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Neurology India, Vol. 58, No. 5, September-October, 2010, pp. 697-701 Original Article Quality of life in stroke patients Nuray Dayapoglu, Mehtap Tan Department of Internal Medicine Nursing, School of Nursing, Atatürk University, Erzurum, Turkey Correspondence Address: Date of Acceptance: 13-Jul-2010 Code Number: ni10192 PMID: 21045490 DOI: 10.4103/0028-3886.72165 Abstract Background and Aim: To determine the quality of life and its relationship with socio-demographic and medical factors in patients with stroke. Setting and Design: Seventy patients with stroke seen in the neurology clinic on a follow-up visit; at least a period of 3 months of follow-up was included. Materials and Methods: Data were collected using (a) a questionnaire to determine patients' socio-demographic factors, (b) Short Form-36 (SF-36) and (c) Perceived Social Support from the Family Scale. Results: The mean score of global quality of life in patients was 37.08±17.03, and the mean score on Perceived Social Support from the Family Scale was 11.21±7.12. The mean score of global quality of life varied significantly according to age, gender, education, profession, place of residence, comorbidities, affected brain area, disease duration and educational level of the caregiver. Conclusion: These results showed a low mean quality-of-life score in patients with stroke. There is a positive and significant correlation between scores on the Perceived Social Support from the Family Scale and various aspects of quality of life, such as functional status, well-being, general health perception and global quality of life. Keywords: Quality of life, social support, stroke Introduction Stroke is the leading cause of disability and the third leading cause of death worldwide, including Turkey. [1] The annual morbidity and mortality statistics in Turkey show that there are increasing trends in mortality and morbidity. [2] Disability associated with stroke significantly interferes with the activities of daily living and, thus, the quality of life. [3] Quality of life is a complex concept comprising physical, emotional and social well-being. While health is an essential ingredient of this concept, [4] World Health Organization (WHO) identifies health-related quality of life as individuals' perception of their position in life according to their purposes, expectations, standards and worries within the context of the culture and value system in which they live. [4] Social support helps patients to cope with the stress associated with the disease and treatment. [5] Social support has positive effect on nursing care and health. Thus nursing staff needs to consider the patients' social support systems, including home environment, family and partners. [6] There is limited data on the quality of life in the early post-stroke phase and the changes in it over time. Social support and stroke-related depression significantly adversely affect the quality of life after stroke. [7] Stroke-associated disability has been found to affect the health status of the individual with stroke over a period of time. [8] The relationship between health status and other socio-demographic and clinical factors has been less well studied. In this study, the global and domain-specific quality of life was studied in patients with first ever episode of stroke, both ischemic and hemorrhagic, of 3 or more months' duration, along with the relationship between the clinical factors, socio-demographic factors and quality of life. Materials and Methods The study was conducted on a cohort of 70 patients attending the neurology outpatient clinic, Yakutive Hospital, Erzurum, between February 2005 and June 2005. All patients gave informed consent, and the study was approved by Atatόrk University Ethics Committee. The inclusion criteria included (1) first ever episode of stroke, both hemorrhagic and ischemic, confirmed by computerized tomography (CT) or magnetic resonance imaging (MRI), of at least 3 months' duration; and (2) providing informed consent for interview during follow-up visit. Patients with communication problems were excluded from the study. If a patient was unable to complete the questionnaire on his/her own, the investigator read the questionnaire items to the patient and recorded the answers. The time taken to complete the questionnaire was approximately 25 to 30 minutes. Instruments Data collected from the case records included type of stroke, affected brain area and disease duration. A 3-part survey was used for data collection. The questionnaire included (a) a section related to demographics, (b) SF-36 Quality of Life Scale [9],[10] and (c) the Perceived Social Support from the Family Scale (PFS). [11],[12] The demographic section contained basic information regarding the patient's gender, age, marital status, education, health insurance, profession, place of residence and comorbid conditions. The reliability and the validity of the SF-36 Scale for the Turkish population have been demonstrated by Pinar. [10] The total Cronbach's alpha parameter was determined to be 0.94; the alpha parameters of sub-dimensioned Cronbach were determined to be as follows: 0.89 for functional status, 0.90 for well-being and 0.75 for general health perception. The test-retest reliability was 0.85 for the PFS. [12] The internal reliability in the present study was 0.95. Statistical analysis The data were evaluated using SPSS 10.0. Kruskal-Wallis variance analysis was applied to examine the difference between the mean score of quality of life and that with regard to each patient's socio-demographic/ medical factors. Percentage was used to evaluate the parameters of age, marital status, educational status, employment, place of residence, disease period, comorbid condition and educational status of caregivers. The t test was applied to determine differences between the mean quality of life scores according to gender, stroke type and brain lesion area. The Mann-Whitney U test was applied to determine differences between mean quality of life scores according to marital status, social insurance, care status and caregivers. The Pearson's correlation analysis was applied to determine the relation between SF-36 scores, income level and point means of perceived social support from the family. Bonferroni's correction was used to determine the significant results in Kruskal-Wallis variance analysis. Significance in all statistical analyses was defined as P< .05. Results The mean scores of the subscales of quality of life are shown in [Table - 1]. The mean age of patients was 64.18±7.91 years; 40% were aged between 61 and 71 years; 60% were males, 74.3% were married, 38.6% were illiterate, 38.6% were housewives, 85.7% were covered by health insurance, 50% lived in the city and 68.6% had no chronic disease other than stroke [Table - 2]. The proportion of patients with ischemic stroke was 74.3%. The affected hemisphere was right in 57.1% of the patients, and the duration of disease was between 3 and 9 months in 42.9% [Table - 3].The mean scores for global quality of life and general health perception, well-being and functional capacity subscales were high in patients aged 50 to 60 years with no comorbidities, and in those with urban residence and secondary or high school education. The differences between groups were significant [Table - 2]. Mean scores for global quality of life, well-being and functional capacity were higher in males and employed patients [Table - 2]. Health insurance and marital status were also associated with significant differences with respect to global quality of life and all subscales of quality of life [Table - 2]. The mean scores of global quality of life with respect to functional status and well-being differed significantly according to brain lesion areas and disease duration but not according to the type of stroke [Table - 3]. All patients required support from a caregiver; 52.9% of caregivers were literate. Of the total patients, 65% had children. The evaluation of the mean quality of life scores according to the profile of caregivers showed a significant effect on patients' functional capacity but not on their well-being, general health perception and mean score of global quality of life. There was also a significant difference in the mean global quality of life scores according to the educational status of caregivers. There was a positive correlation between patients' income and certain domains of quality of life such as functional capacity, well-being, general health perception and global quality of life (r=0.741, P<.01; r= 0.685, P<.01; r=0.361, P<.01; r=0.705, P<.01, respectively). The quality of life improved in conjunction with an increase in the income level. The mean score for perceived social support from the family was 11.21±7.12. There was a positive correlation between the perceived social support from the family and the areas of quality of life such as functional capacity, well-being, general health perception and global quality of life (r=0.570, P<.01; r=0.583, P<.01; r=0.387, P<.01; r=0.602, P<.01, respectively). The quality of life improved as the perceived family support increased [Table - 4]. Discussion Individuals with chronic diseases experience long-lasting physical and social limitations and can lose their jobs, independence, social status and self-respect. Even patients with no serious physical handicap still confront many difficulties in daily life, which can contribute to dissatisfaction. [7] In this study, the quality of life of patients with stroke was found to be poor, which is similar to the observations made in earlier studies. [13] Patients aged 61 to 71 years had the lowest scores with regard to functional status, well-being and general health perception; and the lowest mean score with regard to global quality of life; which is similar to the findings in other studies. [14],[15],[16] This may, to some extent, be attributed to the age-related functional decline. Men had higher mean scores of quality of life as compared to women, which is similar to the observations made in other studies. [17],[18] The reasons for low scores in women could be greater domestic responsibilities, continuing to shoulder responsibilities even with the presence and advancement of disease, and emotional reactions associated with the disease. Higher levels of education were associated with higher scores with regard to functional status, well-being and general health perception; and with higher mean scores with regard to global quality of life; which is similar to the findings in earlier studies. [18],[19] This may be due to better coping skills and secure financial and social status of this group of patients. The highest mean scores of global quality of life and all subscales of the quality of life were observed in patients who were employed; and the lowest scores, in housewives. The latter could be attributed to the lack of financial independence. When mean scores of quality of life were studied with respect to the place of residence, patients residing in the city demonstrated the highest scores with regard to functional status, well-being and general health perception; and the highest mean scores with regard to global quality of life; this is probably related to easy accessibility to health care and public service facilities. Earlier studies have documented low quality-of-life scores and mean scores with regard to global quality of life in stroke patients with other comorbidities. [7],[14],[16] This may be related to the health status associated with other comorbidities and also the increased treatment costs. The location of the brain lesion affected the mean scores of quality of life. Patients with right hemispherical lesions had higher scores with regard to functional status, well-being and general health perception; and higher mean scores with regard to global quality of life in comparison to those with left hemispherical lesions. Similar have been the findings in earlier studies. [13] The mean scores with regard to quality of life were lower in those with prolonged disease. As expected, longer duration of symptoms and limitations, and more medical procedures to be undergone due to the chronic nature of disease may affect life negatively. [20],[21],[22] Patients who were cared by persons with a high school education had higher scores with regard to functional status, well-being and general health perception; and higher mean scores with regard to global quality of life; as has also been shown by other investigators. [23] Educated caregivers are likely to have better understanding of the patients' needs, make better use of medical and social resources, and provide a more stimulating milieu. A positive correlation was shown between income and all areas of quality of life, as expected from the advantages of having fewer concerns, less economical burden from the disease, and more suitable environment. [7] A positive correlation was also found between the perceived social support from the family and all areas of quality of life. This was consistent with the findings of previous studies. [24],[25],[26],[27] Sources of social support for chronic patients play a positive role in helping them overcome the disease and sustain their life. [28],[29] In this study, the mean score of perceived social support from the patients' families was indicative of a medium level of support. As reported previously, providing supportive care may be particularly burdensome for some caregivers of stroke patients, [30] and this indicates that professional support for caregivers is extremely important in helping families to continue in this role. The limitation of this study was that the patients were drawn from among the stroke survivors living in eastern Turkey; therefore, generalization of these findings to individuals living in other geographic regions is limited. However, this study clearly documents that the quality of life of patients with stroke is poor. Stroke-related quality of life should be assessed taking into account the social function and social support of the patient. Stroke survivors can be assisted by maintaining and strengthening their support systems. References
Copyright 2010 - Neurology India The following images related to this document are available:Photo images[ni10192t1.jpg] [ni10192t4.jpg] [ni10192t3.jpg] [ni10192t2.jpg] |
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