Abstract
BackgroundVarious studies have reported discordant profiles of health-related quality of life (HRQOL) after stroke. The aims of this study, the first of its kind, were to determine the real impact of stroke on HRQOL across diverse cultures; and to compare HRQOL between stroke patients and healthy adults, and across stroke severity strata.Methods100 stroke patients and 100 apparently healthy adults (AHAs) in Nigeria; as well as 103 stroke and 50 AHAs in Germany participated. Stroke severity was measured using the National Institute of Health Stroke Scale, Stroke Levity Scale and modified Rankin scale. HRQOL was evaluated using the HRQOL In Stroke Patients (HRQOLISP) measure, a holistic multiculturally-validated measure with seven therapeutically-relevant domains distributed into two spheres.ResultsDomains within the spiritual sphere were considered more important by stroke patients. In both countries, stroke patients significantly (0.00001 < p < 0.004) had worse HRQOL than AHAs in all domains within the physical sphere. This was not so for the spiritual sphere. Consistently, stroke severity correlated significantly with all domains in the physical sphere unlike the spiritual sphere. In diverse cultures, the correlation coefficients between HRQOL and all indices of stroke severity revealed a decremental trend from the physical domain (rho = 0.77, p < 0.00001) to the spiritual domain (rho = 0.01, p = 0.893).ConclusionsConsistently, stroke elicited a decremental response across domains, with domains in the spiritual sphere being relatively stroke-resilient. The potential utility of the relatively preserved spiritual sphere in facilitating stroke rehabilitation requires evaluation in diverse cultures.
Highlights
Various studies have reported discordant profiles of health-related quality of life (HRQOL) after stroke
A total of 353 respondents [100 stroke patients and 100 apparently healthy adults (AHAs) in Ibadan; and 103 stroke and 50 AHAss in Berlin] were assessed. Those excluded from the study were patients with significant comorbidities that were not related to stroke (n = 4 in Ibadan, n = 5 in Berlin), those with communication problems who had no reliable proxies (n = 4 in Berlin) and those who did not give consent (n = 6 in Berlin)
Stroke had a dualistic impact on HRQOL, significantly reducing HRQOL scores for the physical sphere in both countries, while relatively sparing the spiritual sphere
Summary
Various studies have reported discordant profiles of health-related quality of life (HRQOL) after stroke. A leading cause of disability [1], is usually a major life event. The ultimate goal of stroke interventions is to improve the health-related quality of life (HRQOL) of survivors ensuring that they are enabled to fulfil their roles and purpose in life after the event. It is imperative to know the real impact of stroke on HRQOL as a basis for planning and evaluating therapeutic and rehabilitative interventions after stroke [1]. Enormous variations have been reported in the profile of HRQOL in stroke patients [1]. There are conflicting reports on the relative impact of stroke on different domains of HRQOL. While some studies reported impairment of all domains even in those deemed to have recovered, other studies discordantly reported sparing of the domain assessing physical functioning or psychological functioning or autonomy [2,3,4]
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