Psychometric evaluation of a newly developed measure of emotionalism after stroke (TEARS-Q)

Objective: To evaluate, psychometrically, a new measure of tearful emotionalism following stroke: Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q). Setting: Acute stroke units based in nine Scottish hospitals, in the context of a longitudinal cohort study of post-stroke emotionalism. Subjects: A total of 224 clinically diagnosed stroke survivors recruited between October 1st 2015 and September 30th 2018, within 2 weeks of their stroke. Measures: The measure was the self-report questionnaire TEARS-Q, constructed based on post-stroke tearful emotionalism diagnostic criteria: (i) increased tearfulness, (ii) crying comes on suddenly, with no warning (iii) crying not under usual social control and (iv) crying episodes occur at least once weekly. The reference standard was presence/absence of emotionalism on a diagnostic, semi-structured post-stroke emotionalism interview, administered at the same assessment point. Stroke, mood, cognition and functional outcome measures were also completed by the subjects. Results: A total of 97 subjects were female, with a mean age 65.1 years. 205 subjects had sustained ischaemic stroke. 61 subjects were classified as mild stroke. TEARS-Q was internally consistent (Cronbach’s alpha 0.87). TEARS-Q scores readily discriminated the two groups, with a mean difference of −7.18, 95% CI (−8.07 to −6.29). A cut off score of 2 on TEARS-Q correctly identified 53 of the 61 stroke survivors with tearful emotionalism and 140 of the 156 stroke survivors without tearful emotionalism. One factor accounted for 57% of the item response variance, and all eight TEARS-Q items acceptably discriminated underlying emotionalism. Conclusion: TEARS-Q accurately diagnoses tearful emotionalism after stroke.

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Practical guidance on use of TEARS-Q to diagnose post-stroke emotionalism

Clinical Rehabilitation ◽

10.1177/02692155211024801 ◽

2021 ◽

pp. 026921552110248

Author(s):

Niall M Broomfield ◽

Robert West ◽

Mark Barber ◽

David C Gillespie ◽

Allan House ◽

...

Keyword(s):

Classification Tree ◽

Self Report ◽

Daily Functioning ◽

Stroke Severity ◽

Reference Standard ◽

Diagnostic Features ◽

Stroke Units ◽

Post Stroke ◽

Practical Guidance ◽

Stroke Type

Objective: To evaluate, using a classification tree methodology, the ability of the Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q) to determine the need for further assessment of post-stroke emotionalism and to identify those whose emotionalism is sufficiently clear that they need assessment for potential intervention. Setting: Acute stroke units of nine Scottish hospitals in the context of a longitudinal cohort study of post-stroke emotionalism. Subjects: A total of 228 stroke survivors recruited between October 1st 2015 and September 30th 2018, within two weeks of stroke. Measures: The measure was the self-report questionnaire TEARS-Q, constructed based on recognised diagnostic features of post-stroke tearful emotionalism. The reference standard was presence/absence of emotionalism on a diagnostic, semi-structured post-stroke emotionalism interview, administered at the same assessment point. Results: Nine of 159 subjects scoring 0 or 1 on TEARS-Q were diagnosed with post-stroke emotionalism on the reference standard, compared to 11 of 21 subjects scoring 2 to 5 on TEARS-Q and 42 of 48 participants scoring 6 and above. Adding age, sex, deprivation, stroke type, stroke severity, mood, cognition, daily functioning and education did not improve the prediction accuracy sufficiently to change the classification tree. Conclusion: TEARS-Q reliably identifies those who need no further post-stroke emotionalism assessment, those who need further assessment to clarify diagnosis, and those who almost certainly have post-stroke emotionalism and may benefit from intervention.

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Abstract TP161: Sexual Dysfunction in Mild Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp161 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jennifer Blum ◽

Caroline Wisialowski ◽

Susan Taboada ◽

Sarah Clark ◽

Ilene Staff ◽

...

Keyword(s):

Sexual Dysfunction ◽

Safety Concern ◽

Clinical History ◽

Descriptive Statistics ◽

Self Report ◽

Convenience Sample ◽

True Incidence ◽

Post Stroke ◽

Physical Limitations ◽

Mild Stroke

Background: Stroke impacts several aspects of patients’ lives and sexual dysfunction post stroke has been reported in 40%-50% of patients. Current investigations have revealed links to depression, however this has not been examined specifically in mild stroke. Objective: To determine prevalence and factors associated with sexual dysfunction after mild stroke Design/methods: A retrospective study was conducted on a self-report questionnaire completed by a convenience sample of patients during a hospital follow-up appointment in the stroke clinic. Patients were asked about sexual dysfunction after stroke and if yes, to specify the cause: safety concern, physical limitation, consequence or change in libido. In addition, patients completed a PHQ-9 to measure depression, Fatigue Assessment Scale (FAS), and the Montreal Cognitive Assessment (MoCA). A thorough review of clinical history including NIHSS, mRS and demographics was completed by researchers. Descriptive statistics were used to identify and understand the patient population. Mild stroke was defined as NIHSS ≤ 5. Results: In our study of 135 patients, 21 (16%) did not respond to the sexual dysfunction question. Of the 114 who responded, only 11 (9.6%) reported sexual dysfunction and 9 (81%) attributed their sexual dysfunction to physical limitations. Descriptive statistics of the respondent subgroup indicate that the cohort was 59% male with a median (IQR) age of 64 (57,75) and that 52% were living with someone at the time. The mean NIHSS on discharge was 1 (IQR 0-3) and 77% were ischemic strokes. Few patients experienced post stroke depression (21.9%, N=25), and the cohort reported low levels of fatigue (median FAS=19). Low incidence and response rates precluded an analysis of specific predictors in this cohort. Conclusion: Physical limitations are reported to be the main cause of post stroke sexual dysfunction. Roughly 1 in 10 patients with mild stroke reported experiencing sexual dysfunction, however twice as many did not respond to the question. Therefore, the true incidence is unclear, prompting the need for further investigation on post stroke sexual dysfunction in mild stroke.

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Inter-hemispheric inhibition in stroke survivors is related to fatigue and cortical excitability

10.1101/831511 ◽

2019 ◽

Cited By ~ 2

Author(s):

Sasha Ondobaka ◽

Nick Ward ◽

Annapoorna Kuppuswamy

Keyword(s):

Cortical Excitability ◽

Effective Connectivity ◽

Self Report ◽

Stroke Survivors ◽

Corticomotor Excitability ◽

Post Stroke ◽

Motor Cortex Excitability ◽

Persistent Fatigue ◽

Fatigue Severity ◽

Exercise Induced

ABSTRACTObjectivePersistent post-stroke fatigue is a major debilitating condition that has been linked to low corticomotor excitability and aberrant attention, both phenomena that are associated with the inter-hemispheric inhibition balance in the brain. In this study, we examined the relationship between inter-hemispheric inhibitory effective connectivity, motor cortex excitability and chronic persistence of post-stroke fatigue.MethodsWe tested eighteen non-depressed stroke survivors with minimal motoric and cognitive impairments using spectral dynamic causal modelling (spDCM) of ‘resting state’ magnetic resonance imaging (rs-fMRI) and transcranial magnetic stimulation (TMS) measures of cortical excitability. We also assessed the levels of non-exercise induced, persistent fatigue using Fatigue Severity Scale (FSS) - a self-report questionnaire which has been widely applied and validated across different conditions. To understand neural effective connectivity mechanisms involved in fatigue and corticomotor excitability we examined the balance in inhibitory connectivity between homologue regions in M1, anterior insula, caudate and thalamus of the resting brain.ResultsInter-hemispheric inhibition balance between left and right M1 accounted for 67% of variability in the reported fatigue (R=.82, p<0.001). Inter-hemispheric inhibition balance in M1 also accounted for 54% of variability in the corticomotor excitability characterised by individual resting motor thresholds (R=.74, p<0.001), a measure that has been associated with subjective fatigue reports. Other examined inter-hemispheric connections did not show significant relationships with either fatigue or cortical excitability measures.ConclusionOur findings suggest that the balance in inter-hemispheric effective connectivity between primary motor regions is involved in regulation of corticomotor excitability and could explain subjective post-stroke fatigue.

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STROKE PATIENTS AND THEIR PARTNER’S PERCEPTIONS OF SURVIVOR FUNCTIONING

Acta Neuropsychologica ◽

10.5604/01.3001.0010.2407 ◽

2017 ◽

Vol 15 (2) ◽

pp. 0-0 ◽

Cited By ~ 1

Author(s):

Chloe Witty ◽

Thomas Heffernan ◽

Leigh Riby

Keyword(s):

Verbal Memory ◽

Digit Span ◽

Qualitative Interviews ◽

Stroke Survivor ◽

Self Report ◽

Stroke Recovery ◽

Step Test ◽

Stroke Survivors ◽

Post Stroke ◽

Significant Difference

[b]Background: [/b]Research into stroke survivors and their partners have shown that the partner frequently rates the stroke survivor as less capable than the survivors rate themselves through self-report questionnaires or qualitative interviews; however, no research to date has used cognitive tasks as a method for in vestigation. This paper aims to investigate if the stroke survivor or the partner rate the stroke survivor as worse across all cognitive domains. [b]Material/ Methods:[/b]This research aimed to observe the incongruence of stroke survivors and their spouse’s perception of survivor functioning by rating their confidence on Picture Memory, Verbal Memory, Digit Span, Luria’s Three Step Test, NART and Raven’s Matrices. Participants, and to compare these score to see if either could predict the actual score. [b]Results: [/b]Showed that neither the stroke survivor nor the partner consistently rated functioning as worse, but there was a significant difference between the dyad. Further, the stroke survivor and the partner’s confidence had no relationship with raw scores. A thematic analysis was also conducted and themes emerged from the data. These were “Confidence,” “Insight into Ability,” and “Post-Stroke Changes.”[b]Conclusions:[/b]These themes were shown to interlink with the scores provided in the qualitative analysis, and implied that low self-efficacy may be crucial in post stroke recovery. Limitations and implications are discussed in full.

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Abstract TP322: Towards better screening for Post Stroke Depression

Stroke ◽

10.1161/str.44.suppl_1.atp322 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Alyssa J Herzig ◽

Nancy Mayo ◽

Syd Miller

Keyword(s):

Length Of Hospital Stay ◽

Critical Factor ◽

Self Report ◽

Screening Tools ◽

Stroke Recovery ◽

Stroke Survivors ◽

Post Stroke ◽

Rehabilitation Outcomes ◽

C Statistic ◽

Post Stroke Depression

Post stroke depression (PSD), occurring in 33% of stroke survivors, is considered the most critical obstacle to rehabilitation after stroke. PSD is consistently linked with increased length of hospital stay, motivation to undergo rehabilitation, poorer rehabilitation outcomes, decreased engagement in recreational and social pursuits, decreased quality of life, and mortality. Although addressing PSD should be considered a critical factor in stroke recovery, the condition remains largely under-diagnosed. A challenge to diagnosis of PSD is a lack of appropriate screening tools. Existing screening tools were not designed for stroke populations or are too time consuming and complex to be utilized routinely. The goal of the present study was to identify a quick, two item screening tool for PSD that requires no training or scoring. Specifically, we examined what brief combination of dichotomized self-report questions can be used as indicators for a DSM-IV-TR classification of depression in stroke survivors In this prospective natural history study, a consecutive sample of 121 stroke survivors completed comprehensive interviews at 10 days post stroke. Contender questions assessing mood, cognition, physical functioning, social support, and relationship profiles were selected based on previous findings. At 10 days, 7 of 121 participants were classified as depressed in accordance with the SCID-I, the gold standard diagnostic tool for clinical depression. Results of logistic regression indicated that patients who met threshold on two MHI item, are you a happy person and have you been so down in the dumps, were 25 times more likely to be depressed than patients who did not (C Statistic > 0.90). As well, these brief questions better predicted PSD at 10 days than did the total MHI score. In the present paper, screening models are considered with regard to practical and theoretical issues in the assessment of PSD. The present study indicates that quick and simple screening tools designed for PSD can be used to select patients for diagnostic assessments and facilitate timely diagnoses of PSD. The present study contributes to our understanding of the clinical presentation of depression in the context of stroke and to our goal of facilitating recovery from stroke.

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Stroke survivors experience elevated levels of loneliness: a multi-year analysis of the National Survey for Wales

10.1101/2020.07.02.20145417 ◽

2020 ◽

Author(s):

Christopher Byrne ◽

Christopher W. N. Saville ◽

Rudi Coetzer ◽

Richard Ramsey

Keyword(s):

Social Isolation ◽

Large Scale ◽

Self Report ◽

Objective Measures ◽

Stroke Survivors ◽

Post Stroke ◽

Annual Survey ◽

Societal Relevance ◽

Human Stroke ◽

Nationally Representative

AbstractDespite clinical observation that stroke survivors frequently experience loneliness, there is no large-scale empirical evidence to support this observation. To address this issue, we completed two pre-registered analyses of a nationally representative annual survey that included a self-report measure of loneliness (N>21000). Across two separate cohorts, the results consistently showed that human stroke survivors report higher levels of loneliness compared to healthy individuals, and this relationship could not be accounted for by demographic factors (e.g., age, sex) or objective measures of social isolation (e.g., marital status, number of household members). These findings demonstrate that elevated levels of loneliness post-stroke are robust in that they replicate in large nationally representative samples and cannot be reduced to objective measures of social isolation. The work has clinical and societal relevance by suggesting that loneliness post-stroke is unlikely to be adequately “treated” if only the quantity and not the quality of social experiences are considered.

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Measuring Social Anxiety in Late Life: A Psychometric Evaluation of a Newly Constructed Self-Report Measure of Social Anxiety

PsycEXTRA Dataset ◽

10.1037/e655462011-001 ◽

2011 ◽

Author(s):

Christine E. Gould ◽

Caroline Ciliberti ◽

Barry A. Edelstein ◽

Merideth Smith ◽

Lindsay A. Gerolimatos

Keyword(s):

Social Anxiety ◽

Psychometric Evaluation ◽

Late Life ◽

Self Report ◽

Constructed Self ◽

Report Measure

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Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00307-z ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Ingrid Johansen Skogestad ◽

Marit Kirkevold ◽

Petra Larsson ◽

Christine Råheim Borge ◽

Bent Indredavik ◽

...

Keyword(s):

Future Development ◽

Health Professionals ◽

Outcome Measure ◽

Patient Reported Outcome ◽

Stroke Survivors ◽

Structured Interviews ◽

Post Stroke ◽

Patient Reported Outcome Measure ◽

Patient Reported ◽

Initial Hospital

Abstract Background Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity.

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‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke

Clinical Rehabilitation ◽

10.1177/02692155211000740 ◽

2021 ◽

pp. 026921552110007

Author(s):

Hannah Stott ◽

Mary Cramp ◽

Stuart McClean ◽

Ailie Turton

Keyword(s):

Support Groups ◽

Phenomenological Study ◽

Community Support ◽

Phenomenological Approach ◽

The Body ◽

Stroke Survivors ◽

Post Stroke ◽

Personal Perceptions ◽

Psychological Sense ◽

Qualitative Phenomenological

Objective: This study explored stroke survivors’ experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. Design: A qualitative phenomenological study. Setting: Participants’ homes. Participants: A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. Interventions: Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. Results: Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. Conclusion: Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke.

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EXPRESS: Telehealth coaching to improve self-management for secondary prevention after stroke: A randomized controlled trial of Stroke Coach

International Journal of Stroke ◽

10.1177/17474930211017699 ◽

2021 ◽

pp. 174749302110176

Author(s):

Brodie M Sakakibara ◽

Scott A Lear ◽

Susan I Barr ◽

Charles Goldsmith ◽

Amy Schneeberg ◽

...

Keyword(s):

Risk Factors ◽

Controlled Trial ◽

Cognitive Status ◽

Self Management ◽

Community Living ◽

Memory Training ◽

Stroke Survivors ◽

Post Intervention ◽

Lifestyle Behaviour ◽

Mild Stroke

Background: Stroke Coach is a lifestyle coaching telehealth program to improve self-management of stroke risk factors. Aims: To examine the efficacy of Stroke Coach on lifestyle behaviour and risk factor control among community-living stroke survivors within one-year post stroke. Methods: Participants were randomized to Stroke Coach or an attention control Memory Training group. Lifestyle behaviour was measured using the Health Promoting Lifestyle Profile II. Secondary outcomes included specific behavioural and cardiometabolic risk factors, health-related quality of life (HRQoL), cognitive status, and depressive symptoms. Measurements were taken at baseline, post-intervention (6 months), and retention (12 month). Linear mixed-effects models were used to test the study hypotheses (p<0.05). All analyses were intention-to-treat. Results: The mean age of the Stroke Coach (n=64) and Memory Training (n=62) groups was 67.2 and 69.1 years, respectively. The majority of participants (n = 100) had mild stroke (modified Rankin Scale = 1 or 2), were active, with controlled blood pressure (mean = 129/79 mmHg) at baseline. At post-intervention, there were no significant differences in lifestyle (b = -2.87; 95%CI -8.03 to 2.29; p=0.28). Glucose control, as measured by HbA1c (b = 0.17; 95%CI 0.17 to 0.32; p=0.03), and HRQoL, measured using SF-36 Physical Component Summary (b = -3.05; 95%CI -5.88 to -0.21; p=0.04), were significantly improved in Stroke Coach compared to Memory Training, and the improvements were maintained at retention. Conclusion: Stroke Coach did not improve lifestyle behaviour, however, there were improvements to HbA1c and HRQoL among community-living stroke survivors with mild stroke-related disability. (ClinicalTrials.gov identifier: NCT02207023)

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