The Sunlight Exposure Therapy on the Improvement of Depression and Quality of Life in Post-stroke Patients
Condition: Stroke; Depression
MeSH terms: Stroke; Depression; Depressive Disorder
Study type: Observational [Patient Registry]

Summary: 
      Chronic diseases has been the leading causes of death in 2015 to 2017 based on the National
      database. In particular, cerebrovascular disease was the third in 2015, the fourth in 2016
      and 2017. In the Statistical Office of the Ministry of Health and Welfare (2016, 2017,2018).
      Previous studies have suggested that nearly 30% of the stroke victims present with signs of
      depression within the first 5 years of illness. Since post-stroke depression significantly
      affects the patient both physically and psychologically, the emotional disturbances impede
      the progress and effectiveness of rehabilitation. Regarding the non-pharmacological treatment
      of melancholia, the phototherapy has been used to treat psychological, behavioral or
      emotional disorders with satisfactory outcomes.Furthermore, many studies has suggested that
      artificial light should mimic natural sunlight to reach optimal effect. The benefit of
      sunlight in human wellbeing has been well documented, therefore we intend to utilize sunlight
      therapy for stroke patients in order to improve their physical and mental health.
    

Detailed description: 
      This study is an experimental interventional study for two groups with pretest and posttest
      analysis. The subjects of the study met the inclusion criteria and were recruited by
      intention sampling method. They were randomly assigned to the experimental group and the
      control groups. This is a single-blind study with sunlight exposure as intervention.
      Appropriate clothing, skin protection measures were given. The calf portion of feet, forearms
      and hands were exposed to sunlight for at least 30 minutes per day, at least 14 days of
      exposure with intensity at least 10000lux over duration of 4 weeks. A total of 46 patients
      were recruited and 4 have lost follow up. 21 patients from each group have completed the
      study. The research tools include: depression status (Taiwanese depression scale,TDS),
      physical activity function (Barthel Index), the severity of cognitive function (mini-mental
      state examination,MMSE) and severity of stroke (National institutes of health stroke
      scale,NIHSS). Each patient was evaluated 3 times during the study: on the day of enrollment
      (pre-test), 2 to 4 weeks since enrollment (1st post-test) and 6-8 weeks after enrollment (2nd
      post-test). Statistical analysis was performed with the following variables: depression,
      cognitive function (MMSE), severity of stroke (NIHSS) and the Barthel Index for daily
      function.

      The participants in the experimental and control groups were subjected to a pre-test
      measurement after they were recruited. For the experimental group, the first post-test
      measurements were taken right after the participants completed the sunlight therapy (two to
      four weeks after the start of the intervention), and the second post-test measurements were
      taken one month after the intervention was completed (six to eight weeks after the start of
      the intervention). For the control group, the first and second post-test measurements were
      taken two and six weeks, respectively, after they started receiving standard care.

      At the start of intervention, the researchers conducting this study instructed the
      experimental group to fill out a sunshine exposure duration record sheet. The participants
      used symbols on the record sheet to indicate the day's weather, such as sunny, partly sunny,
      and cloudy and rainy. Sunshine records were excluded on cloudy and rainy days, while records
      were taken on partly sunny days with sufficient sunshine, and participants had to expose
      themselves outdoors to the sun in an outdoor environment; they were not allowed to expose
      themselves to the sun from an indoor environment through glass. Participants had to take
      appropriate protective measures on their own beforehand, such as wearing breathable clothing,
      visors or sunglasses, and applying sunblock. Throughout the implementation of the sunlight
      therapy, participants were allowed to rest and drink in shady areas if they had any
      discomforts (dizziness, hyperthermia), so as to avoid overexposure to sunlight. If they had a
      burning skin sensation or itchy skin, they were allowed to rinse their skin with cold water,
      iced water, or ice cubes, or to apply ice cubes on their skin for three to five minutes, so
      as to lower their skin temperature and alleviate skin allergies. They were advised to call
      for a medical examination or to contact the researchers if their symptoms persisted.
    

Intervention name(s): sunlight therapy
Intervention type(s): Behavioral
Intervention description(s): Exposed to sunlight for at least 30 minutes per day, at least 14 days of exposure duration of 4 weeks.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Participants had to be verified one-month post-stroke patients in stable condition, with an
        NIHSS score of not more than 15 (minor or moderate stroke).
      
Keywords: Sunlight; depression; daily active function; stroke