Depression
Introduction
A variety of emotional and behavioural disorders may develop following cerebrovascular lesions. Depression, the most common emotional disorder, may affect up to 40% of all patients with stroke. Depression affects every aspect of one's life, such as their body, emotions, thoughts and mood. It is much more complex than simply "feeling blue" and is characterized by a persistent and pervasive feeling of sadness or hopelessness. Depression can also be associated with a combination of the following symptoms: poor appetite and weight loss (or conversely weight gain), sleep disturbances (insomnia or hypersomnia), constipation, psychomotor retardation or at times agitation, difficulties with concentration and thinking, withdrawal from interpersonal contact, feelings of guilt or self-blame, diminished interest or pleasure in most or all activities, and recurrent thoughts of death or suicidal ideations. Depression can occur early after stroke or in the years following. Detection of post-stroke depression is often overlooked so it is important to evaluate the post-stroke patient using reliable measures.
Authors*: Chelsea Hellings BA, Katherine Salter BA, Sanjit Bhogal MSc, Robert Teasell MD, Norine Foley BASc, Mark Speechley PhD, Elissa Sitcoff BSC, BA, Anita Menon, MSc.
*high quality = PEDro score 6-10 *fair quality = PEDro score 4-5 *poor quality = PEDro score ≤ 3 The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/
*high quality = PEDro score 6-10
*fair quality = PEDro score 4-5
*poor quality = PEDro score ≤ 3
The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/
A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.
Patients longer than 6 months post-stroke are identified as in chronic stage of recovery.
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
*high quality = PEDro score 6-10
*fair quality = PEDro score 4-5
*poor quality = PEDro score ≤ 3
The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/
A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.
Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
*high quality = PEDro score 6-10
*fair quality = PEDro score 4-5
*poor quality = PEDro score ≤ 3
The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/
A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
*high quality = PEDro score 6-10
*fair quality = PEDro score 4-5
*poor quality = PEDro score ≤ 3
The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/
A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.