Life Satisfaction of Two-Year Post-Stroke Survivors: Effects of Socio-Economic Factors, Motor Impairment, Newcastle Stroke-Specific Quality of Life Measure and World Health Organization Quality of Life – bref of Informal Caregivers in Luxembourg and a Rural Area in Portugal

Abstract

Background: Life satisfaction of stroke survivors is known to be associated with socio-economic factors and the survivor’s and his/her caregiver’s quality of life, but their respective influence remains to be fully elucidated. Purpose: To analyse the stroke survivors’ life satisfaction 2 years after the event and its relationships with quality of life, socio-economic and stroke-related characteristics, and with informal caregivers’ life satisfaction and quality of life . Methods: Over 18 months, all stroke patients from Luxembourg and north-eastern Portugal who lived at home were identified from the Inspection Générale de la Sécurité Sociale and hospital records, respectively. The clinical diagnosis of cerebrovascular disease was confirmed. We excluded all patients who declared that stroke did not result in neurological impairments at the time of stroke from the statistical analysis. The samples comprised 79 patients in Luxembourg and 48 in Portugal. Patients and the people they identified as their main caregivers were interviewed using validated questionnaires measuring life satisfaction, i.e. the Newcastle Stroke-Specific Quality of Life (Newsqol – 11 subscales), which identifies the areas affected by stroke among patients, and the World Health Organization Quality of Life – bref (Whoqol-bref – 4 subscales) of informal caregivers. Survivors without neurological impairment at the time of stroke were excluded. Data were analysed via multiple-regression models. Results: Life satisfaction was higher among women and lower among subjects with impaired motor functions. It was lower among Portuguese respondents with low-level education (<12th grade) and higher among those at work (37.6/100). In Luxembourg, retired people had more life satisfaction than did working people (–7.9/100). Controlling for socio-economic factors, life satisfaction was associated with feelings- Newsqol (slope 0.25) among Luxembourg residents, and with feelings-, mobility- and self-care-Newsqol (slopes 0.24, 0.27 and 0.33, respectively) among Portuguese respondents. Life satisfaction of patients was strongly related to that of family caregivers among the Portuguese respondents (slope 0.66) but the relationship was moderate in Luxembourg (slope 0.28). The survivors’ life satisfaction was not correlated with any Whoqol-bref domain in the Luxembourg group, but was correlated with the Whoqol-bref psychological, social relationships and environment domains among the Portuguese respondents (slopes 0.55, 0.59 and 0.51, respectively). Conclusions: The life satisfaction scale and the Newsqol stroke instrument, which identify areas of quality of life affected by stroke, are reliable patient-centred markers of intervention outcome. They can be used within the framework of medical follow-up (such as telephone assistance, clinical practice and prevention). Depending on the stroke survivor’s and the family caregiver’s habitual lifestyle and material circumstances, enhancement of a caregiver’s quality of life can help maintain the patient’s life satisfaction, particularly in a rural setting.