the paretic arm is found in 38% of the stroke patients who show no dexterity in the first week post-stroke. 7 8–9
Arm function plays a critical role in the performance of daily life activities. Most everyday activities require the use of both hands, and because of this, performance of bimanual activities receives considerable attention in the rehabilitation setting. 10 Improved arm and hand function positively contribute to societal participation and (health-related) quality of life. 1,10,11 Health-related quality of life (HRQoL) can be defined as an individual’s (or group’s) perceived physical and mental health over time. 12 There is a growing body of literature that recognizes that different factors influence HRQoL after stroke. 1,4,13,14 A cross-sectional study has shown that the extent of upper limb improvement positively influences a patient’s perception of what activities can be performed, which in turn enhances HRQoL. 1 Incomplete motor recovery of the upper and lower extremities has been found to be the strongest predictor of a lower HRQoL in an observational study. 4
Whilst some research has been carried out on the association between arm function and HRQoL 1,4,13,14 , there has been no longitudinal investigation of improvement in HRQoL in relation to improvement in arm recovery. Obtaining insights into this relationship will be useful for understanding problems faced by patients and for planning and optimization of rehabilitation treatment after stroke.
The first aim of the present study was to identify the relation between upper limb strength and HRQoL at discharge from inpatient rehabilitation and at follow-up (12 weeks later). Second, we aimed to determine whether upper limb strength at discharge from inpatient rehabilitation predicts HRQoL at follow-up, when corrected for patient and stroke characteristics. Third, we aimed to determine whether a change in upper limb strength is related to a change in HRQoL over time. We hypothesized that an improvement in upper limb strength is positively related to an improvement in HRQoL. […]
This study aimed to systematically review studies focusing on levels of physical activity (PA) in people with epilepsy (PWE) compared with non‐epilepsy controls, and identify factors associated with PA in PWE.
Intervention studies were also reviewed to consider the effects of psychological interventions on levels of PA, and the effects of PA‐based interventions on seizure activity, psychiatric comorbidity, and health‐related quality of life (HRQoL). PRISMA guidelines were followed. Searches were conducted using PubMed, Cochrane Controlled Register of Trials, PsycINFO, and Embase.
Forty‐six studies met inclusion criteria, including case‐control, cross‐sectional, and intervention studies. Assessment measures included questionnaires, activity trackers, and measures of physiological fitness. Twelve of 22 (54.5%) case‐control studies utilizing self‐report questionnaire measures reported that PWE were performing lower levels of PA, less likely to be engaging in PA, or less likely to meet PA guidelines than controls. The remaining studies did not find a difference between PWE and controls. Eight of 12 (67%) case‐control studies utilizing exercise/fitness tests reported that PWE performed significantly poorer than controls, whereas in two studies PWE performed better than controls. One of three studies investigating the relationship between PA and seizure frequency found that increased self‐reported PA was associated with having fewer seizures, whereas two did not find a significant relationship.
All seven cross‐sectional studies that included measures of HRQoL and depression/anxiety found a positive relationship between levels of PA and HRQoL/reduced levels of depression and anxiety. All four studies that used PA‐based interventions demonstrated improvements in levels of PA and increased HRQoL. Study quality was almost universally low. In conclusion, there is some evidence that PWE engage in less PA than peers, and that interventions can improve PA levels and HRQoL. However, there is a need for more robust study designs to better understand PA in individuals with epilepsy.
[Abstract] Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study
The aim of this study was to evaluate cognitive function 10 years after moderate-severe traumatic brain injury (TBI) and to investigate the associations among cognitive function, depression, and health-related quality of life (HRQoL). In this prospective cohort study, with measurements at 3, 6, 12, 18, 24, 36, and 120 months post-TBI, patients 18–67 years of age (n = 113) with moderate-severe TBI were recruited. Main outcome measures were depression (Center for Epidemiologic Studies-Depression Scale [CES-D]), subjective cognitive functioning (Cognitive Failure Questionnaire [CFQ]), objective cognitive functioning, and HRQoL (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]). Fifty of the initial 113 patients completed the 10 year follow-up. Twenty percent showed symptoms of depression (CES-D ≥ 16). These patients had more psychiatric symptoms at hospital discharge (p = 0.048) and were more often referred to rehabilitation or nursing homes (p = 0.015) than non-depressed patients. Further, they also had significantly lower scores in six of the eight subdomains of the SF-36. The non-depressed patients had equivalent scores to those of the Dutch norm-population on all subdomains of the SF-36. Cognitive problems at hospital discharge were related with worse cognitive outcome 10 years post-TBI, but not with depression or HRQoL. Ten years after moderate-severe TBI, only weak associations (p < 0.05) between depression scores and two objective cognitive functioning scores were found. However, there were moderate associations (p < 0.01) among depression scores, HRQoL, and subjective cognitive functioning. Therefore, signaling and treatment of depressive symptoms after moderate-severe TBI may be of major importance for optimizing HRQoL in the long term. We did not find strong evidence for associations between depression and objective cognitive functioning in the long term post-TBI. Disease awareness and selective dropping out may play a role in long-term follow-up studies in moderate-severe TBI. More long-term research is needed in this field.
…Results suggest that caring for an individual following a TBI uniquely and adversely impacts HRQOL. While many existing measures capture relevant aspects of HRQOL for these caregivers, there are domains of HRQOL that are not typically addressed. These include anxiety related to the caregiver role (concerns for re-injury, leaving the person alone, etc.), caregiver strain (burden; stress; feeling overwhelmed), and disappointment with the change in social roles for both the caregiver and the care recipient. Findings exemplify the need for a valid and sensitive clinical measurement tool that can evaluate HRQOL in caregivers of individuals with TBI…