Investigation of depression co-morbidity in stroke population and determination of impact to longitudinal stroke rehabilitation outcomes according to measures of disability, ADL (Activities of daily living), FIM (Functional independence), and QoL (Quality of life) - A scoping review

Abstract

Background/ Rationale: It is scientifically accepted that the risk of developing depression is far more greater in stroke populations than in healthy population, implying association between them. Post - stroke depression is hypothesised to compromise optimal stroke rehabilitation and to prevent the recovery of lost functions. In this way the physical/functional disability is prolonging, causing worsening and further impairment of the quality of life of stroke survivor. Post stroke survivors with depression co-morbidity, are anticipated to have withdrawal symptoms and less motivation to participate in rehabilitation therapies and therefore poorer rehabilitation outcomes are expected for this group of patients. This scoping review wants to determine whether depression issues interfere with rehabilitation goals and outcomes and negatively impact rehabilitation participation, function restoration, everyday activities (ADLs) and quality of life. Lastly rehabilitation outcomes are synthesised according to screening time-points to determine the most optimal stage for their evaluation. Objectives: A scoping review approach was chosen to provide an overview of type, extent and quantity of available research on the association between post stroke depressive symptoms and stroke rehabilitation outcomes. This scoping review examines whether post- stroke depression which is prevalent to stroke population, can act as predictor for poor rehabilitation outcomes. Aim of this study is to investigate the possible correlation between PSD and rehabilitation outcomes. Methods: The PRISMA Checklist reporting for scoping reviews and PICOS criteria was followed. A scoping review of literature among Pubmed and Scopus was performed, searching for articles publicated from 2010 to 2020, with filter to identify only human studies written in English, and comparative studies examining the impact post stroke depression upon post- stroke patients’ recovery and rehabilitation outcomes. Results: The findings support the assumption that depression is associated with increased disability in stroke patients, as patients with depression, compared to those without post- stroke depression had significantly more severe functional disability οn follow ups. The findings confirm the hypothesis that there is association between depression and functional disability in stroke patients. (RabiŽikić., et al.,2014; Astuti et al.,2020). There is also evidence that people with depression after stroke, experience greater impairment, including more substantial reductions in activities of daily living (Schmid et al., 2011; Shi et al., 2016 ; Willey et al., 2010 ) social participation (Silva.S., et al, 2019)and increased mortality( Ellis,2010; Naess.,et al 2010)compared with non-depressed stroke patients. Conclusions: Available research literature exhibits large heterogeneous nature of studies and assessment tools used on this subject, therefore scoping review approach is used to group evidence of association between post stroke depression and neurological rehabilitation outcomes. The evidence shows clearly that early identification during acute and subacute phase of stroke enables more effective addressing of neuropsychiatric disturbances and is associated with more positive rehabilitation outcomes (Kang, et al., 2018; Kapoor, et al., 2019; Unsworth,et al.,2019 ) and also that under-estimation of neuropsychiatric complications due to the evidence- practice gap, is associated with poor rehabilitation outcomes( West, et al., 2010; Naess, et al., 2010; Ellis, et al., 2010; Žikić, et al., 2014 ;Kang, et al., 2018; Paolucci, et al., 2019;).