Journal of clinical neurology

Korean Neurological Association (대한신경과학회)
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Factors that Affect the Quality of Life at 3 Years Post-Stroke

Choi-Kwon, Smi;Choi, Ji-M.;Kwon, Sun-U.;Kang, Dong-Wha;Kim, Jong-S.

  • Published : 20060000
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Abstract

Background and Purpose: Elucidating the factors that predict the quality of life (QOL) in stroke patients is important. However, the residual sensory symptoms that are common in stroke patients have not usually been included as factors that influence the QOL. The purpose of the present study was to elucidate the factors that predict the QOL of chronic-stage patients with special attention to residual sensory symptoms. Methods: We examined 214 patients who had experienced a first-time stroke during the subacute (i.e., approximately 3 months poststroke) stage; 151 patients from this group were followed up by telephone interview during the chronic (i.e., approximately 3 years poststroke) stage. Physical disabilities, including motor dysfunction, sensory symptoms that included central poststroke pain (CPSP, described using a standardized questionnaire with a visual analogue scale), activities of daily living (ADL, measured by the Barthel index score), as well as the presence of depression (using the DSM IV criteria), were assessed during both the subacute and chronic stages. Economic and job statuses during the chronic stage were also assessed. QOL ratings were determined by the World Health Organization QOL scale. Results: The following factors at 3 months poststroke were related to low QOL at 3 years poststroke: dependency in ADL, motor dysfunction, depression, and CPSP. At 3 years poststroke, dependency in ADL, depression, CPSP, poor economic status, and unemployment were all factors that were related to low QOL. Multiple regression analysis showed that dependency in ADL (19%), presence of CPSP (12%), and poor economic status (10%) were important explanatory factors for overall QOL. In the analysis of QOL subdomains, the most important explanatory factors were CPSP for both physical and psychological domains, dependency in ADL for both independence and social-relationships domains, economic status for the environmental domain, and female sex for the spiritual domain. Conclusions: We conclude that dependency in ADL, depression, low socioeconomic status, and the presence of CPSP either at 3 months or 3 years poststroke are factors that are related to a low QOL at 3 years poststroke. The recognition of these factors may allow strategies to be developed to improve the QOL for stroke patients. J Clin Neurol 2(1):34-41, 2006

Keywords

References

  1. Jonkman EJ, de Weerd AW, Vrijens NLH. Quality of life after a first ischemic stroke. Long-term developments and correlations with changes in neurological deficit, mood and cognitive impairment. Acta Neurol Scand 1998; 98:169-175 https://doi.org/10.1111/j.1600-0404.1998.tb07289.x
  2. Niemi ML, Laaksonen R, Kotila M, Waltimo O. Quality of life 4 years after stroke. Stroke 1989;19:1101-1106
  3. Carod-Artal J, Egido JA, Gonzalez JL, Varela de Seijas E. Quality of life among stroke survivors evaluated 1 year of a stroke: experience of a stroke unit. Stroke 2000;31: 2995-3000 https://doi.org/10.1161/01.STR.31.12.2995
  4. Williams LS, Kroenke K, Weinberger M, Harris LE, Biller J. Post-stroke depression affects quality of life (QOL) but not other stroke outcome measures. Stroke 1999;30: 236-239
  5. Astrom M, Asplund K, Astrom T. Psychosocial function and life satisfaction after stroke. Stroke 1992;23:527-531 https://doi.org/10.1161/01.STR.23.4.527
  6. King RB. Quality of life after stroke. Stroke 1996; 27:1467-1472 https://doi.org/10.1161/01.STR.27.9.1467
  7. Kwa VIH, Limburg M, de Haan RJ. The role of cognitive impairment in the quality of life after ischaemic stroke. J Neurol 1996;243:599-604 https://doi.org/10.1007/BF00900948
  8. de Haan RJ, Limburg M, Van der Meulen JHP, Jacobs HM, Aaronson NK. Quality of life after stroke. Impact of stroke type and lesion location. Stroke 1996;26:402-408
  9. Carey LM. Somatosensory loss after stroke. Crit Rev Phys Rehabil Med 1995;7:51-91 https://doi.org/10.1615/CritRevPhysRehabilMed.v7.i1.40
  10. Andersen G, Vestergaard K, Ingeman-Nielsen M, Jensen TS. Incidence of central post-stroke pain. Pain 1995; 61:187-193 https://doi.org/10.1016/0304-3959(94)00144-4
  11. Bowsher D. Sensory consequences of stroke. Lancet 1993; 341:156 https://doi.org/10.1016/0140-6736(93)90015-9
  12. Leijon G, Boivie J, Johansson I. Central post-stroke pain - neurological symptoms and pain characteristics. Pain 1989;36:13-25 https://doi.org/10.1016/0304-3959(89)90107-3
  13. Bowsher D. Central pain: clinical and physiological characteristics. J Neurol Neurosurg Psychiatry 1996;61: 62-69 https://doi.org/10.1136/jnnp.61.1.62
  14. Kim JS, Choi-Kwon S. Poststroke depression and emotional incontinence: correlation with lesion location. Neurology 2000;54:1805-1810 https://doi.org/10.1212/WNL.54.9.1805
  15. Kim JS, Choi-Kwon S. Sensory sequelae of medullary infarction: differences between lateral and medial medullary syndrome. Stroke 1999;30:2697-2703 https://doi.org/10.1161/01.STR.30.12.2697
  16. Melzack R. The short-form McGill Pain Questionnaire. Pain 1987;30:191-197 https://doi.org/10.1016/0304-3959(87)91074-8
  17. Park KA, Kim HS, Kim JS, Kwon SU, Choi-Kwon S. Food intake, frequency and compliance in stroke patients. Korean J Community Nutr 2001;6:542-552
  18. Skevington SM. Investigating the relationship between pain and discomfort and quality of life, using the WHOQOL. Pain 1998;76:395-406 https://doi.org/10.1016/S0304-3959(98)00072-4
  19. Amir M, Roziner L, Knoll A, Neufeld MY. Self-efficacy and social support as mediators in the relation between disease severity and quality of life in patients with epilepsy. Epilepsia 1999;40:216-224 https://doi.org/10.1111/j.1528-1157.1999.tb02078.x
  20. The WHOQOL Group. The World Health Organization QOL assessment (WHOQOL): development and general psychometric properties. Soc Sci Med 1998;46:1569-1585 https://doi.org/10.1016/S0277-9536(98)00009-4
  21. Ahlsio B, Britton M, Murray V, Theorell T. Disablement and quality of life after stroke. Stroke 1984;15:886-890 https://doi.org/10.1161/01.STR.15.5.886
  22. Parikh RM, Lipsey JR, Robinson RG, Price TR. Two-year longitudinal study of post-stroke mood disorders: dynamic changes in correlates of depression at one and two years. Stroke 1987;.18:579-584 https://doi.org/10.1161/01.STR.18.3.579
  23. Andersen G, Vestergaard K, Ingemann-Nielsen M, Lauritzen L. Risk factors for post-stroke depression. Acta Psychiatr Scand 1995;92:193-198 https://doi.org/10.1111/j.1600-0447.1995.tb09567.x
  24. Astrom M, Adolfsson R, Asplund K. Major depression in stroke patients. A 3-year longitudinal study. Stroke 1993; 24:976-982 https://doi.org/10.1161/01.STR.24.7.976
  25. van Straten A, de Haan RJ, Limburg M, Schuling J, Bossuyt PM, van den Bos GAM. A stroke-adapted 30-item version of the Sickness Impact Profile to assess quality of life (SA-SIP30). Stroke 1995;28:2155-2161
  26. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. Factors affecting the quality of life after ischemic stroke: young versus old patients. J Clin Neurol 2005; 1:59-68 https://doi.org/10.3988/jcn.2005.1.1.59
  27. MacGowan GJL, Janal MN, Clark WC, Wharton RN, Lazar RM, Sacco RL, et al. Central poststroke pain and Wallenberg's lateral medullary infarction: frequency, character, and determinants in 63 patients. Neurology 1997;49:120-125 https://doi.org/10.1212/WNL.49.1.120
  28. Nasreddine ZS, Saver JL. Pain after thalamic stroke: right diencephalic predominance and clinical features in 180 patients. Neurology 1997;48:1196-1199 https://doi.org/10.1212/WNL.48.5.1196
  29. Schott GD. From thalamic syndrome to central poststroke pain. J Neurol Neurosurg Psychiatry 1995;61:560-564
  30. McHorney CA, Ware JE Jr, Lu R, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994;32:40-66 https://doi.org/10.1097/00005650-199401000-00004
  31. Hayes V, Morris J, Wolfe C, Morgan M. The SF-36 health survey questionnaire: is it suitable for use with older adults? Age Ageing 1995;24:120-125 https://doi.org/10.1093/ageing/24.2.120
  32. Brazier JE, Harper R, Jones NMB, O' Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey questionnaires: new outcome measure for primary care. BMJ 1994;305:160-164 https://doi.org/10.1136/bmj.305.6846.160