-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: 1) to identify different patterns of changes in wheelchair exercise capacity in the period between the start of active spinal cord injury (SCI) rehabilitation and five years after discharge; 2) to examine the pattern determinants of the change in wheelchair exercise capacity. DESIGN: Prospective cohort study. Measurements at the start of active inpatient rehabilitation (start), three months after the start (3M), at discharge of inpatient rehabilitation (discharge), one year after discharge (1Y), and five years after discharge (5Y). SETTING: Eight rehabilitation centers in The Netherlands. PARTICIPANTS: The study included 130 persons with SCI, aged 18-65, who were wheelchair-dependent at least for long distances. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Wheelchair exercise capacity: Peak Power Output (POpeak (W)). RESULTS: We found four different patterns of the change of POpeak (means (standard deviation)): (1) HIGH-PRO (33% of total study group ): high progressive scores (Start: 49 W (15.0) - 5Y: 77 W (17.2)), (2) DETER (12%): progressive scores during inpatient rehabilitation with deteriorating scores after discharge (Start: 29 W (8.7) - Discharge: 60 W (8.4) - 5Y: 39 W (13.1), (3) LOW-PRO (52%): low progressive scores (Start: 20 W (10.1) - 5Y: 31 W (15.9)), and (4) LOW-RISE (3%): low inpatient scores with strong progressive scores after discharge (Start: 29 W (15.5) - 5Y: 82 W (10.6)). A logistic regression of factors that may distinguish between HIGH-PRO and LOW-PRO revealed that older age, female gender, tetraplegic lesion and low functional status were associated with LOW-PRO. DETER showed more neuropathic pain and lower sports participation than HIGH-PRO. CONCLUSION: For the vast majority of patients, wheelchair exercise capacity after SCI shows a positive trend and can be described in distinct patterns that are dependent on personal, lesion and functional characteristics.
Archives of physical medicine and rehabilitation 03/2013; · 2.18 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: ABSTRACT The aim of this study is to examine construct validity, internal consistency, and test-retest reliability of the Dutch translation of the Assessment of Preschool Children's Participation (APCP) a participation measure for children aged 2 to 5 years and 11 months with and without physical disabilities. Parents of 126 preschool children participated. Sixty-seven of the children had no physical disabilities (mean age three years two months, SD 1.2) and 59 children had physical disabilities (mean age two years nine months, SD 1.8). Validity was tested using three hypotheses regarding having a physical disability, gender and age differences. Most, but not all hypotheses were confirmed. Children with a physical disability participated in fewer activities and with lower intensity than children without physical disabilities (p < .001). Boys and girls participated in an equally wide variety of activities and with similar intensity except for skill development. Four- to five-year-old children in general participated in more activities than two- to three-year-old children and had a higher intensity score (p < .001). For activity types, age differences were found for skill development (p < .001) and social activities (p < .001). Internal consistency was sufficient for four out of 10 activity types. Intra Class Correlations for test-retest reliability ranged from 63 to .91. Our findings indicate that the Dutch APCP shows sufficient psychometric properties for some but not all aspects of the measure.
Physical & Occupational Therapy in Pediatrics 03/2013; · 1.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Purpose: To determine the feasibility of the Clinical Nursing Rehabilitation Stroke-guideline (CNRS-guideline) in the care of stroke patients in terms of the experiences, views and attitudes of nurses towards the guideline and their adoption of the guideline and how often the recommendations were used. Method: A four phase cross sectional design was used. Demographic data were collected from nurses (n=30) and patients (n=105). After each test phase the nurses received questionnaires about their experiences of the guideline including questions about their attitude towards the guideline and adoption of the guideline. Also, how often the recommendations were used was registered. Results: The nurses' general impression of the recommendations scored a median of 6.0. A majority of the nurses indicated that the aims of the guideline were clear, that it provided new insights into stroke care. Among the challenges experienced were lack of knowledge and skills and organizational difficulties. Half of the nurses adopted the guideline and the nurses' attitude towards the guideline scored a median of 6.0. Conclusion: The guideline provides nurses with an important means for evidence based care for patients with stroke. The guideline was feasible for nurses to use but various challenges need ongoing attention when planning implementation. [Box: see text].
Disability and Rehabilitation 10/2012; · 1.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Purpose: To describe the prevalence of secondary health conditions (SHCs) (urinary tract and bowel problems, pressure ulcers, spasticity, musculoskeletal and neuropathic pain, sexual dysfunction, respiratory and cardiovascular disorders) in persons with long-term spinal cord injury (SCI), and to explore the impact of SHCs on fitness, active lifestyle, participation and well-being. Methods: A time since injury (TSI)-stratified cross-sectional study among 300 persons between 28- and 65-year-old with a SCI for at least 10 years. Strata of TSI are 10-19, 20-29, and 30 or more years. All eight Dutch rehabilitation centres with a SCI unit will participate. Participants will be invited for a 1-day visit to the rehabilitation centre for an aftercare check-up by the local SCI rehabilitation physician (neurological impairment, SHCs and management), physical tests by a trained research assistant (lung function, wheelchair skills, physical capacity), and they will be asked to complete a self-report questionnaire in advance. Results: Not applicable. Conclusion: This study will provide knowledge on the health status and functioning of persons aging with SCI living in the Netherlands. This knowledge will help us to develop predictive models for the occurrence of SHCs and to formulate guidelines to improve health care for persons with long-term SCI. [Box: see text].
Disability and Rehabilitation 09/2012; · 1.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Stroke is a major cause of disability in the Western world. Its long-term consequences have a negative impact on the quality of life of both the patients and their partners. AIM: The aim of the Restore4Stroke Cohort study is to investigate the changes in quality of life of stroke patients and their partners over time, and to determine factors predicting quality of life in several domains, especially personal and environmental factors. METHOD: Multicentre prospective longitudinal cohort study. Inclusion and the first assessment take place during hospital stay in the first week post-stroke. Follow-up assessments take place at two months, six months, one year, and two years post-stroke. Recruitment of 500 patients from stroke units in six participation hospitals is foreseen. If the patient has a partner, he or she is also asked to participate in the study. OUTCOMES: The main outcome is quality of life, considered from a health-related quality of life and domain-specific quality of life perspective. Factors predicting long-term quality of life will be determined by taking into account the health condition (pre-stroke health condition and stroke-related health condition), personal factors (e.g. coping and illness cognitions), and environmental factors (e.g. caregiver burden and social support). DISCUSSION: This study is expected to provide information about the changes in quality of life of stroke patients and their partners over time. Furthermore, the identification of factors predicting quality of life can be used to improve rehabilitation care and develop new interventions for stroke patients and their partners.
International Journal of Stroke 09/2012; · 2.38 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although poststroke depression has a significant impact on a patient's ability to recover after stroke, it is generally not recognized. Structured screening can help nurses identify symptoms of depression in stroke patients. In clinical practice, the utility of an instrument is as importantas its validity and reliability.
To investigate the reliability, validity, and clinical utility of the nine-item and two-item patient health questionnaires (PHQ-9 and PHQ-2, respectively) in stroke patients in a clinical nursing setting. The results of these questionnaires will be compared against those from the Geriatric Depression Scale.
The PHQ-9 was administered by 43 ward nurses in 55 patients with an intracerebral hemorrhage or ischemic infarction who were able to communicate adequately. The interrater reliability, test-retest reliability and internal consistency, concurrent validity, diagnostic accuracy, and clinical utility were evaluated.
The interrater reliability (intraclass correlation [ICC] = 0.98, 95% CI [0.96, 0.99]), test-retest reliability (ρ(Sp) = 0.75, p < .001), and internal consistency (Cronbach's α = 0.79) of the PHQ-9 were good. The concurrent validity was moderate for the PHQ-9, with a Pearson's correlation of .7 (p < .001) and acceptable for the PHQ-2 with a Pearson's correlation of .8 (p < .01). The optimum cutoff point of the PHQ-9 for major depression was 10 (sensitivity, 100%; specificity,86%; positive predicted value, 50%; and negative predicted value, 100%). For the PHQ-2, the optimum cutoff point was 2 (sensitivity, 100%; specificity, 77%; positive predicted value, 38%; and negative predicted value, 100%).
The PHQ is a brief and easy-to-use instrument for nursing practice. It shows good reliability, validity, and clinical utility when used in stroke patients who are able to communicate adequately.
Nursing research 06/2012; 61(5):333-41. · 1.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home.
Randomised controlled trial with follow-up to 24 weeks.
Multicentre trial in nine outpatient rehabilitation centres in the Netherlands
Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic. Patients were randomly allocated to circuit training or usual physiotherapy, after stratification by rehabilitation centre, with an online randomisation procedure.
Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks. The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency. The control group received usual outpatient physiotherapy.
The primary outcome was the mobility domain of the stroke impact scale (SIS, version 3.0). Secondary outcomes were standing balance, self reported abilities, gait speed, walking distance, stair climbing, instrumental activities of daily living, fatigue, anxiety, and depression. Differences between groups were analysed according to the intention to treat principle. All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks.
126 patients were included in the circuit training group and 124 in the usual care group (control), with data from 125 and 117, respectively, available for analysis. One patient from the circuit training group and seven from the control group dropped out. Circuit training was a safe intervention, and no serious adverse events were reported. There were no significant differences between groups for the stroke impact scale mobility domain (β=0.05 (SE 0.68), P=0.943) at 12 weeks. Circuit training was associated with significantly higher scores in terms of gait speed (0.09 m/s (SE 0.02), P<0.001), walking distance (20.0 m (SE 7.4), P=0.007), and modified stairs test (-1.6 s (SE 0.7), P=0.015). There were no significant differences between groups for the other secondary outcomes, except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale. With the exception of gait speed (-0.04 m/s (SE 0.02), P=0.040), there were no significant differences between groups at follow-up.
Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient.
Dutch Trial Register (NTR1534).
BMJ (Clinical research ed.). 01/2012; 344:e2672.
-
[show abstract]
[hide abstract]
ABSTRACT: To clarify relationships between activities, participation, mental health, and life satisfaction in persons with spinal cord injury (SCI) and specify how personal factors (self-efficacy, neuroticism, appraisals) interact with these components. We hypothesized that (1) activities are related directly to participation, participation is related directly to mental health and life satisfaction, and mental health and life satisfaction are 2 interrelated outcome variables; and (2) appraisals are mediators between participation and mental health and life satisfaction, and self-efficacy and neuroticism are related directly to mental health and life satisfaction and indirectly through appraisals.
Follow-up measurement of a multicenter prospective cohort study 5 years after discharge from inpatient rehabilitation.
Eight Dutch rehabilitation centers with specialized SCI units.
Persons (N=143) aged 18 to 65 years at the onset of SCI.
Not applicable.
Mental health was measured by using the Mental Health subscale of the 36-Item Short Form Health Survey and life satisfaction with the sum score of "current life satisfaction" and "current life satisfaction compared with life satisfaction before SCI."
Structural equation modeling showed that activities and neuroticism were related to participation and explained 49% of the variance in participation. Self-efficacy, neuroticism, and 2 appraisals were related to mental health and explained 35% of the variance in mental health. Participation, 3 appraisals, and mental health were related to life satisfaction and together explained 50% of the total variance in life satisfaction.
Mental health and life satisfaction can be seen as 2 separate but interrelated outcome variables. Self-efficacy and neuroticism are related directly to mental health and indirectly to life satisfaction through the mediating role of appraisals.
Archives of physical medicine and rehabilitation 01/2012; 93(1):82-9. · 2.18 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The early detection of poststroke depression is essential for optimizing recovery after stroke. A prospective study was conducted to investigate the diagnostic value of the 9-item and the 2-item Patient Health Questionnaire (PHQ-9, PHQ-2).
One hundred seventy-one consecutive patients with stroke who could communicate adequately were included. In the 6th to 8th weeks after stroke, depression was measured using the PHQ-9 and PHQ-2 and diagnosed using the Composite International Diagnostic Interview.
Of the participating patients, 20 (12.2%) were depressed. The PHQ-9 performed best at a score ≥10, a sensitivity of 0.80 (95% CI, 0.62-0.98), and a specificity of 0.78 (95% CI, 0.72-0.85) and the PHQ-2 at a score ≥2 with a sensitivity of 0.75 (95% CI, 0.56-0.94) and a specificity of 0.76 (95% CI, 0.69-0.83). Administering the PHQ-9 only to patients who scored ≥2 on the PHQ-2 improved the identification of depression (sensitivity, 0.87; 95% CI, 0.69-1.04).
The diagnostic value is acceptable to good for PHQ-9 scores ≥10 and PHQ-2 scores ≥2. Conducting a PHQ-9 only in patients with a PHQ-2 score ≥2 generates the best results.
Stroke 12/2011; 43(3):854-6. · 5.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To analyze changes in life satisfaction (LS) scores over time in persons with spinal cord injury (SCI) and to interpret what these changes mean.
Multicenter, prospective cohort study of persons with SCI (n = 96) classified into 3 life satisfaction trajectories identified earlier. Assessment took place 6 times from the start of active rehabilitation up to 5 years after discharge. Three LS scores were compared: (1) LS 'now' score, (2) 'comparison' score between LS 'now' and LS 'before the SCI', and (3) retrospective score of LS 'before the SCI'.
Persons in the low LS trajectory showed increase in the LS 'now' score, but not in the LS 'comparison' score and retrospective score. Persons in the recovery trajectory showed increase in the LS 'now' and LS 'comparison' scores, but not in the retrospective score. Persons in the high LS trajectory showed increase in the 'comparison' LS score and decrease in the retrospective score, but no change in the LS 'now' score.
Diverging patterns of change were found and that were interpreted as adaptation or scale recalibration. Recalibration could also be considered healthy rebalancing after SCI. Being able to compare different LS ratings can facilitate the interpretation of change in and stability of LS.
Quality of Life Research 11/2011; 21(9):1499-508. · 2.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Many people with spinal cord injury (SCI) rate chronic neuropathic pain as one of the most difficult problems to manage. The aim of the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI. The intervention consisted of educational, cognitive, and behavioral elements. A total of 61 people were randomized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers. Primary outcomes were pain intensity and pain-related disability (Chronic Pain Grade questionnaire), and secondary outcomes were mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Measurements were performed at baseline, and at 3, and 6 months follow-up. The primary statistical technique was random coefficient analysis. The analyses showed significant changes over time on both primary (t1-t2), and 2 out of 4 secondary outcomes (both t1-t2 and t1-t3). Significant intervention effects (Time*Group interactions) were found for anxiety and participation in activities, but not for the primary outcomes. Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group: decrease of pain intensity, pain-related disability, anxiety, and increase of participation in activities. This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain.
Pain 11/2011; 153(1):120-8. · 5.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To systematically review the research on stroke patients' and caregivers' educational needs.
A search of the literature prior to and including the year January 2009 was conducted using Medline, CINAHL, EMBASE, PsychINFO and the Cochrane Library, yielding 959 articles. Of these, 21 studies were included in the review.
Stroke patients and caregivers reported many and diverse educational needs, which often were not met. The educational needs of stroke patients and caregivers concerned knowledge about the clinical aspects of stroke, prevention, treatment and functional recovery. The most commonly reported needs of caregivers involved patients' moving and lifting, exercises, psychological changes and nutritional issues. Patients and caregivers wanted information that was tailored to their situation.
Patients and caregivers have many unmet educational needs. The findings call for improved education of patients and caregivers on various issues that are specific to the various recovery phases after stroke.
The findings of this review can be used to develop educational interventions for stroke patients and caregivers. Further research is needed to investigate the feasibility and effects of educational interventions and whether they meet the educational needs of patients and caregivers.
Patient Education and Counseling 10/2011; 85(1):14-25. · 2.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To describe the course of life satisfaction in persons with spinal cord injury (SCI) during the first 5 years after discharge from inpatient rehabilitation and to examine its determinants.
Multi-centre prospective cohort study with four measurements, the first at discharge from inpatient rehabilitation, the last 5 years after discharge. Data of 162 persons with SCI were analyzed. Life satisfaction was measured as the sum score of 'current life satisfaction' and 'current life satisfaction compared to life satisfaction before SCI'. Lesion characteristics, functional independence, secondary impairments, pain, social support and self-efficacy were analyzed as possible determinants of life satisfaction. Random coefficient analysis was used for the analyses. Results: No significant changes in life satisfaction were found between discharge and 2 years later, however there were significant increases from two to 5 years post discharge. High functional independence, low pain, high everyday social support and high self-efficacy were significant determinants of a positive course of life satisfaction after discharge.
Increases in life satisfaction were found in persons with SCI in the long run. High functional status, low pain, good social skills and high self-efficacy were related to high life satisfaction.
Disability and Rehabilitation 08/2011; 34(1):76-83. · 1.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the responsiveness of Goal Attainment Scaling compared with the Pediatric Evaluation of Disability Inventory (PEDI) and the 66-item Gross Motor Function Measure (GMFM-66) in multidisciplinary rehabilitation practice.
Observational study. Pretest-posttest design.
Twenty-three children with cerebral palsy, aged 2-13 years.
Goal Attainment Scaling, PEDI and GMFM-66 assessments were performed before and after six months of treatment. Physical, occupational and speech therapists constructed and scored 6-point Goal Attainment Scaling scales meeting predetermined criteria, describing the main functional goal per discipline. The contents of the three measures were compared using International Classification of Functioning, Disability and Health child and youth version (ICF-CY) codes. Spearman's rho correlations between Goal Attainment Scaling change scores per discipline and change scores obtained with the PEDI functional skills scales and GMFM-66 were calculated. Complete goal attainment was compared with significant change in terms of the standardized measures.
Twenty per cent of the Goal Attainment Scaling items were not covered by items of the PEDI or the GMFM-66. Inconclusive correlations were found between Goal Attainment Scaling and PEDI change scores (r 0.28-0.64). Even after exclusion of the non-corresponding items, correlations were moderate (r 0.57-0.73). Of 39/64 Goal Attainment Scaling scales scored as complete goal attainment, 16 individual PEDI scores did not show change on the corresponding scale. Low correlation was found between Goal Attainment Scaling change scores and GMFM-66 change scores.
Goal Attainment Scaling, PEDI and GMFM-66 were complementary in their ability to measure individual change over time in children with cerebral palsy. Using only the standardized instruments could have caused many individual rehabilitation goals actually attained being missed in the outcome evaluation.
Clinical Rehabilitation 07/2011; 25(12):1128-39. · 2.12 Impact Factor
-
Annerieke C van Groenestijn,
Ingrid G L van de Port,
Carin D Schröder,
Marcel W M Post,
Hepke F Grupstra,
Esther T Kruitwagen,
Harmen van der Linde,
Reinout O van Vliet,
Margreet G H van de Weerd,
Leonard H van den Berg, Eline Lindeman
[show abstract]
[hide abstract]
ABSTRACT: Amyotrophic lateral sclerosis (ALS) is a fatal progressive neurodegenerative disorder affecting motor neurons in the spinal cord, brainstem and motor cortex, leading to muscle weakness. Muscle weakness may result in the avoidance of physical activity, which exacerbates disuse weakness and cardiovascular deconditioning. The impact of the grave prognosis may result in depressive symptoms and hopelessness. Since there is no cure for ALS, optimal treatment is based on symptom management and preservation of quality of life (QoL), provided in a multidisciplinary setting. Two distinctly different therapeutic interventions may be effective to improve or preserve daily functioning and QoL at the highest achievable level: aerobic exercise therapy (AET) to maintain or enhance functional capacity and cognitive behavioural therapy (CBT) to improve coping style and cognitions in patients with ALS. However, evidence to support either approach is still insufficient, and the underlying mechanisms of the approaches remain poorly understood. The primary aim of the FACTS-2-ALS trial is to study the effects of AET and CBT, in addition to usual care, compared to usual care alone, on functioning and QoL in patients with ALS.
A multicentre, single-blinded, randomized controlled trial with a postponed information model will be conducted. A sample of 120 patients with ALS (1 month post diagnosis) will be recruited from 3 university hospitals and 1 rehabilitation centre. Patients will be randomized to one of three groups i.e. (1) AET + usual care, (2) CBT + usual care, (3) Usual care. AET consists of a 16-week aerobic exercise programme, on 3 days a week. CBT consists of individual psychological support of patients in 5 to 10 sessions over a 16-week period. QoL, functioning and secondary outcome measures will be assessed at baseline, immediately post intervention and at 3- and 6-months follow-up.
The FACTS-2-ALS study is the first theory-based randomized controlled trial to evaluate the effects, and the maintenance of effects, of AET and CBT on functioning and QoL in patients with ALS. The results of this study are expected to generate new evidence for the effect of multidisciplinary care of persons with ALS.
Dutch Trial Register NTR1616.
BMC Neurology 06/2011; 11:70. · 2.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to examine professionals' perceptions on classifying learning styles in the context of teaching motor activities to children and adolescents with cerebral palsy (CP). The participants were 21 pediatric physical therapists (PPTs) and seven physical educators (PEs) in three schools for special education in The Netherlands. All participants were introduced to the key descriptions of two existing learning style instruments (Kolb's Learning Style Inventory and Myers-Briggs Type Indicator), applied them to children and adolescents with CP, and reported their perceptions in written surveys. This study had a mixed-methods design. Quantitative and qualitative data analyses showed that PPTs and PEs are mostly positive about the idea of classifying learning styles in the context of teaching motor activities to children and adolescents with CP, giving three main reasons: individual approach, professional communication, and treatment awareness. Additionally, qualitative data analysis showed that the key descriptions of the two learning style instruments were not feasible as classifications for children and adolescents with CP. It is therefore recommended that other learning style classification instruments should be explored and that possibly a new learning style classification instrument should be developed in the context of teaching motor activities to children and adolescents with CP.
Physical & Occupational Therapy in Pediatrics 05/2011; 31(4):403-12. · 1.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To identify different life satisfaction trajectories in the period between the start of active spinal cord injury (SCI) rehabilitation and 5 years after discharge, and to find predictors for distinguishing between trajectories. The hypotheses were that different life satisfaction trajectories would be identified and that demographic, lesion, physical, and social characteristics would be predictors of life satisfaction trajectory membership.
Multicenter prospective cohort study with measurements at the start of active rehabilitation, after 3 months, at discharge, and 1, 2, and 5 years after discharge.
Eight Dutch rehabilitation centers with specialized SCI units.
Persons (N=225) with recently acquired SCI between the ages of 18 and 65 years were included, and data from 206 persons were analyzed.
Not applicable.
Life satisfaction was measured as the sum score of "current life satisfaction" and "current life satisfaction compared with life satisfaction before SCI" (range, 2-13).
Five life satisfaction trajectories were identified by using latent class growth mixture modeling: (1) low median scores (3-5) at all time points (27%), (2) intermediate scores (6-7) at all time points (31%), (3) high scores (8-10.5) at all time points (17%), (4) improvements from 3 to 9 (23%), and (5) deterioration from 9 to 4 (2%). Logistic regression showed that predictors of the low versus high life satisfaction trajectory were functional independence and pain. Predictors of the low life satisfaction versus the recovery trajectory were sex and functional independence. These predictors explained only a small part of the total variance.
Life satisfaction in people with SCI follows distinct trajectories. Monitoring life satisfaction at the start of active rehabilitation and 3 months later might allow identification of persons at risk for poor long-term adjustment.
Archives of physical medicine and rehabilitation 02/2011; 92(2):207-13. · 2.18 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Research reports have described the contents of therapy in spinal cord injury (SCI) rehabilitation only as the total number of therapy hours. We developed the Spinal Cord Injury-Interventions Classification System (SCI-ICS) as a tool to classify therapy to improve mobility and self-care into 3 levels (body functions, basic activities, and complex activities) and 25 categories.
The purposes of this study were: (1) to compare specific contents and amount of therapy provided, with the aim of improving mobility and self-care for people with SCI in Australia, Norway, and the Netherlands and (2) to evaluate the use of the SCI-ICS outside the Netherlands.
This was a prospective, descriptive study.
Physical therapists, occupational therapists, and sports therapists in 6 centers recorded all therapy provided to all people with a recent SCI in inpatient rehabilitation during 4 designated weeks. Each treatment session was classified using 1 or more SCI-ICS codes. Duration of each intervention was specified.
Seventy-three therapists recorded 2,526 treatments of 79 people with SCI (Netherlands, 48; Australia, 20; Norway, 11). Most therapy time was spent on exercises (overall mean=84%) and on categories at body function and basic activity level of the SCI-ICS. Therapy time significantly differed among countries for 13 of 25 categories. Mean time in minutes per treatment (Netherlands, 28; Australia, 43; Norway, 39) and in hours per patient per week (Netherlands, 4.3; Australia, 5.8; Norway, 6.2) differed significantly.
The short period and small number of patients may have influenced the results.
Therapy in inpatient SCI rehabilitation in all 3 countries focused on mobility and self-care exercises at body function and basic activity level, but differences were present in focus on the various categories and therapy time. The SCI-ICS can be used reliably to describe therapy in different countries.
Physical Therapy 02/2011; 91(2):210-24. · 3.11 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To describe the contents of interventions to improve self-care and mobility for patients with spinal cord injury (SCI) in early post-acute rehabilitation, using the Spinal Cord Injury-Interventions Classification System (SCI-ICS), and to compare these interventions between rehabilitation centres. The SCI-ICS describes therapy to improve self-care and mobility at three levels of functioning and consists of 25 categories with a total of 139 different interventions.
Fifty-three physical therapists, occupational therapists and sports therapists of three Dutch SCI rehabilitation centres recorded interventions with the SCI-ICS for patients with SCI in early post-acute rehabilitation for four consecutive weeks.
Therapists recorded 1640 treatment sessions of 48 patients with a SCI. The mean number of treatment sessions per patient per week (8.9 overall) differed between centres (p < 0.05), unlike the mean therapy time in minutes per patient per week (259 overall). Highest frequencies for individual categories were found for 'Muscle Power', 'Walking', and 'Hand rim wheelchair propulsion'.
We described the specific contents of therapy of patients with a SCI in three Dutch rehabilitation centres. The largest proportion of time was spent on interventions to improve muscle power, walking, and hand rim wheelchair propulsion.
Disability and Rehabilitation 01/2011; 33(5):412-22. · 1.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This systematic review explores the nursing role in the management of poststroke depression and identifies effective non-pharmacological interventions that nurses can use in the daily care of patients with stroke.
Depression is a common complication poststroke and affects one-third of patients with stroke. It has a negative impact on functional recovery and social activities and is associated with increased morbidity and mortality. Detection and diagnosis of poststroke depression is inconsistent, and many depressed patients are under-treated. Although nurses recognise that observation and assessment are parts of their role in rehabilitation care, little is known about their role in assessing depression or the interventions they can use.
A systematic review was conducted using the Cochrane method.
Literature for the period 1993-2008 was searched in the electronic databases of CINAHL, Medline (PubMed), Nursing Journals (PubMed) and PsycINFO using the following keywords: cerebrovascular accident, stroke, depression, poststroke depression, treatment, therapy, treatment outcome, management.
Fifteen articles and one systematic review were identified. There was strong evidence that information provision reduces the severity of depression. Other interventions with positive effects on the occurrence or severity of poststroke depression were as follows: life review therapy, motivational interviewing, a specific nursing support programme and physical exercise.
Depression after stroke is an important problem with adverse effects on the patient's ability to participate in rehabilitation and on rehabilitation outcome. The interventions described can be implemented in nursing care of patients with poststroke depression. The variety of such interventions and the diversity of their nature and design are consistent with the practice of rehabilitation nursing.
The findings of this review enable nurses to intervene effectively to reduce the occurrence and severity of depression in patients with stroke.
Journal of Clinical Nursing 12/2010; 19(23-24):3274-90. · 1.12 Impact Factor
