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@#A significant percentage of stroke survivors are reported to have anxiety and depression. Autogenic Relaxation Training (ART), a psychophysiological self-control therapy which aims to induce relaxation proved to be effective in reducing the anxiety and depression in some health conditions. However, there is lack of studies which evaluated the effects of ART in the rehabilitation of stroke survivors. The aim of this experimental pilot study is to evaluate the feasibility and outcomes of ART in addition to usual physiotherapy for stroke survivors. A total of 14 sub-acute stroke survivors from a teaching hospital were enrolled in this study. All participants received 20 minutes ART followed by 40 minutes usual physiotherapy once a week and they were requested to carry out the intervention at home for twice per week, for six weeks. Intervention outcomes were assessed using Hospital Anxiety and Depression Scale (HADS-A and HADS-D), Barthel Index (BI), Timed Up and Go (TUG) and EuroQol 5-Dimension 5 Levels (EQ5D5L). Changes in all outcome measures were analysed using paired t-test and Wilcoxon signed rank test, with level of significance set at p<0.05. Post-intervention, there is statistically significant reduction of the HADS-A (p=0.04), HADS-D (p=0.02), TUG (p=0.004) and EQ5D5L (p=0.03) scores of the participants. Although not statistically significant, the mean score ± SD of BI increased from 95 ± 12.5 to 100 ± 6.25. The intervention is feasible and acceptable by the stroke survivors with no adverse events reported. In conclusion, ART in addition to usual physiotherapy is feasible and beneficial in reducing anxiety and depression, and improving functional ability, mobility and quality of life among stroke survivors.
ABSTRACT
@#The Quality of Life-Alzheimer’s Disease (QOL-AD) questionnaire is a reliable, valid and popular outcome measure in dementia related studies. However, to date there is no published report on adopted version of QOL-AD in Malay language. Thus this preliminary study aimed to evaluate the reliability and validity of the QOL-AD in Malay language for patients with dementia and to examine the level of agreement between patient-caregiver as a proxy reports on patient’s quality of life. A total of 65 patients with mild to moderate dementia and their caregivers were recruited from the psycho-geriatric clinic, Universiti Kebangsaan Malaysia Medical Centre using a cross sectional study design. The QOL-AD was translated into Malay language using the standard guidelines for cross-cultural adaptation of measure. The patient-caregiver dyads completed the QOL-AD in Malay language separately. Test-retest and internal consistency was evaluated for reliability and construct validity was tested with principal component factor analysis. The reliability of QOL-AD in Malay language was good with Cronbach alpha coefficients of 0.82 and 0.79 and intraclass correlation coefficients of 0.77 and 0.89 for patients and caregivers report respectively. Meanwhile a positive moderate agreement was achieved between patient and caregiver rating (r=0.60, p<0.01). The principal component factor analysis extracted 4 factors for both patient and caregiver reports which explained 66.02% (patients’ report) and 64.24% (caregivers’ report) of the total variance of the scale. As a conclusion, the QOL-AD in Malay language is a reliable and valid tool to measure the quality of life of people with mild to moderate dementia.
ABSTRACT
@#The quality of relationship between a person with dementia and a family caregiver has been identified as one of important factor in informal dementia care. Currently there is no validated questionnaire to measure the dyadic relationship in Malaysia. The aim of present study is to examine the reliability and validity of Quality of the PatientCaregiver Relationship (QCPR) questionnaire in Malay version. A total of 70 patients with mild to moderate dementia and their caregivers were recruited from the psychogeriatric clinic, Universiti Kebangsaan Malaysia Medical Centre using a cross sectional study. The QCPR questionnaire was translated into Malay following the standard guidelines for crosscultural adaptation of measure. The person with dementia and their caregiver completed the QCPR Malay version separately. Internal consistency and test-retest examined for reliability. Construct validity was tested with principal component factor analysis. The reliability of patient QCPR Malay version was good with Cronbach’s alpha coefficients of 0.86 and intraclass correlation coefficients of 0.85. Item 11 was omitted from the caregiver QCPR Malay version due to its poor correlation with the corrected item-total score. The newly formed scale, 13 items caregiver QCPR Malay version, had satisfactory reliability (Cronbach’s alpha 0.89 and intraclass correlation coefficients 0.91). Principal component factor analysis extracted 4 factors for patient version and 3 factors for caregiver version which explained 69.44% (patients’ report) and 61.20% (caregivers’ report) of the total variance of the scale. As a conclusion, both the patient (14 items) and caregiver (13 items) adapted QCPR Malay version is a reliable and valid tool to measure the quality of dyadic relationship between people with mild to moderate dementia and the caregiver.
Subject(s)
Patient Care , Dementia , Caregivers , Surveys and QuestionnairesABSTRACT
Stroke is a causal factor that commonly caused physical impairments and activity limitations among patients to perform daily activities until at certain level stroke patients will experience disability. The aim of this study is to examine the relationship of each demographic and clinical factors that is believed to associate with physical functioning of patients those who experienced stroke. This present study also try to compare physical functioning of patients with associated factors and then examine the correlation between those factors with physical functioning. A total of 147 respondents that pass for cognitive screening test involved in this study. Barthel Index (ADL) was administered to the respondents after 6 weeks of stroke attack in order to measure their physical functioning status. Results found that there was a significant difference [F(3, 143) = 4.06; p < 0.01] between level of educations with physical functioning of patients. With respect to clinical factors also showed a significant difference (p < 0.01) was higher in physical functioning when stroke attack occurred at right hemisphere of brain. There was a significant difference (p < 0.01) in physical functioning with respect to belief of recovery. Furthermore, number of stroke attack also showed a significant difference [F(1, 145) = 11.19; [p < 0.01] in physical functioning of patients. Correlation test that was carried out found a positive significant correlation (r = 0.24; p < 0.01) between physical functioning with respect to the affected lesion side. In conclusion, demographic and clinical factors also played the roles to determine level of physical functioning among stroke patients and thus these factors should be considered in any studies that intended to enhance physical functioning of patients in future.
Subject(s)
StrokeABSTRACT
Background: The aim of this study was to address the ability of the recovery locus of control scale (RLOC) and post-traumatic stress symptoms (PTSS) to predict physical functioning among stroke patients. In addition, the best predictors within the subdomains of the RLOC and PTSS were also investigated. Methods: A total of 147 stroke patients aged 33–85 years who had intact cognitive functioning were involved in the study. The Recovery Locus of Control Scale (RLOC), the Impact of Event Scale- Revised (IES-R), and the Barthel Index (ADL) were administered to respondents six weeks after stroke. Results: The results showed that the RLOC and PTSS were significant predictors and were capable of predicting 31% of the physical functioning of stroke patients (adjusted R2 = 0.31; P < 0.001). Furthermore, with respect to clinical factors, the affected lesion side contributed to predicting 7% of the physical functioning (R2 = 0.07; P < 0.001). A hierarchical regression analysis found that the internal recovery locus of control (IRLOC) was a predictor capable of explaining 18% of the predicted physical functioning (adjusted R2 = 0.18; P < 0.001). Meanwhile, avoidance was the most influential significant predictor among PTSS, contributing to 24% of the predicting physical functioning (adjusted R2 = 0.24; P < 0.001). Conclusion: In conclusion, the RLOC and PTSS were capable of predicting physical functioning among stroke patients.
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Objective: This study examined the symptoms of PTSD among survivors of the December 26th 2004 Malaysian tsunami disaster, as well as differences among sexes in terms of coping styles and availability of social support. Methods: A total of 64 (28 males and 36 females) respondents from several affected districts of Kuala Muda and Langkawi in Kedah and Batu Maung, Pulau Pinang were recruited through purposive sampling. The Detailed Assessment of Posttraumatic Stress (DAPS) was used to measure the posttraumatic stress disorder/symptoms, while the Social Support Questionnaire and Significant Others Scale (Form A) were used to measure the quality and quantity of social support. The COPE Questionnaire was used to measure two coping styles; adaptive and maladaptive coping. Results: Fifty two (81%) respondents did not fulfill the DAPS-PTSD criteria while only 12 (19%) fulfilled the criteria. There was no significant difference between men and women in terms of posttraumatic stress-total, and the quantity and quality of social support. However, there is a significant difference in adaptive and maladaptive coping styles among victims who fulfill the PTSD diagnosis and those who did not. It was also found that there is no relationship between PTSD symptoms and emotional support, whereas there is a significant relationship between PTSD symptoms and practical support. Conclusion: This research showed that only a small number of respondents fulfilled the diagnosis of PTSD following their experience of a disaster. There were no difference between genders in terms of PTSD symptoms and social support. Among victims who fulfill the PTSD diagnosis and those who do not, there is a significant difference in the adaptive and maladaptive coping styles. As for the relationship between PTSD symptoms and social support, there is a significant relationship between PTSD symptoms and practical support but not with emotional support.
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A preliminary study has been conducted to screen psychogeriatric disorder among elderly. This survey was designed to determine the prevalence of cognitive impairment, stroke and depression in a population sample of 60-89 years old. A total of 40 subjects and informants were selected from the Klang Valley, Kuala Lumpur and Selangor. The screening tools that were used in this survey were Psychogeriatric Assessment Scale (PAS). The Psychogeriatric Assessment Scale (PAS) consists of two sections: the subject’s self report and the informant report. The subject’s self report was used to assess cognitive impairment, stroke and depression. Meanwhile the informant report was used to assess cognitive decline, stroke and behavioral changes in the subject. Results indicated that there was a high percentage cognitive impairment (male 67% case, female 64.3% case) and stroke (male 75% case, female 64.4% case) among elderly. There was also a significant correlation between the subject’s self report and the informant’s report according to PAS each subscale. PAS psychological assessment tool able to screen psychogeriatric problem among elderly and the accuracy of screening ability can be tested with informant report data. Psychogeriatic screening is important to detect early presentation of cognitive impairment and depression among elderly.