Associations between quality of life and socioeconomic factors, functional impairments and dissatisfaction with received information and home-care services among survivors living at home two years after stroke onset

Abstract

BackgroundQuality of life (QoL) assessment is important when monitoring over time the recovery of stroke-survivors living at home. This study explores the associations between QoL and socioeconomic factors, functional impairments and self-reported dissatisfaction with received information and home-care services among survivors two years after stroke onset. This problem remains partially addressed though optimal information and services may improve survivors’ QoL.MethodsStroke-survivors admitted to all hospitals in Luxembourg 18 months or more previously were identified using the only care-expenditure-reimbursement national system database. The clinical diagnosis was confirmed. Ninety four patients aged 65 years and living at home were interviewed to gather socioeconomic characteristics, functional impairments, dissatisfaction with information and home-care services, and QoL (using the Newcastle Stroke-Specific QoL, newsqol) assessing 11 domains. Data were analyzed using multiple linear regression models.ResultsAbout 50% of survivors had low education and lower income. Functional impairments were common: sensory (45%), motor (35%), memory (32%), language (31%), and vision (20%). Survivors with education (<12th grade) or lower income had low values for most newsqol domains (sex-age-adjusted regression coefficient saRC, i.e. mean difference, between -23 and -8). Patients who were working had better values for pain, mental feelings and sleep domains than did retired people (saRC between -3.9 and 4.2). Various functional impairments were associated with markedly low values of nearly all domains (saRC between -33.5 and -7.5) and motor, language, memory and sensory impairments had the highest impact. The survivors’ perceived QoL was markedly low, especially for the domains of interpersonal relationship, sleep, cognition, mental feelings, and pain. Various QoL domains were strongly related to dissatisfaction with information about stroke and its consequences/changes over time, accuracy of information obtained, help received, coordination between services, and the possibility of receiving help when necessary (saRC reaching -30).ConclusionsStroke-survivors had major alterations in QoL that reflected depressive symptoms, which should be appropriately treated. These findings may help with the development of public policies aiming at improving QoL among stroke survivors. The newsqol could be used routinely to measure the recovery of survivors over time and their needs in terms of information, help and care services.

Quality of Life after First-Ever Stroke: An Interview Based Study from Blantyre, Malawi

“…According to the few who were interviewed by NEWSQOL, returning to their occupation did not significantly affect any domains of their QOL. In other studies, returning to work was related to a moderate life satisfaction boost when compared to those without employment 5,21 . Some of the stroke patients who continued working were surprisingly old in our study.…”

“…In many previous studies gender did not influence the QOL in stroke survivors 8,[13][14][15]22 . European studies have found women having a better post-stroke QOL than men 5,21 . In other studies, however, including one from Kenya, women were found to have lower health-related QOL, as well as post-stroke QOL 3,12,23,24 .…”

“…A standard NEWSQOL interview takes 20-30 minutes to conduct, thus patients with severe expressive or receptive dysphasia and those who were severely ill or bed-ridden were not interviewed. To allow comparability to earlier studies, responses were similarly marked 5,21 . NEWSQOL item responses ranged from 1 (worst possible) to 4 (best possible).…”

“…This is, as far as we know, the first time NEWSQOL has been used in Africa. It has recently been used in Europe in two countries: Luxembourg 4,5 , and comparing urban Luxembourg to rural Portugal 21 . These studies surveyed the QOL of patients and their caretakers two years after a stroke.…”

Relationship between body functions and referral to rehabilitation post-stroke

“…In more severe cases, the consequences of stroke can result in multiple disabilities, such as depressive symptoms, impaired cognition, low mobility and low capacity for self-care (5).…”