The Self-Regulation Assessment (SeRA) questionnaire: development and exploratory analyses of a new patient-reported outcome measure for rehabilitation.

PURPOSE: To develop and explore underlying dimensions of the Self-Regulation Assessment (SeRA) and psychometric features of potential components. Further, to identify associations between the SeRA and disability-management self-efficacy, type of diagnosis, and type of rehabilitation. MATERIALS AND METHODS: Based on a previously developed model of self-regulation, expert and patient opinions, and cognitive interviews, a list of 22 items on self-regulation (the SeRA) was constructed. The SeRA was included in a cross-sectional survey among a multi-diagnostic group of 563 former rehabilitation patients. Exploratory analyses were conducted. RESULTS: Respondents had a mean age of 56.5 (SD 12.7) years. The largest diagnostic groups were chronic pain disorder and brain injury. Four components were found within the SeRA, labelled as "insight into own health condition," "insight into own capabilities," "apply self-regulation," and "organization of help." Cronbach's alpha was high (total scale: 0.93, subscales: range 0.85-0.89). Only scores on the first subscale showed a ceiling effect. Subscale three showed the highest correlation with a self-efficacy measure. Small differences in SeRA total scores (range 71.6-78.1) were found between different diagnostic groups. CONCLUSION: The SeRA is a new self-regulation measure with four subscales. Further research is needed to establish the validity and reliability of the SeRA. IMPLICATIONS FOR REHABILITATIONThe Self-Regulation Assessment (SeRA) was developed to provide a comprehensive measurement of self-regulation among rehabilitation populations.The SeRA could potentially be used to identify persons with self-regulation problems at the start of rehabilitation treatment and measure outcomes of rehabilitation for self-regulation.The SeRA could potentially be used to help analyse outcomes of rehabilitation practice as well as evaluate interventions on self-regulation.

Post-traumatic stress disorder in patients 3 years after aneurysmal subarachnoid haemorrhage.

BACKGROUND: Subarachnoid haemorrhage (SAH) from a ruptured intracranial aneurysm accounts for approximately 5% of all strokes. Post-traumatic stress disorder (PTSD) is common in the early phase after recovery from aneurysmal SAH. The aim of our study was to examine the prevalence of PTSD 3 years after SAH, its predictors, and relationship with health-related quality of life (HRQoL) in patients living independently in the community. METHODS: From a prospectively collected cohort of 143 patients with aneurysmal SAH who visited our outpatient clinic 3 months after SAH, 94 patients (65.7%) completed a mailed questionnaire 3 years after SAH. We assessed PTSD with the Impact of Event Scale and HRQoL with the Stroke-Specific Quality of Life Scale (SS-QoL). The χ(2) and t tests were used to investigate if patients who returned the questionnaires were different from those who did not reply. Non-parametric tests (χ(2) and Mann-Whitney tests) were used to test for differences between patients with and without PTSD. Relative risks and 95% confidence intervals were calculated. RESULTS: No relevant differences in demographic (age, sex, education) or SAH characteristics (clinical condition on admission, complication, location of aneurysm, Glasgow Outcome Scale score at 3 months) were seen between participants and drop-outs. In 24 patients (26%), Impact of Event Scale scores indicated PTSD. Passive coping style (relative risk, 5.7; 95% confidence interval, 2.1-15.3), but none of the demographic or SAH-related factors, predicted PTSD. The mean SS-QoL total score was 4.2 (SD 1.1), indicative of a relatively satisfactory HRQoL. PTSD was associated with lower HRQoL (p < 0.001), a mean SS-QoL score of 4.4 (SD 1.0) without PTSD, and a mean SS-QoL score of 3.5 (SD 1.1) with PTSD. CONCLUSIONS: Even 3 years after SAH, 1 out of 4 patients had PTSD, which was associated with reduced HRQoL. Passive coping style was the most important predictor. There is a need to organize SAH care with more attention to and treatment of PTSD. Strategies shown to reduce PTSD in other conditions should be tested for effectiveness in SAH patients.

Determinants of health-related quality of life after aneurysmal subarachnoid hemorrhage: a systematic review.

BACKGROUND AND PURPOSE: Many persons with subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm recover to functional independence but nevertheless experience reduced quality of life (QoL). The aim of this study was to summarize the evidence on determinants of reduced QoL in this diagnostic group. METHODS: Databases PubMed, PsychINFO, and CINAHL were used to identify empirical studies reporting on quantitative relationships between possible determinants and QoL in persons with aneurysmal SAH and published in English. Determinants were classified using the International Classification of Functioning, Disability and Health (ICF). RESULTS: Twenty studies met the inclusion criteria for this review, in which 13 different HRQoL questionnaires were used. Determinants related to Body Structure & Function (clinical condition at admission, fatigue, and disturbed mood), Activity limitations (physical disability and cognitive complaints), and Personal factors (female gender, higher age, neuroticism, and passive coping) are consistently related to worse HRQoL after aneurysmal SAH. Treatment characteristics were not consistently related to HRQoL. CONCLUSION: This study identified a broad range of determinants of HRQoL after aneurysmal SAH. The findings provide clues to tailor multidisciplinary rehabilitation programs. Further research is needed on participation, psychological characteristics, and environmental factors as determinants of HRQoL after SAH.

Predictors of long-term health-related quality of life in patients with aneurysmal subarachnoid hemorrhage.

OBJECTIVE: To determine the predictive value of physical and psychological factors assessed three months after aneurysmal subarachnoid hemorrhage (SAH) for health-related quality of life (HRQoL) one year after the SAH. DESIGN: Prospective cohort study. SUBJECTS: Patients with SAH (n=113) who visited our SAH-outpatient clinic three months after SAH and who were living independently in the community one year after SAH. METHODS: HRQoL was evaluated using the Stroke Specific Quality of Life scale (SS-QoL). We used Spearman correlations, Somers'd, and linear regression analyses. Independent variables were demographic and SAH characteristics, cognitive and emotional complaints, depressive symptoms, anxiety, cognitive functioning, and passive coping style. RESULTS: In the regression analysis, female gender (beta value -0.17), cognitive complaints (-0.31 ), cognitive functioning (0.40) and passive coping style (-0.23) were independent predictors, and together explained 45.9% of the variance of the SS-QoL total score. CONCLUSION: Female gender, cognitive complaints, cognitive functioning and passive coping style assessed at 3 months after SAH are important predictors of HRQoL 1 year after SAH. Early interventions to improve cognitive and emotional functioning should be evaluated for their ability to improve long-term HRQoL after SAH.

Predicting fatigue 1 year after aneurysmal subarachnoid hemorrhage.

Fatigue is an important contributor to quality of life in patients who survive aneurysmal subarachnoid hemorrhage (SAH), but the determinants of this fatigue are unclear. We assessed the occurrence of fatigue 1 year after SAH and its relation to physical or cognitive impairment, passive coping, and emotional problems, measured 3 months after SAH. This was a prospective cohort study of 108 patients who visited our SAH outpatient clinic 3 months after SAH and who were living independently in the community 1 year after SAH. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Analysis of variance was used to analyze the data. Fatigue (FSS ≥ 4) was present in 77 patients (71%). Mean FSS scores were 4.1 (SD 1.6) in the group of patients having 'neither physical nor cognitive impairment,' 5.2 (1.4) having 'either physical or cognitive impairment,' and 5.9 (0.9) having 'both physical and cognitive impairments.' Mean FSS scores were higher in patients scoring high on passive coping (85 vs. 58%; RR 1.46, 95% CI 1.13-1.87), anxiety (84 vs. 55%; RR 1.53, 95% CI 1.17-2.02), or depression (85 vs. 62%; RR 1.36, 95% CI 1.08-1.72) than in patients without these complaints. Relationships between these complaints and FSS scores were higher in patients having neither physical nor cognitive impairments than in patients having physical or cognitive impairments. Fatigue is common after SAH and is related to physical and cognitive impairments. In patients with neither physical nor cognitive impairments, passive coping style and emotional problems are important predictors of fatigue.

Prevalence and determinants of cognitive complaints after aneurysmal subarachnoid hemorrhage.

BACKGROUND: To investigate the prevalence of cognitive complaints after subarachnoid hemorrhage (SAH) and the relationships between cognitive complaints and cognitive impairments, disability and emotional problems. METHODS: Cognitive complaints were assessed with the Checklist for Cognitive and Emotional Consequences following stroke (CLCE-24) in 111 persons who visited our outpatient clinic 3 months after SAH. Associations between cognitive complaints and cognitive functioning, demographic characteristics, disability and emotional problems were examined using Spearman correlations and linear regression analysis. RESULTS: In this study group, 105 patients (94.6%) reported at least one cognitive or emotional complaint that hampered everyday functioning. The most frequently reported cognitive complaints were mental slowness, short-term memory problems and attention deficits. All cognitive domains, disability, depressive symptoms and feelings of anxiety were significantly associated with the CLCE-24 cognition score. In the final regression model, memory functioning (beta value -0.21), disability (-0.28) and depressive symptoms (0.40) were significant determinants of cognitive complaints, together explaining 35.4% of the variance. CONCLUSION: Cognitive complaints are common after SAH and associated with memory deficits, disability and depressive symptoms. Rehabilitation programs should focus on these symptoms and deficits.

Basilar migraine with severe EEG abnormalities.

We report a patient suffering from a series of attacks fulfilling the criteria of basilar migraine. During the attack there was no normal EEG background pattern and the EEG showed predominantly delta activity. After the attack the EEG returned to (nearly) normal in a very short time. Up to now no such EEG findings have been reported in basilar migraine.

Prevalence of silicosis in the Dutch fine-ceramic industry.

In the nineteen-seventies a cross-sectional survey was conducted in the Dutch fine-ceramic industry. Workers employed in the ceramic industry (n = 3258) were examined for the presence of silicosis. In this article the results are reported for the area of Gouda and Maastricht. In Gouda the fine-ceramic industry consists of small workshops. The Maastricht working population comprises workers of two large, mechanized companies. The survey indicated that silicosis is still commonly present in Gouda (total prevalence of 13.3%), but is relatively rare in Maastricht (total prevalence of 1.7%). A clear dose-response relationship was found in both areas between duration of exposure to quartz-containing dust and the prevalence of silicosis. Furthermore it was noted that smoking was a risk factor for silicosis. However, this was restricted to workers who were heavy smokers and had had an occupational history of 20 years or more of exposure to quartz-containing dust. In this exposure category the prevalence of silicosis among heavy smokers was 50% higher than in light smokers and non-smokers.