Joanna Kowalska

The role of depressive and anxiety symptoms in the evaluation of cardiac rehabilitation efficacy after coronary artery bypass grafting surgery.

OBJECTIVES The aim of this study was to evaluate the efficacy of early 3-week cardiac rehabilitation (CR) in terms of the reduction of negative psychological symptoms, and to determine which factors predispose patients to worse rehabilitation results in this regard. METHODS The study involved a random group of 50 patients (11 women and 39 men) who had undergone coronary artery bypass grafting, with a mean age of 63.3 (± 7.2) years. The following screening tests were used: Beck Depression Inventory, State-Trait Anxiety Inventory and Acceptance of Illness Scale. The pulse rate during the first session of physical training was recorded (t(1) P), and after training the patients assessed their level of exertion (t(1) E) on the Borg Scale (BS). The same procedure was repeated at the end of the rehabilitation (t(2) P, t(2) E). RESULTS Among the psychological parameters examined at t(1) (at baseline), the strongest relationship with poor acceptance of illness after 3 weeks of rehabilitation was indicated by the level of depression (P < 0.001), with a slightly lower correlation with the state anxiety and the trait anxiety results (P = 0.005 and 0.027, respectively). A relationship was also found between the severity of depression in t(1) and the level of exertion measured by the BS at the end of rehabilitation (P = 0.007). Before rehabilitation, depressed patients exhibited higher levels of both trait and state anxiety (P = 0.009 and 0.018, respectively). After rehabilitation in the depressed subgroup, there was no improvement in the subjective assessment of exertion or reduction of state anxiety. Sex and co-morbidities also had considerable importance in the context of CR efficacy. The women showed more severe depressive symptoms (P = 0.01), a higher personality tendency to anxiety (P = 0.036) and poorer results of rehabilitation (in relation to the level of exertion after physical training and the intensity of state anxiety symptoms). There was no reduction of state anxiety in patients who suffered from at least two co-morbidities. CONCLUSIONS The presence of severe anxiety-depressive symptoms before rehabilitation has an effect on its outcome. Psychiatric symptomatology should be diagnosed as early as possible and patients should receive additional therapeutic support.

The Level of Anxiety and Depression in Dialysis Patients Undertaking Regular Physical Exercise Training - a Preliminary Study

Background/Aims: The aim of the study was to evaluate the effects of a six-month physical training undertaken by haemodialysis (HD) patients, on the depression and anxiety. Methods: Patients with end stage renal disease (ESRD) were recruited from the dialysis station at the Department of Nephrology and Transplantation Medicine in Wroclaw. Physical training took place at the beginning of the first 4-hours of dialysis, three times a week for six months. A personal questionnaire, Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were used in the study. Results: A total of 28 patients completed the study: 20 were randomised to endurance training and 8 were randomised to resistance training. Statistical analysis of depression and anxiety at the initial (t1) and final examination (t2) indicated a significant reduction in depression and anxiety, particularly anxiety as a trait (X2) in the whole study group. The change in anxiety as a state correlated with the disease duration, duration of dialysis and the initial level of anxiety as a state (t1X1). The change in anxiety as a trait significantly correlated with age and the initial level of anxiety (t1X2). Conclusions: Undertaking physical training during dialysis by patients with ESRD is beneficial in reducing their levels of anxiety and depression. Both resistance and endurance training improves mood, but only endurance training additionally results in anxiety reduction.

Evaluation of a short-term group psychotherapy used as part of the rehabilitation process in nursing home patients

Abstract Purpose: The aim of this study was to assess the impact of a 4-week group psychotherapy on the efficacy of physiotherapy in patients rehabilitated in a nursing home (NH). Materials and methods: The study was performed on 28 women, aged 77.1 (±5.6) years. Thirty-six percent were rehabilitated due to orthopaedic injuries, 36% had undergone a stroke, 28% suffered from chronic diseases of old age. Subjects were divided into two groups: experimental (n = 13) and control (n = 15). In the experimental group, a short-term, goal-focused group psychotherapy was used. To assess cognitive impairment, mood and functional status the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS-15) and the Barthel Index (BI) were used. Results: In the experimental group a four times greater improvement in mood was observed and two times greater physiotherapy efficacy (PE) in the first month of stay in an NH as compared to the control group. The effects of psychotherapy were independent of the type of disease, the patients’ age, number of comorbidities and cognitive status (ranging from 15 to 30 points on the MMSE). Conclusions: Short-term group psychotherapy can be an effective method of supporting the process of rehabilitating older, disabled people rehabilitated in an NH. Implications for Rehabilitation Psychotherapy can improve the efficacy of treatment and rehabilitation in different somatic illnesses despite the advanced age of respondents, high disability rate, and the presence of cognitive impairments. Even short-term (4 weeks) group psychotherapy can provide effective support for the rehabilitation in the elderly.

Occurrence of Depressive Symptoms Among Older Adults after a Stroke in the Nursing Home Facility.

Purpose: The aim of the study was to analyze the prevalence of depressive symptoms among older adults after stroke in a nursing home (NH). Design: The study was conducted in a NH and included 50 patients after stroke with a mean age of 74.62 (±8.2). Method: The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Acceptance Illness Scale (AIS) and Barthel Index (BI) were used. Findings: Mean GDS was 7.60 (±2.75); 74% of patients had depressive symptoms. The study showed a significant relationship between GDS and marital status (p = .043). A negative correlations between GDS and MMSE (p = .029), GDS and BI (p = .049), and GDS and AIS (p < .0001) were found. Conclusion: The occurrence of depressive symptoms in older adults after stroke depends on their mental and functional status, degree of acceptance of illness, and marital status. Clinical Relevance: Early detection of depressive symptoms in stroke patients allows rehabilitation nurses to optimize the therapeutic effects.

Physical activity and childbirth classes during a pregnancy and the level of perceived stress and depressive symptoms in women after childbirth

AIM The aim of this study was to answer the question of whether physical activity during pregnancy and participation in childbirth classes prepare women for childbirth; further, does it influence the levels of perceived stress and the occurrence of depressed mood. METHODS 100 women participated in the study. Half of the women had taken part in the childbirth classes before giving birth. A questionnaires of own authorship, Edinburgh Postnatal Depressioni Scale (EPDS) and Perceived Stress Scale (PSS-10) were used. RESULTS There was no significant relationship observed between participation in childbirth classes and the results of EPDS and PSS-10. The mood of women after childbirth correlated significantly with the level of stress in the whole study group (p<0.0001). Best mean well-being and lowest mean perceived stress were observed in women who stayed in a relationship (p =0.0029, p = 0.0008). Women physically active during pregnancy were also characterized by better mood and lower levels of perceived stress (6.7 and 14.4 vs. 8.4 and 16.0). Among women exercising during pregnancy the participants in childbirth classes was far more numerous (p<0.0001). CONCLUSIONS Declared physical activity during pregnancy was linked to lower levels of stress experienced by women and less severe depressive symptoms after childbirth,; espe- cially in the group of childbirth classes participants.

Role of Family in the Process of Rehabilitation of Older Adults Hospitalized in a Nursing Home

The study involved 39 patients aged 76.0 (SD = 10.9) years (minimum 47 years, maximum 91 years). The examined patients came from families with varying degrees of caring capacity and, on these grounds, were assigned into subgroups. We used Mini-Mental State Examination, the Geriatric Depression Scale, and the Barthel Index. The greatest improvement in functional status after rehabilitation occurred in patients with a family characterized by a lack of caring capacity, and the smallest improvement was in the group of patients with full caring capacity. The greatest improvements in the performance of basic activities of daily living were reported in singles or people from families with a total lack of care.

Effectiveness of physiotherapy in elderly patients with dementia: a prospective, comparative analysis

Abstract Background: The aim of this study was to assess the efficacy of physiotherapy in nursing home patients with comorbid dementia. Materials and methods: The study group consisted of 88 patients, including 48 people with dementia and 40 people without dementia. Before and after physiotherapy, the Mini Mental State Examination and Barthel Index were used. Results: Elderly patients without dementia achieved a greater improvement in functional status. The level of cognitive functioning at the time of admission to a nursing home, but not the patient’s functional status, had a significant impact on physiotherapy efficacy. Conclusion: Understanding the role of dementia in the rehabilitation process is important for care planning. More research is required to ascertain the efficacy of physiotherapy in people with moderate to severe dementia, including the best strategies to improve their functional status. Implications for Rehabilitation The level of cognitive function is important in the rehabilitation process, and it influences effectiveness of physiotherapy. Physiotherapy efficacy in the group of patients with coexisting dementia is lower than that in patients without dementia. Regular physiotherapy can also improve functional status in patients with coexisting dementia. The results of the study may have utilitarian implications, leading to a change in therapy regimens at physiotherapy centres treating disabled chronically ill people with coexisting dementia.

The role of massage in reducing the risk of burnout in employees of large corporations

• There is an increased risk of burnout syndrome among the employees of large corporations, especially in the sales sector.

An Assessment of the Burden on Polish Caregivers of Patients With Dementia: A Preliminary Study

Introduction: The aim of the study was to assess the level of burden of caregivers of persons with dementia and to analyze the factors related to the sense of burden. Methods: The study group consisted of 58 caregivers with an average age of 54.7 (± 12.6) and 45 (78%) were women. The Caregiver Burden Scale, the Beck Depression Inventory (BDI), the Berlin Social Support Scale (BSSS), and the Satisfaction with Life Scale (SWLS) were used. Results: In the study group, 93% could rely on help in caring for the patient, provided mainly by the family. Most caregivers demonstrated a medium level of burden (2.63 ± 0.61). A significant correlation was found between the level of caregiver burden and caregiving frequency, BSSS, BDI, and SWLS. Conclusions: A lot of factors influence the caregivers’ burden. It appears necessary to take into consideration the cultural, religious, and economic distinctiveness of the country in question.

Evaluation of Exercise Tolerance in Dialysis Patients Performing Tai Chi Training: Preliminary Study

Introduction. Patients with end-stage renal disease (ESRD) have poor physical performance and exercise capacity due to frequent dialysis treatments. Tai Chi exercises can be very useful in the area of rehabilitation of people with ESRD. Objectives. The aim of the study was to assess exercise capacity in ESRD patients participating in 6-month Tai Chi training. Patients and Methods. Twenty dialysis patients from Wroclaw took part in the training; at the end of the project, 14 patients remained (age 69.2 ± 8.6 years). A 6-minute walk test (6MWT) and spiroergometry were performed at the beginning and after 6 months of training. Results. After 6 months of Tai Chi, significant improvements were recorded in mean distance in the 6MWT (387.89 versus 436.36 m), rate of perceived exertion (7.4 versus 4.7), and spiroergometry (8.71 versus 10.08 min). Conclusions. In the ESRD patients taking part in Tai Chi training, a definite improvement in exercise tolerance was recorded after the 6-month training. Tai Chi exercises conducted on days without dialysis can be an effective and interesting form of rehabilitation for patients, offering them a chance for a better quality of life and fewer falls and hospitalisations that are the result of it.