Abstract
Objective: As stroke mortality rates decline in Japan, a large proportion of disabled stroke survivors living in their homes are supported by informal caregivers or formal healthcare services. To evaluate the impact of healthcare provision on outcome of stroke patients living at home, this study investigated the associations of long-term care and health-related quality of life (HRQOL) in patients 1 year after stroke onset. Methods: Data on patient and caregiver characteristics, HRQOL of patients, and healthcare services for those living at home were prospectively collected from 426 patients with stroke at baseline and 12 months. Using general measures of HRQOL, namely, Short Form-36 (SF-36) and EuroQOL 5 dimension (EQ-5D), multivariate regression models were used to determine the contribution of variables to changes in HRQOL scores from discharge to the first year after stroke. Results: Five domains of SF-36—role-physical, vitality, social functioning, role- emotional, and mental health—were significantly improved 1 year after stroke. Factors affecting changes in the five domains of HRQOL were age, independence in activities of daily living, and cognitive function. Home care service was positively associated with role-physical, social functioning, and role-emotional. In addition, home rehabilitation and home bathing services were positively associated with social functioning. Conclusion: This study clarified that improvements of HRQOL 1 year after stroke were associated with use of home-based services involving home care service, home rehabilitation, and home bathing services. The use of home-based services contributed to the improved welfare of patients living at home.
Highlights
The number of disabled stroke survivors is increasing with the decline in stroke mortality
With home-based services, the home care service was positively associated with role-physical, social functioning, and role-emotional, while home rehabilitation and home bathing services were positively associated with social functioning
This study clarified that the five domains of Short Form-36 (SF-36)—namely, role-physical, vitality, social functioning, roleemotional, and mental health—were improved 1 year after stroke onset in patients who were at home
Summary
The number of disabled stroke survivors is increasing with the decline in stroke mortality. A previous study showed that the decline of HRQOL of stroke patients was associated with family care giving due to the increased burden on caregivers [11]. A large proportion of disabled stroke survivors living at home are supported by informal caregivers or formal healthcare services in Japan [12]. In Japan, formal healthcare services are covered by the national long-term care insurance system. Issues related to the care system are becoming apparent; for example, the advanced age of caregivers, the growing burden on caregivers, and the imbalance between supply and demand of long-term care due to an increasing number of patients requiring home care [13]
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