Performance and capacity-based measures of locomotion,compared to impairment-based measures,best predicted participation in individuals with hemiparesis due to stroke

Purpose: To determine the potential predictors of participation of individuals with post-stroke hemiparesis, taking into account modifiable variables of impairments, activity limitations, and environmental factors.

Methods: One hundred and nine individuals (58?±?12 years; 64 men) participated in this study. Outcomes included measures of impairments (depressive symptoms: Geriatric Depression Scale and motor-based impairments: finger-to-nose test, lower extremity (LE) motor coordination test, and handgrip strength, isometric strength of the LE muscles), activity (capacity: 10-meter walking speed test and Test d'Évaluation des Membres Supérieurs de Personnes Agées; performance: locomotion and manual abilities; environmental factors (Measure of the Quality of the Environment); and participation: Assessment of Life Habits (LIFE-H 3.1 Brazil)).

Results: Regression analyses revealed that the explanatory variables accounted for 59% and 49% of the variance in the LIFE-H 3.1 Brazil daily activity and social role sub-scales, respectively. Locomotion performance (R²?=?39%; p?R²?=?32%; p?Conclusions: Performance and capacity-based measures of locomotion showed to be the best predictors of participation. Additionally, depressive symptoms should not be underlooked.

• Implications for Rehabilitation

• Activity-related measures of locomotion showed to be the main predictors of participation in individuals with post-stroke hemiparesis, as assessed by the daily activity and social role sub-scales of the LIFE-H 3.1.

• The daily activity model was best predicted by measures of performance, whereas the social role sub-scale, by measures of capacity.

• Although small, the impact of depressive symptoms on participation should not be underlooked.

• Locomotion appeared to be essential for participation and increases in walking speed and locomotion ability should be the main goals for both professionals and individuals, when the aim is to increase participation.

     

首发脑卒中患者出院后1周的社会参与水平及影响因素分析

目的探讨首发脑卒中患者出院后1周的社会参与水平及影响因素,为制订针对性的措施提供依据。方法选取符合纳入标准的271例首发脑卒中患者,使用参与和自主性测评问卷在患者出院后1周进行随访调查。结果首发脑卒中患者出院后1周的社会参与总分为（61．14±13．44）分;各维度得分为：家庭角色自主参与（21．69±5．07）分、室外自主参与（15．22±2．55）分、室内自主参与（14．27±4．88）分、社会生活自主参与（9．96±5．50）分。经多元逐步回归分析显示,影响首发脑卒中患者社会参与水平的主要因素是：婚姻状况、照顾者类型、医疗费用支付方式和发病到入院的间隔时间。结论首发脑卒中患者社会参与水平受限,医护人员应根据其影响因素制订针对性的干预措施,以促进其参与社会,提高其生活质量。     

Activities, participation and satisfaction one-year post stroke

Purpose. To evaluate the chronic consequences of stroke in terms of activity limitations, restricted participation and dissatisfaction from life, and the relationship between these variables, in stroke survivors living in the community one-year post onset.

Method. A total of 56 stroke patients (mean age: 57.7) who completed an in-patient rehabilitation programme, were evaluated one-year post onset in their homes, using the following instruments: Functional Independence Measure (FIM), Instrumental Activities of Daily Living Questionnaire (IADLq), Activity Card Sort (ACS), a work questionnaire, Life-Satisfaction Questionnaire (Li-Sat 9) and the Geriatric Depression Scale (GDS).

Results. One year post stroke onset the mean FIM motor score was 75.88 (max score: 91), yet more than 50% of the sample still required assistance (usually mild to moderate) in dressing, bathing and use of stairs. The majority of the sample required full assistance in some IADL domains, notably meal preparation (77%), housekeeping (70%) and laundry (82%). Only one subject returned to paid employment and the mean activity level (ACS), representing the percentage of leisure and IADL activities retained from before stroke, was 42.8%. Satisfaction ratings were generally low but varied between domains. Only 39% were satisfied from 'life as a whole'. The lowest satisfaction rates were noted for 'vocational situation' (14%), 'leisure situation' (34%) and 'ability in self-care' (43%), whereas the satisfaction rate from family life was high (84%). Significant correlations were found between overall life satisfaction scores and the overall FIM motor, IADLq, and ACS scores (Pearson r values: 0.32, 0.48 and 0.57, respectively). Activity level was found to be a significant predictor of satisfaction (p = 0.007) beyond that accounted for by demographic variables and depression.

Conclusions. Stroke survivors dwelling in the community demonstrate long-standing dissatisfaction one-year post onset, correlating with activity limitation and restricted participation. The findings present a compelling need for rehabilitation services with a focus on participation in IADL and leisure activities, in order to improve the satisfaction of this population.     

出院后脑卒中病人日常生活活动及社会参与的研究进展

从出院后脑卒中病人的日常生活活动水平、社会参与水平及其测量工具、影响因素方面综述了出院后脑卒中病人日常生活活动研究及社会参与现状。     

Factors impacting the household and recreation participation of older adults living in the community

Abstract

Purpose: To identify demographic, physical and psychosocial determinants associated with participation in daily activities of community-dwelling older adults. Methods: A cross-sectional design of older adults (≥70 years) from Victoria, Australia, residing in their homes was drawn from a convenience sample. The outcomes were recent participation in household and recreational activities as measured by the Phone-FITT. Explanatory variables included demographics, physical and mental health functioning (Short Form-12 version 2, Geriatric Depression Scale 15). Associations were analyzed through linear regression. Results: There were 244 participants (60% female), with a mean age of 77.5 years (SD 5.7). Higher levels of depression and fewer falls (during the previous year) were independently associated with restrictions in household participation (p?<?0.001, p?<?0.001). For recreational participation, higher levels of depression were associated with restricted participation (p?<?0.001). Conclusion: Screening for depression should be a key component of health assessments with older adults. Untreated depression may lead to lower participation rates in daily activities potentially resulting in social isolation. Fewer falls and restricted household participation were associated, but no association was observed between falls and recreational participation. Further studies are required to explore this association in more detail.

• Implications for Rehabilitation

• Depression is significantly correlated with the level of participation in daily activities for older adults.

• Health professionals need to screen for depression when working with older adults.

     

Social stressors associated with antepartum depressive symptoms in low-income African American women

ABSTRACT Objectives: To describe depressive symptomatology and examine the relationship between social stressors and depressive symptoms in pregnant African American women. Design and Sample: Cross‐sectional study of 119 women receiving care at 2 prenatal clinics in Northern California. Measures: Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES‐D). Social stress variables included discrimination, trauma exposure, social conflict, and economic stress. Results: In this sample, mean CES‐D score was 15.88. Forty‐two percent of the women had CES‐D scores ≥16 (possible risk), and 23% had CES‐D scores ≥23 (probable risk). There were significantly positive relationships between the social stress variables (discrimination, trauma exposure, social conflict, economic stress) and CES‐D scores. Stepwise multiple regression analysis indicated that together discrimination and social conflict accounted for 36% of the variance in antepartum depressive symptoms. Conclusions: Discrimination and social conflict are considerable sources of stress that contribute to levels of antepartum depressive symptoms in African American women. While the results reinforce the importance of universal prenatal screening, comprehensive strategies are also needed to help ameliorate the impact that social stressors such as discrimination and social conflict have on the mental health of pregnant African American women.     

The association between depressive symptoms and social support in Taiwanese women during the month

The purpose of the study was to explore the association between depressive symptoms and social support in Taiwanese women doing the month. A correlational survey design using the Postpartum Social Support Questionnaire (PSSQ) and the Edinburgh Postnatal Depression Scale (EPDS) to measure social support and postnatal depressive symptomatology was employed. Two hundred and forty postpartum women receiving care in two teaching hospitals in Taipei, Taiwan, aged between 20 and 35, with no peri-natal complications or previous psychiatric history, experiencing a normal spontaneous delivery of one full term healthy baby, were selected. Each was mailed the PSSQ and the EPDS as well as a short, semi-structured self-report questionnaire requesting demographic details and subjective data relating to the experience of doing the month and depressive symptoms during the fourth week following birth. One hundred and eighty six women (78%) returned questionnaires. Taiwanese postpartum women were less depressed when they stayed in their parents' home and had their own mothers take care of them. It was found that the greater the level of postpartum social support received by the women doing the month, the lower the risk of postnatal depressive symptoms experienced. Almost a quarter (24%) of the variance of the symptoms was attributed to dissatisfaction with parents' instrumental support and unwanted emotional support from parents-in-law. It is concluded that the ritual of doing the month provides valuable social support and may help to prevent postnatal depression in Taiwanese women.     

文拉法辛缓释片与氟西汀治疗脑卒中后抑郁障碍对照研究

目的探讨文拉法辛缓释片与氟西汀治疗脑卒中后抑郁障碍的临床疗效和安全性。方法将58例脑卒中后抑郁障碍患者随机分为两组,每组29例,研究组口服盐酸文拉法辛缓释片治疗,对照组口服氟西汀治疗,观察6周。于治疗前及治疗后1周、2周、4周、6周末采用汉密顿抑郁量表、副反应量表评定临床疗效及不良反应。结果研究组治疗1周末起汉密顿抑郁量表评分较治疗前有显著下降,对照组治疗2周末起有显著下降（P〈0．01）;研究组治疗1周未较对照组下降更显著（P〈0．01）,2周、4周、6周末则无显著性差异（P〉0．05）。治疗6周末,研究组显效率82．76％,总有效率100％;对照组分别为79．31％、93．10％,两组无显著性差异（P〉0．05）。研究组不良反应发生率显著低于对照组（x^2=8．861,P＜0．01）。结论盐酸文拉法辛缓释片治疗脑卒中后抑郁疗效显著,且与氟西汀相当,但起效更快、安全性更高、依从性更好,可作为治疗脑卒中后抑郁障碍的一线用药。     

Long-term functional outcome of patients with longitudinal radial deficiency: cross-sectional evaluation of function,activity and participation

Purpose: To evaluate all functional aspects of patients with longitudinal radial dysplasia and to clarify the relationship between body functions on the one hand and limitations in activity and participation on the other hand. Methods: Thirty-one arms of seventeen adult patients with longitudinal radial dysplasia were analysed. Body function was assessed by measuring grip and pinch strength and active range of motion (ROM) of the hand. Activities were measured using the “Sequential Occupational Dexterity Assessment “, to measure perceived restrictions in participation the “Impact on Participation and Autonomy questionnaire” was used. Relationships between severity of dysplasia, body function, participation and activity were determined. Results: Patients with a severe type scored significantly lower in body function scores than patients with a mild form. Patients with limited active finger joint motion performed worse on activities. We found no significant differences in activity and participation between mild or severe types and found no correlation in participation scores. Conclusion: Although considerable restrictions in joint mobility and strength were revealed, little or no limitations on the activity and participation level were found. Limitations in body functions hardly influenced capacity on activity level and did not influence participation in societal roles.

Implications for Rehabilitation

• People with LRD learn to accomplish many of the everyday tasks without great difficulty and do not report a low quality of participation in major life activities.

• Professionals working in rehabilitation medicine should focus on activity and participation rather than on body structure or functions. Therapy focused solely on increasing joint motion or strength does not lead to further improvement.

• For parents it will be reassuring to know that children with severe radial deficiencies can satisfactory fulfill social roles in later life.

     

A review of the evidence underpinning the use of visual and auditory feedback for computer technology in post-stroke upper-limb rehabilitation

Purpose.?To identify and review the evidence to determine the current scientific basis underpinning the use of visual and/or auditory feedback for computer technology in home-based upper-limb stroke rehabilitation.

Method.?A systematic search was conducted using the following databases: CINAHL (EBSCO), MEDLINE (Ovid and CSA), PubMed, Science Direct (Elsevier) and Cochrane Library. Journals, book chapters and conference proceedings were also used in the systematic search. Relevant papers were critically appraised using the Critical Appraisal Skills Programme tool for randomised controlled trials/quantitative designs.

Results.?Four controlled trials were identified as being relevant. Although the evidence is scarce, existing findings suggest that extrinsic visual and auditory feedback may improve motor and functional performance. In addition, concurrent feedback, knowledge of performance, knowledge of results and explicit feedback may be key components in the promotion of improved performance.

Conclusions.?There is a paucity of evidence to inform the development and the use of technological systems for home-based stroke rehabilitation and specifically how such systems might be developed to provide best forms of feedback in the absence of a therapist. Further work is required to first investigate the efficacy of visual and auditory feedback using technology systems and second to explore their utilisation with the end user.     

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy

BACKGROUND:

The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis.

OBJECTIVE:

To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP).

METHOD:

Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents'' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively.

RESULTS:

The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children''s participation, while the subscale attitude/support had the least impact.

CONCLUSION:

The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study''s results regarding the effect of school participation in this population.     

Continuity, transition and participation: Preparing clients for life in the community post-stroke

Aims. To examine issues of continuity and transition facing clients as they return to life in the community following stroke and the role of rehabilitation in this process.

Key findings and implications. The sudden onset of disability following a stroke represents a major disruption to the continuity of a person's life experience. Rehabilitation has an important role in the transition from the non-disabled to the disabled state however current rehabilitation services and outcomes post-stroke focus on functional recovery rather than on a return to meaningful roles and activities and pay little attention to the transition from the non-disabled to the disabled self. Although some current rehabilitation models address the importance of involvement in a life situation, they do not adequately address issues of the role of the environment, the nature of community, the importance of meaning and choice when thinking about life situations, and change in abilities across the life course.

Conclusions. Models of rehabilitation service delivery need to move to a chronic disease management model that incorporates outcomes that are meaningful to clients, and not the assumed needs or outcomes as defined by rehabilitation professionals.     

盐酸氟西汀治疗脑卒中后抑郁临床疗效分析

目的 探讨盐酸氟西汀治疗对脑卒中后抑郁(PSD)及神经功能恢复的疗效.方法 将入选的60例脑卒中患者随机分为治疗组(加用盐酸氟西汀治疗)和对照组(常规治疗)各30例,于治疗前、治疗后8周各采用神经功能缺损量表(DNF)评定和汉密尔顿抑郁量表(HAMD)进行评定,于治疗2、8周末评定副作用发生情况,进行疗效及副作用的评定.结果 60例脑卒中患者中发生PSD 22例,PSD发生率为36.67%.其中轻度抑郁10例(45.45%),中度抑郁8例(36.36%),重度4例(18.18%).治疗8周后抑郁情绪恢复评分显示抑郁情绪恢复治疗组的疗效明显高于对照组,差异具有统计学意义(P<0.05).治疗8周后两组均无明显副作用.结论 脑卒中患者应用盐酸氟西汀胶囊治疗的临床疗效好,可明显改善患者的抑郁状态及神经功能障碍,同时应用药物治疗的副作用小,安全性高.盐酸氟西汀可作为脑卒中后抑郁患者药物治疗的首选.     

Differences in patterns of participation in leisure activities in Swedish children with and without disabilities

Abstract

Purpose: To compare participation in leisure activities between Swedish children with and without disabilities and to examine whether age, gender, presence of disabilities, and mother’s educational level influence participation. Method: A Swedish version of the Children’s Assessment of Participation and Enjoyment was used to study the diversity, intensity, and enjoyment of participation in leisure activities of children aged 6 to 17 years. Fifty-five of the children had disabilities and 337 of the children did not have disabilities. A multiple regression analysis was conducted to explore the impact of age, gender, mother’s level of education, and disability on the diversity, intensity, and enjoyment of leisure activities. A t-test for independent samples was used to compare the diversity and intensity of participation between children with and without disabilities. Results: The multiple regression analysis explained 4–36% of the variance of diversity, intensity, and enjoyment. Children with disabilities participated with higher diversity, but with less intensity, than children without disabilities. Younger children had higher levels of enjoyment. Conclusions: Children with disabilities participated in several different activities, but the presence of a disability was associated with lower intensity of participation. The low explanatory value of the investigated variables indicates that the combined effect of several variables needs to be taken into consideration when designing participation interventions.

• Implications for Rehabilitation

• Children with disabilities participated in a high number of activities but with a low intensity compared to children without disabilities. Analysis of the children’s personal and environmental barriers and facilitators is critical to providing the therapist with ideas about which strategies should be implemented to increase participation. Assessment and intervention may need to focus on methods for supporting the children’s autonomy and on creating goals for intervention that focus on activities that are determined by the child based on their interests and desires.

• Age and gender influenced the variance in the diversity and enjoyment outcome and the presence of disability was associated with the intensity outcome.

• Age, gender, parental educational level, and disability only explain a small proportion of the variance in leisure participation patterns. Thus, client-centred and individually tailored interventions are needed that are based on the individual's unique situation.

     

A review of factors influencing participation in social and community activities for wheelchair users

Objective: To systematically identify factors associated with participation in social and community activities for adult wheelchair users (WCUs). Data sources: PubMed/MEDLINE, CINAHL, PsycINFO and EMBASE. Study selection: Quantitative and qualitative peer-reviewed publications were included, which were written in English, reported original research and investigated factors associated with social and community participation in adult WCUs. Data extraction: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Factors were organized using the International Classification of Functioning, Disability and Health (ICF). Data synthesis: Thirty-five studies were selected: two of power WCUs, 10 of manual WCUs and 23 of both. Six qualitative studies, ranging in quality from 8/10 to 9/10 and 29 quantitative studies were included, ranging in quality from 4/15 to 11/15. Fifteen body function, 4 activity, 5 participation, 15 environmental and 14 personal factors were found to be associated with social and community participation. Conclusions: Social and community participation of WCUs is associated with factors from all ICF domains. Wheelchair factors, accessibility, skills with wheelchair use, pain, finances and education are modifiable factors frequently reported to be associated with participation. Experimental research focusing on modifiable factors is needed to further our understanding of factors influencing participation among WCUs.

• Implications for Rehabilitation

• Wheelchair factors, including comfort and durability, are associated with participation and may be targeted in clinical intervention.

• Wheelchair skills are clinically modifiable and have been shown to improve participation in manual wheelchair users.

• Body functions (e.g. confidence, depression and fatigue) and personal factors (e.g. finances and level of education) may be considered for clinical intervention.

     

镜像治疗对脑卒中偏瘫后患者上肢功能恢复及日常生活能力的影响研究

目的 探讨镜像治疗对脑卒中偏瘫后患者上肢功能恢复的影响及相关治疗的可能机制.方法 选择83例脑卒中后偏瘫患者随机分为镜像治疗组42例（采用镜像治疗）和对照组41例（采用常规康复治疗）,治疗前及经4周治疗后,采用Wolf运动功能试验（WMFT）、Fugl-Meyer运动功能评分法（FMA）对患者上肢运动功能进行测评,用视觉模拟评分（VAS）、改良Asworth痉挛量表对患者上肢疼痛、痉挛程度进行评定,用Barthel指数（BI）测评患者的日常生活能力.结果 经过4周的治疗后,两组患者组内比较,WMFT、FMA、VAS、BI评分均较治疗前有明显提高（P＜0.05）;两组间WMFT（60.17 ±4.82 VS 47.31 ±4.57）分、FMA（58.77 ±3.79 VS 46.32 ±3.84）分比较,镜像治疗组明显高于对照组（P＜0.05）,但VAS（1.47 ±0.23 VS 1.53 ±0.25）分、BI（79.75±7.94 VS 75.25±7.55）分评分两组比较差异无统计学意义（P＞0.05）.两组治疗前后及治疗后组间Asworth痉挛改善情况比较,差异无统计学意义（P＞0.05）.结论 镜像疗法对脑卒中偏瘫后患者上肢运动功能的恢复具有一定疗效,但对改善ADL及患肢痉挛程度,减轻患者上肢疼痛作用不明显.     

Effects of environmental modification on activities of daily living,social participation and quality of life in the older adults: a meta-analysis of randomized controlled trials

Abstract

Purpose: This study aims to provide evidence of the benefits and effects of environmental modification intervention on activities of daily living, quality of life and social participation in older adults.

Methods: This study searched and used randomized controlled trial research studies from the databases of MEDLINE, CINAHL and the Cochrane Library. A systematic review and meta-analysis were conducted using the Jadad scale, risk of bias and the patient, intervention, comparison, outcome (PICO) process. The domains of impact considered in this meta-analysis were activities of daily living, quality of life and social participation. The analysis was completed with the Review Manager software 5.3.

Results: Jadad scores of collected studies were 3–4 in seven studies and 2 in one study, which means that most studies had high levels of quality. This study comprised of 733 subjects in the experimental group and 672 subjects in the control group. The effect size of environmental interventions on basic activities of daily living, instrumental activities of daily living and overall activities of daily living were 0.37, 0.65 and 0.47, respectively. Meanwhile, the environmental intervention was neither effective on quality of life nor social participation.

Conclusions: Environmental modifications are effective in facilitating the daily life activities of older adults. This kind of intervention is shown to be useful for enhancing life performance. In order to confirm intervention effects on the quality of life and social participation of older adults, studies should conduct environmental modifications interventions that take into account contexts such as individual characteristics, lifestyle and physical activities.

• Implications for rehabilitation

• Environmental modifications are effective in improving older adults’ performance of daily activities (ADL).

• Appropriate environmental modification interventions should be considered before the quality of life (QoL) and levels of social participation of older adults decline.

     

Participation in community-based activities of daily living: Comparison of a pushrim-activated,power-assisted wheelchair and a power wheelchair

Purpose. The purpose of this study was to evaluate pushrim-activated, power-assisted wheelchair (PPW) performance among dual-users in their natural environment to determine whether the PPW would serve as a satisfactory alternative to a power wheelchair for community-based activities.

Methods. A concurrent mixed methods research design using a cross-over trial was used. The outcome measures used were number of hours reported using the different wheelchairs, Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), Functioning Everyday with a Wheelchair (FEW), Psychosocial Impact of Assistive Devices Scale (PIADS) and Canadian Occupational Performance Measure (COPM).

Results. The number of hours spent participating in self-identified activities was not significantly different. Only the Self-Esteem subscale of the PIADS identified a statistically significant difference between the PPW and power wheelchair conditions (p = 0.016). A clinically important difference for Performance and Satisfaction was suggested by the COPM, in favour of the power wheelchair.

Conclusions. Additional knowledge was gained about the benefits of PPW technology. Participants were able to continue participating independently in their self-identified community activities using the PPW, and identified comparable ratings of satisfaction and performance with the PPW and the power wheelchair. For some individuals requiring power mobility, the PPW may provide an alternative to the power wheelchair.