TY - JOUR
T1 - Personalized predictions of treatment outcome in patients with post-stroke depressive symptoms
AU - Rauwenhoff, Johanne C. C.
AU - Van Bronswijk, Suzanne C.
AU - Peeters, Frenk
AU - Bol, Yvonne
AU - Geurts, Alexander C. H.
AU - Van Heugten, Caroline M.
N1 - Funding Information:
The study is funded by ZonMW. The funder had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.
Publisher Copyright:
© 2020 Foundation for Rehabilitation Information. All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - Objective: Post-stroke depressive symptoms have a vast individual and societal impact. However, research into interventions for such symptoms show contradictory results; it is unclear what works for which patients. In addition, clinical prediction tools are lacking. This study aimed to develop a prognostic index model for treatment outcome in patients with post-stroke depressive symptoms.Methods: Data from a randomized controlled trial (n = 61) evaluating 2 interventions for post-stroke depressive symptoms were used to predict post-treatment post-stroke depressive symptoms and participation. From 18 pre-treatment variables of patients and caregivers, predictors were selected using elastic net regression. Based on this selection, prognostic index scores (i.e. predictions) for both out comes were computed for each individual patient.Results: The depression model included all pre-treatment variables, explaining 44% of the variance. The strongest predictors were: lesion location, employment, participation, comorbidities, mobility, sex, and pre-treatment depression. Six predictors of post-treatment participation were identified, explaining 51% of the variance: mobility, pre-treatment participation, age, satisfaction with participation, caregiver strain, and psychological distress of the spouse. The cross-validated prognostic index scores correlated highly with the actual outcome scores (depression: correlation = 0.672; participation: correlation = 0.718).Conclusion: Post-stroke depressive symptoms form a complex and multifactorial problem. Treatment outcome is influenced by the characteristics of the stroke, the patients, and their spouses. The results show that psychological distress is probably no obstacle to attempting to improve participation. The personalized predictions (prognostic index scores) of treatment outcome show promising results, which, after further replication and validation, could aid clinicians with treatment selection.
AB - Objective: Post-stroke depressive symptoms have a vast individual and societal impact. However, research into interventions for such symptoms show contradictory results; it is unclear what works for which patients. In addition, clinical prediction tools are lacking. This study aimed to develop a prognostic index model for treatment outcome in patients with post-stroke depressive symptoms.Methods: Data from a randomized controlled trial (n = 61) evaluating 2 interventions for post-stroke depressive symptoms were used to predict post-treatment post-stroke depressive symptoms and participation. From 18 pre-treatment variables of patients and caregivers, predictors were selected using elastic net regression. Based on this selection, prognostic index scores (i.e. predictions) for both out comes were computed for each individual patient.Results: The depression model included all pre-treatment variables, explaining 44% of the variance. The strongest predictors were: lesion location, employment, participation, comorbidities, mobility, sex, and pre-treatment depression. Six predictors of post-treatment participation were identified, explaining 51% of the variance: mobility, pre-treatment participation, age, satisfaction with participation, caregiver strain, and psychological distress of the spouse. The cross-validated prognostic index scores correlated highly with the actual outcome scores (depression: correlation = 0.672; participation: correlation = 0.718).Conclusion: Post-stroke depressive symptoms form a complex and multifactorial problem. Treatment outcome is influenced by the characteristics of the stroke, the patients, and their spouses. The results show that psychological distress is probably no obstacle to attempting to improve participation. The personalized predictions (prognostic index scores) of treatment outcome show promising results, which, after further replication and validation, could aid clinicians with treatment selection.
KW - post-stroke depressive symptoms
KW - cognitive behavioural therapy
KW - treatment outcome
KW - prognostic index
KW - COGNITIVE-BEHAVIORAL THERAPY
KW - MINI-MENTAL STATE
KW - PROGNOSTIC INDEX
KW - MAJOR DEPRESSION
KW - PRACTICAL METHOD
KW - STROKE
KW - PARTICIPATION
KW - REGRESSION
KW - SCALE
KW - VALIDATION
U2 - 10.2340/16501977-2744
DO - 10.2340/16501977-2744
M3 - Article
C2 - 32965505
SN - 1650-1977
VL - 52
JO - Journal of Rehabilitation Medicine
JF - Journal of Rehabilitation Medicine
IS - 11
M1 - 00120
ER -