Longitudinal Changes in Functioning and Disability in Patients with Disorders of Consciousness: The Importance of Environmental Factors

International Journal of Environmental Research and Public Health

Michelle Willems²  Davide Sattin²  Ad J.J.M. Vingerhoets¹  Matilde Leonardi²  Alarcos Cieza³  Carla Sabariego³ 

[1] Department of Medical & Clinical Psychology, Tilburg University, P.O. Box 90153, Tilburg 5000 LE, The Netherlands; E-Mail:;Neurology, Public Health, Disability Unit—Scientific Directorate, Neurological Institute Carlo Besta Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation, Via Celoria 11, Milan 20133, Italy; E-Mails:Neurology, Public Health, Disability Unit—Scientific Directorate, Neurological Institute Carlo Besta Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation, Via Celoria 11, Milan 20133, Italy;

关键词: unresponsive wakefulness syndrome;    vegetative state;    minimally conscious state;    disorders of consciousness;    disability;    functioning;    International Classification of Functioning;    Disability;    and Health;    longitudinal study;   

DOI  :  10.3390/ijerph120403707

来源: mdpi

【 摘 要 】

Disorders of consciousness are neurological conditions associated with low levels of functioning which pose a serious challenge to public health systems. The current study aimed to examine longitudinal changes in functioning in patients with disorders of consciousness and to identify associated biopsychosocial factors using the International Classification of Functioning, Disability, and Health. An Italian sample of 248 patients was assessed longitudinally. Differences in relative variability (an index of change that controls for baseline levels) between acute and chronic patients and predictors of relative variability in “Activities & Participation” were examined. Results showed that there were subgroups of patients whose functioning improved over time. The number of problems in “Activities & Participation” decreased in acute patients over time, whereas in chronic patients, an increase was found. The significant difference in relative variability for the environmental factor “support and relationships” reflects the increase in facilitators in acute patients, whereas the number of facilitators in chronic patients remained unchanged over time. Age at event, time from event, and relative variability in “Environmental Factors” were significant predictors of relative variability in “Activities & Participation”. It is of clinical relevance that patients with disorders of consciousness are kept in a supportive and facilitative environment, in order to prevent a decline in their functioning. Moreover, caregivers should receive tailored support in order to enhance and facilitate appropriate care of patients with disorders of consciousness.

【 授权许可】

CC BY   
© 2015 by the authors; licensee MDPI, Basel, Switzerland.