Academic journal article Hong Kong Journal of Psychiatry

Longitudinal Study of Quality of Life Following Stroke

Academic journal article Hong Kong Journal of Psychiatry

Longitudinal Study of Quality of Life Following Stroke

Article excerpt

Abstract

The purpose of this study was to conduct a longitudinal examination of various dimensions of quality of life for patients following their first stroke and to identify variables that predict subsequent quality of life. 121 patients with a first stroke and 121 matched healthy controls from the same community were assessed at baseline and 1 year after discharge from hospital using a self-administered General Quality of Life Inventory.

One year after discharge, the clinical condition of 84% of patients following a stroke had improved or they had fully recovered. However, their quality of life had not reached the level of the healthy controls. Of note was that 16% of patients whose stroke symptoms were unchanged or worse after 1 year of follow-up showed no change in quality of life scores compared with baseline. One year after discharge, family and social support had significantly decreased and self esteem and body image were impaired compared with baseline, particularly for patients experiencing deterioration of their condition.

Multiple stepwise regression analysis showed that quality of life was best predicted by the severity of the stroke, patients' outcome expectancy, their values of need level for life, and potential for neuroticism. Stroke was found to impair most aspects of patients' quality of life. During rehabilitation after stroke, more attention should therefore be paid to adjusting patients' outcomes expectancy and their values of need level for life to a more realistic level and ensuring sufficient psychosocial support as well as active drug and physical therapy.

Key words: Stroke, Quality of life

Introduction

Stroke is a major chronically disabling brain trauma that often radically and permanently changes the lives of patients. Most strokes are not fatal, but the disabilities caused may be profound and lead to severe impairment of quality of life (QOL). (1-4) Gage et al (3) and Solomon et al (4) reported that the QOL of a patient after a moderate or major stroke is perceived as worse than or equal to death by many patients. Hence, there is a growing consensus that QOL should be considered as an important index of health care outcome.

However, despite the potential for stroke to affect multiple domains of life and related outcomes, few studies have addressed QOL after stroke. Some reported studies have reached contradictory conclusions. (5-7) However, nearly all research into QOL after stroke has failed to include a comparison group of healthy adults. (4,5,8-12)

Over the years, QOL has been defined in many different ways. A broad consensus has emerged that at least 4 dimensions should be included in a QOL assessment: physical, psychological, social function, and patients' symptoms. (1,2,13,14) This study, therefore, was undertaken to compare the QOL of patients after stroke with healthy controls, and to prospectively examine the QOL of patients followed up during a 12-month period after discharge from hospital using a multidimensional measure that includes physical health, psychological health, social functioning, and living conditions. (1,2,14,15)

Methods

Patients

Patients were included in the study as long as the following criteria were met.

The patients were discharged from hospital within 1 week of improvement in their condition after a first stroke. There were no other neuro-musculoskeletal conditions that would interfere with normal function and the patients had no previous history of psychiatric illness. Cognitive and language functioning was adequate for participation in the study procedures. Patients could read and write Chinese and were well enough to give informed consent. The diagnosis of stroke was confirmed clinically and by computed tomography.

The control subjects were matched in terms of the patients' age groups (<45 years, 45 to 65 years, >65 years), gender, and occupation (manual worker, farmer, office worker, professional, other) by healthy individuals from the same community who had no history of seeking medical attention during the previous year. …

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