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- Influência da comunicação na vida dos cuidadores de pessoas com afasiaPublication . Silva, Fátima; Patrício, BrígidaEste estudo tem como objectivo verificar se os cuidadores informais de pessoas com afasia consideram pertinente a sua participação no processo de habilitação/reabilitação do seu familiar, em terapia da fala, tendo em conta o impacto da afasia na sua vida. Foram entrevistados 7 cuidadores. Verificou-se que a sua qualidade de vida diminuiu, que houve alterações nos padrões de comunicação, nos papéis desempenhados e nos seus relacionamentos. É atribuída importância à terapia da fala na melhoria das competências comunicativas dos familiares e na relação entre ambos, considerando a sua participação pertinente, apesar de nem sempre conseguirem acompanhar o familiar às sessões.
- Clinical Education - a fundamental curricular unit for all health practitionersPublication . Patrício, Brígida; Magina, Eugénia; Nunes, Helena; Faria, Paula Cristina; Araújo, André; Cunha, Maria JoãoClinical education is recognized as being crucial for the training of health professionals. This subject is debated amongst teachers, students and professionals. Besides the clinical and research skills, we look for other competencies such as oratory, creative thinking or leadership. We present the results of a study with 4th graders. It’s a exploratory study; the main purpose was to evaluate the outcomes of a unit of clinical education prepared according a new set of competencies and methodologies. The competencies were seen as valuable. Organization, leading or supporting a colleague, rethinking a program to serve client and family are equally important.
- RELEASE: a protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasiaPublication . Brady, Marian C.; Patrício, BrígidaSpeech and language therapy (SLT) benefits people with aphasia following stroke. Group level summary statistics from randomised controlled trials hinder exploration of highly complex SLT interventions and a clinically relevant heterogeneous population. Creating a database of individual participant data (IPD) for people with aphasia aims to allow exploration of individual and therapy-related predictors of recovery and prognosis. To explore the contribution that individual participant char acteristics (including stroke and aphasia profiles) and SLT intervention components make to language recovery following stroke. Methods and procedures: We will identify eligible IPD datasets (including randomised controlled trials, non-randomised comparison studies, observational studies and registries) and invite their contribution to the database. Where possible, we will use meta and network meta-analysis to explore language performance after stroke and predictors of recovery as it relates to participants who had no SLT, historical SLT or SLT in the primary research study. We will also examine the components of effective SLT interventions. Outcomes include changes in measures of functional communication, overall severity of language impairment, auditory comprehension, spoken language (including naming), read ing and writing from baseline. Data captured on assessment tools will be collated and transformed to a standardised measure for each of the outcome domains. Our planned systematic-review-based IPD meta- and network meta-analysis is a large scale, international, multidisciplin ary and methodologically complex endeavour. It will enable hypotheses to be generated and tested to optimise and inform development of interventions for people with aphasia after stroke. The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018110947).
- Conhecimento dos estudantes finalistas dos cursos de enfermagem, fisioterapia, medicina e terapia ocupacional sobre afasiaPublication . Moreira, Inês; Patrício, Brígida; Silva, FátimaA afasia pode interferir com a capacidade de comunicar da pessoa, impactando negativamente na sua qualidade de vida (Patrício, 2015). Interlocutores preparados para comunicar com pessoas com dificuldades comunicativas podem ser um facilitador, nomeadamente profissionais de saúde que intervêm no processo de reabilitação (Hallowell, 2017). Existem poucos estudos que abordam o conhecimento que estes profissionais e os estudantes da área da saúde apresentam sobre afasia.
- Quality of life predictors and normative dataPublication . Patrício, Brígida; Jesus, Luis; Cruice, Madeline; Hall, AndreiaPurpose: Identify predictors and normative data for quality of life (QOL) in a sample of Portuguese adults from general population Methods: A cross-sectional correlational study was undertaken with two hundred and fifty-five (N=255) individuals from Portuguese general population (mean age 43yrs, range 25-84yrs; 148 females, 107 males). Participants completed the European Portuguese version of the World Health Organization Quality of Life short-form instrument (WHOQOL-Bref) and the European Portuguese version of the Center for Epidemiologic Studies Depression Scale (CES-D). Demographic information was also collected. Results: Portuguese adults reported their QOL as good. The physical, psychological and environmental domains predicted 44% of the variance of QOL. The strongest predictor was the physical domain and the weakest was social relationships. Age, educational level, socioeconomic status and emotional status were significantly correlated with QOL and explained 25% of the variance of QOL. The strongest predictor of QOL was emotional status followed by education and age. QOL was significantly different according to: marital status; living place (mainland or islands); type of cohabitants; occupation; health. Conclusions: The sample of adults from general Portuguese population reported high levels of QOL. The life domain that better explained QOL was the physical domain. Among other variables, emotional status best predicted QOL. Further variables influenced overall QOL. These findings inform our understanding on adults from Portuguese general population QOL
- Sintomatologia depressiva em indivíduos com afasia: Proposta de linha de corte do Stroke Aphasic Depression Questionnaire-21Publication . Patrício, Brígida; Santos, Maria EmíliaEste estudo tem como objectivos: (1) determinar a linha de corte do Stroke Aphasic Depression Questionnaire-21 (SADQ- 21); e (2) verificar a incidência da sintomatologia depressiva em indivíduos com afasia crónica. Envolveu uma amostra de 33 indivíduos com afasia com mais de um ano de evolução e uma amostra de 66 sujeitos sem patologia incapacitante. A avaliação da sintomatologia depressiva foi feita através das versões Portuguesas da Center for Epidemiologic Studies Depression Scale (CES-D) e do SADQ-21. Os resultados mostraram que valores superiores a 17 na SADQ-21 são indicativos de sintomatologia depressiva importante, pelo que se determinou como linha de corte o valor 17. Verificou-se, ainda que indivíduos com afasia crónica tem significativamente mais sintomas depressivos do que indivíduos sem lesão cerebral (t = -6,023, gl = 97, p = 0,000).
- Ensino de ferramentas de coaching e programação neurolinguística a estudantes de licenciatura em Terapia da Fala: a perspetiva dos estudantesPublication . Patrício, Brígida; Araújo, André; Faria, Paula Cristina; Pinto, Marta; Ribeiro, CarolinaO ensino de soft skills a estudantes do ensino superior tem-se revelado muito importante. No Curso de Licenciatura em Terapia da Fala da Escola Superior de Saúde do Instituto Politécnico do Porto (ESS-P.Porto), este ensino é feito, também, através da utilização de ferramentas de Coaching e Programação Neurolinguística. No último ano de formação os estudantes implementam processos de intervenção diretamente com clientes, pelo que este ensino é feito de forma explícita, empoderando os estudantes para usá-las consigo próprios, com clientes, supervisores e equipa. Neste estudo são identificadas, na perspetiva dos estudantes: a) vantagens; b) desvantagens c) ferramentas mais importantes d) ferramentas utilizadas e d) dificuldades na utilização. A metodologia é qualitativa, com análise documental de peças reflexivas dos portefólios de Educação Clínica III. Foram analisados 56 portefólios, identificadas 32 peças sobre a temática e analisadas 16. Os estudantes identificaram vantagens para o desenvolvimento de competências intrapessoais e interpessoais. Não foram identificadas desvantagens. As ferramentas mais importantes e mais usadas foram as perguntas poderosas. A maior dificuldade foi a necessidade de treino. Esta prática pedagógica é útil no desenvolvimento de soft skills dos estudantes de ensino superior, em particular, dos estudantes de terapia da fala.
- Validade e fiabilidade da versão portuguesa do Stroke Aphasic Depression Questionnaire-21Publication . Patrício, BrígidaO objectivo deste estudo é determinar as propriedades psicométricas da versão portuguesa do Stroke Aphasic Depression Questionnaire-21 (SADQ-21). Envolveu 120 sujeitos, 33 dos quais com afasia. Os resultados demonstraram que o SADQ-21 revela uma consistência interna muito elevada (α=0,87). A validade de construção identificou cinco domínios. A variância total explicada pelos factores foi elevada (65,85%). A correlação entre a medida de ouro e o SADQ-21 é estatisticamente significativa (p<0,05). Os indivíduos com afasia estão significativamente mais deprimidos que os sem afasia (p=0,0001). Conclui-se que o SADQ-21 é um instrumento adequado para a avaliação da sintomatologia depressiva em pessoas com afasia.
- Quality of life of the caregivers of people with aphasia. A systematic review.Publication . Patrício, Brígida; Jesus, Luis; Cruice, MadelinePurpose: Systematic review to identify the factors associated to the quality of life (QOL) of the caregivers of people with aphasia (PWA). Methods: Studies were searched using Medline, Pubmed, Cochrane Library, CINAHL, PsycINFO and Web of Science databases. Peer-reviewed papers that studied the QOL of PWA’s caregivers or the consequences of aphasia in caregivers’ life were included. Findings were extracted from the studies that met the inclusion criteria. Results: No data is available reporting particularly the QOL of PWA caregivers’ or their QOL predictors. Nevertheless, it was possible to extract aspects related to QOL from the studies that report the consequences of aphasia, and life changes in PWA’s caregivers. Nine (9) studies including PWA’s caregivers were found, but only 5 reported data separately on them. Methodological heterogeneity impedes cross-study comparisons, although some considerations can be made. PWA’s caregivers reported life changes such as: loss of freedom; social isolation; new responsibilities; anxiety; emotional loneliness; need for support and respite. Conclusions: Changes in social relationships, in emotional status, increased burden and need for support and respite were experienced by PWA’s caregivers. Stroke QOL studies need to include PWA caregivers’ and report separately on them. Further research is needed in this area in order to determine their QOL predictors and identify what interventions and referrals better suit their needs.
- Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysisPublication . Brady, Marian C.; Patrício, BrígidaStroke rehabilitation interventions are routinely personalized to address individuals’ needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild–moderate/ moderate–severe based on language outcomes’ median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants’ greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3–4 SLT-h/week; ⩾ 50 hours). For moderate–severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild–moderate participants’ greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males’ greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. We observed a treatment response in most subgroups’ overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild–moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate–severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.
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