Original article
Quality of Life of Stroke Survivors: A 1-Year Follow-Up Study

https://doi.org/10.1016/j.apmr.2006.05.015Get rights and content

Abstract

Kwok T, Lo RS, Wong E, Wai-Kwong T, Mok V, Kai-Sing W. Quality of life of stroke survivors: a 1-year follow-up study.

Objectives

To examine the changes in and to identify determinants of health-related quality of life (HRQOL) during the first year after stroke.

Setting

Regional university teaching hospital in China.

Participants

Chinese survivors of stroke (N=303). Patients who were previously physically handicapped were excluded.

Interventions

Not applicable.

Main Outcome Measures

Barthel Index, Lawton Instrumental Activities of Daily Living (IADL), Chinese Mini-Mental State Examination, Geriatric Depression Scale (GDS), and the abbreviated Hong Kong Chinese version of the World Health Organization Quality of Life measure domain scores at 3, 6, and 12 months after the stroke.

Results

A total of 268 (88%) subjects completed the study. HRQOL data were available in 247 (82%) subjects at 3 months. Between 3 and 12 months, there was no significant change in Barthel Index and IADL scores, but there was significant increase in GDS scores. On multivariate analysis and multilevel modeling, there was a small but significant decrease in social interaction and environment HRQOL domain scores with time. GDS score was negatively associated with all 4 domains of HRQOL, whereas the Barthel Index score was associated with physical and psychological HRQOL domains only. Female sex, nursing home residence, welfare assistance, pain in affected limbs, soft diet or tube feeding, and lack of physical exercise were associated with poorer HRQOL.

Conclusions

Environment and social interaction HRQOL may decrease after 1 year of stroke among Chinese stroke patients. Depression has a more generalized adverse effect on HRQOL than basic functional disabilities. Health care professionals should focus on treating depression; group exercises and self-help group activities may help in promoting socialization and reintegration into community life.

Section snippets

Participants

Hong Kong has a comprehensive and almost fully publicly funded hospital-based rehabilitative service for stroke patients. From January through July 2002, a research assistant prospectively screened patients with acute stroke within 2 days of admission to the Prince of Wales Hospital (PWH)—a regional university teaching hospital with 1500 beds serving a population of 0.7 million people. Patients were included in the study if they were Chinese. Patients were excluded if the stroke had occurred

Results

During the study period, 392 patients with stroke were admitted to PWH. Of these, 303 (77%) were recruited and followed up at 3 months after stroke onset. The reasons for excluding the 89 patients were as follows: handicapped before stroke (n=24), death before 3 months (n=38), recurrence of stroke (n=14), terminal illness (n=5), non-Chinese ethnicity (n=1), unable to contact (n=4), and refusal to participate (n=3).

Of the 303 subjects, 269 (88.8%) subjects had ischemic strokes; 13 (4.3%)

Discussion

This prospective cohort study of patients during the first year of stroke showed that self-perceived HRQOL deteriorated significantly at 12 months in terms of social interactions and living environment. Depression had a negative association with all 4 domains of HRQOL, whereas decreasing disability in basic ADLs (reflected by an increasing Barthel Index score) had a positive association with physical and psychological HRQOL. Female sex, residence in a nursing home, some forms of welfare

Conclusions

Environment and social interaction HRQOL may diminish after 1 year of stroke among elderly Chinese patients. Some of the factors that are associated with HRQOL—depression, diet, exercise, and limb pain—are potentially modifiable, whereas others—sex, marital status, and poverty—are not. We recommend that all stroke patients should be followed up by a health care professional for at least 1 year. Apart from the need to control risk factors of recurrent strokes, attending doctors or nurses should

Acknowledgments

We thank Leung Kwok Fai, chief of occupational therapy, Queen Elizabeth Hospital, for his advice on research design and his training of our research assistants in administering WHOQOL-BREF (HK), and to Ashley Yu, Centre for Clinical Trials and Epidemiological Research, the Chinese University of Hong Kong, for statistical advice.

References (36)

  • D.S. Nichols-Larsen et al.

    Factors influencing stroke survivors’ quality of life during subacute recovery

    Stroke

    (2005)
  • A.C. Jonsson et al.

    Determinants of quality of life in stroke survivors and their informal caregivers

    Stroke

    (2005)
  • J.T. Wilson et al.

    Improving the assessment of outcomes in strokeuse of a structured interview to assign grades on the modified Rankin Scale

    Stroke

    (2002)
  • T.G. Brott et al.

    Measurements of acute cerebral infarctiona clinical examination scale

    Stroke

    (1989)
  • F.I. Mahoney et al.

    Functional evaluationthe Barthel index

    Md State Med J

    (1965)
  • M. Lawton et al.

    Assessment of older peopleself-maintaining and instrumental activities of daily living

    Gerontologist

    (1969)
  • H.F. Chiu et al.

    Reliability, validity and structure of the Chinese geriatric depression scale in a Hong Kong contexta preliminary report

    Singapore Med J

    (1994)
  • H.F. Chiu et al.

    Prevalence of dementia in Chinese elderly in Hong Kong

    Neurology

    (1998)
  • Cited by (0)

    Supported by the Health Services Research Fund in Hong Kong (grant no. 931012).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    View full text