Assessing quality of life and associated factors in post-stroke patients using the world health organization abbreviated generic quality of life questionnaire (WHOQOL-BREF)

Eating difficulties among Nigerian community-dwelling stroke survivors: prevalence, correlates, and association with quality of life

BACKGROUND

Eating ability is central to human existence and survival, societal acceptance, life satisfaction, and social participation. Although eating difficulties (EDs) are common after stroke, few studies are reporting their impact on the quality of life (QoL) of stroke survivors. This study aimed to assess the prevalence, correlates, and association of EDs with QoL among stroke survivors.

METHODS

A cross-sectional study on 233 (Mean age: 59.6 ± 10.9 years; 52.8% female) Nigerian community-dwelling stroke survivors attending rehabilitation at three public hospitals was conducted. The Minimal Eating Observation Form- version II and WHOQOL-BREF were used to collect data on EDs and QoL respectively. Socio-demographic, stroke-related, and clinical characteristics of patients were assessed using structured questionnaires. The association of EDs with each domain of WHOQOL-BREF (physical health, psychological health, social relationships, environmental health, perceived health status, and overall QoL) was assessed with hierarchical regression analyses.

RESULTS

The majority (60.9%) of stroke survivors had at least one form of ED. Among the three types of EDs assessed, difficulty with energy/appetite (45.1%) was the most prevalent, followed by difficulty with ingestion (43.8%) and deglutition (40.8%). The results showed that EDs were associated with haemorrhagic stroke (r = 0.158; p = 0.016), right-sided hemiplegia (r = 0.172; p = 0.008), increasing stroke severity (r = 0.466; p < 0.001), increasing co-morbidity (r = 0.384; p < 0.001), poor oral health (r = 0.511; p < 0.001), poor mental health (r = 0.260; p < 0.001), poor affected grip strength (r= -0.157; p = 0.016), poor nutritional status (r= -0.362; p < 0.001), low functional ability (r= -0.415; p < 0.001), and low social support (r= -0.257; p < 0.001). After adjustments, EDs independently explained 10.7% of the variance in psychological health (β= -0.467; p < 0.001), 4.7% in social relationships (β= -0.308; p < 0.001), 2.4% in perceived health status (β= -0.221; p = 0.002), and 7.4% in overall QoL (β= -0.383; p < 0.001). However, the variance accounted for by EDs in physical and environmental health domains was insignificant.

CONCLUSION

The prevalence of EDs among Nigerian community-dwelling stroke survivors is high, which is associated with many stroke-related and clinical factors. Meanwhile, increasing in EDs is independently associated with reduced QoL among stroke survivors using WHOQOL-BREF. Emphasis on screening and management of EDs in stroke rehabilitation protocols may assist in improving survivors' QoL.

Respiratory Strength Training Versus Respiratory Relaxation Training in the Rehabilitation of Physical Impairment, Function, and Return to Participation After Stroke: Protocol for a Randomized Controlled Trial

BACKGROUND

Persistent disability in chronic stroke survivors is often attributed to arm or leg weakness; however, respiratory muscle weakness also impedes poststroke rehabilitation, reduces quality of life, and increases the risk of health complications. Respiratory complications are common after stroke and place patients at risk for both prolonged functional disability and mortality. In addition, stroke survivors face ongoing cardiovascular disease that places them at risk for recurrent stroke.

OBJECTIVE

The study aims to compare the effects of 2 respiratory training programs, paired with individualized flexibility, strengthening, and cardiovascular exercise programs, on physiologic, activity, and societal participation outcomes in chronic stroke survivors.

METHODS

This study will be a randomized controlled trial. Participants are 80 community-dwelling adults with chronic stroke. In conjunction with a 24-session (3 times/week for 8 weeks), American Heart Association-informed, whole-body exercise program, participants will be randomized to receive either respiratory strength training or respiratory relaxation training. Study intervention will be directed by a physical therapist and take place in a community fitness center. Outcome assessments will occur in a clinical research center. The primary outcome measure is maximal respiratory pressure. Secondary outcome measures include airway clearance, walking endurance, spatial-temporal gait characteristics, community walking, functional strength and fatigue, depression, and societal participation measures. Longer-term societal participation is a complex domain that may be influenced by other factors beyond physical function. Participants' health status will be monitored for 1 year following the intervention for falls, respiratory illness, and hospitalizations. Additional subanalyses will evaluate the effect of smoke exposure on short- and long-term outcomes. Outcome assessors are blinded to group assignments. Respiratory relaxation training is an active comparator, but no pure control group is included.

RESULTS

This study was funded in March 2020 with enrollment commencing in November 2020. Completion of enrollment is projected for May 2025 with a study projected end date of April 2026. Published results are anticipated in Fall 2026.

CONCLUSIONS

Results from this study will improve our understanding of the additive benefits of respiratory exercises on short- and long-term physiologic, functional, and societal gains for these individuals. These data will be instructive to meet a current unmet rehabilitative need to promote patient-centered care and contribute to decreasing morbidity and mortality in chronic stroke survivors.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05819333; https://clinicaltrials.gov/study/NCT05819333.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59749.

The Relation Between Deviation From the Balanced Time Perspective and Quality of Life Among Older People. The Mediating Role of Death Anxiety and the Moderating Role of Awareness of Aging

Our study aims to identify if the deviation from a balanced time perspective (DBTP) is a predictor of the quality of life among older adults. We also investigated whether awareness of aging moderated and death anxiety mediated the relationship between DBTP and quality of life. A sample of 436 participants was involved in the study (M = 68.27; SD = 6.56; 66.7% female, 33.3% male). They completed scales for measuring the study variables. The results showed that DBTP did not predict quality of life. Awareness of aging did not moderate the relationship between DBTP and quality of life, while death anxiety negatively predicts quality of life, and also mediated the relationship between DBTP and quality of life. Starting from the results obtained, promotion and intervention plans can be developed to improve mental and physical health services.

Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts

There is a deterioration in the quality of life (QoL) of survivor victims of warlike conflicts. Because there is a need to guarantee the effectiveness of assessment tools for these populations, we studied the adequacy of the World Health Organization Quality of Life Questionnaire (WHOQoL-BREF) to assess the QoL of 1,136 surviving victims of the armed conflict in Colombia. Although this questionnaire has yielded promising results, questions remain about its psychometric suitability for specific populations. We used model modification at the item level, comparisons of models with different factor structures, and dimensionality analysis to address the psychometric problems encountered. Dimensionality analysis using a bifactor model suggests that WHOQoL-BREF total scores might be a more appropriate way of reporting results when model fit adequacy is not reached. Conclusions are offered on the psychometric properties of the WHOQoL-BREF, the evaluation of special populations, and possible strategies to address future questionnaire modifications.

Effectiveness of Immersive Virtual Reality-Based Hand Rehabilitation Games for Improving Hand Motor Functions in Subacute Stroke Patients

Stroke rehabilitation faces challenges in attaining enduring improvements in hand motor function and is frequently constrained by interventional limitations. This research aims to present an innovative approach to the integration of cognitive engagement within visual feedback incorporated into fully immersive virtual reality (VR) based games to achieve enduring improvements. These innovative aspects of interaction provide more functional advantages beyond motivation to efficiently execute repeatedly hand motor tasks. The effectiveness of virtual reality games incorporated with innovative aspects has been investigated for improvements in hand motor functions. A randomized controlled trial was conducted, a total of (n=56) subacute stroke patients were assessed for eligibility and (n=52) patients fulfilled the inclusion criteria. (n=26) patients were assigned to the experimental group and (n=26) patients were assigned to the control group. VR intervention involves four VR based games, developed based on hand movements including flexion/extension, close/open, supination/pronation and pinch. All patients got therapy of 24 sessions, lasting 4 days/week for a total of 6 weeks. Five clinical outcome measures were Fugl- Meyer Assessment-Upper Extremity, Action Research Arm Test, Box and Block Test, Modified Barthel Index, and Stroke-Specific Quality of Life were assessed to evaluate patients' performance. Results revealed that after therapy there was significant improvement between the groups (p<0.05) and within groups (p<0.05) in all assessment weeks in all clinical outcome measures however, improvement was observed significantly greater in the experimental group due to fully immersive VR-based games. Results indicated that cognitive engagement within visual feedback incorporated in VR-based hand games effectively improved hand motor functions.

The Applicability of the ESPEN and EASO-Defined Diagnostic Criteria for Sarcopenic Obesity in Japanese Patients after Stroke: Prevalence and Association with Outcomes

Sarcopenic obesity is of growing research and clinical interest; however, validated diagnostic criteria are lacking. We therefore aimed to examine the prevalence of sarcopenic obesity as diagnosed by the criteria recently proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO), and its association with outcomes among patients after stroke. This study was based on a cohort of 760 Japanese patients after stroke admitted to a post-acute rehabilitation hospital. Sarcopenic obesity was diagnosed at admission according to the ESPEN and EASO criteria using reference values specific to Asians. Outcomes included the motor domain of the functional independence measure (FIM-motor) and the food intake level scale (FILS) at discharge. Multivariate linear regression models were used to assess the associations between sarcopenic obesity and outcomes. Among 760 patients (median age, 73 years; 352 women and 408 men), sarcopenic obesity was diagnosed in 34 patients (4.5%; 5.4% of women and 4.1% of men). In multivariate analyses, sarcopenic obesity was independently and negatively associated with FIM-motor (β = −0.048, p = 0.031) and FILS at discharge (β = −0.095, p = 0.046) in women. In contrast, in men, sarcopenic obesity showed an independent negative association with FIM-motor at discharge (β = −0.117, p < 0.001) but no statistically significant association with FILS at discharge (β = −0.004, p = 0.323). In conclusion, the prevalence of sarcopenic obesity diagnosed by the ESPEN and EASO-defined criteria was as low as 4.5% among Japanese patients after stroke. Furthermore, sarcopenic obesity was negatively associated with improvements in activities of daily living and dysphagia.