Psychometric evaluation of a newly developed measure of emotionalism after stroke (TEARS-Q)

Niall M Broomfield, Robert West, Allan House, Theresa Munyombwe, Mark Barber, Fergus Gracey, David C Gillespie, Matthew Walters, Niall M Broomfield, Robert West, Allan House, Theresa Munyombwe, Mark Barber, Fergus Gracey, David C Gillespie, Matthew Walters

Abstract

Objective: To evaluate, psychometrically, a new measure of tearful emotionalism following stroke: Testing Emotionalism After Recent Stroke - Questionnaire (TEARS-Q).

Setting: Acute stroke units based in nine Scottish hospitals, in the context of a longitudinal cohort study of post-stroke emotionalism.

Subjects: A total of 224 clinically diagnosed stroke survivors recruited between October 1st 2015 and September 30th 2018, within 2 weeks of their stroke.

Measures: The measure was the self-report questionnaire TEARS-Q, constructed based on post-stroke tearful emotionalism diagnostic criteria: (i) increased tearfulness, (ii) crying comes on suddenly, with no warning (iii) crying not under usual social control and (iv) crying episodes occur at least once weekly. The reference standard was presence/absence of emotionalism on a diagnostic, semi-structured post-stroke emotionalism interview, administered at the same assessment point. Stroke, mood, cognition and functional outcome measures were also completed by the subjects.

Results: A total of 97 subjects were female, with a mean age 65.1 years. 205 subjects had sustained ischaemic stroke. 61 subjects were classified as mild stroke. TEARS-Q was internally consistent (Cronbach's alpha 0.87). TEARS-Q scores readily discriminated the two groups, with a mean difference of -7.18, 95% CI (-8.07 to -6.29). A cut off score of 2 on TEARS-Q correctly identified 53 of the 61 stroke survivors with tearful emotionalism and 140 of the 156 stroke survivors without tearful emotionalism. One factor accounted for 57% of the item response variance, and all eight TEARS-Q items acceptably discriminated underlying emotionalism.

Conclusion: TEARS-Q accurately diagnoses tearful emotionalism after stroke.

Keywords: Stroke; emotionalism; mental health.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Receiver operating characteristic curve for testing emotionalism after recent stroke – questionnaire. This gives a graphical representation of the values of sensitivity and specificity for each potential cut point for the TEARS-Q measure. The Youden cut point maximises the sum of sensitivity and specificity and occurs at 1.5 yielding a specificity of 90.1% and a sensitivity of 88.7%.
Figure 2.
Figure 2.
Scree plot for TEARS-Q indicating one dimension. The pronounced ‘elbow’ shows that most of the information comes from the first component of a principal component analysis: that is TEARS-Q is a unidimensional measure.

References

    1. Allida S, Patel K, House A, et al.. Pharmaceutical interventions for emotionalism after stroke. Cochrane Database Syst Rev 2019; (3): CD003690.
    1. Woodward TJ, Kim C, Calderon F, et al.. Review of the diagnosis and management of pseudobulbar affect. US Pharm 2017; 42: 31–35.
    1. House AO, Dennis M, Molyneux A, et al.. Emotionalism after stroke. Br Med J 1989; 298: 991–994.
    1. Gillespie DC, Cadden AP, Lees R, et al.. Prevalence of post-stroke pseudobulbar affect following stroke: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2016; 25: 688–694.
    1. George S, Wilcock AA, Stanley M. Depression and lability: the effects on occupation following stroke. Br J Occup Ther 2001; 64: 455–461.
    1. Robinson RG, Parikh RM, Lipse JR, et al.. Pathological laughter and crying following stroke: validation of a measurement scale and a double-blind treatment study. Am J Psychiatry 1993; 150: 286–293.
    1. Moore SR, Gresham LS, Bromberg MB, et al.. A self-report measure of affective lability. J Neurol Neurosurg Psychiatry 1997; 63: 89–93.
    1. Calvert T, Knapp P, House AO. Psychological associations with emotionalism after stroke. J Neurol Neurosurg Psychiatry 1998; 65: 928–929.
    1. Eccles S, House AO, Knapp P. Psychological adjustment and self-reported coping in stroke survivors with and without emotionalism. J Neurol Neurosurg Psychiatry 1999; 67: 125–126.
    1. Enderby P, Crow E. Frenchay aphasia screening test: validity and comparability. Disabil Rehabil 1996; 18: 238–240.
    1. Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1972; 1: 35–40.
    1. Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud 1988; 10: 64–67.
    1. National Institute of Neurological Disorders and Stroke (U.S.). NIH stroke scale. Bethesda, MD: National Institute of Neurological Disorders and Stroke, Department of Health and Human Services, USA, 2011.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–370.
    1. Herdman M, Gudex C, Lloyd A, et al.. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011; 20: 1727–1736.
    1. Scottish Government Index of Multiple Deprivation: SIMD. Scottish government, (2012, accessed 23 September 2020).
    1. Nguyen TH, Han H-R, Kim MT, et al.. An introduction to item response theory for patient-reported outcome measurement. Patient 2014; 7: 23–35.
    1. Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol 2010; 5: 1315–1316.
    1. Parvizi J, Coburn KL, Shillcutt SD, et al.. Neuroanatomy of pathological laughing and crying: a report of the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 2009; 21: 75–87.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner