Psychological Health in Late Effects of Poliomyelitis: Ten-Year Follow-Up.

BACKGROUND: Individuals with late effects of poliomyelitis (LEoP) cope with various physical and psychological symptoms throughout their entire life which become more severe as they are ageing. OBJECTIVES: To perform a 10-year follow-up of the functional status and levels of psychological health of individuals with LEoP and to examine the associations of hope levels, work status, health perceptions, and life satisfaction with functional and psychological changes. DESIGN: A within-subject 10-year follow-up study. PARTICIPANTS: Eighty-two individuals with LEoP who participated in a previous study 10 years ago. METHODS: Outcome measures included the functional status of individuals with LEoP assessed by the activities of daily living (ADL) questionnaire, emotional distress based on the Global Health Questionnaire (GHQ), hope based on the Hope Scale, life satisfaction as measured by the Satisfaction with Life Scale (SWLS), and subjective health perception. The McNemar test, paired t-test, Spearman's correlation coefficient, and linear regression were used for statistical analysis. RESULTS: The mean age was 66.9 ± 8.5 years with a male-female ratio of 0.52. A significant functional deterioration was noticed during the follow-up years. Yet, the functional deterioration was not associated with changes in psychological health. Psychological health was associated with elevated levels of hope and life satisfaction. Individuals with LEoP who continued to work demonstrated higher psychological health, higher levels of hope, and greater life satisfaction. CONCLUSIONS: Individuals with LEoP demonstrated significant psychological health, manifested in their ability to block emotional distress and maintain life satisfaction despite the deterioration in their functional status. Hope and psychological health were associated with increased life satisfaction. Work appeared to be a significant source of psychological health in this population.

Correlations between Disease Severity and Rehabilitation Outcomes in Patients Recovering from Covid-19 Infection.

OBJECTIVE: Based on long-term follow-up of patients with COVID-19, to evaluate whether the severity of acute COVID-19 infection affects rehabilitation outcomes. DESIGN: Observational cohort study. SUBJECTS: A total of 61 post-acute COVID-19 patients underwent inpatient and outpatient customized rehabilitation treatment. METHODS: The severity of acute COVID-19 infection was measured with the World Health Organization Clinical Progression Scale (WHO-CPS). Motor, cognitive, and functional variables were measured using standard and specified scales 6 months or more after acute illness. RESULTS: Of the 61 subjects, 65.6% had severe disease according to WHO-CPS. Significant improvement was found in activities of daily living functions (Functional Independence Measure (FIM) at admission 103.7 ± 18.9 vs FIM at discharge 118.7 ± 6.8) (p < 0.00). Of participants, 88% were able to wean off oxygen completely. A significant correlation was found between higher WHO-CPS, prolonged acute hospitalization, and days of ventilation were correlated with lower total and motor FIM at admission, but not with cognitive FIM or Montreal Cognitive Assessment (MoCA). No correlation was found between WHO-CPS, prolonged acute hospitalization and day of ventilation and funnctional level at discharge. CONCLUSION: The severity of acute COVID-19 infection affects the functional status of survivors at admission to rehabilitation, but, contrary to expectations, not the functional outcomes at discharge. These findings show that even patients with severe acute COVID-19 infection may improve their daily functioning significantly during rehabilitation program.

Assessing the fear of COVID-19 scale among health care workers in Israel: a psychometric validation study.

We explored the psychometric properties of the Hebrew version of the Fear of COVID-19 (FCV-19S) scale among health care workers in a large medical center in Israel. Participants (N = 705) completed the FCV-19S scale, as well as resilience, subjective well-being, and meaning in life using validated scales. Results showed a two-factor structural model accounting for 79.33% of the total variance. Both factors were negatively associated with resilience and satisfaction with life. Results suggest the FCV-19S has good psychometric properties among health care workers and may be used to assess the effects of the pandemic in this population.

Risk factors for functional deterioration in a cohort with late effects of poliomyelitis: A ten-year follow-up study.

BACKGROUND: More than 7000 patients developed poliomyelitis during the main epidemic in the fifties in Israel. In recent years, there is a further deterioration in their condition due to accelerated aging process and post-polio syndrome. OBJECTIVE: To evaluate the risk factors for the progression of functional status in a cohort of patients with late effect of poliomyelitis over a period of ten years. METHODS: A cross-sectional cohort study including 82 individuals with late effect of poliomyelitis evaluated over ten years. Mean age was 67±8.5 years, 52.4%were men and 79.3%were Jewish. Functional status was evaluated by activities of daily living (ADL) questionnaire. Risk factors, including general comorbidities, history of poliomyelitis infection, use of assistive devices, employment, and physical activity statuses were evaluated using specific questionnaires. RESULTS: Independence in ADL functions deteriorated significantly over ten years. Older age, ethnicity, use of a wheelchair, and use of orthotic devices in childhood were risk factors for deterioration in ADL function. No correlation was found between the presence of other comorbidities or poliomyelitis parameters and worsening of ADL functions. CONCLUSIONS: Late effect of poliomyelitis was associated with deterioration in ADL functions probably due to the combined effect of the initial severity of the paralytic poliomyelitis symptoms and accelerated aging.

[DISEASE SEVERITY AND PSYCHOLOGICAL HEALTH AMONG POLIOMYELITIS PATIENTS IN JERUSALEM - 10 YEARS FOLLOW-UP STUDY].

INTRODUCTION: More than 7000 patients contracted poliomyelitis (polio) during the major epidemic in the fifties in Israel. In recent years, there is further deterioration in their condition due to the accelerated aging process and post-polio syndrome. OBJECTIVES: To evaluate the correlation between disease severity, functional and psychological parameters among polio patients in Jerusalem over a period of 10 years. METHODS: A total of 145 polio patients were included in the study; 82 of them were evaluated 10 years ago. The severity of polio sequelae was evaluated using the Index of Post-Polio Sequelae (IPPS) and the psychological status was evaluated using the General Health Questionnaire (GHQ), Hope and Satisfaction with Life scales. RESULTS: The mean age of our sample was 66.4 ± 8.0 years as compared to 57.8 ± 12.8 years in the previous study; 75.9% were Jewish and 28.3% were employed as compared to 75% and 37.3% in the previous study. The severity of polio symptoms according to the IPPS increased and more patients needed assistance in ADL as compared to the previous study, whereas the GHQ score was unchanged. The condition of non-Jewish polio patients was worse as compared to their Jewish counterparts. CONCLUSIONS: The severity of long standing polio symptoms increased with age in correlation with the reduced level of independence in ADL functions. Polio patients have emotional resilience albeit their physical deterioration and work is a significant source of emotional strength. DISCUSSION: Long standing poliomyelitis has a significant effect on patients' health even after many years. The disease contributes to accelerated aging and therefore there is a need for special rehabilitation programs including vocational training in order to prevent further functional deterioration in this population.

Hospice Care: Hope and Meaning in Life Mediate Subjective Well-Being of Staff.

OBJECTIVES: Subjective well-being has been associated with decreased work burnout and elevated work engagement. We investigated the impact of hope and meaning in life on subjective well-being among workers in a hospice care setting. Comparison was made to health-care workers in a rehabilitation unit. METHODS: Thirty-five hospice care workers were surveyed and their responses compared with those of 36 rehabilitation workers. Survey instruments measuring hope, meaning in life, work engagement, and satisfaction with life were utilized. RESULTS: Individuals working in a hospice care center have significantly higher levels of work engagement than their counterparts in rehabilitation. For both groups, hope was significantly related to subjective well-being. For hospice care but not rehabilitation workers, meaning in life was also related to subjective well-being. Multivariate analysis showed that hope and meaning in life were independent factors predicting subjective well-being in hospice care workers. SIGNIFICANCE OF RESULTS: Hospice care workers are highly engaged in their work despite the challenging nature of their work. What characterizes these workers is a level of subjective well-being that is related to both meaning in life and hope. Maintaining a high level of subjective well-being may be an important factor in preventing burnout among those working in hospice care settings.

Long-standing poliomyelitis and psychological health.

OBJECTIVE: To compare the psychological health of the individuals with long-standing poliomyelitis, with or without post-polio syndrome (PPS), to the general population and to identify the role of work as well as other variables with regard to their psychological health. DESIGN: A cross-sectional study. SUBJECTS: One hundred and ninety-five polio patients attending postpolio clinic in Jerusalem. METHODS: Emotional distress (ED) was measured using the general health questionnaire (GHQ-12). Demographic, medical, social and functional data were recorded using a specific structured questionnaire. Each polio patient was compared to four age- and sex-matched controls. RESULTS: ED was higher in the polio population as compared to the general population. Within the polio population ED was inversely correlated with work status. No correlation was found between ED and the functional level of polio participants and no difference was found in GHQ score between polio participants with or without post-polio. In addition, ED was less affected by subjective perception of physical health among polio patients as compared to the general population. CONCLUSIONS: Long-standing poliomyelitis is associated with decreased psychological health as compared to the general population. Yet, the resilience of polio survivors is manifested by their ability to block further decline of their psychological health in spite of deterioration in their physical health. Work appears as a significant source of resilience in the polio population. Implications for Rehabilitation Individuals with long-standing poliomyelitis often suffer from high emotional distress and may benefit from psychotherapy aimed at reducing distress. As active employment status is associated with increased mental health among polio survivors, encouraging participation at work needs to be a significant component of psychotherapeutic programs. Polio survivors, although physically disabled, may be relatively resilient, as their mental health is less affected by their negative health perception. This and other expressions of resilience may serve as a platform for increasing personal growth among them by implementing hope-oriented psychotherapy.

A virtual reality system combined with biofeedback for treating pediatric chronic headache--a pilot study.

OBJECTIVE: Pediatric headache is highly widespread and is associated with distress and reduced quality of life. Pharmacological treatment of chronic headache in children has been only partially effective and, as in medication-overuse headache, can sometimes be counterproductive. Therefore, there is a substantial need to develop other effective methods of treatment. Here we present the rationale, feasibility, and preliminary results of a pilot study applying a novel system, combining virtual reality and biofeedback, aimed as an abortive treatment of pediatric chronic headache. DESIGN: A prospective single-arm open-label, pilot study. Ten children attending an outpatient pediatric neurology clinic were treated by the proposed system. Participants practiced relaxation with biofeedback and learned to associate successful relaxation with positive pain-free virtual images of themselves. RESULTS: Nine patients completed the 10-session intervention. Ratings of pain, daily functioning, and quality of life improved significantly at 1 and at 3 months posttreatment. Most patients reported applying their newly acquired relaxation and imagery skills to relieve headache outside the lab. CONCLUSION: This novel system, combining biofeedback and virtual reality, is feasible for pediatric use. Randomized controlled studies in larger populations are needed in order to determine the utility of the system in reducing headache, improving daily functioning, and elevating quality of life.

Novel virtual reality system integrating online self-face viewing and mirror visual feedback for stroke rehabilitation: rationale and feasibility.

PURPOSE: To introduce the rationale of a novel virtual reality system based on self-face viewing and mirror visual feedback, and to examine its feasibility as a rehabilitation tool for poststroke patients. METHOD: A novel motion capture virtual reality system integrating online self-face viewing and mirror visual feedback has been developed for stroke rehabilitation.The system allows the replacement of the impaired arm by a virtual arm. Upon making small movements of the paretic arm, patients view themselves virtually performing healthy full-range movements. A sample of 6 patients in the acute poststroke phase received the virtual reality treatment concomitantly with conservative rehabilitation treatment. Feasibility was assessed during 10 sessions for each participant. RESULTS: All participants succeeded in operating the system, demonstrating its feasibility in terms of adherence and improvement in task performance. Patients' performance within the virtual environment and a set of clinical-functional measures recorded before the virtual reality treatment, at 1 week, and after 3 months indicated neurological status and general functioning improvement. CONCLUSIONS: These preliminary results indicate that this newly developed virtual reality system is safe and feasible. Future randomized controlled studies are required to assess whether this system has beneficial effects in terms of enhancing upper limb function and quality of life in poststroke patients.

Post-polio syndrome: impact of hope on quality of life.

PURPOSE: To determine the effect of future-oriented coping strategies on the quality of life (QOL) of individuals with post-polio syndrome (PPS). METHODS: A correlative study, in which a cohort of 61 patients was surveyed and a group of 40 healthy, age-matched individuals served as controls. Patients were surveyed as to their QOL, levels of hope and utilization of proactive coping, employment status and degree of functionality. RESULTS: PPS patients had lower total, physical and mental QOL indices compared to controls. Future-oriented coping strategies associated with hope were positively associated with physical and mental QOL in the PPS group, but not in the controls. In a multivariate analysis, hope and employment status predicted higher QOL among those with PPS. CONCLUSIONS: Future-oriented coping strategies, particularly hope are distinctively associated with improved QOL benefits in PPS patients. Fostering future-oriented coping related to hope may improve the self-perceived mental and physical status of patients with PPS.

The association between reality-based beliefs and indirectly experienced traumatization.

The purpose of the study was to examine the association between belief types and the magnitude of indirect traumatization. Specific types of beliefs were defined in terms of the cognitive orientation theory, which is a cognitive-motivational approach to the understanding, predicting, and changing of behaviors. Belief types that were analyzed included beliefs about self, general beliefs, beliefs about norms, and goal beliefs as they relate to personal growth. Study participants included 38 rescuers (body handlers), 37 nurses, and 31 rehabilitation workers who treated injured civilians that had been exposed to politically motivated violence. The Cognitive Orientation for Posttraumatic Growth Scale was used to assess beliefs about personal growth. The Revised Posttraumatic Stress Disorder Inventory was administered to evaluate indirect traumatization. The results indicate that three of the four belief types related to personal growth were associated with the level of indirect traumatization. Optimistic and positive beliefs about self and general beliefs were associated with a lower level of indirect traumatization symptomatology, suggesting that these types of beliefs may counteract indirect traumatization. On the other hand, stronger goal beliefs were associated with greater indirect traumatization. The negative association between positive goal beliefs and indirect trauma may be related to the gap the individual perceives between the hoped-for ideals and the trauma-stricken reality. These results indicate the importance of cognitive beliefs and their possible role in determining the response to indirect traumatization.

Positive and negative psychological impact after secondary exposure to politically motivated violence among body handlers and rehabilitation workers.

The positive and negative psychological impact of secondary exposure to politically motivated violence was examined among body handlers and hospital rehabilitation workers, 2 groups that differed in their proximity and immediacy to violent events. Survivors of politically motivated violence served as a comparison group. Body handlers experienced high levels of positive psychological impact and traumatic stress symptoms. Levels of positive psychological impact among on-scene body handlers were higher than those experienced by rehabilitation workers. Traumatic stress symptoms predicted positive psychological impact among body handlers. These findings indicate that proximity to stressors is associated with higher levels of positive and negative psychological impact. Physical proximity is a major contributory factor to both positive and negative psychological effects of secondary exposure to trauma.

Positive psychological impact of treating victims of politically motivated violence among hospital-based health care providers.

BACKGROUND: Health care personnel treating victims of politically motivated violence are at risk for traumatic stress symptoms. Few studies have assessed the positive psychological impact of politically motivated violence on health care workers. In this study, the level of positive psychological impact among health care workers with recurrent exposure to victims of politically motivated violence was examined. METHODS: A validated questionnaire survey of health care personnel treating victims of politically motivated violence during 2000-2005 in two hospital settings was conducted. Positive psychological impact was assessed by the Posttraumatic Growth Inventory and traumatic stress symptoms were assessed using the Revised Posttraumatic Stress Disorder Inventory. Subjects included physicians (surgeons and anesthesiologists), nurses, and psychotherapists. RESULTS: The rate of response to the mail-in questionnaires was 68.3% (n = 138). The sample consisted of 70 physicians, 37 nurses, and 31 hospital-based psychotherapists. Positive psychological impact was noted for the entire sample and among all professions. Traumatic stress symptoms predicted positive psychological impact for the entire sample and for each profession, and there was a curvilinear relationship between traumatic stress symptoms and positive psychological impact. Women experienced greater levels of positive psychological impact. CONCLUSIONS: Hospital-based health care providers treating victims of politically motivated violence experience both positive and negative psychological impact. Individuals who are more traumatized by their experience are more likely to also have a positive psychological impact.

[Rehabilitation outcomes of terror victims with multiple trauma: the experience in Hadassah University Hospital 2000-2004].

From late September 2000 until 2005, the State of Israel was attacked by continuing acts of terrorism known as the Al Aqsa Intifada. During this period the number of terror victims treated in rehabilitation facilities has escalated significantly. The city of Jerusalem has a unique place in the heart of the Israel-Palestinian conflict and, therefore, almost 20% of national atrocities have been carried out in Jerusalem. Between September.2000 and September 2004, 72 terror victims were treated in the department of rehabilitation in Hadassah University Hospital. Among them, 47 (65%) suffered from multiple trauma without CNS involvment, 19 (26%) suffered from traumatic brain injury and 6 (8%) suffered from spinal cord injury. The rehabilitation outcomes of terror victims was compared to the rehabilitation outcomes of non-terror multiple trauma patients treated in the same rehabilitation facility over the same period. The rehabilitation outcomes were evaluted using the following parameters: length of hospitalization (LOH) in acute care departments, inpatient and outpatient rehabilitation departments, functional outcome (Functional Independence Measurement, FIM), occupational outcome (returning to previous occupation) and psychological outcome (Salomon PTSD questionnaire). The mean LOH of terror victims was 218 +/- 131 days as opposed to 152 +/- 114 days for the non-terror group (p < 0.01). The difference between FIM value at entry and discharge (delta FIM) was significantlly higher in terror victims as compared to controls (41.1 +/- 21.6 vs. 30.8 +/- 21.8, p = 0.002). The rate of PTSD was higher among terror victims than non-terror control (40.9% vs. 24.2%, p = 0.04). The rate of returning to previous occupation was similar between terror and non-terror victims (53% vs. 46.9% respectively). Long term study showed that terror victims still suffer from lower quality of life and life satisfaction 2 years after the insult. In summary, terror victims spent longer periods in rehabilitation and regained most of the Activities of Daily Living (ADL) functions similar to the non-terror group. In spite of the higher rate of PTSD, terror victims succeeded in returning to their previous occupation similar to the non-terror group.

Positive psychological impact of bariatric surgery.

BACKGROUND: Psychological impact of bariatric surgery has been described mostly in terms of reduction of psychopathology. This exploratory study examines the impact of bariatric surgery in terms of positive psychological growth and development. METHODS: 57 patients who underwent LAGB were recruited to this study; 31 patients (54.4%) completed a questionnaire battery 1 year or more following surgery. Positive impact was assessed using the posttraumatic growth questionnaire. Mental and physical health were assessed using the SF-36. Family support was assessed using the perceived family support questionnaire and weight loss measure was assessed using measured weight differences prior to and 1 year after surgery. RESULTS: Positive impact was apparent in all dimensions including greater appreciation of life, increased sense of personal strength and improvement in relating to others. Positive impact appears to be independent of physical and mental health as well as of family social support. CONCLUSION: Positive impact of bariatric surgery is a substantial outcome and should be examined further. Positive impact of bariatric surgery should be taken into account as a therapeutic tool in positive oriented psychological interventions following bariatric surgery.

Rehabilitation outcomes of terror victims with multiple traumas.

OBJECTIVES: To describe the rehabilitation outcomes of terror victims with multiple traumas, and to compare those outcomes with those of patients with nonterror-related multiple traumas treated in the same rehabilitation facility over the same time period. DESIGN: Retrospective chart reviews. SETTING: Rehabilitation department in a university hospital in Jerusalem, Israel. PARTICIPANTS: Between September 2000 and September 2004, we treated 72 victims of terrorist attacks who had multiple traumas. Among them, 47 (65%) had multiple traumas without central nervous system involvement (MT subgroup), 19 (26%) had multiple traumas with traumatic brain injury (TBI subgroup), and 6 (8%) had multiple traumas with spinal cord injury (SCI subgroup). We matched, according to their types of injury and demographic data, each terror victim with a control patient treated in the same period in our rehabilitation department. INTERVENTION: Interdisciplinary inpatient and outpatient rehabilitation. MAIN OUTCOME MEASURES: Hospital length of stay (LOS) in acute care departments, inpatient and outpatient rehabilitation departments, functional outcome (FIM instrument score), occupational outcome (returning to previous occupation), and psychologic outcome (Solomon PTSD [post-traumatic stress disorder] Inventory). RESULTS: The mean LOS of terror victims was 218+/-131 days; for the nonterror group it was 152+/-114 days (P<.01). In comparison with the control subgroups, the MT subgroup of terrorist victims had significantly longer LOS in the acute care and outpatient rehabilitation departments (P=.06) and the terror TBI subgroup had a longer LOS in outpatient department only (P<.05). The LOS of the SCI patients, both terror victims and control patients, was significantly longer than that of the other 2 subgroups. The difference between FIM value at entry and discharge (DeltaFIM) was significantly higher for terror victims than for the controls (41.1+/-21.6 vs 30.8+/-21.8, P=.002). This difference was mainly the result of the significantly higher DeltaFIM achieved by the terror MT subgroup than by the MT controls. The rate of PTSD was higher among terror victims than among controls (40.9% vs 24.2%, P=.04). The rate of return to previous occupations was similar between terror victims and nonterror patients (53% vs 46.9%, respectively). CONCLUSIONS: Victims of terror spent longer periods in rehabilitation than the nonterror group; however, they regained most activity of daily living functions similar to the nonterror group. Despite the higher rate of PTSD, terror victims succeeded in returning to their previous occupations at a similar rate to that of the nonterror group.