The Walsh Family Resilience Questionnaire: the Italian version.

BACKGROUND: Resilience focuses on strength under stress, in the context of adversity. Walsh's theoretical model identifies relational processes that allow families to tackle and overcome critical situations, dividing them into three domains of family function. The aim of this study was to assess resilience in families of patients with a chronic disease by adapting and validating the Italian version of the Walsh Family Resilience Questionnaire (Walsh-IT). PATIENTS AND METHODS: An Italian adult sample of 421 participants (patients and relatives) was collected with the aim to assess the reliability and validity of the Walsh-IT. Concurrent validity was carried out by comparing this instrument with the Family Adaptability and Cohesion Evaluation Scale III (FACES III) administered at the same time as the Walsh-IT. RESULTS: Reliability showed high correlation between repeated measurements. The alpha coefficient was 0.946. Both parallel analysis and minimum average partial criteria suggested that the best number of domains is equal to 3, explaining 50.4% of the total variance. Based on the results obtained from the Rasch analysis, items 10, 11, 16, 22, and 23 have been removed resulting in a short-form questionnaire (Walsh-IT-R) of 26 items with three domains: shared beliefs and support (SBS, α=0.928); family organization and interaction (FOI, α=0.863); and utilization of social resources (USR, α=0.567). The total score of the Walsh-IT-R was strongly correlated with the total score of FACES III Real Family Scale (r=0.68; p<0.0001). CONCLUSION: Results support that the Walsh-IT-R is a valid instrument for the assessment of family resilience in Italy when contending with the challenges of chronic disease. It could be used in pre- and post-assessment in practice effectiveness research, offering a profile of family resilience processes at the start and end of interventions and follow-up.

Home-based telesurveillance and rehabilitation after stroke: a real-life study.

BACKGROUND: After discharge from in-hospital rehabilitation, post-stroke patients should have the opportunity to continue the rehabilitation through structured programs to maintain the benefits acquired during intensive rehabilitation treatment. OBJECTIVE: The primary objective was to evaluate the feasibility of implementing an home-based telesurveillance and rehabilitation (HBTR) program to optimize the patient's recovery by reducing dependency degree. METHOD: Post-stroke patients were consecutively screened. Data were expressed as mean ± standard deviation (SD). 26 patients enrolled: 15 were sub-acute (time since stroke: 112 ± 39 days) and 11 were chronic (time since stroke: 470 ± 145 days). For 3 months patients were followed at home by a nurse-tutor, who provided structured phone support and vital signs telemonitoring, and by a physiotherapist (PT) who monitored rehabilitation sessions by videoconferencing. RESULTS: 23 patients completed the program; 16.7 ± 5.2 phone contacts/patient were initiated by the nurse and 0.9 ± 1.8 by the patients. Eight episodes of atrial fibrillation that required a change in therapy were recorded in two patients. Physiotherapists performed 1.2 ± 0.4 home visits, 1.6 ± 0.9 phone calls and 4.5 ± 2.8 videoconference-sessions per patient. At least three sessions/week of home exercises were performed by 31% of patients, two sessions by 54%. At the end of the program, global functional capacity improved significantly (P < 0.001), in particular, static (P < 0.001) and dynamic (P = 0.0004) postural balance, upper limb dexterity of the paretic side (P = 0.01), and physical performance (P = 0.002). Symptoms of depression and caregiver strain also improved. CONCLUSION: The home-based program was feasible and effective in both sub-acute and chronic post-stroke patients, improving their recovery, and maintaining the benefits reached during inpatient rehabilitation.

Impact of Clinical and Quality of Life Outcomes of Long-Stay ICU Survivors Recovering From Rehabilitation on Caregivers' Burden.

BACKGROUND: The objective of this work was to evaluate the time course of clinical and health-related quality of life outcomes of long-stay ICU survivors' and caregivers' burden. METHODS: The study included 23 subjects of mixed diagnosis (66 ± 11 y, body mass index 26.5 ± 5.6 kg/m(2)) with a recent episode of acute respiratory failure needing in-hospital rehabilitation. Subjects and caregivers were evaluated at hospital discharge (T0, n = 23) and 6 months later (T6, n = 16). At T0 and T6, subjects' clinical status (Dependence Nursing Scale), FVC (percent-of-predicted FVC and percent-of-predicted FEV), maximum inspiratory/expiratory pressures, effort tolerance (sit-to-stand, Takahashi test, 6-min walking distance), and disability (Barthel index) were evaluated. EuroQol-5D (EQ-5D), McGill Quality of Life, General Perceived Self-Efficacy Scale, and Hospital Anxiety and Depression Scale (HADS-A/HADS-D) were assessed. Caregivers' burden was measured by the Family Strain Questionnaire short form and Caregiver Needs Assessment. Correlation between subjects' clinical status and caregiver assessments was performed at T0. RESULTS: At T0, subjects showed compromised EQ-5Dindex (0.42 ± 0.28); 69% of caregivers had high Family Strain Questionnaire and moderate Caregiver Needs Assessment scores (30 ± 13). EQ-5Dindex was significantly related to Dependence Nursing Scale score (P < .001), percent-of-predicted FVC (P < .02), effort tolerance (all P < .01), disability (P < .001), and caregiver Family Strain Questionnaire score (P < .02). At T6, subjects significantly improved percent-of-predicted FVC (P < .05), maximum expiratory pressure (P < .01), effort tolerance (all P < .05), disability (P < .02), and EQ-5Dindex (P < .05), whereas caregivers' burden scores were unchanged. However, the percentage of caregivers with strain increased. CONCLUSIONS: In prolonged-ICU-stay survivors, EQ-5Dindex at hospital discharge is related to clinical status and caregivers' strain. Subjects' clinical status and EQ-5Dindex improves over time, but caregivers' burden remains high, suggesting the need to monitor/support caregivers.

Blood pressure control and treatment adherence in hypertensive patients with metabolic syndrome: protocol of a randomized controlled study based on home blood pressure telemonitoring vs. conventional management and assessment of psychological determinants of adherence (TELEBPMET Study).

BACKGROUND: Inadequate blood pressure control and poor adherence to treatment remain among the major limitations in the management of hypertensive patients, particularly of those at high risk of cardiovascular events. Preliminary evidence suggests that home blood pressure telemonitoring (HBPT) might help increasing the chance of achieving blood pressure targets and improve patient's therapeutic adherence. However, all these potential advantages of HBPT have not yet been fully investigated. METHODS/DESIGN: The purpose of this open label, parallel group, randomized, controlled study is to assess whether, in patients with high cardiovascular risk (treated or untreated essential arterial hypertension--both in the office and in ambulatory conditions over 24 h--and metabolic syndrome), long-term (48 weeks) blood pressure control is more effective when based on HBPT and on the feedback to patients by their doctor between visits, or when based exclusively on blood pressure determination during quarterly office visits (conventional management (CM)). A total of 252 patients will be enrolled and randomized to usual care (n = 84) or HBPT (n = 168). The primary study endpoint will be the rate of subjects achieving normal daytime ambulatory blood pressure targets (< 135/85 mmHg) 24 weeks and 48 weeks after randomization. In addition, the study will assess the psychological determinants of adherence and persistence to drug therapy, through specific psychological tests administered during the course of the study. Other secondary study endpoints will be related to the impact of HBPT on additional clinical and economic outcomes (number of additional medical visits, direct costs of patient management, number of antihypertensive drugs prescribed, level of cardiovascular risk, degree of target organ damage and rate of cardiovascular events, regression of the metabolic syndrome). DISCUSSION: The TELEBPMET Study will show whether HBPT is effective in improving blood pressure control and related medical and economic outcomes in hypertensive patients with metabolic syndrome. It will also provide a comprehensive understanding of the psychological determinants of medication adherence and blood pressure control of these patients. TRIAL REGISTRATION: Clinical Trials.gov: NCT01541566.

Six-month programme on lifestyle changes in primary cardiovascular prevention: a telemedicine pilot study.

BACKGROUND: Technology and information systems enabling transmission of patients' data and ability to provide and exchange professional support remotely to the general practitioners can improve quality and continuity of care. DESIGN: We set up a programme of primary prevention in 27 patients at risk for cardiovascular diseases by using Telemedicine Service for 6 months. METHODS: Telemedicine Service enlisted the involvement of physicians and nurse-tutors. The following cardiovascular activity markers were assessed: (i) cardiovascular risk cards (Framingham Study and Progetto CUORE); (ii) blood pressure; (iii) physical activity (three sessions of bicycle exercise training and calisthenic exercises a week); and (iv) questionnaires on stress and quality of life. RESULTS: Both cardiovascular risk cards showed a statistically significant reduction of the score (p < 0.05). Systolic and diastolic blood pressures showed a statistically significant reduction (128 ± 10 mmHg vs. 121 ± 9 mmHg, p = 0.04; 80 ± 8 mmHg vs. 73 ± 7 mmHg, p = 0.001). There was a noticeable increase in patient compliance for reporting blood pressure data. 89% of patients complied with the physical activity programme. Effort test significantly increased from 11.4 ± 3.5 to 12.7 ± 3.4 min (p = 0.02). There was a significant improvement in physical health (p = 0.04) and 85% of patients were satisfied with the service. CONCLUSIONS: A home multidisciplinary programme for primary cardiovascular disease prevention is simple, efficacious, and very well accepted by the patients with the majority of patients showing reduction in cardiovascular risk scores.

[Chronic heart failure as a crisis event of the family]. / La malattia cardiaca cronica come evento critico familiare.

The family greatly influences any of its members and significantly contributes to the patient rehabilitation. A limited and superficial interest from the family as well as an overprotective and anxiogenic behavior may lead to chronicization, relapse or even to progression of the disease. The close relationship between the patient and the physician is an illusion, since family members deeply affect this interaction. They may first influence the cardiologist's choice and later, through comments or actions, treatment expectations, diagnosis and therapy by sustaining or, on the contrary, minimizing the patient-physician interaction. A therapeutic triangle, which includes the family, the patient and the physician, develops from the beginning; thus the physician needs to be aware of it to use these interactions in the best interest of the patient himself. In this context clinical psychologists play a pivotal role first in identifying dysfunctional relations within the family and then in supporting the family to overcome crisis events.

Functional recovery after hemiplegia in patients with neglect: the rehabilitative role of anosognosia.

BACKGROUND AND PURPOSE: The aim of this study was to verify whether the presence of anosognosia (A) affects the rehabilitative prognosis of hemiplegic subjects with neglect (N). METHODS: This study was carried out on 30 patients with left hemiplegia: 15 patients had neglect (group N) and 15 had neglect and anosognosia (group N+A). Mean age was 68.2+/-6.3 in group N (9 men and 6 women) and 72.1+/-6.4 in group N+A (7 men and 8 women). The average interval from onset of stroke to admission for rehabilitation was 23 and 23.6 days, respectively, in group N and in group N+A. Patients were assessed through the Mesulam test, Bisiach test, Wechsler Adult Intelligence Scale, Fugl-Meyer scale, Functional Independence Measure (FIM), and Rankin scale. RESULTS: Before rehabilitation, cognitive FIM scores of patients of group N were significantly higher than those of group N+A (P=0.001), whereas motor FIM scores and total FIM scores did not differ between the 2 groups. After rehabilitation, cognitive FIM scores (P=0.000) and even motor (P=0.009) and total FIM scores (P=0.000) were statistically higher in group N than in group N+A. Effectiveness (P=0.005) and efficiency (P=0.012) in the motor FIM scores of group N were significantly greater than those of group N+A. Disability was lower in group N (P=0.040). CONCLUSIONS: Our study shows that the presence of anosognosia worsens the rehabilitation prognosis in hemiplegic subjects who also have neglect.

[Anxiety, depression, and stressed life in patients awaiting heart transplantation: are these factors to be considered?]. / Ansia, depressione e vita stressante nel paziente in attesa di trapianto cardiaco: dimensioni da considerare?

RATIONALE: Heart transplantation is a therapeutic procedure in which biological, psychological, social and ethical aspects play an important role, none of them has to be underestimated. It is known that the waiting period up to heart transplantation is extremely stressful for patients and their families, causing psychopathological and disadaptive reactions. Aim of the present study was to investigate psychological tract characteristics, stress reactions and quality of life in a group of patients registered for heart transplantation. METHODS: Sixty two patients (47 M, 15 F), with mean age of 53 +/- 9.9 years in NYHA class (16 class II, and 43 class III/IV) and ejection fraction 29 +/- 10 have filled in the following two questionnaires: the Cognitive Behavioural Assessment form H (CBA-H), to measure psychological functioning and/or behaviours at risk for heart disease, and the Short Form 36 (SF-36), to evaluate physical and functional health status. RESULTS: In patients awaiting heart transplantation, the presence of anxiety contributes to reduce physical activity, vitality and mental health. Depressed mood disorders negatively influence physical and mental health and vitality. Perception of stressed life limits role and physical activity, vitality, and emotional status and augments intensity of physical pain. CONCLUSIONS: Symptoms of anxiety, depression and stress influence negatively mental health and daily physical activity. These aspects may vary of intensity with progression of the disease and lengthening of waiting. The importance of an early and continuous psychological support to the patient becomes fundamental to individuate and treat these disorders to favour optimal post-transplant outcomes.