Hileen Boosman

Development and validation of a short version of the Stroke Specific Quality of Life Scale

Background and purpose The Stroke Specific Quality of Life Scale (SS-QoL) is a well validated measure of health related quality of life in patients with stroke, but with 49 items its length is a disadvantage. A short version of the SS-QoL was developed and tested here. Methods Secondary analyses of three different studies. The short version was developed using data from 141 patients with aneurysmal subarachnoid haemorrhage (SAH) and tested on data from independent samples of 97 patients with SAH and 105 patients with ischaemic stroke or intracerebral haemorrhage. The item with the highest item domain correlation from each of the SS-QoL domains was selected to obtain a 12 item SS-QoL (SS-QoL-12) with a total score and physical and psychosocial subscores. Criterion validity of the SS-QoL-12 scores was tested in each sample with the original SS-QoL as reference. Results All three scores of the SS-QoL-12 showed good internal consistency (Cronbachs alpha 0.77–0.89). The SS-Qol-12 scores predicted 88–95% of the variance of the original SS-QoL. Mean differences between the SS-QoL-12 and SS-QoL and their 95% CI were generally within 0.1 points on a 1–5 scale. The limits of agreement were generally within 0.4 points. Conclusion The SS-QoL-12 has good criterion validity for all subsets of stroke. Because it consists of only 12 questions, this short form will be easy to use in research and clinical settings.

Validation of the Stroke Specific Quality of Life scale in patients with aneurysmal subarachnoid haemorrhage

Background and purpose Disease specific quality of life measures have been validated for patients with ischaemic stroke and intracerebral haemorrhage, but not for patients with aneurysmal subarachnoid haemorrhage (SAH). The aim of this study was to validate the Stroke Specific Quality of Life (SS-QoL) scale for patients with SAH. Methods Cross sectional survey of 141 aneurysmal SAH patients. Construct and criterion validity were studied and various ways to merge the 12 SS-QoL domains into a limited number of subtotal scores were explored. Statistics included assessing score distributions, Cronbachs α, principal components analysis (PCA) and Spearman correlations between SS-QoL and the Glasgow Outcome Scale (GOS), Cognitive Failures Questionnaire (CFQ), Life Satisfaction-9 (LiSat-9) and Hospital Anxiety and Depression Scale (HADS). Results PCA revealed two components reflecting physical health and psychosocial health with a mutual correlation of 0.73. A ceiling effect was present for 10 out of 12 domains and for the physical component. Internal consistency was good for all 12 domains (α ≥0.80), two components (α ≥0.95) and the total score (0.97). Physical SS-QoL scores showed weak to moderate correlations (0.24–0.32) with the GOS. All SS-QoL scores showed moderate to strong correlations (0.35–0.72) with the CFQ, LiSat-9 and HADS. Conclusions The SS-QoL is a valid measure to assess quality of life in patients after aneurysmal SAH. Using physical and psychosocial SS-QoL summary scores simplifies the use of this measure without concealing differences in outcomes on different quality of life domains.

Validity of the Barrow Neurological Institute (BNI) Screen for Higher Cerebral Functions in Stroke Patients with Good Functional Outcome

Cognitive impairments are often under diagnosed in stroke patients with good functional outcome. There is a need for a cognitive screening instrument that is sufficiently sensitive to cognitive impairments in these stroke patients. For this goal, we tested the feasibility and validity of the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS). Stroke patients with good functional outcome (Barthel Index 19/20) within 1 year poststroke were administered the BNIS and a brief neuropsychological assessment (NPA) including tests for perception, language, memory, attention, reasoning, and executive functioning. We compared the BNIS with the NPA to investigate its feasibility, internal consistency, floor and ceiling effects, concurrent validity, sensitivity and specificity. Fifty-four stroke patients were included. It took significantly less time to administer the BNIS (median = 16 minutes) than the NPA (median = 32.7 minutes). The BNIS showed good internal consistency (alpha = .82) and no floor or ceiling effects. The recommended cutoff values yielded good sensitivity and low to good specificity, depending on age. Except for perception (Spearman correlation .33), BNIS domain scores were significantly (0.44–0.55) associated with matching neuropsychological tests. This study provides promising results for the BNIS as a measure to detect cognitive impairments in stroke patients with good functional outcome.

Evaluation of change in fatigue, self-efficacy and health-related quality of life, after a group educational intervention programme for persons with neuromuscular diseases or multiple sclerosis: a pilot study

Purpose. An intervention for persons with neuromuscular diseases (NMD) or multiple sclerosis (MS) who experienced severe fatigue was developed which aimed at educating participants in maintaining a balance between capacity and load in their daily activities. This pilot study evaluated the results of this intervention. Methods. Persons with NMD or MS who experienced severe fatigue were included. Outcome measures were: fatigue (Fatigue Severity Scale), health-related quality of life (HRQoL; SF-36) and self-efficacy (ALCOS-16). Changes in scores between the start of the intervention (T0) and 3 months post-intervention (T1) were tested with the Wilcoxon tests in the complete group and in subgroups (gender, education, high/low self-efficacy). Results. Forty-three persons participated. Significant improvements of HRQoL were found for the domains role-physical, mental health and general health perceptions. Subgroup analyses showed more improvement in males (fatigue, role-physical, vitality, bodily pain, general health perceptions), participants with lower education (role-physical, vitality) and participants with low self-efficacy at T0 (self-efficacy, mental health, general health perceptions) than in females, participants with higher education and participants with higher initial self-efficacy. Conclusion. This pilot-study provides preliminary evidence for the effectiveness of a group educational intervention in improving HRQoL without increasing fatigue in persons with NMD and MS.

Exploring the relation between learning style and cognitive impairment in patients with acquired brain injury

The way a patient prefers to approach or choose a learning situation represents the patients learning style. The objective of this chart review study was to explore the relation between learning style and cognitive impairment in patients with acquired brain injury (ABI). We used data from files of 92 adult patients with ABI referred to inpatient rehabilitation, who completed the Adapted Learning Style Inventory (A-LSI) and at least one of the following neuropsychological tests: Trail Making Test, Rey Auditory Verbal Learning Test, WAIS-III Digit Span, Rey-Osterrieth Complex Figure Test–Copy, Stroop Color-Word Test, or the Brixton Spatial Anticipation Test. The A-LSI yielded the following distribution of learning styles: 4 doers, 48 observers, 2 deciders and 38 thinkers. No significant correlation coefficients were found between the neuropsychological tests and the A-LSI. Furthermore, Chi-square tests revealed no significant associations between learning style (observer, thinker) and cognitive impairment. The results of this exploratory study suggest that learning style and cognitive impairment are independent in patients with ABI.

Validity of the dynamic Wisconsin Card Sorting Test for assessing learning potential in brain injury rehabilitation

The dynamic Wisconsin Card Sorting Test (dWCST) examines the effects of brief training on test performance where pre- to post-test change reflects learning potential. The objective was to examine the validity of the dWCST as a measure of learning potential in patients with acquired brain injury (ABI). A total of 104 patients with ABI completed the dWCST at rehabilitation admission. Performance of a subgroup (n=63) was compared to patients (n=28) who completed a repeated administration of the conventional WCST (rWCST). Furthermore, dWCST performance was compared between patients with ABI (n=63) and healthy controls (n=30) matched on gender, age, and education. Three learning potential indices were used: post-test score, gain score, and a group classification (decliners, poor learners, strong learners, high achievers). The median dWCST administration time was 30 min. The dWCST showed no floor or ceiling effects and the post-test and gain score were significantly intercorrelated. The pre-test score showed no significant associations with other neuropsychological tests. The learning potential indices were significantly associated with language and/or memory. In contrast to the dWCST group, the rWCST group showed no significant pre- to post-test improvement. There were significantly more poor learners in the rWCST group. Compared to controls, patients obtained similar gains, but significantly lower pre- and post-test scores for the dWCST. The ratio of poor learners between-groups was not significantly different. The results support the validity of the dWCST for assessing learning potential in patients with ABI. Further research is needed to investigate the predictive validity of the dWCST.

Clinicians' views on learning in brain injury rehabilitation

Abstract Primary objective: To determine clinicians’ views on learning ability in brain injury rehabilitation. Research design: Online survey. Methods and procedures: An online survey was sent to physicians, psychologists and therapists of three Dutch organizations for neuropsychology or rehabilitation. The survey enquired (1) whether clinicians take learning ability into account; (2) about factors influencing learning ability; and (3) about assessment tools used to assess learning ability. Main outcomes and results: Thirty-seven physicians, 83 psychologists and 43 therapists completed the online survey. In total, 93% of respondents reported that they take learning ability into account when making a prognosis. The most frequently mentioned factors influencing learning ability were cognition, awareness of deficits and motivation. Learning ability was mainly determined by means of cognitive and memory tests and observations during therapy. Conclusions: This study demonstrates that a patient’s learning ability may be influenced by not only cognition but also by motivation and awareness of deficits. Structured and standardized assessment of these factors may be suggested for standard use in clinical practice. More research is needed about the influence these factors have on the learning process.

Further validation of the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q) in patients with acquired brain injury

The Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q) evaluates motivation for rehabilitation in four subscales: Interest in rehabilitation, Lack of anger, Lack of denial, and Reliance on professional help. The objective of this study was to further validate the MOT-Q in 122 inpatients and 92 outpatients with acquired brain injury (ABI). The main measures were motivation for rehabilitation (MOT-Q), self-awareness (Patient Competency Rating Scale), and treatment motivation (Visual Analogue Scale). The MOT-Q showed adequate feasibility in terms of few items with missing responses and few undecided responses. We found no floor or ceiling effects, and significant item-total MOT-Q correlations for 29 of 31 items. Internal consistency was good for the MOT-Q total and acceptable to good for the subscales. The MOT-Q scores were significantly intercorrelated except for the subscales Lack of denial and Reliance on professional help in the inpatient group. The MOT-Q total and subscales were significantly associated with treatment motivation. The Lack of denial subscale showed no significant association with treatment motivation and no to moderate significant associations with self-awareness. In conclusion, the overall MOT-Q is a valid instrument to assess motivation for rehabilitation in patients with ABI. Further research is needed to examine the validity of the subscales.

Awareness of memory functioning in patients with stroke who have a good functional outcome

Abstract Primary objective: To determine whether patients with stroke who have a good functional outcome show awareness of memory functioning and whether over- and under-estimation of memory performance are differentially related to neuropsychological performance. Research design: Prospective cohort study. Methods and procedures: The Barrow Neurological Institute Screen for Higher Cerebral Functions and a brief neuropsychological assessment were used to evaluate language, orientation, attention, visuospatial problem-solving, perception, reasoning, executive functioning, memory, affect and awareness of memory functioning. As for the latter, the patient’s estimate of memory functioning was compared with his or her actual memory performance. Patients were divided into three groups: good-estimators (estimated performance = actual performance), over-estimators (estimated performance > actual performance) and under-estimators (estimated performance < actual performance). Main outcomes and results: In total, 54 patients with stroke were included, of whom 27 patients were classified as good-estimators, 19 as over-estimators and eight as under-estimators. Compared to good-estimators, over-estimators had significantly lower scores for all cognitive domains. Under-estimators had significantly poorer affect compared to good-estimators. Conclusions: These preliminary results suggest that over- and under-estimation of memory functioning can be observed in patients with stroke who have a good functional outcome and that they may reflect distinct underlying neuropsychological processes.

Validity and feasibility of a learning style instrument for brain injury rehabilitation

Abstract Purpose: Identifying learning styles of acquired brain injury (ABI) patients may aid the learning process by tailoring to the patient’s learning needs and preferences. Currently, there is no learning style instrument for ABI patients. We therefore determined the validity and feasibility of the Adapted Learning Style Inventory (A-LSI) for patients with ABI. Method: We included 99 patients with ABI and 42 healthy controls. Learning styles were determined and subgroups were used to evaluate the validity of the A-LSI. Furthermore, rehabilitation professionals’ perceptions on learning style and the A-LSI were evaluated. Results: In the patient group, the A-LSI yielded the following learning styles: 4 doers, 54 observers, 2 deciders and 39 thinkers. A similar distribution was found for the control group (3, 28, 0 and 11, respectively). Spearman correlations revealed moderate internal validity. Content validity of the A-LSI was also moderate; 11 out of 19 patients recognized themselves in their A-LSI learning style. Furthermore, 12 rehabilitation professionals reported positive and negative aspects of the A-LSI and suggestions for using learning style in rehabilitation. Conclusions: Rehabilitation professionals were generally positive about using learning style in ABI rehabilitation. This study, however, raises doubts about the validity and feasibility of the A-LSI for this population. Implications for Rehabilitation Rehabilitation professionals are generally positive about the assessment and implementation of learning style in rehabilitation. The A-LSI seems to be an inappropriate learning style instrument for individuals with ABI. There is a need for a more practical instrument to assess learning style directly at start of rehabilitation.