How does a cerebral stroke affect quality of life? Towards an adequate theoretical account

Experiences of quality of life the first year after stroke in Denmark and Norway. A qualitative analysis

Purpose: This study aims to explore quality of life (QOL) during the first year of recovery after stroke in North Norway and Central Denmark. Method: Individual in-depth interviews with 11 stroke survivors were performed twelve months after stroke onset. An interpretative, inductive approach shaped the interview process and the processing of data. Results: We found that QOL reflected the individuals' reconstruction of the embodied self, which was identified by three intertwined and negotiating processes: a familiar self, an unfamiliar self, and a recovery of self. Further, we found that reconstruction of the embodied self and QOL could be framed as an ongoing and interrelated process of "being, doing, belonging and becoming". Enriching social relations, successful return to work, and continuity and presence in professional support during recovery enhanced the experience of QOL. Fatigue and sustained reduced function hindered participation in meaningful activities and influenced the perceived QOL negatively. Conclusions: The two countries differed in descriptions of continuity and support in the professional follow-up during the recovery process, influencing the degree of encouragement in reconstructing the embodied self. Reconstruction of the embodied self is a means of understanding stroke survivors' QOL during the first year of recovery, supporting an individualized and tailored rehabilitation practice.

The Importance of Independence in Toileting: the Views of Stroke Survivors and their Occupational Therapists

The profession of occupational therapy claims to be patient centred; however, research shows that the views of patients and health care professionals often differ. Toileting is a fundamental daily activity, yet to date there have been few studies investigating the perceived importance of independence in toileting.

A qualitative study was conducted to determine the views of stroke survivors and their occupational therapists regarding the importance of independence in toileting. A symbolic interactionistic framework was used, allowing the views of these two disparate groups to be compared. Thirteen stroke survivors and seven occupational therapists were interviewed.

Five categories were identified in the data collected: the occupational form normally used in toileting; incontinence and continence; independence and dependence in toileting; issues relating to toileting and hospital discharge; and the role of occupational therapy. Both participant groups agreed that independence in toileting was important in avoiding the need for assistance and in avoiding feelings of decreased self-esteem. However, the patient participants' views extended further in that they stated that the method of toileting was important, not merely that it was conducted independently.

In conclusion, it is essential that occupational therapists consider how they can facilitate a return to the method usually undertaken for toileting by patients. If a return to the previous methodology for toileting will not be possible, then the occupational therapists must give consideration as to how to facilitate adjustment by the patients.

Reliability and validity of a postal version of the Reintegration to Normal Living Index, modified for use with stroke patients

Objective: To adapt the Reintegration to Normal Living Index (RNLI) for postal use with stroke patients.

Design: Reliability was examined using test–retest on 26 stroke patients. Construct validity was tested on 76 patients by examining correlations between the modified RNLI and related scales.

Subjects: Patients at three months to one year post stroke.

Results: All items demonstrated better than chance agreement between test and retest and seven items substantial agreement (kappa= >0.61). The modified RNLI correlated positively with related scales. Patients with stronger reintegration to normal living had better outcomes in anxiety, depression, daily activity and quality of life.

Conclusion: This postal instrument appears reliable and valid and may be a useful outcome measure in stroke studies.

Quality of Life Following Stroke: Negotiating Disability, Identity, and Resources

Residual physical and cognitive impairments following a stroke can pose a significant threat to a survivor’s quality of life. Yet, there is not always a direct one-to-one correlation between functional disability and subjective quality of life. This research investigated the complexity of factors that influence quality of life after stroke, using qualitative interviews. Results indicate that a stroke has a significant impact on the quality of life of survivors, but some individuals find ways to adapt to their functional disabilities and report a high quality of life. Common elements of this process consist of reordering priorities to focus on those activities considered most salient to an individual’s identity; then drawing on existing resources, including health services and social supports, to maintain a customary activity, even in a modified form, retaining salient aspects of the individual’s identity and maintaining a sense of continuity in his or her life.

Conceptualization of a New Stroke-Specific Outcome Measure: The Stroke Impact Scale

Current stroke outcome measures are unable to detect some consequences of stroke that affect patients, families, and providers. The objective of this study was to ensure the content validity of a new stroke outcome measure. This was a qualitative study using individual interviews with patients and focus group interviews with patients, caregivers, and health care professionals. Participants included 30 individuals with mild and moderate stroke, 23 caregivers, and 9 stroke experts. Qualitative analysis of the individual and focus group interviews generated a list of potential items. Consensus panels reviewed the potential items, established domains for the measure, developed item scales, and decided on mechanisms for administration and scoring. Although the participants with stroke appeared highly recovered based on scores from conventional stroke assessments (Barthel Index and NIH Stroke Scale), stroke survivors and their caregivers identified numerous persisting impairments, disabilities, and handicaps. In general, stroke survivors described themselves as only about 50% recovered and reported that they had difficulty in activities in which they were not independent. To fully assess the impact of stroke on patients, we used the results of this qualitative study to develop a new stroke-specific outcome, the Stroke Impact Scale.

Health state descriptions to elicit stroke values: do they reflect patient experience of stroke?

Background

To explore whether stroke health state descriptions used in preference elicitation studies reflect patients’ experiences by comparing published descriptions with qualitative studies exploring patients’ lived experience.

Methods

Two literature reviews were conducted: on stroke health state descriptions used in direct preference elicitation studies and the qualitative literature on patients’ stroke experience. Content and comparative thematic analysis was used to identify characteristics of stroke experience in both types of study which were further mapped onto health related quality of life (HRQOL) domains relevant to stroke. Two authors reviewed the coded text, categories and domains.

Results

We included 35 studies: seven direct preference elicitation studies and 28 qualitative studies on patients’ experience. Fifteen coded categories were identified in the published health state descriptions and 29 in the qualitative studies. When mapped onto domains related to HRQOL, qualitative studies included a wider range of categories in every domain that were relevant to the patients’ experience than health state descriptions.

Conclusions

Variation exists in the content of health state descriptions for all levels of stroke severity, most critically with a major disjuncture between the content of descriptions and how stroke is experienced by patients. There is no systematic method for constructing the content/scope of health state descriptions for stroke, and the patient perspective is not incorporated, producing descriptions with major deficits in reflecting the lived experience of stroke, and raising serious questions about the values derived from such descriptions and conclusions based on these values.

Coping strategies associated with participation and quality of life in older adults

Background.

It is important to understand the coping strategies that optimize or restrict participation or quality of life, especially for older adults.

Purpose.

The purpose of this study was to examine the associations between, on the one hand, problem- and emotion-focused coping strategies used to deal with aging limitations or health problems and, on the other hand, participation and quality of life.

Method.

A cross-sectional design was used with 82 community-dwelling participants aged 65 and older.

Findings.

Participants used both problem-focused (distancing, self-control) and emotion-focused (seeking social support, planful problem solving, positive appraisal) coping strategies to deal with aging limitations or health problems. Only a few moderately significant associations were found except for escape–avoidance coping strategies, which were significantly associated with lower participation and quality of life.

Implications.

Before developing interventions to improve or maintain older adults’ participation and quality of life, more studies are needed to better understand coping strategies used by older adults to deal with aging limitations or health problems and especially escape–avoidance strategies.

Peer support for stroke survivors: a case study

BACKGROUND

Innovative and sustainable programs are required to support the well-being of stroke survivors. Peer support is a potentially low cost way to enhance well-being of recent stroke survivors and the well-being and community reintegration of their peer supporters. This article describes the perceptions of stroke survivors, care partners, peer supporters, and professionals of an individual peer support program.

METHODS

An instrumental case study design was used to examine a volunteer peer support program that provides acute care visits and telephone follow-up post-discharge. In particular, a) type of support provided, b) benefits for the stroke survivor and care partner, c) potential harms to the stroke survivor, d) impact of providing support on the peer supporter, and e) required processes were considered. Semi-structured interviews were carried out with 16 new stroke survivors and 8 care partners immediately following hospital discharge and then 6 months later, and with 7 peer supporters, 3 program co-ordinators and 4 health professionals to gather feedback from multiple stakeholders.

RESULTS

Emotional, affirmational and informational support were perceived as being offered by the peer supporters. Peer visits were perceived as providing encouragement, motivation, validation, and decreased feelings of being alone. However, the visits were not perceived as beneficial to all stroke survivors. The impact on the peer supporters included increased social connections, personal growth, enjoyment, and feelings of making a difference in the lives of others. Involvement of the healthcare team, peer supporter training and a skilled coordinator were crucial to the success this program.

CONCLUSIONS

Peer support can potentially enhance service to stroke survivors and promote community reintegration for peer volunteers. Further research is needed to determine the preferred format and timing of peer support, and the characteristics of stroke survivors most likely to benefit.

Intelligent data analysis of instrumented gait data in stroke patients-a systematic review

Instrumented gait analysis (GA) may be used to analyze the causes of gait deviation in stroke patients but generates a large amount of complex data. The task of transforming this data into a comprehensible report is cumbersome. Intelligent data analysis (IDA) refers to the use of computational methods in order to analyze quantitative data more effectively. The purpose of this review was to identify and appraise the available IDA methods for handling GA data collected from patients with stroke using the standard equipment of a gait lab (3D/2D motion capture, force plates, EMG). Eleven databases were systematically searched and fifteen studies that employed some type of IDA method for the analysis of kinematic and/or kinetic and/or EMG data in populations involving stroke patients were identified. Four categories of IDA methods were employed for the analysis of sensor-acquired data in these fifteen studies: classification methods, dimensionality reduction methods, clustering methods and expert systems. The methodological quality of these studies was critically appraised by examining sample characteristics, measurements and IDA properties. Three overall methodological shortcomings were identified: (1) small sample sizes and underreported patient characteristics, (2) testing of which method is best suited to the analysis was neglected and (3) lack of stringent validation procedures. No IDA method for GA data from stroke patients was identified that can be directly applied to clinical practice. Our findings suggest that the potential provided by IDA methods is not being fully exploited.

Life changed existentially: a qualitative study of experiences at 6-8 months after mild stroke

PURPOSE

To explore experiences of mild-stroke survivors in the context of early supported discharge. The meanings patients attributed to activities and participation in the home recovery process were our main interest.

METHODS

Eight participants (45-80 years) from a randomised controlled study were selected for this sub-study. This purposive sample had received rehabilitation in their homes in the post-stroke acute phase of recovery as part of the larger study. Extensive interview data were analysed using an interpretive strategy and systematic text condensation. Coping theory was included in later stages of analysis.

FINDINGS

The mild-stroke survivors' stories revealed that life had changed profoundly. Differences and similarities in experienced changes were related to: self-perceived health, the body, practical activities, taking part in society, and self-perception. The findings showed the ways in which life changed for mild-stroke survivors, experienced challenges, and survivors' thoughts about the future.

CONCLUSIONS

Mild-stroke rehabilitation should focus more strongly on basic concerns related to self-perceived health, self-perception, and body, since these dimensions seem to complicate daily activities and close relationships. Professionals should also be aware of patients who experience an uncertain situation and unresolved rehabilitation needs, which still can be present 6-8 months after the stroke.

IMPLICATIONS FOR REHABILITATION

When living with mild stroke, entrance to practical and social activities seemed founded on the patients' perception of the body and self as comprehensible or not. Comprehending their own changed body and sense of self seem to be a long-term process when living with mild stroke. It is suggested that long-term follow-up be incorporated in home rehabilitation service, also in the context of early supported discharge. This may contribute to help patient cope more optimally with activities and participation of importance to them.

A systematic review of qualitative studies on adjusting after stroke: lessons for the study of resilience

PURPOSE

To synthesize qualitative studies on adjusting after stroke, from stroke survivors' and carers' perspectives, and to outline their potential contribution to an understanding of resilience.

METHODS

A systematic review of qualitative studies in peer reviewed journals from 1990 to 2011 was undertaken. Findings from selected studies were summarized and synthesized and then considered alongside studies of resilience.

RESULTS

Forty studies were identified as suitable. These suggested that the impact of stroke was felt on many dimensions of experience, and that the boundaries between these were permeable. Nor was stroke as an adverse "event" temporally bounded. Adjustment was often marked by setbacks and new challenges over time. Participants identified personal characteristics as key, but also employed practical and mental strategies in their efforts to adjust. Relationships and structural factors also influenced adjustment after stroke.

CONCLUSIONS

The impacts of stroke and the processes of adjusting to it unfold over time. This presents a new challenge for resilience research. Processes of adjustment, like resilience, draw on personal, inter-personal and structural resources. But the reviewed studies point to the importance of an emic perspective on adversity, social support, and what constitutes a "good" outcome when researching resilience, and to a greater focus on embodiment. Implications for Rehabilitation Stroke is a sudden onset condition which for around a third of people has long-term consequences. Stroke can cause a variety of physical and cognitive impairments, some of which may not be obvious to an outsider. As well as physical functioning, stroke can have a profound effect on survivors' sense of self and on their relationships. Stroke survivors' accounts suggest that relationships (including relationships with health care professionals) and structural factors (such as access to health services, employment possibilities and welfare systems) mediate efforts to adjust after stroke. While there is considerable overlap between notions of adjustment and resilience, the experiences of stroke survivors suggest further issues that need to be addressed in order to gain a more comprehensive understanding of resilience.

Living an unfamiliar body: the significance of the long-term influence of bodily changes on the perception of self after stroke

The aim of this study is to illuminate the significance of the long-term influence of bodily changes on the perception of self after stroke by means of narrative interviews with 23 stroke survivors. A phenomenological-hermeneutic approach inspired by the philosophy of Merleau-Ponty and Ricoeur is the methodological framework. Zahavi's understanding of the embodied self and Leder's concept of dys-appearance along with earlier research on identity guide the comprehensive understanding of the theme. The meaning of bodily changes after stroke can be understood as living with an altered perception of self. Stroke survivors perceive their bodies as fragile, unfamiliar and unreliable and tend to objectify them. The weak and discomforting body that 'cannot' demands constant, comprehensive awareness to keep itself in play. These long-term and often permanent consequences of bodily weakness may turn stroke survivors' intentionality inwards, away from external activities and projects and relationships with others. Negative judgements from others are added to lost roles and positions and threaten the vulnerable self. Stroke survivors try to regain familiarity with their body by their life-long project of testing its boundaries. Mastering important tasks helps them strengthen their self-concept. Health care workers should be aware of the embodied self and engage in long-term dialogues with stroke survivors to strengthen positive perceptions of body and self. More research is needed to understand destructive post-stroke phenomena such as fatigue and pain and to find effective methods to help stroke survivors regain wholeness of body and self.

Integrating situated learning theory and neuropsychological research to facilitate patient participation and learning in traumatic brain injury rehabilitation patients

PURPOSE

Traumatic brain injury (TBI) constitutes a major health problem throughout the world. Despite interdisciplinary efforts, patients reach varying outcomes in terms of every-day life functioning and quality-of-life. This paper suggests that a situated learning perspective supplemented with evidence from neurophysiologic and neuropsychological research provides a perspective to get a grasp of problems typically encountered in rehabilitation. Applying such a perspective may help to facilitate patient participation and learning during the rehabilitation process by taking their altered abilities into consideration.

METHOD

Qualitative study. Theoretical analysis and synthesis of 'situated learning theory', neuropsychological theory and empirical studies of cognitive and emotional functioning following a TBI collected through interviews with 11 interdisciplinary rehabilitation experts and a field study of two patients at a rehabilitation hospital. The data were analysed from a hermeneutic perspective using N-VIVO 8.

RESULTS/CONCLUSION

Patients with severe TBI pose challenges in terms of being participants in the 'rehabilitation practice community'. Two levels of pedagogical challenges seem to exist: Helping the patient regain or compensate for changed learning abilities and supporting the patient in learning or compensating for lost abilities. This study highlighted six main categories of changed abilities that need to be considered in developing a practice which fosters re-learning: perception, attention, memory, language, physical competencies and emotion/model of behaviour.

Recovering from a stroke: a longitudinal, qualitative study of older Norwegian women

AIM

To illuminate older women's experiences and the characteristics of the recovery process following a stroke.

BACKGROUND

Patients with stroke face serious challenges related to bodily changes, existential aspects and daily life after stroke. Few qualitative longitudinal studies have examined the recovery process from the perspective of the patient. Knowledge about older women's experiences in coping with life after a stroke is limited.

DESIGN

Prospective, longitudinal, case-study design.

METHODS

Six women aged 68-83 suffering from first-time stroke were recruited from two stroke units. Each participant was interviewed in-depth 12-14 times during the first two years post stroke. The interviews addressed how they experienced their body, their self-understanding, daily life and how this had changed over time. Most interviews took place in the participants' homes. Gadamer's philosophical hermeneutics informed the analyses.

RESULTS

Post stroke recovery was slow and complex and evolved through four distinct phases. In the first phase (0-2 months post stroke), the participants' main concerns were their bodily changes; in the second phase (2-6 months), activities of daily life; in the third phase (6-12 months), self-understanding and in the fourth phase (12-24 months), going on with life. The transition between phases was gradual.

CONCLUSION

Recovery from stroke evolves over time through four distinct phases, which differ depending on significant experiences and associated meanings. Psychological and social resources are equally critical in the women's process of recovery.

RELEVANCE TO CLINICAL PRACTICE

The four phases of rehabilitation suggest at what points various concerns require increased therapeutic attention. Psychological and social resources must be vitalised at an early phase similar to bodily resources. This knowledge may assist professionals in offering adequate help throughout the recovery process even beyond the established rehabilitation period.

[Quality of life in stroke patients. A phenomenological study]

OBJECTIVE

To examine the perception of quality of life in those affected by the first episode of stroke.

METHOD

A phenomenological qualitative study. Data collection was carried out by semi-structured interviews with patients attending a neurology clinic in the Ramón y Cajal Hospital from February to October 2008. The 20 participants met the inclusion criteria of 10-14 months of development and the exclusion criteria of not having changes in higher mental functions, or communication. Purposive sampling was used, selected according to predetermined profiles.

RESULTS

Stroke is interpreted as momentary event in health and not a disease. Adjusting to the environment means facing the consequences, which will directly influence the perception of how to build and organise their social networks; a social network demand for care, a formal and informal social network affected by the change, in the workplace and friends using different coping strategies, with advances and setbacks.

CONCLUSIONS

The perception of quality of life is subjective, flexible and unique to the subject that fits every moment of the process of recovery and whose base is focused on meeting the required bio-psycho-social needs in every phase of experimentation. Surviving a stroke is to overcome the impact and recover, in so far as possible, from the effects arising, changing individual and shared lifestyle, in restructuring the new identity and adjusting to the social context.

Meaning perspective transformation following stroke: the process of change

PURPOSE

Transformative Learning in an educational theory that posits that individuals learn and grow when their meaning perspectives (frames of reference for interpreting an experience based on knowledge, feelings, values and beliefs) are reformulated following a critical event. This theory has become quite influential in the exploration of adaptation to chronic illness. This study explored whether the change that occurs following stroke follows a process similar to transformative learning.

METHOD

Grounded Theory approach was used to explore changes in meaning perspective among 12 people who were members of stroke support organisations, had a stroke at least 1 year prior to the study and described themselves as viewing life positively following stroke. Constant comparison analysis of interviews with these individuals was used to explore their experience following stroke.

RESULTS

Meaning perspective transformation occurred with four factors contributing to transformation: triggers, support, knowledge and choices to action. A substantive grounded theory of the process of meaning perspective transformation following stroke is presented, which illustrates the interaction of these contributing factors in initiating and facilitating the transformation process.

CONCLUSION

Transformative learning can offer insight into how people who have experienced stroke learn, rebuild competence and re-engage in valued activities.

Meaning of quality of life for older adults: importance of human functioning components

This study explored the perceptions and lived experience of community-dwelling older adults about their quality of life (QOL) in regards to personal factors, social participation and environment. A qualitative design was used to extend existing work on QOL focusing on human functioning components and advanced QOL conceptualization. Based on a semi-structured interview guide, two individual in-depth interviews were conducted with 18 participants (aged 63-92; 12 women) having various levels of ability and QOL. Personal factors, such as health, inner life and behavioral abilities, were found to be essential for QOL. Being occupied and doing activities associated with good health habits are also important. Accomplishment of social roles is, for the majority of participants, more significant than daily activities. The physical and social environment must be adapted to the person's needs and preferences. Participants' perceptions differed only slightly according to their ability and QOL levels. Findings show the critical role of adaptation to disabilities and aging for better QOL. A sense of control over one's own life also has beneficial effects. These results point up the importance of considering perceptions about personal factors, social participation and environmental factors in older adults' QOL. Other theoretical as well as methodological implications for further QOL study are highlighted.

Hope, health work and quality of life in families of stroke survivors

AIM

This paper reports a study to examine the relationships among hope, family health promotion, and quality of life after stroke, by testing hypotheses derived from the Developmental Model of Health and Nursing.

BACKGROUND

Little attention has been given to the influences of family strengths on health promotion behaviours and quality of life after stroke. The majority of studies have focused on stroke survivors, not their spouses.

METHOD

A descriptive, correlational study was carried out with 40 families of stroke survivors with moderate to severe functional impairments and their spouses. Both partners completed the Herth Hope Index (measure of hope), the Health Options Scale (measure of health work), the Reintegration to Normal Living Index (measure of quality of life) and a demographic questionnaire.

RESULTS

For both partners, moderate, positive relationships were found between hope and health work (r = 0.52, r = 0.39, P < 0.01) and between hope and quality of life (r = 0.59, r = 0.32, P < 0.05). Family health work was positively associated with quality of life of stroke survivors (r = 0.50, P </= 0.001), but not their spouses. Spouses' employment status, number of supports and functional independence at discharge predicted 40.6% and 46.3% of the variance in quality of life for stroke survivors and spouses, respectively, with the combination of hope and health work contributing an additional 17.8% in predicting stroke survivors' quality of life but no additional variance to the prediction of spouses' quality of life.

CONCLUSION

Theoretical relationships of the Developmental Model of Health and Nursing were supported for stroke survivors, but the model was less useful in explaining spouses' experiences of hope, health work and quality of life. Findings provide direction for identifying 'at risk' families and raise awareness of the contribution of caregiver burden to quality of life in families of stroke survivors.

Health-related quality of life in persons with long-term pain after a stroke

BACKGROUND

No study has, to our knowledge, previously been published on health-related quality of life (HRQoL) in a group suffering from long-term pain after a stroke.

AIM

The aim of the present study was to describe HRQoL in persons with long-term pain after a stroke, and to compare this with different types of pain conditions, age, gender and household status.

DESIGN

This study has a design combining qualitative and quantitative methods.

METHODS

Forty three participants suffering from long-term pain after a stroke were included. A qualitative interview was performed and then analysed by means of latent content analysis. In addition, two self-report questionnaires, SF-36 and the Hospital Anxiety and Depression Scale (HAD Scale), were used.

RESULTS

The qualitative data revealed that physical and cognitive functioning, economic security and good relationships, support and having the ability to be together with family and friends were important factors with regard to experienced HRQoL. No significant differences were found in SF-36 and the HAD Scale with regard to the different types of pain. The older age group had decreased physical functioning in SF-36. The men had more decreased vitality than the women.

CONCLUSION

The results show, that the participants in this study have a lower HRQoL due to their long-term pain than those in previous studies on stroke survivors. It is evident that further research is needed with longitudinal studies and larger populations to gain more knowledge and thereby provide better supportive care.

RELEVANCE TO CLINICAL PRACTICE

Awareness and understanding of the patients' perceptions and transitions with regard to their life situation and suffering from long-term pain after a stroke is important in order to support a maintained or increased HRQoL. This is also important after the acute stage and rehabilitation, including quality of life of the relatives, especially to older and dependent persons.

Qualitative studies of stroke: a systematic review

BACKGROUND AND PURPOSE

Qualitative studies are increasingly used to investigate social processes and phenomena influencing health behaviors and service provision. We aimed to identify the scope of published qualitative studies of stroke, consider their relevance to development and delivery of services for people with stroke, and make recommendations for future work.

METHODS

Literature review of published articles was identified by systematically searching online literature databases using keywords from the start of each database until 2002. Articles were reviewed by 2 authors, using a standardized matrix for data extraction. The 2003 European Stroke Initiative recommendations for stroke management were used to categorize the literature for consideration of its contribution to stroke research.

RESULTS

We included 95 articles. Their empirical contribution includes an emphasis on recording the "human" experience of stroke; identification of needs as perceived by patients and their families, differences in priorities between patients and professionals, and barriers to best-quality care. We identified 12 papers that were specifically undertaken to develop or evaluate interventions.

CONCLUSIONS

Qualitative studies have addressed a wide range of issues related to the impact of stroke on individuals and caregivers, and to the organization and delivery of services. Significant problems remain in ensuring the delivery of best-quality stroke care, which such studies have the potential to address. Maximizing this potential requires greater collaboration between nonclinical and clinical scientists, service providers, and users to formulate research questions of interest as well as new research strategies, such as meta-analysis, to pool qualitative research findings and multisited investigations.

Neurological outcome and quality of life after stroke due to vertebral artery dissection

BACKGROUND

Vertebral artery dissection is a well-recognized cause of posterior circulation stroke for which there is relatively little information on long-term outcomes. Quality of life (QOL) is an important patient-centred outcome measure.

METHODS

Stroke due to vertebral artery dissection was conservatively defined by neuroimaging documentation. Thirty sequential cases were identified based on a retrospective database and chart review with prospective follow-up. Surviving patients completed the Short Form-36 (SF-36) and the Stroke-Specific Quality of Life (SSQOL) scales and were subsequently examined neurologically and scored on the National Institutes of Health Stroke Scale (NIHSS). Comparisons were made between outcome on the stroke scale and QOL scales and between outcome on the SF-36 and the Canadian population.

RESULTS

There was discordance between outcomes recorded on a standard stroke scale and QOL measures with more patients scoring poorly on QOL measures. QOL was low in one third of the survivors. Overall QOL was significantly lower than the general population.

CONCLUSIONS

Stroke due to vertebral artery dissection results in poorer outcomes on patient-centred QOL measures than on a standard stroke scale.