The Factors Associated With Health-Related Quality of Life in Stroke Survivors Age 40 and Older

Ethnic disparities in long-term outcomes and health care usage after stroke in the Netherlands

BACKGROUND

Poststroke health-related quality of life (HRQOL) is an important outcome that may be influenced by ethnicity.

OBJECTIVE

To compare long-term HRQOL, mental health and healthcare utilization between stroke survivors with a European (EUB) and non-European background (NEUB) in a hospital population.

METHODS

In this retrospective cohort study patients completed questionnaires 2-5 years after stroke. Assessments included the EuroQol-5D-3L (EQ-5D), Short Form (SF-36, with physical and mental component summary scales, PCS and MCS), Hospital Anxiety and Depression Scale (HADS; scores ≥8 indicate clinically relevant complaints) and a questionnaire on the usage of services from physicians and/or healthcare professionals (HCP) in the past 6 months. Linear and logistic regression analysis was used, adjusted for age, sex, level of education and functional outcome.

RESULTS

We included 207 patients (169 EUB, 38 NEUB); mean age 63.8 years (SD 14.4); 60.4 % male; mean follow up 36.3 months (SD 9.9). The EQ-5D and the PCS were higher in EUB versus NEUB patients (42.9 vs 35.4, p < 0.01; 0.76 vs 0.60, p < 0.01). The MCS showed a comparable, non-significant trend. The percentage of patients with HADS depression ≥8 was higher in NEUB patients versus EUB patients (54.3 % vs 29.8 %; p > 0.01). Significantly more NEUB patients had visited two or more physicians in the past six months compared to EUB patients (52.0 % vs 26.0 %; p = 0.01) whereas the use of services from HCP was similar.

CONCLUSIONS

NEUB stroke patients had worse outcomes regarding HRQOL and depressive symptoms compared to EUB patients. NEUB patients visited more physicians.

Cardiovascular risk factors and quality of life among stroke survivors in Korea from 2013 to 2018: a cross-sectional cohort study

Background

Although the cardiovascular health and quality of life (QoL) of stroke survivors have been previously studied, no study has investigated the correlation between cardiovascular health and QoL. This study aimed to investigate whether there would be a difference in the quality of life (QoL) in this population depending on the degree of cardiovascular health.

Methods

Overall, 577 people aged > 40 years who participated in the Korea National Health and Nutrition Examination Survey from 2013 to 2018 were included and were divided into three groups according to the survey period (2013–2014, n = 145; 2015–2016, n = 198; and 2017–2018, n = 234). Participants were further divided into the following groups based on their cardiovascular health score, as defined by the American Heart Association: poor, intermediate, and ideal groups. We examined how the health-related QoL score was expressed through the five-dimensional European Quality of Life Questionnaire (EQ-5D-3L).

Results

The ideal (cardiovascular health scores 11–14) and intermediate (cardiovascular health scores 8–10) groups had the lowest (7.72–8.14%) and highest (46.39–57.70%) number of participants, respectively. The total EQ-5D index score was highest in the ideal group, followed by the intermediate and poor groups across all three periods (2013–2014, p = 0.0015; 2015–2016, p = 0.0040; 2017–2018, p < 0.0001). The dimension-specific analysis revealed that, Findings showed that stroke survivors' mobility significantly varied by cardiovascular health scores (p = 0.0371 in 2015–2016, p =0.0486 in 2017–2018), whereas usual activities (p = 0.0322) and pain/discomfort (p = 0.0420) were significantly different among the three groups in 2015–2016.

Conclusion

QoL in post-stroke survivors, when related to cardiovascular health degree, could be correlated with stroke sequelae.

Health-related quality of life profiles and their dimension-specific associated factors among Malaysian stroke survivors: a cross sectional study

Background

Apart from maximizing functional abilities and independence after stroke, improving overall health-related quality of life (HRQoL) should also become part of the stroke treatment and rehabilitation process goals. This study aimed to assess the HRQoL profiles and explore the dimension-specific associated factors of HRQoL among stroke survivors.

Methods

This was a cross-sectional study of stroke survivors attending post-stroke care clinics in three public hospitals in the states of Pahang and Terengganu, Malaysia. The HRQoL was assessed by EuroQol-5 dimension-5 levels. Data on socio-demographic, clinical profiles, malnutrition risk, and physical activity level were collected through an interviewer-administered survey. Descriptive analyses for HRQoL profiles and multiple logistic regression analyses for its associated factors were performed. Crude and adjusted odds ratios were reported.

Results

A total of 366 stroke survivors were recruited with a mean age of 59 ± 11 years. The most -commonly reported health problems were mobility (85%), followed by usual activities (82%), pain/discomfort (63%), anxiety/depression (51%) and self-care (41%). The mean of the EQ visual analogue scale and the median of the EQ5D summary index was reported at 60.3 ± 14.2 and 0.67 ± 0.37, respectively. Malnutrition risk (mobility, usual activities, and self-care), wheelchair users (self-care and usual activities), speech impairment (usual activities and pain/discomfort), number of stroke episodes (self-care and pain/discomfort), body mass index, physical activity level and types of strokes (usual activities), age and use of a proxy (anxiety/depression), working and smoking status (mobility), were factors associated with either single or multiple dimensions of HRQoL.

Conclusion

Routine malnutrition screening, tailored program for speech therapy, prevention of recurrent stroke, and physical activity promotion should be addressed and further reinforced in current rehabilitation interventions to improve the HRQoL among stroke survivors in Malaysia.

Influence of Type D Personality on Health Promoting Behaviours and Quality of Life in Stroke Patients: A Cross-Sectional Study in South Korea

OBJECTIVES

Type D personality is vulnerable to stress and is associated with high symptom severity, unhealthy behaviors, and low quality of life (QoL) in patients with chronic diseases. This study aimed to identify the influence of type D personality on health promoting behaviors and QoL in patients with ischemic stroke in South Korea.

MATERIALS AND METHODS

A descriptive, cross-sectional design was used. This study collected data from a convenience sample of 170 patients with ischemic stroke. Demographic and clinical characteristics, health promoting behaviors, and QoL were compared between the type D personality group and the non-type D group. Stepwise multiple regression analysis was performed to identify factors influencing patients' QoL.

RESULTS

Of the 170 subjects, 39 (22.9%) were classified as having type D personality. Type D personality was associated with higher National Institutes of Health Stroke Scale scores at admission and discharge, higher modified Rankin Scale (mRS) scores at 3 months after stroke, lower scores for health promoting behaviors, and lower QoL. Regression analysis showed that mRS score 3 months after stroke was the most significant factor influencing QoL, followed by health promoting behaviors, type D personality, speech deficits, and family income.

CONCLUSIONS

Type D personality should be considered together with health promoting behaviors and QoL in patients with ischemic stroke. Interventions considering type D personality may be helpful in improving health promoting behavior and QoL for the stroke patients.

Health-related quality of life after ischemic stroke: impact of sociodemographic and clinical factors

BACKGROUND AND AIMS

Ischemic stroke (IS) is one of the leading causes of death and long-term disability in Bulgaria. IS affects different aspects of the patient's life and results in loss of independence and poor health-related quality of life (HR-QoL). We aimed to analyze the impact of IS on HR-QoL and to identify possible associations with sociodemographic, clinical features, and vascular risk factors (RF).

METHODS

A prospective, hospital-based study was undertaken from 1 July 2019 to 31 June 2020, at a tertiary care referral center for neurological disorders in Bulgaria. A total of 150 patients with acute IS - 50 with thrombolytic and 100 with non-thrombolytic therapy - were included. Thorough clinical and sociodemographic data were collected. The NIHSS scale determined stroke severity, and HR-QoL was assessed with the Stroke Impact Scale Version 3.0 (SIS 3.0) during the first 3 months.

RESULTS

The overall HR-QoL improved during the observation period, but still, it remained significantly worse. The major predictors of a marked reduction in HR-QoL were age, female sex, lower education level, and actively working at stroke onset, high NIHSS score, anterior circulation stroke, and more extended hospital. Atrial fibrillation and heart failure were significantly associated with poor HR-QoL. The other investigated vascular risk factors were associated with different extends with poorer HR-QoL, except for dyslipidemia.

CONCLUSION

Stroke survivors have significantly reduced HR-QoL. Multiple interacting factors are associated with an unfavorable outcome after IS. Early detection of these factors would help to improve the care for IS patients, to reduce disabilities and improve HR-QoL.

Association of Health Utility Score with Physical Activity Outcomes in Stroke Survivors

Health-related quality of life (HRQoL) after stroke tends to vary across studies or across stages of stroke. It is useful to use the health utility score to compare HRQoL across studies. Physical activity after stroke also tends to vary similarly. The purpose of the present study was to determine associations between the health utility score and physical activity outcomes in stroke survivors. This cross-sectional study recruited stroke survivors who could ambulate outside, free of assistance. We assessed the health utility score with the EuroQoL 5-Dimension 3-Level questionnaire. The physical activity outcomes were the number of steps taken and duration of moderate-to-vigorous physical activity (MVPA) as measured with an accelerometer. Multiple linear regression analyses were used to determine whether the physical activity outcomes were independently associated with the health utility score. Fifty patients (age: 68.0 years; 40 men, 10 women) were included. Multiple linear regression analysis showed the health utility score to be significantly associated with the number of steps taken (β = 0.304, p = 0.035) but not with MVPA. This is the first study to examine the association between the health utility score and objectively measured physical activity in stroke survivors. Promoting physical activity especially by increasing the number of steps taken might be a priority goal in improving a patient's health utility score after stroke.

Depression and Quality of Life after Cerebral Venous Sinus Thrombosis

Introduction:

Cerebral venous sinus thrombosis (CVST) is an important cause of stroke in young and has a favorable outcome. Long-term sequelae of CVST include motor disability, cognitive impairment, depression, anxiety, fatigue, impaired employment and poor quality of life.

Objective:

To evaluate depression and quality of life after CVST.

Methods:

Patients who completed at least 1 year after discharge were recruited for this cross-sectional observational study from our CVST cohort. Quality of life was assessed using Stroke-Adapted Sickness Impact Profile (SA-SIP 30) and depression using Hamilton Depression scale (HAM-D).

Results:

A total of 100 patients (60 men and 40 women) were included in the study. Their age ranged from 14 to 60 years (34.97 ± 10.06). The interval from discharge to assessment of quality of life was 2.2 ± 1.6 years. In all, 98% of patients had good modified Rankin score at follow-up. SA-SIP 30 did not reveal any functional disability for physical functioning. Seven had impairment for psychosocial domain despite having good modified Rankin scores. Thirty patients had depression. Patients with higher mRS at discharge had increased presence of depression. Quality-of-life scores did not correlate with presence of seizure, headache, infarction and sinuses involved.

Conclusion:

This is the first Indian study demonstrating depression in patients with CVST and use of SA-SIP to assess quality of life in them. Occurrence of depression in CVST is as high as in arterial strokes.

Life satisfaction of 511 elderly Chinese stroke survivors: moderating roles of social functioning and depression in a quality of life model

OBJECTIVE

Using a published quality of life model, to investigate the moderating roles played by social functioning and post-stroke depression in buffering the relationship between physical functioning and life satisfaction among elderly Chinese stroke survivors.

DESIGN

Cross-sectional survey through face-to-face interviews.

SETTING

Fangshan district of the Beijing Municipality in China.

PARTICIPANTS

A representative random sample of 511 community-dwelling elderly Chinese stroke survivors aged 60 years or above. In total, 127 participants were categorized as stroke survivors with clinical depression and 384 without.

MEASURES

Satisfaction With Life Scale, Center for Epidemiologic Studies Depression Scale, International Residential Assessment Instrument Activities of Daily Living Hierarchy scale, International Residential Assessment Instrument Instrumental Activities of Daily Living Performance scale, De Jong Gierveld Loneliness Scale, and Lubben Social Network Scale.

RESULTS

Analyses revealed that the unique variance shown by social functioning (16%) is more important than physical functioning (5%) or depressive symptoms (12%) in promoting life satisfaction among all elderly stroke survivors. The moderation model denotes the interaction effect between depressed mood and physical functioning (β = .152 to .176, p < .001) for all stroke survivors. For stroke survivors without clinical depression, loneliness (β = .264 to .287, p < .001) and social support (β = .115 to .151, p < .05) buffered the relationship between physical functioning and life satisfaction; whereas for those with clinical depression, only loneliness (β = -.264 to .236, p < .05) moderated the corresponding relationship.

CONCLUSIONS

Social functioning and post-stroke depression buffered the relationship between physical dependence and life satisfaction among elderly Chinese stroke survivors.

Quality of life and social support: Perspectives of Saudi Arabian stroke survivors

Given that stroke is an indispensable health burden in Saudi Arabia and around the world, great importance has been attached on studies of social support and other factors that could improve the quality of life of stroke survivors. Perceptions of quality of life and social support may vary depending on patients' cultural and societal background. This research assessed the quality of life and social support of community-dwelling Saudis who survived stroke. A quantitative study was performed among 123 Saudi stroke survivors. Questionnaire-guided interviews measuring social support and quality of life were performed, and the multivariate effects of predictor variables on the four domains of quality of life were determined through multivariate multiple regression analysis. Among the dimensions of social support, support from family members had the highest average, whereas support from friends had the lowest. The environmental domain of quality of life was perceived to be the best aspect, whereas physical health was perceived to be the poorest. Multivariate analysis revealed that age, gender, employment status, monthly family income, type of community, education, type of stroke, side of stroke and support from significant others had multivariate influences on the domains of quality of life. Several sociodemographic and disease-related variables and social support influence patients' quality of life. The study adds critical knowledge as to how Arab stroke survivors perceive their quality of life and social support. Ensuring that stroke survivors receive adequate social support is imperative because it can improve their quality of life.

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

BACKGROUND

Stroke is a major global health concern which affects the health related quality of life (HRQOL). As the prevalence of stroke is increasing especially in lower-middle income countries, it is vital to identify the factors associated with the HRQOL of affected individuals. Available literature for post stroke HRQOL and the associated factors are mainly from high income countries. Therefore, we conducted this study to identify the factors associated with HRQOL of stroke survivors using a stroke specific measure.

METHODS

A longitudinal study was conducted with the participation of 257 stroke survivors. Participants were followed up after 3 months at the neurology and medical clinics in the Teaching Hospital, Karapitiya, Sri Lanka. Health related quality of life was assessed using the validated version of Stroke Aphasia Quality of Life (SAQOL)-39 generic scale. Pearson correlation, independent sample t-test, one-way ANOVA and regression analysis were used to identify the factors associated with quality of life.

RESULTS

Mean age of the participants with stroke was 66.1 (SD 11.7) years. The mean overall HRQOL was 3.15 (SD 0.96) as measured by the SAQOL-39 g. The socio-demographic factors which had significant associations with HRQOL were; gender, level of education, marital status, occupation and monthly income (p < 0.05). The clinical factors which had significant associations with HRQOL were; level of dependence and disability, type of stroke, side of the lesion, type of aphasia, level of language impairment, receiving physiotherapy and speech therapy and follow up care (p < 0.05). The results of regression indicated six independent predictors [F (6,234) = 42.6, p < 0.05], with an R² of 0.52. The HRQOL was significantly predicted by the level of dependence (β = .43, p < .01), level of language impairment (β = .20, p < .01), age (β = -.23, p < .01), type of stroke (β = -.19, p < .01), side of the lesion (β = .17, p < .01) and the level of education (β = .12, p < .05).

CONCLUSION

Severe degree of dependence, severe level of language impairment, older age, hemorrhagic stroke, and lesions in the left side were associated with lower HRQOL. Higher education level was associated with higher HRQOL scores.

Predictors of quality of life 1 year after minor stroke or TIA: a prospective single-centre cohort study

OBJECTIVES

In patients after a transient ischaemic attack (TIA) or minor stroke, dysfunction is often underestimated by clinical measures due to invisible symptoms, including cognitive and emotional problems. Many of these patients need stroke care programme, but others do not. In this study, we aim to identify potential predictors of quality of life (QoL) in patients with TIA or minor stroke 1 year poststroke to be able to select which of these patients will need aftercare.

DESIGN

Prospective observational cohort study.

SETTING

Single-centre hospital in the Netherlands.

PARTICIPANTS

120 patients, diagnosed with TIA or minor stroke and discharged without rehabilitation treatment, completed the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

QoL (RAND-36), anxiety and depressive symptoms (Hospital Anxiety and Depression scale), the degree of disability or functional dependence after stroke (modified Rankin Scale (mRS)) and symptoms of anxiety and depression specific to stroke (SSADQ) were assessed at baseline (2-6 weeks poststroke) and compared with follow-up at 1 year poststroke.

RESULTS

Depression (B=-1.35, p<0.001) and anxiety (B=-0.57, p=0.041) at baseline predicted a worse mental component of QoL after 1 year. Depression (B=-1.100, p<0.001) at baseline, but also age (B=-0.261, p=0.002) and female sex (B=4.101, p=0.034) predicted a worse physical component of QoL after 1 year.

CONCLUSION

With the identification of these predictors, we might be able to select more efficiently and timely the patients with TIA or minor stroke who need stroke aftercare.

An online intervention for improving stroke survivors' health-related quality of life: study protocol for a randomised controlled trial

Background

Recurrent stroke is a major contributor to stroke-related disability and costs. Improving health-risk behaviours and mental health has the potential to significantly improve recovery, enhance health-related quality of life (HRQoL), independent living, and lower the risk of recurrent stroke. The primary aim will be to test the effectiveness of an online intervention to improve HRQoL among stroke survivors at 6 months’ follow-up. Programme effectiveness on four health behaviours, anxiety and depression, cost-effectiveness, and impact on other hospital admissions will also be assessed.

Methods/design

An open-label randomised controlled trial is planned. A total of 530 adults will be recruited across one national and one regional stroke registry and block randomised to the intervention or minimal care control group. The intervention group will receive access to the online programme Prevent 2nd Stroke (P2S); the minimal care control group will receive an email with Internet addresses of generic health sites designed for the general population. The primary outcome, HRQoL, will be measured using the EuroQol-5D. A full analysis plan will compare between groups from baseline to follow-up.

Discussion

A low-cost per user option to supplement current care, such as P2S, has the potential to increase HRQoL for stroke survivors, and reduce the risk of second stroke.

Trial registration

Australian and New Zealand Clinical Trials Registry, ID: ACTRN12617001205325p. Registered on 17 August 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3604-0) contains supplementary material, which is available to authorized users.

The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients

Drop foot is a frequent abnormality in gait after central nervous system lesions. Different treatment strategies are available to functionally restore dorsal extension during swing phase in gait. Orthoses as well as surface and implantable devices for electrical stimulation of the peroneal nerve may be used in patients who do not regain good dorsal extension. While several studies investigated the effects of implanted systems on walking speed and gait endurance, only a few studies have focussed on the system’s impact on kinematics and long-term outcomes. Therefore, our aim was to further investigate the effects of the implanted system ActiGait on gait kinematics and spatiotemporal parameters for the first time with a 1-year follow-up period. 10 patients were implanted with an ActiGait stimulator, with 8 patients completing baseline and follow-up assessments. Assessments included a 10-m walking test, video-based gait analysis and a Visual Analogue Scale (VAS) for health status. At baseline, gait analysis was performed without any assistive device as well as with surface electrical stimulation. At follow-up patients walked with the ActiGait system switched off and on. The maximum dorsal extension of the ankle at initial contact increased significantly between baseline without stimulation and follow-up with ActiGait (p = 0.018). While the spatio-temporal parameters did not seem to change much with the use of ActiGait in convenient walking speed, patients did walk faster when using surface stimulation or ActiGait compared to no stimulation at the 10-m walking test at their fastest possible walking speed. Patients rated their health better at the 1-year follow-up. In summary, a global improvement in gait kinematics compared to no stimulation was observed and the long-term safety of the device could be confirmed.

Distribution of Stroke Risk Factors in Eastern Croatia

The aim of this study was to determine the distribution of risk factors according to age, gender, subtypes and recurrence of stroke in eastern Croatia. The study included 250 acute stroke patients admitted to University Department of Neurology, Osijek University Hospital Centre in 2011. Patients were grouped according to age, gender, subtypes and recurrence of stroke. The study showed significant differences in the distribution of cigarette smoking, diabetes, cardiomyopathy and hyperuricemia according to patient age. According to gender, male patients had a significantly higher prevalence of smoking and alcohol abuse, whereas in female patients the prevalence of arterial hypertension, atrial fibrillation and hyperuricemia was significantly higher. Regarding stroke subtypes, significant differences were noticed in the prevalence of arterial hypertension, atrial fibrillation, cardiomyopathy and cerebral blood vessel stenosis. Atrial fibrillation was significantly more common in first-ever than in recurrent stroke. Study results identified the groups of patients requiring special attention regarding particular risk factors in eastern Croatia and emphasized the need of developing regional strategies of screening, prevention and holistic care for stroke patients.