Quality of life of stroke survivors and their informal caregivers: A prospective study

doi:10.1016/j.dhjo.2015.10.007

Disability and Health Journal

Volume 9, Issue 2, April 2016, Pages 306-312

https://doi.org/10.1016/j.dhjo.2015.10.007 Get rights and content

Abstract

Background

Health care improvements have led to increased survival among stroke patients; however, the disability level remains high. These patients require assistance from caregivers, particularly in the first year after stroke. Longitudinal studies of quality of life (QoL) and the factors associated with QoL for both patients and caregivers are limited.

Objectives

To describe the changes in QoL and determine the factors associated with QoL for both stroke patients and their informal caregivers in the first year after stroke.

Methods

This multicenter prospective study was conducted in public hospitals in Mongolia. In this study, 155 first-time stroke patients and their 88 informal caregivers were followed up for 1 year. The WHOQOL-BREF questionnaire was used to assess QoL. The Barthel Index was administered to the patients at the baseline and after 1 year. A generalized estimating equation analysis was used to determine the factors associated with QoL.

Results

The QoL of stroke patients in the domains of physical and environmental aspects improved significantly (p < 0.05) after 1 year; however, social relationship and psychological health declined, but the decline was not significant. Among caregivers, psychological health and social relationship domains improved significantly. Factors associated with low QoL among stroke patients were advancing age, male patients, being single and less improvements on BI score, and among caregivers were poor physical health and financial difficulties.

Conclusions

Efficient rehabilitation therapy for poststroke patients can improve their QoL. Disability training and financial support for caregivers of poststroke patients might be helpful; however, further research is required.

Section snippets

Methods

This study had a multicenter prospective design and was conducted in nine public hospitals (three tertiary-level and six secondary-level hospitals) in Ulaanbaatar, Mongolia. All acute stroke cases in Ulaanbaatar receive care in these hospitals; moreover, stroke patients from other provinces are admitted to these tertiary hospitals. Ethical approval was obtained from the ethics committees of National Yang Ming University and local hospitals, and informed consent was obtained from each

Participants

The mean age of the patients was 58 years (range, 17–91 years); 59% of the patients were men, 83% were married, approximately 48% had education levels lower than college, and 58% had an ischemic stroke (Table 1). At the baseline (the acute stage of stroke), patients with a mean BI score of 31.8 (SD = 25.7), MRS score of 3.99 (SD = 1.1), CCI score of 3.51 (SD = 1.1), and GCS score of 11.7 (SD = 2.4) were considered dependent. After 1 year, the patients were considered to have become moderately

Stroke patients

The stroke patients showed significant improvements in QoL in the environment domain 1 year after stroke. However, significant changes were not observed in the other domains. The environment domain covers extensive aspects including safety of daily life, healthiness of the physical environment, financial situation, obtaining information, leisure activities, satisfaction with the place of residence, health care services, and transportation. Thus, significant improvement in this domain may be

References (45)

G. Robinson-Smith et al.
Self-care self-efficacy, quality of life, and depression after stroke
Arch Phys Med Rehabil
(2000)
M.E. Charlson et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987)
G. Teasdale et al.
Assessment of coma and impaired consciousness: a practical scale
Lancet
(1974)
T. Kwok et al.
Quality of life of stroke survivors: a 1-year follow-up study
Arch Phys Med Rehabil
(2006)
Global Burden of Disease
(2008)
Global Status of Report on Non-communicable Diseases 2014
(2014)
Clinical Guideline of Acute Stroke
(2013)
A.G. Thrift et al.
Global stroke statistics
Int J Stroke
(2014)
Global Atlas of Cardiovascular Diseases
(2011)
B. Han et al.
Family caregiving for patients with stroke: review & analysis
Stroke
(1999)

C. Bugge et al.

Stroke patients' informal caregivers: patient, caregiver, and service factors that affect caregiver strain

Stroke

(1999)

J. Carod-Artal et al.

Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit

Stroke

(2000)

J. Carod-Artal et al.

Quality of life after stroke: the importance of a good recovery

Cerebrovasc Dis

(2009)

P.R. Wilkinson et al.

A long-term follow-up of stroke patients

Stroke

(1997)

Development of the WHOQOL: rationale and current status

Int J Ment Health

(1994)

WHOQOL Measuring Quality of Life

(1997)

A.C. Jönsson et al.

Determinants of quality of life in stroke survivors and their informal caregivers

Stroke

(2004)

W.M. Hopman et al.

Quality of life during and after inpatient stroke rehabilitation

Stroke

(2003)

L. de Weerd et al.

Perceived wellbeing of patients one year post stroke in general practice – recommendations for quality aftercare

BMC Neurol

(2011)

E.J. Jonkman et al.

Quality of life after a first ischemic stroke: long-term developments and correlations with changes in neurological deficit, mood and cognitive impairment

Acta Neurol Scand

(1998)

V. Parag et al.

The impact of stroke on unpaid caregivers: results from the Auckland Regional Community stroke study, 2002–2003

Cerebrovasc Dis

(2008)

Neurology AAo. Guidelines for the early management of patients with acute ischemic stroke. Available from:...

Cited by (40)

Area-level and individual-level socio-economic differences in health-related quality of life trajectories: Results from a 10-year longitudinal stroke study
2023, Journal of Stroke and Cerebrovascular Diseases
We examined area-level (aSES) and individual-level (iSES) socio-economic status on trajectories of HRQoL to 10 years following stroke.
Participants with strokes between 1/5/1996 and 30/4/1999 completed the Assessment of Quality of Life instrument (AQoL, range: -0.04 [worse than death] to 0 [death] to 1 [full health]) at ≥one of 3month, 6-month, 1-year, 2-year, 3-year, 4-year, 5-year, 7-year and 10-year interviews after stroke. Sociodemographic and health information were collected at baseline. We derived aSES from postcode using the Australian Socio-Economic Indexes For Area (2006) (categories: high, medium, low), and iSES from lifetime occupation (categories: non-manual, manual). Multivariable linear mixed effects modelling was used to estimate trajectories of HRQoL over 10 years, by aSES and iSES, adjusting for age, sex, cardiovascular disease, smoking, diabetes, stroke severity, stroke type, and the time influence on age and health conditions.
Of 1,686 participants enrolled, we excluded 239 with ‘possible’ stroke and 284 with missing iSES. Among the remaining 1,163 participants, 1,123 (96.6%) had AQoL assessed at ≥3 timepoints. In multivariable analysis, over time, people in the medium aSES group had mean 0.02 (95% CI -0.06, 0.02) greater reduction in AQoL score, and people in the low aSES group had mean 0.04 (95% CI, -0.07, -0.001) greater reduction, than those in the high aSES group. Manual workers had an average 0.04 (95% CI, -0.07, -0.01) greater reduction in AQoL score over time than non-manual workers.
Over time, HRQoL declines in all people with stroke, declining most rapidly in lower SES groups.
Assessing quality of life and associated factors in post-stroke patients using the world health organization abbreviated generic quality of life questionnaire (WHOQOL-BREF)
2022, Clinical Epidemiology and Global Health
Citation Excerpt :
The results of multiple linear regression found that education level was an associated factor affecting perception of health, physical health, and psychological health. The existing knowledge often highlighted health disparities.26,27 The level of education is a condition that influences a person to accept or reject new knowledge that they received.
This study piloted the World Health Organization Quality of Life short version form (WHOQOL-BREF) to compare the quality of life (QoL) in post-stroke patients who followed the medical stroke rehabilitation program and those whom did not. This study determined which quality of life domains were mostly affected by stroke, and whether there are influencing factors other than rehabilitation.
A cross-sectional study was conducted at Public Hospital in Surabaya. Patients with stroke less than two years since the first attack were included in this study (n = 52). Cronbach's alpha test was performed to assess the internal consistency of WHOQOL-BREF questionnaire. The independent t-test and ANOVA were used to compare the differences between patient's characteristics and the six domains of QoL (i.e., perception of QoL, perception of health, physical of health, psychological health, social relationship, and environmental health). Multiple linear regression was performed to assess the influential factors of QoL.
post-stroke patients aged more than 50 years old (76.9%), male (55.8%). But, only 48.1% of those patients participating in medical rehabilitation programs. Age group was significantly associated with QoL in the psychological health domain (p = 0.021); participating in medical stroke rehabilitation programs was significantly associated with social relationship domain (p = 0.026) and the education level was significantly associated to physical health (p = 0.005), psychological heath (p = 0.035) and perception of health (p = 0.003).
Lower education level was significantly associated with a low perception of health, one of QoL domains; and it was the most influential factor of QoL among post-stroke patients.
Longitudinal study of quality of life in acquired brain injury: A self- and proxy-report evaluation
2021, International Journal of Clinical and Health Psychology
After an acquired brain injury (ABI), the person remains with several impairments and disabilities that cause a decrease in his/her quality of life (QoL), which could change over time. The objective of the study was to analyse the evolution patterns of QoL in a sample of persons with ABI for one-year as well as the differences in proxy- and self-report versions of a QoL instrument. Method: The sample comprised 402 persons with ABI with ages ranging between 18 and 91 years, whom 36.20% had had the accident recently (i.e., three years or less). Patients, professionals and relatives responded at three evaluation points to the CAVIDACE scale, an ABI-specific QoL tool. Results: ANOVAs showed an improvement in QoL in the two follow-ups; the improvement was especially significant in the period between baseline and six months. The respondent factor did not interact with the evaluation time, but significant differences were found between respondents, with scores of patients higher than that for proxies. Finally, the QoL’s evolution interacts with the time elapsed since injury, showing significant improvements in the most recent group (i.e., three years or less). Conclusions: QoL must be considered from the earliest moments after ABI to obtain more significant improvements.
Después del daño cerebral adquirido (DCA), la persona permanece con secuelas y discapacidades severas que pueden causar una disminución de su calidad de vida (CV) variable a lo largo del tiempo. El objetivo de este estudio es analizar los cambios en la CV a lo largo de un año, así como las diferencias entre las versiones autoinforme y heteroinforme de un instrumento de CV. Método: La muestra estuvo compuesta por 402 personas con DCA, con edades entre 18 y 91 años, de quiénes el 36,20% había tenido el accidente recientemente (tres años o menos). Pacientes, profesionales y familiares respondieron en los tres momentos de evaluación a la escala CAVIDACE, un instrumento específico para DCA. Resultados: Los ANOVAs mostraron una mejoría en muchas de las dimensiones de CV en ambos seguimientos, especialmente significativa entre la línea base y los seis meses. Los pacientes puntuaron más alto que el resto de evaluadores, pero este factor no mostró interacción con el momento de evaluación. Finalmente, la evolución de la CV interactuó con el tiempo transcurrido desde el DCA, encontrándose mejorías en el grupo con menor recorrido. Conclusiones: La CV debe ser tenida en cuenta desde los primeros momentos tras el DCA para obtener mejorías más significativas.
Health-Related Quality of Life and Associated Variables in People With Physical Disabilities
2024, Revista Iberoamericana de Psicologia y Salud
Socioeconomic status and health-related quality of life after stroke: a systematic review and meta-analysis
2023, Health and Quality of Life Outcomes
Associations of effort-reward imbalance at work and quality of life among workers after stroke: a one-year longitudinal study in Thailand
2023, BMC Public Health

View all citing articles on Scopus

View full text

Research PaperQuality of life of stroke survivors and their informal caregivers: A prospective study

Abstract

Background

Objectives

Methods

Results

Conclusions

Section snippets

Methods

Participants

Stroke patients

Arch Phys Med Rehabil

J Chronic Dis

Lancet

Arch Phys Med Rehabil

Global Burden of Disease

Global Status of Report on Non-communicable Diseases 2014

Clinical Guideline of Acute Stroke

Global stroke statistics

Int J Stroke

Global Atlas of Cardiovascular Diseases

Family caregiving for patients with stroke: review & analysis

Stroke

Stroke patients' informal caregivers: patient, caregiver, and service factors that affect caregiver strain

Stroke

Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit

Stroke

Quality of life after stroke: the importance of a good recovery

Cerebrovasc Dis

A long-term follow-up of stroke patients

Stroke

Development of the WHOQOL: rationale and current status

Int J Ment Health

WHOQOL Measuring Quality of Life

Determinants of quality of life in stroke survivors and their informal caregivers

Stroke

Quality of life during and after inpatient stroke rehabilitation

Stroke

Perceived wellbeing of patients one year post stroke in general practice – recommendations for quality aftercare

BMC Neurol

Quality of life after a first ischemic stroke: long-term developments and correlations with changes in neurological deficit, mood and cognitive impairment

Acta Neurol Scand

The impact of stroke on unpaid caregivers: results from the Auckland Regional Community stroke study, 2002–2003

Cerebrovasc Dis

Research Paper
Quality of life of stroke survivors and their informal caregivers: A prospective study