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Quality of life of stroke survivors: a 1-year follow-up study
Timothy Kwok1, Raymond S Lo, Eric Wong
1Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China. tkwok@cuhk.edu.hk
Insights
Health-related quality of life (HRQOL) may decline in Chinese stroke survivors, particularly in social and environmental domains. Depression significantly impacts HRQOL more than functional disability, highlighting the need for mental health support.
Area of Science:
- Neurology
- Public Health
- Gerontology
Background:
- Stroke is a leading cause of long-term disability.
- Understanding health-related quality of life (HRQOL) changes post-stroke is crucial for patient recovery.
- Determinants of HRQOL in Chinese stroke survivors require further investigation.
Purpose of the Study:
- To examine changes in HRQOL during the first year after stroke.
- To identify factors influencing HRQOL in Chinese stroke survivors.
- To assess the impact of depression and functional status on HRQOL.
Main Methods:
- Prospective cohort study of 303 Chinese stroke survivors in a regional university teaching hospital.
- Assessed HRQOL using the WHOQOL-BREF, Barthel Index, Lawton IADL, MMSE, and GDS at 3, 6, and 12 months.
- Multivariate analysis and multilevel modeling were used to identify determinants of HRQOL.
Main Results:
- A significant increase in Geriatric Depression Scale (GDS) scores was observed between 3 and 12 months.
- Social interaction and environment HRQOL domains showed a significant decrease over time.
- Depression (GDS) negatively impacted all HRQOL domains, while functional status (Barthel Index) affected physical and psychological domains.
Conclusions:
- Environment and social interaction HRQOL may decrease 1 year post-stroke in Chinese patients.
- Depression has a more pervasive adverse effect on HRQOL than functional disabilities.
- Healthcare professionals should prioritize depression management and promote social reintegration activities.
Objectives:
To examine the changes in and to identify determinants of health-related quality of life (HRQOL) during the first year after stroke.
Design:
Prospective cohort study.
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.
