title: Longitudinal changes in functioning and disability in patients with disorders of consciousness: the importance of environmental factors.
abstract: 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 &amp; Participation" were examined. Results showed that there were subgroups of patients whose functioning improved over time. The number of problems in "Activities &amp; 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 &amp; 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.
authors.affiliation: 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. michelle.willems@istituto-besta.it.|Department of Medical & Clinical Psychology, Tilburg University, P.O. Box 90153, Tilburg 5000 LE, The Netherlands. michelle.willems@istituto-besta.it.
authors.forename: Michelle
authors.initials: M
authors.lastname: Willems
authors.affiliation: 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. davide.sattin@istituto-besta.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Sattin
authors.affiliation: Department of Medical & Clinical Psychology, Tilburg University, P.O. Box 90153, Tilburg 5000 LE, The Netherlands. vingerhoets@uvt.nl.
authors.forename: Ad J J M
authors.initials: AJ
authors.lastname: Vingerhoets
authors.affiliation: 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. leonardi@istituto-besta.it.
authors.forename: Matilde
authors.initials: M
authors.lastname: Leonardi
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000368:Aged; D017028:Caregivers; D003244:Consciousness Disorders / Q000503:physiopathology / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012931:Social Environment; D012932:Social Facilitation; D055815:Young Adult
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