Factors associated with health related quality of life of patients with stroke in Sri Lankan context

Felt stigma as a determinant of health-related quality of life among community-dwelling stroke survivors in China: A cross-sectional study

OBJECTIVES

To assess the role of felt stigma versus enacted stigma in the health-related quality of life of community--dwelling stroke survivors in China.

MATERIALS AND METHODS

A sample of 189 community--dwelling stroke survivors were investigated with the Stigma Scale for Chronic Illness (SSCI), 12-item Short Form-12 Health Survey (SF-12), modified Barthel index (MBI), Zung Self-Rating Depression Scale (ZSDS), and demographic and disease-related characteristics. Hierarchical multiple regression analysis was used to estimate the influence of felt stigma and enacted stigma on quality of life after controlling for depression, activities of daily living, and patient characteristics.

RESULTS

In total, 189 S survivors were included in the study. Overall stigma, felt stigma, and enacted stigma were moderately and strongly positively and significantly correlated with quality of life, depression, and activity in daily living (P < 0.05). Felt stigma significantly explained 2.2 % (P < 0.01) of the variance in the physical component summary (PCS). Felt stigma significantly explained 8.6 % (P < 0.01) of the variance in the mental component summary (MCS). However, enacted stigma had no effect on PCS or MCS.

CONCLUSION

Felt stigma significantly and independently contributed to the PCS and MCS quality of life of community-dwelling stroke survivors after adjustment for depression, activity of daily living and patient characteristics.

The correlations between demographic factors, self-efficacy, and quality of life among Indonesian patients with ischemic stroke: A cross-sectional study

Background

Ischemic stroke is the primary cause of neurological disability and can lead to psychological issues that affect self-efficacy. Changes in self-efficacy, in turn, influence the overall quality of life. Although many studies have examined factors that affect self-efficacy, quality of life, or both, few have specifically explored the role of demographic factors in shaping the quality of life in patients with ischemic stroke.

Objective

This study aimed to identify the correlations between demographic factors, self-efficacy, and quality of life Indonesian in patients with ischemic stroke.

Methods

This study employed a quantitative approach with a cross-sectional design. A total of 143 participants were recruited between February and April 2024 based on defined inclusion criteria. The research instruments included a demographic questionnaire, the Stroke Self-Efficacy Questionnaire, and the Specific Stroke Quality of Life Questionnaire. Data were analyzed using descriptive statistics, logistic regression, and Spearman rank test.

Results

The findings revealed that females were 2.213 times more likely (95% CI = 1.128-4.341; p = 0.031) to achieve high self-efficacy compared to males. Occupational status significantly influenced self-efficacy, with employed individuals being 6.333 times more likely (95% CI = 3.134-16.599; p <0.001) to achieve high self-efficacy. The duration of stroke experienced by respondents also had a significant impact, with an odds ratio (OR) of 1.908 (95% CI = 0.980-3.715; p = 0.025). Additionally, occupational status significantly affected the quality of life, as employed respondents were 7.213 times more likely to achieve a good quality of life (OR = 7.213; 95% CI = 3.134-16.599; p <0.001). There was a significant positive correlation between self-efficacy and quality of life (r = 0.898, p <0.001).

Conclusion

The results of this study provide valuable insights for nursing practice, emphasizing the importance of interventions to enhance patients' self-efficacy. By increasing patients' confidence in managing their condition, such interventions can lead to improved quality of life and better recovery outcomes. Strategies including health education, psychological support, and patient empowerment during rehabilitation are essential for strengthening self-efficacy and improving overall care outcomes. These findings highlight the need for healthcare professionals and families to address the psychological aspects of care in patients with stroke. Enhancing self-efficacy is critical in helping patients achieve a better quality of life and more successful recovery.

Changes of health-related quality of life within 6 months after stroke by clinical and sociodemographic factors

Stroke causes functional disabilities and reduces the quality of life of stroke survivors. This retrospective cohort study aimed to examine changes in health-related quality of life (HRQoL) six months after a stroke and the effect of stroke characteristics and sociodemographic factors on HRQoL. Participants completed a questionnaire that included the stroke characteristics, sociodemographic characteristics, and the 5-level European Quality of Life 5 dimensions (EQ-5D-5L) before discharge. Follow-up assessments of HRQoL were performed at one, three, and six months after discharge. Descriptive statistics and linear mixed models were used for data analyses. A total of 155 first-stroke patients were included, of which N = 152 patients completed follow-up assessments until six months. The mean EQ-5D-5L index score at discharge was 0.69 (SD 0.33). The trends of HRQoL significantly increased from discharge to three months, but there was no significant HRQoL improvement after three months. Considering stroke severity, mean HRQoL significantly improved for patients with no stroke symptoms, minor stroke, and moderate stroke (p < 0.05) but not those with severe stroke (p = 0.156). HRQoL among patients with sufficient monthly income significantly increased over six months (p < 0.05). HRQoL among patients with severe stroke and having insufficient income were poor. Supportive programs are required to improve their HRQoL.

Multidimensional Approach of Genotype and Phenotype in Stroke Etiology: The MAGPIE Study

Background and Aims

Stroke is a leading cause of mortality and morbidity in Bangladesh. It is estimated that genetic determinants account for around 40%-60% of its etiology, similar to environmental factors. This study aimed to provide a better understanding of the genetic, environmental, and clinical risk factors in stroke patients from Bangladesh.

Methods

The MAGPIE (Multidimensional Approach of Genotype and Phenotype In Stroke Etiology) study is a population-based case-control study that will allow a hypothesis-free genome-wide association study (GWAS) to identify genetic risk factors associated with adult stroke (age ≥ 18 years) in Bangladesh. This study will collect detailed phenotypic data as well as blood samples from stroke patients and control subjects. High-molecular-weight genomic DNA will be isolated and archived using Qiagen DNA isolation kits.

Results

We will utilize SPSS v28.0, vR-4.3.2 and gPLINK v2.0 software to analyse the study variables, as appropriate. Further, appropriate statistical tests will be applied to test the significance level between study groups. As applicable, data will be presented in tables and graphs, such as Manhattan plots and Quantile-Quantile (QQ) plots. A p < 0.05 will be considered as statistical significance.

Conclusion

This will be the first large-scale carefully phenotyped biobank of Bangladeshi stroke patients which will enable a GWAS enabling an understanding of the association between gene-phenotype risk factors which has the potential to revise and refine national stroke guidelines.

Evaluating Biomarkers of Bone Health After an 8-Week Walking Program in Non-Ambulatory Stroke Survivors: A Pilot Study

Background/Objectives: Stroke survivors have a significantly increased likelihood of developing osteoporosis, a condition characterized by weak and brittle bones as well as an elevated risk of bone fractures. However, previous studies on exercise intervention have mostly been on stroke survivors who are able to walk. The objective of this study was to examine the effect of walking exercise on bone health in non-ambulatory stroke survivors. Methods: This pre- and post-test study enrolled a group of chronic non-ambulatory stroke survivors. They were instructed to complete an 8-week aerobic walking exercise program, three sessions per week. Serum concentrations of osteocalcin (OC) and carboxy-terminal telopeptides of type I collagen (ICTP) were evaluated at baseline and after completing the walking exercise program. In addition, we assessed the ambulation capacity and balance control using the functional ambulation category (FAC) and Berg Balance Scale (BBS), respectively. Results: A total of 9 out of 10 non-ambulatory stroke survivors who were recruited completed the intervention. The serum concentration of OC significantly increased from 8.51 ± 2.28 ng/mL to 9.39 ± 2.97 ng/mL (p < 0.10). The serum concentration of ICTP significantly increased from 4.45 ± 2.58 ng/mL to 5.31 ± 2.92 ng/mL (p < 0.10). Both FAC and BBS scores significantly improved from 1.0 ± 0 to 1.33 ± 0.5 (p < 0.1) and from 7.22 ± 10.02 to 15.78 ± 14.81 (p < 0.01), respectively. Conclusions: The findings of this pilot study suggest that walking exercise may improve bone health by initiating a bone remodeling process in chronic non-ambulatory stroke survivors.

Tools for Assessing Quality of Life in People with Stroke-Induced Aphasia: A Literature Review

BACKGROUND

The quality of life (QOL) of individuals with stroke-induced aphasia is significantly impacted by the condition. Clinicians and researchers are increasingly focusing on QOL assessments for people with aphasia (PWA) to gauge the effects of aphasia and the effectiveness of interventions. While several QOL assessment tools are utilized for PWA, there is limited literature comparing and evaluating their suitability for this population. This review aimed to explore the QOL measurement tools used with PWA, their aphasia-friendly characteristics, their applicability to severe aphasia, and the technical aspects of these questionnaires.

SUMMARY

The review process involved two stages. Initially, a search was conducted to identify the tools used for assessing the QOL of PWA in studies published between 1975 and 2022. Various databases such as Google Scholar, PubMed, Scopus, and Web of Science were searched using specific keywords related to stroke, aphasia, QOL, questionnaires, outcome measurements, tools, scales, and instruments. Subsequently, hand searching was employed to gather additional information on the identified tools, including technical properties, communication and language domains, and crucial factors for QOL assessment in PWA. Results revealed that 28 articles met the inclusion criteria, identifying 26 tools for QOL assessment in PWA, comprising 11 generic, 9 stroke-specific, and 6 aphasia-specific tools. Technical details such as research country distribution, publication years (ranging from 1972 to 2015), completion time, administration methods (self-reporting), item formats (question or statement), response types (all tools, except SIP-136, NHP, and SA-SIP30 used Likert type scale for ratings), scoring methods (sum of score or using an algorithm), translation/adaptation status (EQ-5D-3L among generic tools, SIS-16 among stroke-specific questionnaires, and SAQOL-39 among aphasia-specific instruments received the most amount of translation/adaptation), respondent characteristics (almost all the tools except aphasia-specific tests excluded people with severe aphasia), number of dimensions (ranged 1-12), item numbers [6-136], and coverage of communication/language domains (BOSS, CDP, ALA, AIQ-21 covered all language domains) were analyzed. Notably, ALA emerged as the most suitable tool for assessing QOL in PWA due to its alignment with the desired features.

KEY MESSAGES

Based on the review findings, clinicians and researchers are advised to prioritize the following features when selecting a QOL questionnaire for PWA: aphasia-specific and aphasia-friendly design, comprehensive coverage of QOL dimensions, inclusion of all language domains, and provision of self-reporting opportunities for PWA across all severity levels. ALA stands out as the preferred tool for QOL assessment in PWA based on its adherence to these criteria.

Using a Mixed-Method Approach to Explore the Factors Influencing the Family Resilience of Stroke Survivors in China

Background

Stroke is a critical public health issue in China that necessitates a closer examination of family resilience (defined here as the collective capacity of individuals, families and communities to effectively navigate challenges, recover from adverse events and foster positive adaptation). Amid rising stroke incidence, this study addresses the dearth of research on family resilience among stroke survivors in China, aiming to assess its level, identify influencing factors and establish coping strategies for family caregivers.

Methods

This mixed-methods research employed a sequential explanatory design. Questionnaires were distributed to 258 stroke survivors and their family members at outpatient follow-up visits. In the first stage (ie the quantitative research stage), the research tools for data collection included a general demographic sociological data questionnaire, the Family Resilience Assessment Scale (FRAS), the Self-Efficacy for Managing Chronic Disease 6-Item Scale, the Caregiver Burden Scale, the Family Functioning Scale and the Social Support Rating Scale. Quantitative data were analysed using IBM SPSS 26.0 software, utilising descriptive statistics for summarising sociodemographic characteristics and conducting analyses, such as independent-sample t-tests, one-way analysis of variance and Spearman correlation analysis. The second stage (ie the qualitative research stage) involved complementing and validating the data, developing a quantitative-qualitative interview framework and selecting participants for interviews. Colaizzi's seven-step analysis was applied to analyse interview data. In the third stage, the quantitative and qualitative research results were integrated, and a comprehensive analysis was performed to obtain an accurate conclusion.

Results

A total of 242 families responded to the questionnaire (response rate: 93.8%). In total, the mean age of stroke survivors was 61.86 ± 8.76 years old, and 69.8% were male. The quantitative results showed that the FRAS mean score was (185.33 ± 24.78), which was above the medium level. The multiple linear regression analysis confirmed that family function was the strongest influencing factor on family resilience (β = 0.948, p < 0.01). The qualitative analysis revealed four themes of family adaptation experience: loss of independence and certainty, facing threats and challenges, seeking family advantage resources and adopting coping strategies.

Conclusion

This hybrid study sheds light on the adaptation process of the families of stroke survivors, revealing family function as the primary influencer of resilience. Recognising that eliminating risk factors is challenging, our suggestion is for clinical practitioners to emphasise family strengths and implement resilience-oriented interventions. Focusing on enhancing coping abilities and fostering adaptation within families can aid in the rehabilitation process, promoting the well-being and growth of both the family unit and individual members, while alleviating caregiver burden.

Functional independence measured in the acute phase of stroke predicts both generic and specific health-related quality of life: a 3-month prospective study in a middle-income country

PURPOSE

To identify acute predictors of both generic and specific health-related quality of life (HRQoL) 3 months after stroke in individuals from a middle-income country.

MATERIALS AND METHODS

A 3-month prospective study with individuals who had suffered their first stroke, without previous disability, discharged from a stroke unit. The dependent outcomes, assessed 3 months after stroke, were generic and specific HRQoL (SF-36 and SSQOL total scores, respectively). The predictors assessed in the stroke unit were age, sex, education level, duration of hospital stay, current living arrangement, stroke severity (National Institutes of Health Stroke Scale-NIHSS), functional independence (Modified Barthel Index-MBI), motor impairment (Fugl-Meyer Assessment), and lower- and upper-limb residual muscle strength deficits. Linear multiple regression analyses were employed to identify predictors of both generic (model-1) and specific (model-2) HRQoL (α = 5%).

RESULTS

One hundred twenty-six individuals were assessed at 3-month post-stroke (61.3 ± 13.6 years). Regression analysis showed that functional independence was the best predictor of both generic (R2 = 21%; F = 34.82; p < 0.001) and specific (R2 = 29%; F = 51.71; p < 0.001) HRQoL at 3-month post-stroke.

CONCLUSION

Both generic and specific HRQoL at 3-month post-stroke can be predicted by functional independence assessed in the acute phase with the MBI.

Socioeconomic status and health-related quality of life after stroke: a systematic review and meta-analysis

BACKGROUND

Socioeconomic status (SES) is associated with stroke occurrence and survival following stroke but its association with health-related quality of life (HRQoL) following stroke remains uncertain. We performed a systematic review and meta-analysis to examine the association between SES and HRQoL after stroke.

METHODS

PubMed, SCOPUS, EMBASE, and Web of Science were searched to identify relevant cohort and case-control studies between January 2000 and May 2022. Two authors screened titles, abstracts and full text articles. One author extracted data from all included studies. Meta-analyses were performed for studies with comparable measurements of SES and HRQoL. Random effects models were used to estimate pooled summary standardised mean differences in HRQoL by SES.

RESULTS

Out of 1,876 citations, 39 studies incorporated measurement of overall HRQoL following stroke and were included in the systematic review, with 17 studies included in the meta-analyses. Overall, reports including education, income, occupation and work status effects on HRQoL after stroke were inconsistent among all included 39 studies. In the global meta-analysis of 17 studies, HRQoL among survivors of stroke was lower in the low SES group than in the high SES group (standardised mean difference (SMD) -0.36, 95% CI -0.52, -0.20, p < 0.0001). When using education and income indicators separately, summary effects were similar to those of the global analysis (low versus high education SMD -0.38, 95% CI -0.57, -0.18, p < 0.0001; low versus high income SMD -0.39, 95% CI -0.59, -0.19, p < 0.0001).

CONCLUSIONS

Across all SES indicators, people with stroke who have lower SES have poorer overall HRQoL than those with higher SES. Accessibility and affordability of poststroke support services should be taken into consideration when planning and delivering services to people with low SES.

Predictors of quality of life at 6 months in patients with mild stroke: A prospective observational cohort study

OBJECTIVES

This study aimed to analyze the factors affecting the long-term quality of life of patients with mild stroke and evaluate the differences according to age and sex.

MATERIALS AND METHODS

The Korean Stroke Cohort for functioning and rehabilitation data was used, and patients with mild stroke with a National Institute of Health Stroke Scale score of < 5 were included. Quality of life after 6 months was analyzed using EuroQol-5 dimensions. Demographic and clinical characteristics were evaluated, and factors affecting the quality of life at 6 months were analyzed.

RESULTS

Age, current drinking, marital status, length of stay, and modified Rankin Scale, Fugl-Meyer assessment, Functional Independence Measure, and Geriatric Depression Scale scores affected the quality of life at 6 months in patients with mild stroke. Fugl-Meyer assessment score was a predictor for those aged < 65 years, while the functional ambulatory category was a predictor for those aged ≥ 65 years. Predictors of quality of life, excluding alcohol consumption, were comparable between male and female.

CONCLUSIONS

Among patients aged <65 years, individuals who consumed alcohol, and those who showed better motor function and fewer comorbidities had a higher quality of life. Among patients aged ≥65 years, quality of life was higher in males, younger age, married individuals, those with diabetes, and those with a better walking ability. Among male, individuals who consumed alcohol had a higher quality of life. Rehabilitation treatment should prioritize improving modifiable factors to enhance the quality of life in patients with mild stroke.

Factors Associated with Health-Related Quality of Life among Government Employees in Putrajaya, Malaysia

The current rapid growth of the economy has necessitated an assessment of health-related quality of life (HRQOL) and its associated factors among employees. Unfortunately, there are still limited data available in this area among the Malaysian working population in government sectors. The aim of this study was to evaluate the factors associated with HRQOL among government employees in Putrajaya, Malaysia. This cross-sectional study recruited 460 eligible government employees who worked in the area of Putrajaya through simple random sampling. The self-administered questionnaire was distributed to these participants to collect information on the SF-36 profile of scores, sociodemographic factors, lifestyle factors, and medical history. The results of this study signify that most of the participants were identified as having good HRQOL with the mean score of overall HRQOL was 72.42 ± 14.99. Multivariate analysis showed that being younger, receiving a better monthly personal income, a smaller household number, performing more physical activity, not having any chronic disease, and not using any long-term medication were significantly positively associated with overall HRQOL. The participants who did not have a family history of chronic disease were reported to be significantly associated with better mental component summary (MCS). Further, males were significantly positively associated with bodily pain (BP) and general health (GH) only, whereas better occupational status was limited to social functioning (SF). In conclusion, the results of this study provide motivation for future research and initiatives for improving the physical, emotional, and social well-being of government employees.