Confidence In Recovery Research Articles

Healthcare professionals beliefs and priorities for the rehabilitation of patients after ankle fracture surgery: A qualitative study

ObjectiveThe study aims to understand healthcare professionals’ (HCPs) beliefs and practices in the treatment and rehabilitation of patients after ankle fracture surgery, with the goal of informing new rehabilitation interventions based on these insights. BackgroundThere is considerable variation in postoperative rehabilitation advice given to patients with ankle fractures, leading to inconsistent care. Prior studies have primarily focused on patients' experiences, making it crucial to explore HCPs' perspectives to identify areas for intervention. MethodsThe study utilised semi-structured interviews with HCPs involved in the multicentre randomised controlled Weightbearing in Ankle Fractures (WAX) trial. Interviewees included physiotherapists, consultant trauma and orthopaedic surgeons, and trainee surgeons. Interviews were conducted between February 2020 and December 2021. Data were analysed using a mixed deductive and inductive approach, aligning with the Behavioural Change Wheel framework to translate findings into potential intervention strategies. Results18 Interviews were conducted, revealing discrepancies between patient and HCP beliefs about recovery, particularly regarding weight-bearing and managing physical symptoms like swelling and numbness. HCPs expressed varying beliefs on the safety of early weight-bearing and recognised historical practice and medicolegal concerns influencing rehabilitation advice. Themes highlighted the need for clearer communication, standardised advice, and the impact of HCPs' remarks on patients' recovery confidence. ConclusionsFindings underscore the mismatch between patient expectations and HCP guidance, emphasising the need for consensus on rehabilitation protocols. The study advocates for tailored rehabilitation pathways that address individual patient recovery trajectories, reduce dependency on HCPs, and encourage patient self-management.

THE RELATIONSHIP OF COPING MECHANISM AND SELF EFFICACY IN TUBERCULOSIS PATIENTS: A CROSS-SECTIONAL STUDY

Tuberculosis (TB) is a contagious infectious disease caused by mycobacterium tuberculosis. TB sufferers feel sad because they receive statements about disease transmission which can give rise to negative perceptions and cause stress. Effective coping mechanisms can influence the patient's self-efficacy towards healing. The aim of this research is to analyze the relationship between coping mechanisms and self-efficacy in TB sufferers at the Tamansari Public Health Center, Tasikmalaya City, Indonesia. The population in this study was people with TB disease. Total sample was 41 respondents with a random sampling technique. Quantitative research and cross-sectional method used in this study. The research results showed that the majority of TB sufferers had adaptive coping mechanisms with high self-efficacy. The results of the Chi-Square test obtained a p-value of 0.001 < 0.05, meaning that there was a relationship between coping mechanisms and self-efficacy in TB sufferers. Coping mechanisms can influence sufferers' self-confidence in their abilities, adaptive coping mechanisms can make TB sufferers have high self-confidence to achieve optimal recovery. The results of this research are expected to play a role in providing health education and family support to sufferers to increase sufferers' confidence in recovery.

Mediation role of perceived social support between recurrence risk perception and health behaviour among patients with stroke in China: a cross-sectional study

ObjectivesTo examine whether patients who had a stroke with high recurrence risk perception would have healthier behaviour and to explore whether perceived social support would function as a mediator.DesignA cross-sectional...

Exploring Factors that Influence Physicians’ Usage of mHealth on Physician-Patient Communication

Background: A desirable physician-patient communication is broadly concluded to be able to reduce waste of medical resources and increase the patients’ confidence in recovery. Along with the rapid development of internet of things, hospitals have largely used mHealth as relationship structure to increase information exchange and relationship be- tween bilateral parties. Drawing on the theories of social exchange and social capital, this study extends technology acceptance model (TAM) to investigate social effects on mHealth adoption. Methods: 120 valid hypertension patient samples were collected with the attending aids of a medical center in Taiwan. Results: The result indicates that the conventional TAM constructs of perceived ease of use (PEOU) and perceived usefulness (PU) of mHealth technology are effective in constructing the social capital (mainly relational capital). The social capital (SC) is found to be significant that generated by PEOU and PU in affecting the mHealth adoption. However, negative capital (NC) effect due mainly to excessive structure capital that annoys patients will decrease adoption. Conclusions: While most studies focused so far on the positive outcomes of building relationship with doctors, we have to revealed its dark side as well. And we proof that patients would really suffered in overwhelmed relationships.

Self-stigma, hope for future, and recovery: An exploratory study of men with early-onset substance use disorder.

The internalizing of experience of stigma among patients with substance use disorders (SUDs) can be debilitating to recovery. Individual factors such as self-regulation and abstinence self-efficacy can impact confidence in recovery and hope for future. The aim of the study was to explore relationship among self-stigma, self-regulation, self-efficacy, optimism, and confidence in recovery of patients with early-onset SUDs. The study was carried out on a sample of 40 male patients with SUDs. The study had a single group exploratory design. The Self-Regulation Questionnaire, Drug Taking Confidence Questionnaire, Substance Abuse Self Stigma Scale, Revised Generalized Expectancy of Success (GES), and visual analog scale for craving were the measures used in the study. Pearson and spearman's correlation coefficient were used to test associations between the variables. Multiple regression models were drawn to examine predictors of generalized expectancy of success and confidence in recovery. Self-regulation, generalized expectancy of success (optimism), and confidence in recovery were found to be significantly correlated with self-stigma dimensions. The multiple regression model revealed self-regulation and self-devaluation as significant predictors of optimism (GES), whereas abstinence self-efficacy and values disengagement dimension of self-stigma predicted patients' confidence in recovery. Poor regulatory capacities along with internalized feelings of shame, guilt, and devaluation may lead to lower levels of optimism and poorer expectancies of success from future. Patient's self-efficacy in terms of abstaining from use behaviors and disengagement from pursuing life goals can lead to lower levels of confidence in recovery from SUDs and have implications for treatment seeking.

Determinants of Farmers’ Confidence in Agricultural Production Recovery during the Early Phases of the COVID-19 Pandemic in China

The COVID-19 pandemic has adversely impacted the agricultural supply chain, export of agricultural products, and overall food security. However, minimal exploration has been attempted of farmers’ confidence in agricultural production recovery after the COVID-19 pandemic. Therefore, this study intends to explore the determinants of farmers’ confidence in agricultural production recovery in China during the early stages of the COVID-19 pandemic. More specifically, we analyzed the relationship between risk expectation and social support on the farmers’ confidence in agricultural production recovery by using the ordered probit model. Cross-sectional survey data were collected from February to March 2020 from 458 farm households in the 7 provinces of China to produce the findings. We found that the risk expectation of farmers had a significant negative impact on farmers’ confidence in agricultural production recovery. Social support seemingly had a significant positive impact on the farmers’ confidence in agricultural production recovery, and could play a supportive role in moderating the relationship between risk expectation and farmers’ confidence in recovery. However, social support alleviates the adverse effect of risk expectation on farmers’ confidence in agricultural production recovery to a certain extent. In addition, there were intergenerational differences in the effects of risk expectation and social support on farmers’ confidence in agricultural production recovery. These results imply that policies establishing the risk early warning mechanisms for agricultural production and strengthening the social support from governments and financial institutions are likely to significantly impact agricultural development in the post-COVID-19 era. The formal and informal risk minimization mechanisms should extend their support to vulnerable sectors such as agribusiness.

고등학교 태권도 선수의 성취목표성향과 인지된 경기력의 관계에서 다차원자신감의 매개효과

The purpose of this study is to provide basic data to help the development of Taekwondo games by verifying the mediating effect of multi-dimensional sports confidence in the relationship between Taekwondo athletes achievement goals and perceived performance. To achieve the goal of the study, a questionnaire was distributed and retrieved through Google to 300 high school players, and 252 copies were selected as final analysis, excluding unfaithful responses from the retrieved questionnaire. Data processing used the PASW Statistics 21 version to produce Frequency Analysis, Exploration Factor Analysis and Cronbachs α coefficient. Furthermore, we conduct a mediated effect analysis by correlation analysis and regression analysis. According to the analysis, first, the recovery confidence and recognition confidence of multi-dimensional sports confidence had a mediated effect in the relationship between ego orientation and perceived performance, but the proficiency confidence did not have a mediated effect. Second, the recovery confidence and proficiency confidence of multi-dimensional sports confidence had a mediated effect in the relationship between task goal orientation and perceived performance, but recognition confidence did not have a mediated effect.

Crisis management practices in the hospitality and gambling industry during COVID-19

PurposeThe purpose of this paper is to examine crisis management practices among gambling-related hospitality business stakeholders (GBSs) during the coronavirus disease 2019 (COVID-19) pandemic.Design/methodology/approachAn online survey was administered to a sample of GBSs resulting in 64 completed surveys. The survey explored the COVID-19 crisis using a three-phase framework: preparedness (prior experience and response plans), response (level of importance and use of crisis practices) and future (confidence in recovery, beliefs about consumer behavior and new strategies). Independent-samples t-tests were conducted to investigate the influence of preparedness variables on crisis management capabilities. Importance-Performance Analysis was used to evaluate GBSs' crisis management capabilities and identify where performance might be improved. Factor analyses were employed to explore groupings of response practices as well as future strategies.FindingsPrior experience had a significant impact on GBSs' crisis management. IPA indicated gaps between the importance GBSs assign to response practices and their corresponding level of use, specifically for those related to marketing and government. Factor analysis revealed response practices did not group according to the questionnaire's four themes, instead, three themes of marketing, efficiency and expenses were revealed. Prevention and hygiene emerged as dominant themes with respect to future strategies.Originality/valueThis is a timely study that investigates crisis management among GBSs during the COVID-19 pandemic. It provides important methodological contributions as well as valuable practical considerations for gambling-related hospitality businesses.

Predictors of Sickness Absence in a Clinical Population With Chronic Pain

Chronic pain-related sickness absence is an enormous socioeconomic burden globally. Optimized interventions are reliant on a lucid understanding of the distribution of social insurance benefits and their predictors. This register-based observational study analyzed data for a 7-year period from a population-representative sample of 44,241 chronic pain patients eligible for interdisciplinary treatment (IDT) at specialist clinics. Sequence analysis was used to describe the sickness absence over the complete period and to separate the patients into subgroups based on their social insurance benefits over the final 2 years. The predictive performance of features from various domains was then explored with machine learning-based modeling in a nested cross-validation procedure. Our results showed that patients on sickness absence increased from 17% 5 years before to 48% at the time of the IDT assessment, and then decreased to 38% at the end of follow-up. Patients were divided into 3 classes characterized by low sickness absence, sick leave, and disability pension, with eight predictors of class membership being identified. Sickness absence history was the strongest predictor of future sickness absence, while other predictors included a 2008 policy, age, confidence in recovery, and geographical location. Information on these features could guide personalized intervention in the specialized healthcare. PerspectiveThis study describes sickness absence in patients who visited a Swedish pain specialist interdisciplinary treatment clinic during the period 2005 to 2016. Predictors of future sickness absence are also identified that should be considered when adapting IDT programs to the patient's needs.

Multifaceted interventions are required to improve physical activity behaviour in hospital care: a meta-ethnographic synthesis of qualitative research.

What are the views of patients, close relatives and healthcare professionals on physical activity behaviour in hospital care? A meta-ethnographic synthesis of qualitative studies was conducted with a lines-of-argument analysis. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. The lines of argument were synthesised and mapped in an existing theoretical model. The confidence of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. Eleven studies were included and provided data from 290 participants (145 patients, 0 close relatives and 145 healthcare professionals). We have synthesised six lines of argument that explained the (intention of) physical activity behaviour of patients during their hospital stay: patients and healthcare professionals perceive benefits and risks of physical activity for patients' health (high confidence); physical activity gives a sense of freedom, confidence in recovery and mental wellbeing (high confidence); all healthcare professionals should offer timely and tailored physical activity promotion (high confidence); patient motivation to be physically active may be contingent upon encouragement (moderate confidence); family members can influence physical activity behaviour favourably or unfavourably (low confidence); and hospital culture has a negative influence on physical activity behaviour of patients (high confidence). Physical activity behaviour of patients during their hospital stay is a complex phenomenon with multiple interactions at the level of patients, healthcare professionals and hospital culture. Considering the results of this synthesis, multifaceted implementation strategies are needed to improve physical activity intention and behaviour of patients during their hospital stay.

Contextual and Psychosocial Factors Influencing the Use of Safe Water Sources: A Case of Madeya Village, uMkhanyakude District, South Africa.

Background: Schistosomiasis is a public health problem that affects over 240 million people worldwide. It is mostly prevalent in tropical and sub-tropical areas among communities with limited access to clean water and adequate sanitation. This study was conducted in uMkhanyakude District in rural South Africa, where water resources are limited. In this community, individuals frequently come into contact with freshwater bodies for various reasons. The objective of the study was to identify critical contextual and psychosocial factors for behaviour change to reduce risk of schistosomiasis transmission in Madeya Village, uMkhanyakude district. Methods: Structured household interviews were held with 57 primary caregivers to assess their thoughts and attitudes towards collecting water from a safe source. We used the Risk, Attitude, Norm, Ability, and Self-regulation model (RANAS) to estimate the intervention potential for each factor by analysing differences in means between groups of current performers and nonperformers who use safe water sources. Results: The subscale vulnerability belonging to the risk factor on the RANAS was scored as low. Furthermore, attitudinal factors towards the use of safe water sources were found to be low. Ability factors (confidence in performance and confidence in recovery) towards the use of safe water sources were low as well, indicating that these factors should be the target of the intervention in the study area. Discussion: Based on this study, it is recommended that a community-based empowerment intervention strategy it appropriate. The strategy should prompt behavioural practice and public commitment, use persuasive language to boost self-efficacy and target younger low-income caregivers between 18 and 35 years of age.

Feasibility of peer support services among people with severe mental illness in China

BackgroundPeer-delivered services potentially provide broad, multifaceted benefits for persons suffering severe mental illness. Most studies to date have been conducted in countries with well-developed outpatient mental health systems. The objective of this study was to examine the feasibility for developing a community-based peer service in China.MethodsThirteen peer service providers and 54 consumers were recruited from four communities in Beijing. We initiated the program in two communities, followed by another two in order to verify and add to our understanding of potential scalable feasibility. Semi-structured face-to-face interviews were conducted 12 month after initiation at each site to measure satisfaction and perceived benefits from perspectives of peer service providers, and consumers and their caregivers.ResultsKey stakeholders reported that peer support services were satisfying and beneficial. Eleven of 13 peer service providers were willing to continue in their roles. Ten, 8, and 7 of them perceived improvements in working skills, social communication skills, and mood, respectively. Among consumers, 39 of 54 were satisfied with peer services. Improvements in mood, social communication skills, illness knowledge, and illness stability were detected among 23, 18, 13, and 13 consumers, respectively. For caregivers, 31 of 32 expressed a positive view regarding peer services. Caregivers reported improvement in their own mood, confidence in recovery of their family members, and reduction in caretaker burdens.ConclusionsThe findings highlight that peer-delivered services have promise in China for benefiting persons with severe mental illness and their family caregivers, as well as the peer service providers themselves.

The Injury-Psychological Readiness to return to sport (I-PRRS) scale and the Sport Confidence Inventory (SCI): A cross-cultural validation

ObjectivesThe purpose of this study was to cross-culturally validate in the Italian language the I-PRRS and the SCI. DesignCross-sectional study. SettingInjured Italian athletes. ParticipantsWe recruited male (n = 73) and female (n = 27) athletes who returned to practice after having completed the rehabilitation. Main outcome measuresThe measures comprised the I-PRRS, the SCI, and the Italian Mood Scale (ITAMS). Athletes completed the questionnaires within 1 day before their first official competition following injury. We investigated the construct validity, the internal consistency, and the concurrent validity of the I-PRRS and SCI with the ITAMS. ResultsConfirmatory Factor Analysis supported the two-factor structure of the I-PRRS (Confidence in performance capability and Confidence in recovery) and the three-factor structure of the SCI (SC-Physical Skills and Training, SC-Cognitive Efficiency, and SC-Resilience). The reliability scores of both I-PRRS and SCI subscales indicated good internal consistency. Correlation between the I-PRRS and the SCI ranged in magnitude from weak to moderately high. A similar trend of correlations was found between the subscales of the I-PRRS and the ITAMS, as well as between the subscales of the SCI and the ITAMS. ConclusionsStudy findings showed satisfactory psychometric properties of the Italian version of the I-PRRS and SCI.

Positive effects of the inclusion of open-mouth pressure for elimination of blood in microscopic subinguinal varicocelectomy.

Primary varicocele (PVC) may cause testicular hypofunction and scrotal pain. We believe that the currently used procedure microscopic subinguinal varicocelectomy (MSV) can be further improved to provide more benefits to the patients. In total, 100 patients who were diagnosed as having PVC grade II or III with venous reflux based on ultrasound results, along with scrotal pain and visible scrotal varicose veins, were enrolled; they were randomly divided into two groups. When the experimental group underwent MSV, stagnant venous blood in the internal spermatic vein close to the testis was drained using manual pressure, whereas the control group was treated with routine MSV procedure. The patients' psychological condition, symptoms, prognoses, scrotal appearances, and other related indexes were evaluated before and after the surgeries, and the results were compared. Scores on days 1-3 after the surgeries were significantly different between the two groups (P < 0.05) for the Hamilton Depression Scale (HAMD) after viewing the scrotum immediately after the surgeries, the Hamilton Anxiety Scale (HAMA) after viewing the scrotum immediately after the surgeries, and the average visual analog scale (VAS). No significant differences were found between the groups for other evaluation indexes (P > 0.05). The use of open-mouth pressure for elimination of blood reduces postoperative filling of dilated scrotal veins, reduces the visual stimuli to patients immediately after surgery, significantly improves the anxiety and depression of patients, helps to maintain positive mental condition in patients after the surgeries, and increases their confidence in recovery from the disease. It also leads to better pain relief within a short period after the surgery and maximizes surgical benefits for the patients.

Effects of WeChat-based peer education on patients after retinal detachment

Objective To explore the effects of WeChat-based peer education on improving special position compliance in patient after retinal detachment and to provide reference for clinical nursing staff. Methods Totally 82 patients after retinal detachment who were hospitalized in the First Affiliated Hospital of Zhengzhou University from March 2017 to April 2018 were selected by purposive sampling and randomly divided into the control group (n=41) and the intervention group (n=41) according to the random number table. Patients in the control group received conventional health education, while patients in the intervention group received WeChat-based peer education on the basis of conventional health education. The special position compliance and the incidence rate of complications 3 months post surgery were compared between the two groups. Their satisfaction with the WeChat-based peer education was also evaluated. Results The score of special position compliance in the intervention group was (5.23±0.854) , higher than that of the control group (P<0.01) , which was (2.11±0.997) . The incidence rate of nuchal muscle pain, headache, dizziness and insomnia caused by special positions in the intervention group was lower than that in the control group (P<0.05) . The patients' satisfaction with the WeChat-based peer education was 92.68%. Conclusions The WeChat-based peer education improves patients' awareness of diseases and enhance their confidence in recovery, thereby improving their special position compliance and accelerating recovery. Key words: Retinal detachment; WeChat; Peer education; Compliance

Patient Attitudes Toward Transplantation as Preferred Treatment Modality in Different Stages of Renal Disease

ObjectiveKidney transplantation is generally considered to be the best treatment for end-stage renal disease. Not every patient can be operated, but many of suitable patients refuse this possibility. We aimed to explore the attitudes of patients with chronic kidney disease towards renal replacement therapies to recognize motives, thoughts, and feelings concerning accepting or refusing the treatment. We studied the attitudes towards the illness and the treatment, the appearance of depression, and the disease burden during different stages of the disease. MethodsFor this study we implemented a questionnaire that we developed (which has been described in an earlier publication of this journal) with 99 pre-dialysis patients, 99 dialysis patients, and 87 transplantation patients. We completed the attitude questionnaire designed by our team to include disease burden and depression questionnaires. ResultsWe used discriminant analysis to describe different stages of the disease. There was a significant difference in the following factors between the three patient groups: accepting the new kidney, lack of confidence in transplantation therapy, fear of surgery, accepting self-responsibility in recovery, dependency on the transplanted kidney, confidence in recovery, subjective burden of dialysis, and denial of personal responsibility in maintaining the transplanted kidney. Significant differences were also detected in these three groups regarding the level of depression and disease burden: we measured the highest value among the dialysis patients, and the lowest value among the pre-dialysis patients. Comparing patients accepting and refusing transplantation, we found a correlation between the refusal of transplantation and the attitudes towards the illness and treatment. ConclusionsMost patients remain unmotivated to change treatment modality and refuse transplantation. Misbelief about transplantation shows a correlation with the motive of refusal. Dissemination of information may facilitate a change in the situation.

Social Resources and Community Resilience in the Wake of Superstorm Sandy.

Recovery efforts after natural disasters typically focus on physical infrastructure. In general less attention is paid to the social infrastructure that might impact the capacity of the community to rebuild. We examine perceptions of preparedness and recovery (markers of resilience at the community level) in the wake of Superstorm Sandy with a novel data set that includes a multi-mode survey of twelve neighborhoods severely affected by the storm. With these data, we suggest that social resources are associated with beliefs about neighborhood resilience. People who live in communities with higher social cohesion (coefficient = .73, p <.001), informal social control (coefficient = .53, p <.001), and social exchange (coefficient = .69, p <.001) are more likely to believe their neighborhoods are well prepared for a disaster. Likewise, people living in communities with higher social cohesion (coefficient = .35, p <.01), informal social control (coefficient = .27, p <.05), and social exchange (coefficient = .42, p <.001) are more likely to be confident their neighborhoods will recover quickly from a disaster. However, the effects of social resources on beliefs about resilience vary based on neighborhood socioeconomic status (SES) and the impact of the storm. Informal social control and social exchange lead to a greater increase in confidence in recovery in low, as compared to high, SES neighborhoods. Social resources tend to have more impact on perceptions of recovery in communities less affected by the storm. In sum, these findings suggest the potential value of various forms of social intervention to better equip communities to respond when disaster strikes.

Tracing the second stage of ozone recovery in the Antarctic ozone-hole with a &amp;quot;big data&amp;quot; approach to multivariate regressions

Abstract. This study presents a sensitivity analysis of multivariate regressions of recent springtime Antarctic vortex ozone trends using a "big data" ensemble approach. Our results indicate that the poleward heat flux (Eliassen–Palm flux) and the effective chlorine loading respectively explain most of the short-term and long-term variability in different Antarctic springtime total ozone records. The inclusion in the regression of stratospheric volcanic aerosols, solar variability and the quasi-biennial oscillation is shown to increase rather than decrease the overall uncertainty in the attribution of Antarctic springtime ozone because of large uncertainties in their respective records. Calculating the trend significance for the ozone record from the late 1990s onwards solely based on the fit of the effective chlorine loading is not recommended, as this does not take fit residuals into account, resulting in too narrow uncertainty intervals, while the fixed temporal change of the effective chlorine loading does not allow for any flexibility in the trends. When taking fit residuals into account in a piecewise linear trend fit, we find that approximately 30–60% of the regressions in the full ensemble result in a statistically significant positive springtime ozone trend over Antarctica from the late 1990s onwards. Analysis of choices and uncertainties in time series show that, depending on choices in time series and parameters, the fraction of statistically significant trends in parts of the ensemble can range from negligible to a complete 100% significance. We also find that, consistent with expectations, the number of statistically significant trends increases with increasing record length. Although our results indicate that the use multivariate regressions is a valid approach for assessing the state of Antarctic ozone hole recovery, and it can be expected that results will move towards more confidence in recovery with increasing record length, uncertainties in choices currently do not yet support formal identification of recovery of the Antarctic ozone hole.

Incidence and Predictors of Acute Psychological Distress and Dissociation After Motor Vehicle Collision: A Cross-Sectional Study

Objective: We examined the incidence and predictors of peritraumatic distress and dissociation after one of the most common forms of civilian trauma exposure: motor vehicle collision (MVC). Method: In this study, patients presenting to the emergency department after MVCs who were without serious injury and discharged to home after evaluation (n = 935) completed an emergency department interview evaluating sociodemographic, collision-related, and psychological characteristics. Results: The incidence and predictors of distress (Peritraumatic Distress Inventory score ≥23) and dissociation (Michigan Critical Events Perception Scale score >3) were assessed. Distress was present in 355 of 935 patients (38%), and dissociation was present in 260 of 942 patients (28%). These outcomes showed only moderate correlation (r = .45) and had both shared and distinct predictors. Female gender, anxiety symptoms prior to the MVC, and vehicle damage severity predicted both distress and dissociation. Higher socioeconomic status (higher education, higher income, full-time employment) had a protective effect against distress but not dissociative symptoms. Better physical health and worse overall mental health were associated with increased risk of dissociation but not distress. Distress but not dissociation was associated with lower patient confidence in recovery and a longer expected duration of recovery. Conclusion: There are unique predictors of peritraumatic distress and dissociation. Further work is needed to better understand the neurobiology of peritraumatic distress and dissociation and the influence of these peritraumatic outcomes on persistent psychological sequelae.

Self-management programmes for people post stroke: a systematic review

Objective: To examine the evidence base underlying self-management programmes specific to stroke survivors. Data sources: Eleven electronic databases were searched using combinations of keywords related to stroke and self-management. Review methods: Studies involving adults with a clinical diagnosis of stroke, which explored self-management interventions, were included. Study selection was verified by two reviewers who independently conducted methodological quality appraisal and data extraction using a tool developed by The American Academy for Cerebral Palsy and Developmental Medicine. Results: Fifteen studies were included in this review. Significant treatment effects in favour of the self-management intervention were found in six out of nine randomized controlled trials, and three out of six non-randomized trials in our review. Four randomized controlled trials involving more than 100 participants per trial reported statistically significant results in favour of the self-management group in relation to measures of disability, confidence in recovery, the stroke specific quality of life (sub-scales of family roles and fine motor tasks), and the physical component scale of the short form SF-36 Score. The wide range of outcome measures used prevented comparison across studies. Conclusions: This review provides some preliminary support for the potential importance of self-management interventions after stroke. The most appropriate content and best approach for delivery of these interventions remains to be determined. Further high-quality randomized controlled trials are needed to test the feasibility, acceptability, and efficacy of stroke self-management programmes.