Posts Tagged QoL

[ARTICLE] Enhancing epilepsy self-management and quality of life for adults with epilepsy with varying social and educational backgrounds using PAUSE to Learn Your Epilepsy – Full Text

Highlights

•PAUSE is a personalized epilepsy self-management (SM) education program.

•PAUSE was implemented in diverse and mostly underserved adults with epilepsy.

•Self-efficacy, frequency of SM behaviors, and QOL significantly improved over time.

•Personal negative impact of epilepsy significantly reduced over time.

•Greater improvement was seen in those with lower scores at baseline.

Abstract

Purpose

People with epilepsy (PWE) come from a wide variety of social backgrounds and educational skillsets, making self-management (SM) education for improving their condition challenging. Here, we evaluated whether a mobile technology-based personalized epilepsy SM education intervention, PAUSE to Learn Your Epilepsy (PAUSE), improves SM measures such as self-efficacy, epilepsy SM behaviors, epilepsy outcome expectations, quality of life (QOL), and personal impact of epilepsy in adults with epilepsy.

Methods

Recruitment for the PAUSE study occurred from October 2015 to March 2019. Ninety-one PWE were educated using an Internet-enabled computer tablet application that downloads custom, patient-specific educational programs from Epilepsy.com. Validated self-reported questionnaires were used for outcome measures. Participants were assessed at baseline (T0), the first follow-up at completion of the PWE-paced 8–12-week SM education intervention (T1), and the second follow-up at least 3 months after the first follow-up (T2). Multiple linear regression was used to assess within-subject significant changes in outcome measures between these time points.

Results

The study population was diverse and included individuals with a wide variety of SM educational needs and abilities. The median time for the first follow-up assessment (T1) was approximately 4 months following the baseline (T0) and 8 months following baseline for the second follow-up assessment (T2). Participants showed significant improvement in all SM behaviors, self-efficacy, outcome expectancy, QOL, and personal impact of epilepsy measures from T0 to T1. Participants who scored lower at baseline tended to show greater improvement at T1. Similarly, results showed that participant improvement was sustained in the majority of SM measures from T1 to T2.

Conclusion

This study demonstrated that a mobile technology-based personalized SM intervention is feasible to implement. The results provide evidence that epilepsy SM behavior and practices, QOL, outcome expectation for epilepsy treatment and management, self-efficacy, and outcome expectation and impact of epilepsy significantly improve following a personalized SM education intervention. This underscores a greater need for a pragmatic trial to test the effectiveness of personalized SM education, such as PAUSE to Learn Your Epilepsy, in broader settings specifically for the unique needs of the hard-to-reach and hard-to-treat population of PWE.

1. Introduction

Epilepsy, characterized by spontaneous recurrent seizures with unpredictable frequency, is a common and complex neurological disorder that affects the health and quality of life (QOL) of people with epilepsy (PWE) [1]. It is the fourth most common chronic neurological disorder after migraines, Alzheimer’s disease, and Parkinson’s disease in terms of 1-year prevalence per 1000 in the general population [2]. In 2015, approximately 1.2% of American adults reported living with epilepsy; 68.5% had seen a neurologist or epilepsy specialist; 93% were taking antiseizure medication (ASM), and, among those taking medication to control seizures, only 42.4% were seizure-free in the past year [3]. Epilepsy, especially with uncontrolled seizures, poses an immense burden to the people who have it, caregivers, and the society due to a number of factors including associated developmental, cognitive, and psychiatric comorbidities; ASM side effects; higher injury and mortality rates; poorer QOL; and increased financial burden. An estimated 3.0% of global disability-adjusted life years (DALYs) were from neurological disorders in 2010, a quarter of which were from epilepsy; epilepsy was the second-most burdensome chronic neurologic disorder worldwide in terms of DALYs [4].

Self-management (SM) education has shown to improve SM skills & behaviors and QOL in many chronic diseases including heart disease, diabetes, asthma, and arthritis [5,6]. Barlow defines self-management as an individual’s ability to manage the symptoms, treatments, physical and psychological consequences, and life style changes inherent in living with a chronic condition [7]. However, successful SM requires sufficient knowledge of the condition, its treatment, and necessary skills to perform SM activities. Like other chronic conditions, day-to-day management of epilepsy shifts from healthcare professionals to PWE. Epilepsy care demands active involvement of PWE in keeping up with the health effects of epilepsy and coping with social (e.g., family/friends, stigma, hobbies), health (e.g., seizure response/tracking, comorbidities such as depression/anxiety, sleep, safety, health literacy), employment (e.g., transportation, disability, absenteeism), and economic (e.g., cost of healthcare and medication) challenges. One can only self-manage their disease if they have the tools to do so, including knowledge, access to information relevant to their specific healthcare needs, and the ability to carry out the SM tasks needed for their condition. Evidence shows that many PWE are not knowledgeable about their disorder or often not educated about the risks of epilepsy, injury, and mortality [1,8]. Education needs also vary between individuals and subgroups of PWE. Women, in particular, may seek information on bone health and the effect of ASM on pregnancy or contraception, while older adults’ priorities may relate to fall safety and interactions of ASM with other medications. Existing evidence also reveals that, while patients with chronic diseases are willing to receive SM education materials, perceived information overload (i.e., too much or complex information) negatively influences their usage willingness [9]. Patients with low health literacy are even more susceptible to information overload [10]. The Institute of Medicine recognized SM education gaps for PWE and recommended (Recommendation 9) in its 2012 report, “Epilepsy Across the Spectrum: Promoting Health and Understanding,” to improve and expand educational opportunities for PWE and their families, as well as to ensure that all PWE and their families have access to accurate, clearly communicated educational materials and information [1].

Several studies have reported contradictory results after examining the efficacy of SM education interventions in improving PWE’s knowledge and understanding of epilepsy and QOL. The Modular Service Package Epilepsy study (MOSES) reported significant improvements in ASM tolerability, epilepsy knowledge, coping with epilepsy, and seizure frequency after 6 months following a 2-day SM education program [11]. Self-management education for people with poorly controlled epilepsy [SMILE (UK)] adapted MOSES for use in the United Kingdom and did not find the 2-day course to be effective in improving QOL or secondary outcome measures (anxiety and depression), after 12 months [12]. Though both MOSES and SMILE were randomized control trials (RCTs), MOSES included all adults with epilepsy whereas SMILE included only adults with chronic epilepsy who had two or more seizures in the prior 12 months. Another RCT compared the effectiveness of a multicomponent SM intervention consisting of five weekly, 2-hour group sessions each followed by a 2-hour group session after three weeks with usual care; they found no difference in measures of self-efficacy, though did find improvements in some epilepsy QOL domains and decreases in measures of ASM side effects [13]. Other studies examining the efficacy of in-person, group-based, online or phone/internet SM interventions, including the Centers for Disease Control and Prevention-supported Managing Epilepsy Well (MEW) network programs, did show improvement in epilepsy SM and QOL [[14][15][16][17][18]].

In addition to existing group-based programs, which require permission to use and specialized training, there is a greater need for patient-centered and patient-specific individualized education interventions for epilepsy SM that are publicly available, cost-effective, and easily disseminated to clinics or in community. The PAUSE to Learn Your Epilepsy (hereafter referred to as “PAUSE”), a MEW network collaboration center, was developed and implemented to address the needs of all PWE, especially those in underserved populations. This program uses publicly available education information from the Epilepsy Foundation (EF) website, epilepsy.com, linked to a mobile technology-based PAUSE application to provide patient-centered personalized epilepsy SM lesson plan to PWE. Detailed information about PAUSE including study design, recruitment, intervention, and assessments has been published previously [19,20]. We reported significantly lower epilepsy SM practices and behaviors among PWE from an underserved population as compared to all PWE. In this paper, we sought to determine whether the PAUSE intervention significantly improves self-efficacy, SM behavior & skills, QOL, personal impact of epilepsy, and epilepsy outcome expectancies over time in adults with epilepsy. We also assessed whether perceived depression symptoms influence longitudinal changes in SM measures following the PAUSE intervention.[…]

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[ARTICLE] Effects of acquired chronic brain injury on quality of life: A preliminary study in patients with a left or right-sided lesion – Full Text PDF

Highlights

  • Quality of life comprises physical, emotional, cognitive, social, & general health
  • Left hemisphere injured patients are less satisfied with their cognitive function
  • Right hemisphere patients are less satisfied with their physical function
  • Age, education, and lesion size influence perceived quality of life after injury
  • Lesion location may mediate which aspects of quality of life are adversely impacted

Abstract

Objectives

To test the hypothesis that quality of life (QOL) is made up of different components and each of these has different anatomic and demographic contributors.

Design

Questionnaire-based study ;

Setting

Center for Cognitive Neuroscience, University of Pennsylvania

Participants

52 people with chronic brain injury volunteered for the study. After excluding patients with severe communication deficits, bilateral lesions, and incomplete data, 42 patients with focal lesions were included in the final study: 22 patients with left hemisphere injury, LHI (9 females and 13 males; mean age 60.6 years (SD=11.2; Range: 36-83) mean chronicity 11.5 years (SD=4.2)) and 20 patients with right hemisphere injury, RHI (16 females and 4 males; mean age 62.7 years (SD= 12.8; Range: 31-79); mean chronicity 10.1 years (SD=4.3)).

Main Outcome Measures

We administered the RAND36-Item Health Survey (RAND-Version-1.0), Stroke Impact Scale (SIS-Version 3.0), Positive Affect and Negative Affect Scale (PANAS) and Distress Thermometer (DT) to measure QOL in LHI and RHI patients. Exploratory Factor Analysis (EFA) with principal component method reduced these measures to five factors, roughly categorized as— 1. Physical functioning, 2.General health, 3. Emotional health, 4. Social functioning, and 5. Cognitive functioning. Exploratory analyses attempted to relate these factor scores to demographic variables, neuroanatomical data, and neuropsychological measures.

Results

Physical functioning was the biggest contributor to reduced QOL, explaining 32.5%, of the variance. Older age, less education, and larger lesion size predicted poorer physical functioning (p < .001). Age also affected emotional health. (p=.019). Younger patients reported poorer emotional health than older patients. LHI patients reported less satisfaction with their cognitive functioning (p=.009) and RHI patients with their physical functioning (p=.06). Exploratory neuroanatomical analyses hinted at brain areas that may be associated with the perception of disability in each QOL component.

Conclusions

QOL is comprised of five components. Clinical and demographic factors appear to differentially impact these aspects of patients’ perceived quality of life, providing hypotheses for further testing and suggesting potential relationships for therapeutic interventions to consider.

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via Effects of acquired chronic brain injury on quality of life: A preliminary study in patients with a left or right-sided lesion – ScienceDirect

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[Abstract] Water-Based Exercise on Functioning and Quality of Life in Poststroke Persons: A Systematic Review and Meta-Analysis

Abstract

OBJECTIVE:

To investigate the effects of water-based exercise on functioning and quality of life in poststroke persons.

DATA SOURCES:

We searched the following electronic database: MEDLINE, PeDro, Scielo, and the Cochrane Central Register of Controlled Trials up to September 2018 Study Selection: Only randomized controlled trials were included. Two review authors screened the titles and abstracts and selected the trials independently.

DATA EXTRACTION:

Two review authors independently extracted data of the included trials, using standard data-extraction model. We analyzed the pooled results using weighted mean differences, and standardized mean difference and 95% confidence intervals (CIs) were calculated.

DATA SYNTHESIS:

Twenty-four studies met the study criteria, but only 15 studies were included on meta-analyses. The studies presented moderate methodological quality, due to the lack of blinding of subjects and therapists and the nonperformance of the intention-to-treat analysis. Water-based exercise compared with land exercise had a positive impact on: muscle strength balance gait speed and mobility aerobic capacity and functional reach. Combined water-based exercise and land exercise was more effective than land exercise for improving balance, gait speed, and functional reach. The meta-analysis showed significant improvement in role limitations due to physical functioning and emotional problems, in vitality general mental health, social functioning, and bodily pain for participants in the water-based exercise and land exercise group versus land exercise group.

CONCLUSIONS:

Water-based exercise may improve muscle strength, balance, mobility, aerobic capacity, functional reach, joint position sense, and quality of life in poststroke persons and could be considered for inclusion in rehabilitation programs.

via Water-Based Exercise on Functioning and Quality of Life in Poststroke Persons: A Systematic Review and Meta-Analysis. – PubMed – NCBI

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[BOOK] Epilepsy Across the Spectrum – NCBI Bookshelf

Cover of Epilepsy Across the Spectrum

Epilepsy Across the Spectrum

Promoting Health and Understanding

Institute of Medicine (US) Committee on the Public Health Dimensions of the Epilepsies; Editors: Mary Jane England, Catharyn T Liverman, Andrea M Schultz, and Larisa M Strawbridge.

Washington (DC): National Academies Press (US); 2012.

ISBN-13: 978-0-309-25506-6

Excerpt

Throughout this report, the committee emphasizes the ways in which epilepsy is a spectrum disorder. Epilepsy comprises more than 25 syndromes and many types of seizures that vary in severity. Additionally, people who have epilepsy span a spectrum that includes men and women of all ages and of all socioeconomic backgrounds and races/ethnicities, who live in all areas of the United States and across the globe. The impacts on physical health and quality of life encompass a spectrum as well, with individuals experiencing different health outcomes and having a range of activities of daily living that may be affected, including driving, academic achievement, social interactions, and employment. For some people, epilepsy is a childhood disorder that goes into remission (although the seizures may have lifelong consequences), while for others it is a lifelong burden or a condition that develops later in life or in response to an injury or other health condition. These many complexities of epilepsy make it a challenging health condition to convey to the general public to promote understanding and alleviate stigma. This report aims to provide evidence and impetus for actions that will improve the lives of people with epilepsy and their families.

Contents

via Epilepsy Across the Spectrum – NCBI Bookshelf

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[ARTICLE] The Efficacy of the proprioceptive neuromuscular facilitation (PNF) approach in stroke rehabilitation to improve basic activities of daily living and quality of life: a systematic review and meta-analysis protocol – Full Text

Abstract

Introduction Proprioceptive neuromuscular facilitation (PNF) is a widely used rehabilitation concept, although its efficacy has not yet been demonstrated in stroke survivors. The aim of this systematic review is to identify, assess and synthesise the potential benefits of using PNF to improve the activities of daily living (ADL) and quality of life (QoL) of individuals with stroke.

Methods and analysis A systematic electronic search will be conducted in MEDLINE, Embase, CENTRAL and PEDro. We will include randomised or quasi-randomised controlled trials of PNF interventions conducted in stroke survivors up to April 2017. Two review authors will independently select relevant studies and will extract data using the Cochrane handbook for systematic reviews of interventions approach and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The methodological quality will be assessed by using the PEDro scale. Finally, with the permitted numeric data, we will carry out a meta-analysis.

Ethics and dissemination Ethical considerations will not be required. Results will be disseminated in a peer-review journal. This systematic review aims to examine the effects of PNF (neurophysiological approach) in order to clarify its efficacy in improving ADL and QoL in the rehabilitation process of stroke survivors.

 

Strengths and limitations of this study

  • To our knowledge this study is the first systematic review focused on the proprioceptive neuromuscular facilitation (PNF) approach for stroke survivors.

  • This systematic review has an open eligibility criteria to clarify the efficacy of the PNF method for different clinical situations in stroke patients.

  • The electronic search will only include randomised controlled and quasi-randomised controlled trials published in English, Spanish, French and Portuguese that could limit the inclusion of studies.

 

Introduction

Every year, stroke survivors, related deaths, and disability-adjusted life-years are increasing, although the mortality rates for stroke have decreased in the last two decades.1 Motor and sensory impairments due to stroke often affect the patients’ mobility, limiting their activities of daily living (ADL) and their social participation, and hindering their chances of resuming their professional life. Motor function among other factors (such as social or personal factors) could contribute to a low overall quality of life (QoL).2

Throughout the years, a number of conceptualisations have been used to describe QoL in stroke survivors.3–5 The lack of an agreed definition on QoL means that most QoL outcomes have been assessed using standardised questionnaires. However, these questionnaires do not reveal important domains of patients’ QoL and sometimes scores may be difficult to interpret.5

Dijkers4 separated the QoL term into three categories: (1) QoL as subjective well-being (SWB); (2) QoL as achievement; and (3) QoL as utility. QoL as SWB has been defined as the sum total of the cognitive and emotional reactions that people experience when they compare what they have and do in life with their aspirations, needs, and other expectations. QoL as achievement refers to people’s possessions, relationships and accomplishments, among others, using metrics defined by an outsider’s point of view. Within the medical rehabilitation field, QoL measurements commonly involve health status or are qualified by the term “health-related”. Health-related QoL (HRQoL) is defined by the value assigned to the duration of life when modified by impairment, functional state, perception and social factors that are influenced by disease, injury, treatment or policy.6 According to Dijkers4some researchers base themselves on the WHO’s encompassing definition of health, and may add to this different social health indicators such as interactions with others and social role functioning. Finally, in QoL as utility, achievements and statuses are judged in terms of societal norms and standards that quantify the value of a life.

An optimal rehabilitation effectively addresses components, as coded by the International Classification of Functioning (ICF), such as impairment, activity limitations and participation restrictions, and contextual and personal factors, with the goal of a satisfactory QoL as perceived by the individual. The relationship between the three domains of the ICF is clear: impairments impact activities and activities have an impact on participation. Functionality and ADL take a specific role in influencing QoL in stroke survivors positively. During the recovery process and according to the degree of disability, it is important to impact on those variables at any time throughout the rehabilitation treatment, taking into account that they are variables that change over time.7 Much of the focus of stroke rehabilitation is on the recovery of impaired movement and the associated functions. According to Jørgensen8there seems to be a correlation between motor impairments and activity limitations; for example, lower-limb strength (impairment) has been correlated with independence in walking (activity level). In order to improve the neuromuscular system’s effectiveness in coordinating movement and function, there are different physical rehabilitation approaches used for enhancing recovery in post stroke patients, but neither method was more (or less) effective in terms of improving independence in ADL or motor function.9Proprioceptive neuromuscular facilitation (PNF) is widely used in rehabilitation practice.10

The PNF approach has existed since the late 1930s and ’40s when the physician and neurologist Herman Kabat, and the physiotherapist Margaret Knott, began using proprioceptive techniques on younger individuals with cerebral palsy and other neurological conditions. The main goal of this intervention method is to help patients achieve their highest function level. PNF uses the body’s proprioceptive system to facilitate or inhibit muscle contraction. The definition of PNF encompasses the terms proprioceptive (which has to do with any of the sensory receptors that provide information concerning movement and position of the body); neuromuscular (involving the nerves and muscles); and facilitation (making it easier).11

Recently, various systematic reviews 12–17 and an evidence-based clinical practice guideline18 have evaluated the efficacy of stroke rehabilitation interventions, including PNF techniques. However, none were specifically focused on PNF, and only one narrative review assessed PNF as the principal topic.10 Furthermore, the most frequent objectives to assess the efficacy of this intervention method were motor function and mobility. It is necessary that therapists base their clinical decisions on the most reliable scientific evidence available; hence, this systematic review aims to determine the efficacy of PNF techniques in improving ADL and QoL in stroke survivors.

Objectives

The primary purpose of this systematic review is to examine the efficacy of PNF in improving ADL and QoL in individuals with stroke. Secondary specific aims are to determine the efficacy of the PNF techniques in postural control, gait, upper limb function and muscle strength.[…]

 

Continue —> The Efficacy of the proprioceptive neuromuscular facilitation (PNF) approach in stroke rehabilitation to improve basic activities of daily living and quality of life: a systematic review and meta-analysis protocol | BMJ Open

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[Abstract+References] Fuzzy System as an Assessment Tool for Analysis of the Health-Related Quality of Life for the People After Stroke

Abstract

Stroke remains one of the leading causes of long-term disability in both developed and developing countries. Prevalence and impact of the stroke-related disability on Health-Related Quality of Life (HRQoL) as a recognized and important outcome after stroke is huge. Quick, valid and reliable assessment of the HRQoL in people after stroke constitutes a significant worldwide problem for scientists and clinicians – there are many tools, but no one fulfills all requirements or has prevailing advantages. This paper presents proposition of an evaluation of HRQoL based on the two-level hierarchical fuzzy system. It uses five clinical scores and scales as the inputs and gives in result value from the interval [0; 1]. It may constitute a useful semi-automated tool for supplementary initial assessment of patient functioning and further cyclic re-assessment for rehabilitation process and patient-centered goals of rehabilitation shaping purposes.

Source: Fuzzy System as an Assessment Tool for Analysis of the Health-Related Quality of Life for the People After Stroke | SpringerLink

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[Abstract] The feasibility and impact of a yoga pilot programme on the quality-of-life of adults with acquired brain injury – CNS

Abstract

OBJECTIVE: This pilot study measured the feasibility and impact of an 8-week yoga programme on the quality-of-life of adults with acquired brain injury (ABI).

METHODS: Thirty-one adults with ABI were allocated to yoga (n = 16) or control (n = 15) groups. Participants completed the Quality of Life After Brain Injury (QOLIBRI) measure pre- and post-intervention; individuals in the yoga group also rated programme satisfaction. Mann-Whitney/Wilcoxon and the Wilcoxon Signed Rank tests were used to evaluate between- and within-group differences for the total and sub-scale QOLIBRI scores, respectively.

RESULTS: No significant differences emerged between groups on the QOLIBRI pre- or post-intervention. However, there were significant improvements on overall quality-of-life and on Emotions and Feeling sub-scales for the intervention group only. The overall QOLIBRI score improved from 1.93 (SD = 0.27) to 2.15 (SD = 0.34, p = 0.01). The mean Emotions sub-scale increased from 1.69 (SD = 0.40) to 2.01 (SD = 0.52, p = 0.01), and the mean Feeling sub-scale from 2.1 (SD = 0.34) to 2.42 (SD = 0.39, p = 0.01).

CONCLUSION: Adults with ABI experienced improvements in overall quality-of-life following an 8-week yoga programme. Specific improvements in self-perception and negative emotions also emerged. High attendance and satisfaction ratings support the feasibility of this type of intervention for people with brain injury.

Source: Traumatic Brain Injury Resource Guide – Research Reports – The feasibility and impact of a yoga pilot programme on the quality-of-life of adults with acquired brain injury

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[ARTICLE] Visual Impairment Following Stroke – The Impact on Quality of Life: A Systematic Review – Full Text PDF

ABSTRACT

Background: The visual impairments caused by stroke have the potential to affect the ability of an individual to perform activities of daily living. An individual with visual impairment may also have reduced level of independence. The purpose of this review was to investigate the impact on quality of life from stroke related visual impairment, using subjective patient reported outcome measures.

Methods: A systematic search of the literature was performed. The inclusion criteria required studies to have adult participants (aged 18 years or over) with a diagnosis of a visual impairment directly resulting from a stroke. Studies which included visual impairment as a result of other intracranial aetiology, were included if over half of the participants were stroke survivors. Multiple scholarly online databases and registers of published, unpublished and ongoing trials were searched, in addition articles were hand searched. MESH terms and alternatives in relation to stroke and visual conditions were used. Study selection was performed by two authors independently. Data was extracted by one author and verified by a second. The quality of the evidence was assessed using a quality appraisal tool and reporting guidelines.

Results: This review included 11 studies which involved 5646 participants, the studies used a mixture of generic and vision-specific instruments. The seven instruments used by the included studies were the EQ-5D, LIFE-H, SF-36, NEI VFQ-25, VA LV VFQ-48, SRA-VFP and DLTV.

Conclusion: A reduction in quality of life was reported by all studies in stroke survivors with visual impairment. Some studies used generic instruments, therefore making it difficult to extract the specific impact of the visual impairment as opposed to the other deficits caused by stroke. The majority of studies (8/11) primarily had participants with visual field loss. This skew towards visual field loss and no studies investigating the impact ocular motility prevented a comparison of the effects on quality of life due to different visual impairments caused by stroke. In order to fully understand the impact of visual impairment following stroke on quality of life, further studies need to use an appropriate vision-specific outcome measure and include all types of visual impairment which can result from a stroke.

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[ARTICLE] Prediction of quality of life after stroke rehabilitation – Full Text

Abstract

Introduction:

The purpose of this study was to develop a computational method to identify potential predictors for quality of life (QOL) after post stroke rehabilitation.

Methods:

Five classifiers were trained by five personal factors and nine functional outcome measures by 10-fold cross-validation. The classifier with the highest cross-validated accuracy was considered to be the optimal classifier for QOL prediction.

Results:

Particle Swarm-Optimized Support Vector Machine (PSO-SVM) showed highest accuracy in predicting QOL in stroke patients and was adopted as the optimal classifier. Potential predictors were assessed by PSO-SVM with feature selection. The early outcomes of Quality of Movement scale of the Motor Activity Log (MAL_QOM) and the Stroke Impact Scale (SIS) were identified to be the most predictive outcome predictors for QOL.

Conclusion:

The approach provides the medical team another possibility to improve the accuracy in predicting QOL in stroke patients. Therapists could determine the therapies for stroke patients more accurately and efficiently to enhance the quality of life after stroke.

Introduction

Stroke remains a leading cause of death and disability in the developed world [1]. After stroke, the effects of stroke and post stroke rehabilitation are usually assessed by health professional ratings and performance tests [24]. However, real life of stroke survivors is affected in multiple ways and may not be described completely by only health and functional status. It is possible that a treatment succeeds in enhancing physical function recovery however induces psychosocial problems [5,6]. In this case, quality of life (QOL) may actually be degraded after poststroke rehabilitation. The WHO suggests that a comprehensive view of quality of life includes not only physical health, but also psychological health, social relationships, and environmental quality [4]. Therefore, to obtain a comprehensive view of the effects after stroke, life quality should also be considered when assessing a person’s health and functioning.

In recent years, assessment of QOL in stroke has become increasingly common. Many recent rehabilitation therapies have been reported to be effective in restoring upper limb motor function after stroke but showed varied effects in QOL [710]. Different rehabilitation therapies may benefit different subgroups of the stroke population and cause different effects to QOL. Identifying key predictors of QOL may assist therapists to determine an optimal therapy, which can not only improve physical function but also maximize QOL for a specific subgroup of stroke survivors. Decision making of rehabilitation strategies may be more efficient and complete with identifying predominant predictors of QOL.

Only three studies examined predictors of QOL [5,11,12]. In these three studies, the predictive ability of multiple factors was examined, including demographic factors, vascular risk factors, clinical scales and neuropsychological assessment, and lesion characteristics. However, general predictors of outcomes of QOL were hard to determine because of the heterogeneity among these studies. Both physical and psychological factors were reported to be important in predicting QOL after stroke [5,11,12]. Although stroke rehabilitation gains in QOL are important, the question of which patients may benefit most in QOL from specific therapies has not been widely addressed, and statistical approaches to reveal such associations and predictors may not be optimal [13,14]. However, possible predictors related to QOL performance outcome after rehabilitation remained less discussed. More studies are needed to clarify the predictive ability of diverse QOL predictors in stroke patients.

Practical implementation of outcome predictors in clinical use was also constrained by the complexity of the algorithms. Developing prognostic algorithm based on existing and simple algorithms may reduce the complexity in clinical implementation, increase the use of prognostic model, and further improve the efficiency of rehabilitation therapy. Traditionally, studies examined outcome predictors used regression analysis to discriminate the most predictive factors from others [1518]. However, the results of regression analysis can only explained the variance of the outcome in percentage. Computational methods can provide another aspect of outcome prediction. The results of regression statistical method showed that the factors were predictors for the outcome measure model, and the model only explained how percentage of the variance in the outcome measure scores. However, the results of computational classifier methods can provide accuracy and more application related to the predictors.

It has been applied in predicting clinical outcome in cancer patients and showed high accuracy and efficiency [19,20]. Using classifiers could improve the accuracy in predicting QOL. Hopefully, predominant predictors could also be better identified. That’s why we try to utilize a computational classifier method to identify potential predictors for quality of life (QOL) after post stroke rehabilitation.

Continue —> Prediction of quality of life after stroke rehabilitation

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[WEB SITE] Research Reports – Quality of life after traumatic brain injury – CNS

OBJECTIVE: The aim of this study was to assess the quality of life (QoL) of
traumatic brain injury (TBI) patients and to explore its predictive factors.
MATERIAL/PATIENTS AND METHODS: This is a descriptive and analytical
cross-sectional study, including 27 TBI patients followed in the physical
medicine and rehabilitation department (PMR). The collected data were: age,
educational level, marital status, initial Glosgow score and intensive care unit
length of stay. The assessment of the QoL was based on two scales, the first one was specific: Quality of Life after Brain Injury (QOLIBRI), while the second was generic: the SF-36. We had assessed memory disorders by the mini mental state (MMS) and functional capacity by The Functional Independence Measure (FIM). The handicap was assessed by Go Outcome Scale (GOS). Possible correlations between QoL and the different variables were explored.
RESULTS: The mean age of patients was 32.19 years. For QOLIBRI scale, the overall average score was 48.03%, the most affected dimensions were the feelings and social relations. Regarding the SF-36 scale, impaired QoL was found in 74% of these patients, the overall average score was 43.02. A significant correlation was found between QOLIBRI and mental composite score of the SF-36 (P=0.012). Memory disorder was significantly correlated with QoL (P=0.037). There were no statistically significant correlations between QoL and the other variables.
DISCUSSION-CONCLUSION: Memory disorder was the main predictive factor of impaired quality of life of traumatic brain injury patients; however, there was no correlation between handicap and QoL. This alteration of QOL has clinical implications and highlights the necessity of more efforts to optimize the rehabilitation interventions.

Source: http://www.neuroskills.com/resources/special-reports.php?report=1290

 

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