Relaxation training after stroke: potential to reduce anxiety

Kneebone, Ian; Walker-Samuel, Natalie; Swanston, Jennifer; Otto, Elisabeth

doi:10.3109/09638288.2013.808275

Cited by 33 publications

(44 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, it is debatable whether patients with very severe stroke would be included in early depression/anxiety screening programmes. Unavailable during study design was a DISCs equivalent for anxiety, although recently one has been published [30]. We recognise that MINI is not a substitute for clinical assessment.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Diagnostic Accuracy of Early Mood Screening to Diagnose Persisting Clinical Depression/Anxiety Disorder after Stroke

Lees¹,

Stott²,

Quinn³

et al. 2014

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: Depression/anxiety disorders are common after stroke and have a negative impact on outcomes. Guidelines recommend that all stroke survivors are screened for these problems. However, there is no consensus on timing or method of assessment. We investigated the feasibility and accuracy of a very early screening strategy and the diagnostic accuracy this has for depression/anxiety disorders at 1 month. Methods: Screening tools were Hospital Anxiety and Depression Scale (HADS) and Depression Intensity Scale Circles (DISCs); we also assessed cognition using the Montreal Cognitive Assessment (MoCA). Screening was offered to sequential stroke admissions. At 1 month we assessed for clinical depression/anxiety disorder using Mini-International Neuropsychiatric Interview (MINI) and retested screening tools. We described test accuracy of acute depression/anxiety screening for clinical diagnosis of depression/anxiety disorder at 1 month and described temporal change in screening test scores. We assessed feasibility by describing proportions that were able, agreed to and completed the screening tests. Results: Over 4 months, 102/146 admissions were suitable for screening following initial medical assessment, 69 (68%) agreed to screening, of whom 33 (48%) required researcher assistance to complete the screening test battery. Median time to assessment was 2 days (IQR: 1-4). Early HADS suggested n = 9 (13%) with depression; DISCs n = 25 (37%). Median acute MoCA was 21/30. At 1 month, n = 61 (88%) provided data. Repeat scores showed improvement over time; HADS (anxiety) mean difference: 2.5 (95% CI: 1.2-3.7), HADS (depression) mean difference: 1.6 (95% CI: 0.3-2.9). MINI defined n = 12 (20%) with depression and n = 6 (10%) with anxiety disorder. Comparing baseline screening to 1-month clinical diagnosis, HADS sensitivity was 0.25 (95% CI: 0.09-0.53) and specificity 0.94 (95% CI: 0.84-0.98); DISCs sensitivity was 0.92 (95% CI: 0.65-0.99) and specificity 0.78 (95% CI: 0.64-0.87). Conclusions: Even amongst ‘medically stable' stroke patients, depression/anxiety screening at the acute stage may not be feasible or accurate. Half of participants required assistance from the researcher to complete assessments. The poor predictive accuracy of HADS for depression/anxiety disorder at 1 month may be due in part to the high prevalence of cognitive impairment in our sample. Screening in the first few days after stroke does not appear useful for detecting clinically important and sustained depression/anxiety problems.

show abstract

Section: Discussionmentioning

confidence: 99%

Feasibility and Diagnostic Accuracy of Early Mood Screening to Diagnose Persisting Clinical Depression/Anxiety Disorder after Stroke

Lees¹,

Stott²,

Quinn³

et al. 2014

Cerebrovasc Dis

View full text Add to dashboard Cite

show abstract

“…Indeed only one instrument has been subject to reliability and validity testing and has established sensitivity and specificity in a stroke population (Lincoln, Kneebone, Macniven, & Morris, 2012), the Anxiety Scale of the Hospital Anxiety and Depression Scale (HADS-A; Zigmond & Snaith, 1983). Unfortunately, this scale is difficult to use with many patients post stroke, even in those without substantial cognitive and/or communication problems, on account of its relative complexity (Kneebone, Walker-Samuel, Swanston, & Otto, 2014) and those with severe aphasia are unable to complete self-report assessments or even to report their feelings (Sutcliffe & Lincoln, 1998). The importance of developing a measure of anxiety for use with those with communication difficulties is highlighted by estimates suggesting that 23-38% of stroke survivors are affected by aphasia (Dickey et al, 2011;Engelter et al, 2006;Flowers, Silver, Fang, Rochon, & Martino, 2013;Kyrozis et al, 2009;Pedersen, Jorgensen, Nakayama, Raaschou, & Olsen, 1995;Wade, Hewer, David, & Enderby, 1986).…”

mentioning

confidence: 99%

“…The need to develop suitable measures to detect and monitor anxiety after stroke has become more urgent as treatments are developed for this disorder in the stroke population (Kneebone & Jeffries, 2013;Kneebone et al, 2014;Waldron, Casserly, & O'Sullivan, 2012). To address this need, a team of clinicians have proposed an observational instrument, the Behavioural Outcomes of Anxiety scale (BOA; Kneebone, Neffgen, & Pettyfer, 2012).…”

mentioning

confidence: 99%

The Behavioural Outcomes of Anxiety scale (BOA): A preliminary validation in stroke survivors

Linley-Adams

Morris

Kneebone

2014

British J Clinic Psychol

Self Cite

View full text Add to dashboard Cite

show abstract

“…15 Finally, we also aimed to undertake preliminary evaluations of an observational version of the self-report Generalised Anxiety Disorder-7 16 and the Tension Rating Circles. 17 The latter uses self-rated muscle tension to gauge anxiety. Neither of these instruments has been studied with an aphasic stroke population.…”

Section: Introductionmentioning

confidence: 99%

Psychometric properties of the Behavioural Outcomes of Anxiety questionnaire in stroke patients with aphasia

2016

Self Cite

View full text Add to dashboard Cite

Objective:To evaluate the psychometric properties of an observational, carer-completed anxiety screen for aphasic stroke patients.Design:Phase 1: A cross-sectional questionnaire design to establish psychometric properties. Phase 2: A randomized longitudinal design with treatment and control to evaluate sensitivity to change and repeatability/reliability.Subjects:Phase 1: 111 patient-carer dyads were recruited through stroke charities: patient mean age 69.7(10. 7), 6.2(5. 2) years since stroke, 76 male; carer mean age 64.7(12. 2), 27 male. Phase 2. A subsample of 50 dyads (29 completed).Measures:All patients completed the Tension Rating Circles and the Frenchay Aphasia Screening Test. Carers completed the Behavioural Outcomes of Anxiety questionnaire, observational versions of the Hospital Anxiety and Depression Scale (HADS-A) and the Generalised Anxiety Disorder-7, and a feedback questionnaire.Intervention:Phase 2: 25 dyads were offered relaxation training and 25 acted as controls.Results:The Behavioural Outcomes of Anxiety questionnaire correlated .77 with the HADS-A and Cronbach’s Alpha was .82 demonstrating validity and internal consistency. Using HADS-A cut-off > 7 as criterion the area under the curve was 0.90 and at cut-off of > 16 sensitivity (0.85) and specificity (0.85) were both good. Scores declined significantly more in a group given anxiety training (n = 12) than in a control group (n = 17), demonstrating sensitivity to change and construct validity. Two-week repeatability/reliability was .92. Feedback suggested the scale was acceptable.Conclusions:The Behavioural Outcomes of Anxiety questionnaire shows promise as an anxiety screen for stroke patients with aphasia and is sensitive to change. Further analysis of dimensionality and discriminant validity is needed.

show abstract

Relaxation training after stroke: potential to reduce anxiety

Cited by 33 publications

References 17 publications

Feasibility and Diagnostic Accuracy of Early Mood Screening to Diagnose Persisting Clinical Depression/Anxiety Disorder after Stroke

Feasibility and Diagnostic Accuracy of Early Mood Screening to Diagnose Persisting Clinical Depression/Anxiety Disorder after Stroke

The Behavioural Outcomes of Anxiety scale (BOA): A preliminary validation in stroke survivors

Psychometric properties of the Behavioural Outcomes of Anxiety questionnaire in stroke patients with aphasia

Contact Info

Product

Resources

About