Health-related Quality Of Life In Stroke Survivors Research Articles

Psychosocial factors as main predictors of quality of life 5 years after stroke: a cross-sectional study from a third-level Italian center.

Stroke causes a significant reduction in health-related quality of life (HRQoL), and studies addressing its predictors often rely on models with few variables. This study aimed to assess the degree to which health status, health habits, and features of the environment predict HRQoL in stroke survivors with stable clinical condition. WHO Quality of Life questionnaire for old-Age subjects (WHOQOL-AGE) was used to assess HRQoL. We ran a multivariable linear regression to predict WHOQOL-AGE variation, entering measures of health state, bad habits, healthy behaviors, physical environment features, and social support. Patients were stroke survivors with a stable clinical condition, distance from acute event of more than 6 months, and National Institutes of Health Stroke Scale (NIHSS) of 10 or less. A total of 122 participants (47 females, 97 with ischemic stroke) were enrolled, the mean age was 64.1, mean NIHSS 2.9, and mean distance from the acute event was 5.1 years. State anxiety (β = -0.202), trait anxiety (β = -0.232), depression (β = -0.255), social support (β = 0.247), and functional independence (β = -0.210) predicted WHOQOL-AGE variation (Adj. R2 = 0.549). Our results show that psychological symptoms, reduced social network, and functional dependence together have a negative impact on HRQoL. These elements, which are partly stroke-specific, should be taken into account in the recovery process to enhance patients' health outcomes.

Persisting consequences of ischemic stroke after three months, assessed with the Stroke Impact Scale Version 3.0

ABSTRACT Introduction Acute ischemic stroke (AIS) has a significant impact on different aspects of the patient’s life resulting in loss of independence and poor Health-related Quality of life (HR-QoL). Aims This study aimed to evaluate the impact of AIS on HR-QoL during the first three months post-stroke in a defined Bulgarian population. Methods A total of 150 patients with AIS – 50 with thrombolytic and 100 with non-thrombolytic therapy, were enrolled in a hospital-based study at a tertiary care referral center for neurological disorders in Bulgaria. The HR-QoL of stroke survivors was assessed with the Stroke Impact Scale 3.0 on discharge, in the first and the third-month post-stroke. Results The overall HR-QoL remained significantly reduced during the observation period. The most affected domains in the third-month were Participation, Hand function, Mobility, Strenght, and Activities of daily living (ADL). Improvement in all HR-QoL domains was found, most pronounced up to the first-month post-stroke. The higher age, NIHSS and mRS scores were associated with worse SIS 3.0 scores. Left-hemispheric AIS was associated with worse Memory and Communication outcomes, while Right-hemispheric lesions had a higher impact on the Emotions. Large-artery occlusion determined diminished Strenght scores, whereas cardioembolism impacted Communication and ADL domains. Contrarily, lacunar stroke showed more favourable outcomes in all domains. Conclusion There is the utmost need to focus on the long-term effects of ischemic stroke, due to the rising number of patients who live with the consequences of stroke. Stroke treatment should not be directed exclusively to acute stroke care or prevention, but also to optimizing the post-stroke functioning and Quality of life.

Impact of post-stroke disability and disability-perception on health-related quality of life of stroke survivors: the moderating effect of disability-severity

ABSTRACT Objective The influence of disability-perception on health-related quality of life (HRQoL) remains unclear. This study investigated impact of disability and disability-perception on HRQoL of stroke survivors and explores the moderating effect of disability-severity. Methods Post-stroke disability, disability-perception/acceptance and HRQoL were assessed in 102 stroke survivors using the World Health Organisation Disability Assessment Schedule, Attitudes towards Disabled Persons Form-A and Short Form-36, respectively. Results There was significant disability score of at least 42 in the participants with severe disability accounting for 76.5% while 52% of them having positive disability-perception. Although no sex difference exists in their HRQoL, their score was just fair (46.1 ± 1.9) with their physical health being most affected. Severe disability impacted negatively on their HRQoL but disability-perception had no significant effect except in ‘role limitation due to the emotional problem’ domain. Only severe disability moderated the effects of disability on the overall HRQoL (R 2 change = 3.2%; p = 0.018). Disability-severity (mild/moderate and severe disability) moderated the effects of disability level on their physical health (R 2 change = 3.1% and 6%; p = 0.012 and 0.0001, respectively). Conclusion Significant disability exists among stroke survivors and impaired their HRQoL while disability-severity moderating the effect. More stroke survivors have positive attitude towards their disability and impact positively on their physical health.

Factors associated with health related quality of life of patients with stroke in Sri Lankan context

BackgroundStroke is a major global health concern which affects the health related quality of life (HRQOL). As the prevalence of stroke is increasing especially in lower-middle income countries, it is vital to identify the factors associated with the HRQOL of affected individuals.Available literature for post stroke HRQOL and the associated factors are mainly from high income countries. Therefore, we conducted this study to identify the factors associated with HRQOL of stroke survivors using a stroke specific measure.MethodsA longitudinal study was conducted with the participation of 257 stroke survivors. Participants were followed up after 3 months at the neurology and medical clinics in the Teaching Hospital, Karapitiya, Sri Lanka.Health related quality of life was assessed using the validated version of Stroke Aphasia Quality of Life (SAQOL)-39 generic scale. Pearson correlation, independent sample t-test, one-way ANOVA and regression analysis were used to identify the factors associated with quality of life.ResultsMean age of the participants with stroke was 66.1 (SD 11.7) years. The mean overall HRQOL was 3.15 (SD 0.96) as measured by the SAQOL-39 g. The socio-demographic factors which had significant associations with HRQOL were; gender, level of education, marital status, occupation and monthly income (p < 0.05). The clinical factors which had significant associations with HRQOL were; level of dependence and disability, type of stroke, side of the lesion, type of aphasia, level of language impairment, receiving physiotherapy and speech therapy and follow up care (p < 0.05). The results of regression indicated six independent predictors [F (6,234) = 42.6, p < 0.05], with an R2 of 0.52. The HRQOL was significantly predicted by the level of dependence (β = .43, p < .01), level of language impairment (β = .20, p < .01), age (β = −.23, p < .01), type of stroke (β = −.19, p < .01), side of the lesion (β = .17, p < .01) and the level of education (β = .12, p < .05).ConclusionSevere degree of dependence, severe level of language impairment, older age, hemorrhagic stroke, and lesions in the left side were associated with lower HRQOL. Higher education level was associated with higher HRQOL scores.

Health-related quality of life, social support, and social networks in African-American stroke survivors with and without aphasia.

Background Health-related quality of life (HRQL) provides insight into the impact of a health condition on an individual's ability to lead a fulfilling life. Previous research has identified determinants of HRQL in stroke survivors to include communication, mobility, mental/emotional health, role, and social functioning. However, health disparities among minority populations may influence HRQL in stroke survivors with and without aphasia. The aim of this study was to explore the HRQL and social functioning in a homogenous sample of African-Americans with chronic stroke. Methods A cross-sectional case control descriptive research design was adopted. A total of 39 African-American men (53.8%) and women (46.2%) participated in the study aged from 33 to 79 (M = 62.4 ±11.10). Three groups of 13 were developed based on behavioral performance and neurological report: stroke survivors with aphasia (SWA), stroke survivors without aphasia (SSA) and successfully aging/healthy adults with no history of neurological injury (SAH). The majority of stroke survivors (84.6%) reported a left hemisphere stroke. Patient-reported outcomes were administered face to face without the use of a proxy to measure HRQL and social functioning–the Stroke and Aphasia Quality of Life Scale-39g, the EuroQol-5D, the Medical Outcome Study Social Support Survey and the Lubben Social Network Scale. An ANOVA test and Scheffe post hoc analysis was used to compare means of the three groups. Results Chronic stroke survivors reported a lower HRQL than SAH adults. No differences were noted between the groups in specific areas of social functioning related to social support and social network. However, condition-specific HRQL differences in communication and social domains were identified between SWA to SSA and SAH adults. Physical domain differences were noted between SSA and SAH groups. Level of education was significantly different among the sample with individuals with higher education reporting a better HRQL. No significant differences were noted between the groups for presence of co-morbid conditions. Conclusion This study provides a preliminary examination of HRQL and social functioning in African American stroke survivors with and without aphasia compared to age and ethnicity-matched peers. Larger studies will be needed to examine determinants of HRQL in this understudied population.

Effects of Virtual Reality Therapy on the Balance and Health-Related Quality of Life of Patients With Stroke: A Systematic Review

Introduction: Stroke is one of the leading causes of death worldwide. Despite the glowing advancement of Virtual Reality Therapy (VRT), clear evidence about its effectiveness in stroke is still scarce. Hence it is essential to review the current information to provide up-to-date insight. Therefore the aim of this review is to evaluate the effects of VRT on the balance and Health-related Quality of Life (HRQoL) in patients with stroke.Data Sources: A literature search was done in Google Scholar, PEDro, Cochrane Library, Medline, Web of Science, and PubMed databases.Eligibility Criteria: We performed a systematic review of randomized controlled trials published from June 2014 to January 2020, evaluating the effects of VRT on the balance and/or HRQoL in stroke. Fourteen eligible trials were analyzed, of which, 7 studies focused on balance and 7 on HRQoL.Quality Appraisal: Methodological quality and risk of bias were assessed using the Cochrane tool.Results: Most of the trials supported the effectiveness of VRT in improving balance and HRQoL. However, few trials reported similar improvements in HRQoL using VRT via Nintendo WiiTM games and conventional physiotherapy.Conclusions: High to moderate evidence supports the effectiveness of VRT use in improving balance and HRQoL in stroke survivors.

Health-related quality of life loss associated with first-time stroke.

ObjectivesThis study aimed to quantify health-related quality of life (HRQoL) loss associated with first episode of stroke by comparing patient-reported HRQoL before and after stroke onset. The impact of stroke in local population was also evaluated by comparing the pre- and post-stroke HRQoL with that of the general population.MethodsThe HRQoL of stroke survivors was assessed with the EQ-5D-3L index score at recruitment, for recalled pre-stroke HRQoL, and at 3 and 12 month post-stroke. Change in HRQoL from pre-stroke to 3 and 12 month was self-reported by 285 and 238 patients, respectively. Mean EQ index score at each time point (baseline: 464 patients; 3 month post-stroke: 306 patients; 12 month post-stroke: 258 patients) was compared with published population norms for EQ-5D-3L.ResultsThere was a significant decrease in HRQoL at 3 (0.25) and 12 month (0.09) post-stroke when compared to the retrospectively recalled patients’ mean pre-stroke HRQoL level (0.87). The reduction at 3 month was associated with the reduction in all EQ-5D-3L health dimensions; reductions remaining at 12 month were limited to dimensions of mobility, self-care, usual activities, and anxiety/depression. Stroke patients had a lower mean EQ index than the general population by 0.07 points pre-stroke (0.87 vs. 0.94), 0.33 points at 3 month (0.61 vs. 0.94) and 0.18 points at 12 month (0.76 vs. 0.94) post-stroke.ConclusionsStroke has a substantial impact on HRQoL in Singapore, especially in the first three months post-stroke. Compared to the general population, stroke survivors have lower HRQoL even before stroke onset. This pre-stroke deficit in HRQoL should be taken into account when quantifying health burden of stroke or setting goals for stroke rehabilitation.

Abstract TP381: Health-related quality of life in stroke survivors: The 2015 Korea National Health and Nutrition Examination Survey

Introduction: Health-related quality of life (HRQOL) is an important index of poststroke health outcome. Hypothesis: We hypothesized that the HRQOL in stroke survivors than individuals without stroke would be worse and associated with sociodemographic status, impaired health behaviors, and comorbidities among stroke survivors in Korea. Methods: This cross-sectional, population-based study included 5130 (132 stroke survivors; 4998 individuals without stroke) Korean adults (aged ≥18 years) who had complete data on stroke-related items in the 2015 Korea National Health and Nutrition Examination Survey. Descriptive statistics, χ 2 test, t-test, and regression analyses were used. Results: Stroke survivors than adults without stroke were more likely to be older, had lower income and education level, while having more physician-diagnosed diseases (hypertension, diabetes mellitus, dyslipidemia, myocardial infarction, angina, arthritis, osteoporosis, and depression), less meeting aerobic exercise guidelines with more physical activity limit, and more smoking at present or past (p&lt;.001). EQ-5D index and all 5 dimensions of EQ-5D (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) of stroke survivors were much worse than that of adults without stroke (p&lt;.01). Stroke survivors who had lower income and education level, did not meet the aerobic exercise guidelines with more physical activity limit, and had comorbidities (diabetes mellitus, depression) were more likely to have worse HRQOL score (p&lt;.01). Education level, physical activity limit, and depression were predictors of HRQOL in stroke survivors (p&lt;.05). Conclusions: Clinicians should pay a special attention to stroke survivors with lower sociodemographic status, while improving HRQOL of stroke survivors by intervening physical activity and comorbidities, which is important in planning effective poststroke care.

Enlarged perivascular spaces are associated with health-related quality of life in patients with acute ischemic stroke.

This study explored the association between enlarged perivascular spaces (EPVS) and the health-related quality of life (HRQoL) in patients with acute ischemic stroke. This was an observational study of consecutively screened patients with acute ischemic stroke from March 2010 to March 2015. EPVS were rated in the basal ganglia and the centrum semiovale with a validated scale. The HRQoL was assessed 3months after the stroke onset using the Stroke-Specific Quality of Life (SSQoL). Linear regression models were used to study the association between EPVS and HRQoL. The study included 648 patients (mean age 65.8years; 40.0% women) with mild to moderately severe stroke (median NIHSS score 2), of whom 640 (98.8%) exhibited signs of small vessel disease. The median EPVS scores in the basal ganglia and the centrum semiovale were 1 each. In linear regression analysis, EPVS in the basal ganglia were associated with a lower total SSQoL score (P=0.02) and lower mobility (P=0.01), mood (P=0.03), and self-care (P<0.01). EPVS in the centrum semiovale were associated only with a lower SSQoL work/productivity subscore (P=0.002). EPVS are associated with lower HRQoL in patients with mild to moderate acute ischemic stroke. Early identification and intervention of EPVS may improve HRQoL in stroke survivors.

The health-related quality of life in stroke survivors: clinical, functional, and psychosocial correlate

AimThe aims of this study were to examine the health-related quality of life (HRQOL) in stroke survivors attending an outpatient rehabilitation clinic and to examine the relation between some clinical variables and HRQOL.Participants and methodsSixty-four stroke survivors were enrolled. Demographic data were obtained using a structured questionnaire. The functional level of the patients was assessed using the Barthel Index (BI). HRQOL was measured by the short-form 36 (SF-36) and the stroke-specific quality-of-life (SSQOL) scale.ResultsOur patients’ ages ranged from 42 to 95 years (mean 60.81 years), and men represented 81.2% of the participants. Low mean scores of all the eight domains of SF-36 were found. The 12 domains of SSQOL showed different degrees of deterioration in their means. Statistically significant differences between the means of the mobility level, and upper-limb and lower-limb voluntary control with the means of both SF-36 and SSQOL were found in favor of functional independency and full control of the limbs (P < 0.05). Voluntary control of the limbs and BI showed a significant positive correlation with both SSQOL and the physical component of SF-36. Multiple regression analysis showed that the BI score, the nature of stroke, and the comorbidities are the most significant predictors of SSQOL, with P values of 0.004, 0.013, and 0.047, respectively.ConclusionIt was concluded that HRQOL is impaired in stroke survivors, and that the functional independency level is its most significant predictor. We recommend considering the assessment of HRQOL in stroke survivors undergoing rehabilitation management as it is more relevant to the patients.

The impact of pain on health-related quality of life 3 months after stroke

Background:Pain is common in stroke; however, its impacts on health-related quality of life (HRQoL) are unclear due to the limitations of previous studies.Objectives:The current study aims to examine and compare the demographic and clinical characteristics of Chinese stroke patients with and without pain and explore the correlations between poststroke pain and HRQoL.Method:Four hundreds and forty-one participants recruited in an acute stroke unit in a regional hospital. They were assessed 3 months after the index stroke with the following instruments. HRQoL was measured using the Short Form-12 (SF-12). The Chinese version of the Faces Pain Rating Scale-Revised (FPS-R) was used to determine the presence and intensity of pain. The demographic and clinical characteristics of patients were obtained using Barthel Index (BI), Fatigue Severity Scale (FSS), Geriatric Depression Scale (GDS), Anxiety subscale of the Hospital Anxiety and Depression Scale (HADSA), Instrumental Activities of Daily Living (IADL), Mini Mental State Examination (MMSE), Modified Rankin Scale (MRS), and National Institutes of Health Stroke Scale (NIHSS).Results:Of all participants screened, 167 reported pain and 69 had novel pain. The pain group had significantly lower physical component summary (PCS) scores after adjusting for sex, education, DSM-IV depression and BI, GDS, HADSA, and FSS scores. The FPS score was negatively correlated with a lower PCS score in patients with pain and with novel pain.Conclusion:The presence and intensity of pain have significant negative effects on HRQoL in stroke survivors. Interventions for pain could make a valuable contribution to improving HRQoL in stroke survivors.

Insomnia and health-related quality of life in stroke

Background:Insomnia is a common complaint in stroke survivors. Insomnia after stroke is correlated with physical disability, dementia, anxiety, depression, and fatigue. However, the influence of insomnia following stroke on health-related quality of life (HRQoL) has not been investigated.Objectives:The current study aimed to examine the effect of insomnia on HRQoL in stroke survivors 3 months after their index stroke over and above confounding variables.Method:Three hundred and thirty-six patients were recruited from the acute stroke unit in a regional hospital in Hong Kong. Insomnia was ascertained by a single item on a locally validated, seven-item insomnia questionnaire. HRQoL was measured by the total score and the 12 domain scores of the Stroke Specific Quality of Life (SSQoL) scale. Demographic and clinical characteristics were obtained using the following scales: National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS).Results:Forty-four percent of stroke survivors reported experiencing insomnia in the past month; they were more likely to be female and to have a higher GDS score. The insomnia group had significantly lower overall SSQoL, energy and thinking scores after adjusting for sex, BI, and GDS scores.Conclusion:The findings show that stroke survivors who experienced insomnia had a reduced overall HRQoL and were impaired in the energy and thinking domains of HRQoL. Early screening for sleep disturbance would be beneficial to prevent later development of post-stroke insomnia. Pharmacological and non-pharmacological interventions are suggested to improve HRQoL in stroke patients with insomnia.

Consistent determinants of health-related quality of life in the first 12 months after stroke: a prospective study in Nigeria

Background:Health-related quality of life (HRQoL) of stroke survivors can be described as an important and holistic index of stroke outcome. To enhance this all encompassing construct, information on its predictors at different phases of stroke is required.Objective:This study sought to identify consistent determinants of HRQoL over the course of 1 year after stroke in Nigeria.Methods:Information on socio-demographic, clinical, and functioning attributes of 55 consecutive individuals with first-ever stroke were obtained during acute admission and at 1, 3, 6, and 12 months post-stroke. Attributes of functioning namely, motor performance, functional activity, and participation were assessed using the Simplified Fugl–Meyer Assessment, the motor-Functional Independence Measure, and the London Handicap Scale, respectively. HRQoL was also assessed with the Health-Related Quality of Life in Stroke Patients-40 scale at 1, 3, 6, and 12 months. Attributes that were associated with HRQoL at these time points were identified using bivariate and multivariable regression analyses.Results:Among the independent variables, concurrently assessed participation was the sole significant (P < 0.0001) determinant of HRQoL at 1, 3, and 6 months, respectively accounting for 70%, 64%, and 75% variance in HRQoL. At 12 months, participation (P < 0.0001), and functional activity (P < 0.05) accounted for 83% variance in HRQoL, with better functional activity and participation associated with better HRQoL.Conclusion:The outcome of this study indicates that optimizing post-stroke functional activity and participation through proven and effective rehabilitation strategies may result in better HRQoL in stroke survivors.

Determinants of Quality of Life in Stroke Survivors After 6 Months, from a Comprehensive Stroke Unit: A Longitudinal Study.

In the social model of stroke, health-related quality of life (HRQoL) is the result of interplay among stroke severity, social support, and health-promoting behaviors. Our objective was to identify determinants of HRQoL in stroke survivors. Ischemic stroke patients were evaluated at 6 months with the Short Form 12 Health Survey, including physical component survey (PCS) and mental health component survey (MCS) summary scores. Multivariate stepwise regression analyses determined independent predictors of scores. Models included age, gender, socioeconomic class, education, residential environment, social support, previous comorbidity (Charlson Index), previous stroke, side of stroke, National Institutes of Health Stroke Scale (NIHSS) score at admission, Barthel Index (BI) and modified Rankin Scale (mRS) scores at discharge, and length of stay. A total of 131 patients participated (mean age 70.1, SD = 12.5; 62.6% males). In all, 33.6% had a BI score <90 and an mRS score >2 (poor outcome). The mean (SD) PCS score was 39.46 (9.3) and mean (SD) MCS score was 34.86 (10.1). Lower PCS score was associated with female sex (β = 0.204, p = .009), poor social support (β = -0.225, p = .003), and poor Charlson Index (β = -0.162, p = .032) and BI scores (β = 0.384, p < .0001). Lower MCS score was associated with female sex (β = 0.162, p = .062) and poor NIHSS (β = -0.265, p = .019) and BI scores (β = 0.203, p < .071). Stroke severity, disability, gender, social support, and previous stroke have significant impacts on the physical and mental domains of generic HRQoL.

Apathy and Health-Related Quality of Life in Stroke

ObjectiveTo examine differences in health-related quality of life (HRQOL) in stroke survivors with and without apathy. DesignCross-sectional study. SettingAcute stroke unit in a regional hospital. ParticipantsStroke survivors (N=391) recruited from the acute stroke unit. InterventionsNot applicable. Main Outcome MeasuresParticipants were divided into apathy and nonapathy groups. Participants who scored ≥36 on the Apathy Evaluation Scale, clinician's version formed the apathy group. HRQOL was measured with the 2 component scores, mental component summary (MCS) and physical component summary (PCS), of the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12). Demographic and clinical information were obtained with the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS). ResultsThirty-six (9%) participants had apathy. The apathy group had significantly lower MCS and PCS scores. After adjusting for sex, education, diabetes mellitus, and NIHSS, MMSE, GDS, and BI scores, the MCS score in the apathy group remained significantly lower. ConclusionsApathy has a significant negative effect on HRQOL in stroke survivors, particularly on their mental health. Interventions for apathy could improve the HRQOL of stroke survivors.

Impact of Anxiety on Health-Related Quality of Life After Stroke: A Cross-Sectional Study

ObjectiveTo examine the impact of anxiety on health-related quality of life (HRQOL) of stroke survivors. DesignCross-sectional study. SettingAcute stroke unit in a regional hospital. ParticipantsPatients (N=374) from an acute stroke unit. InterventionsNot applicable. Main Outcome MeasuresThe presence of anxiety was defined as a score of ≥8 on the anxiety subscale of the Hospital Anxiety Depression Scale. HRQOL was measured by the total score and 12 domain scores of the Stroke Specific Quality of Life (SSQOL) scale. Demographic characteristics and history of medical conditions were also recorded. Clinical characteristics were obtained using the following scales: National Institutes of Health Stroke Scale, Barthel Index, Mini-Mental State Examination, and Geriatric Depression Scale (GDS). ResultsEighty-six (23%) stroke survivors had anxiety. The anxiety group had significantly more women (62.8% vs 35.1%), higher GDS scores (7.5±4.5 vs 3.5±3.6), and lower scores for total SSQOL (3.9±0.6 vs 4.5±0.6) and SSQOL domains of energy (2.0±1.2 vs 3.4±1.4), mood (3.6±1.5 vs 4.6±0.9), personality (3.4±1.7 vs 4.4±1.1), and thinking (2.4±1.2 vs 3.5±1.4), after adjustment for sex and GDS score. In subsequent multivariate regression analysis, the Hospital Anxiety Depression Scale anxiety score was negatively associated with the SSQOL total score (r=−.154) and 5 of the 12 domain scores, namely energy (r=−.29), mood (r=−.102), personality (r=−.195), thinking (r=−.136), and work/productivity (r=−.096). ConclusionsAnxiety has a negative effect on HRQOL of stroke survivors, independent from depression. Interventions for anxiety should improve stroke survivors' quality of life.

White matter hyperintensities and quality of life in acute lacunar stroke

White matter hyperintensities (WMH) are common in stroke. The influence of WMH on health-related quality of life (HRQoL) following a lacunar stroke is unknown. This study evaluated the impact of WMH on HRQoL in acute lacunar stroke. A cohort of 160 patients with acute lacunar stroke admitted to the stroke unit of a university-affiliated regional hospital in Hong Kong was recruited. Three months after the index stroke, a research assistant administered the Short Form-36 (SF-36) to assess HRQoL. The severity of WMH was evaluated with magnetic resonance imaging (MRI). In univariate analysis, the severity of deep WMH (DWMH) negatively correlated with patients' vitality (VT; p < 0.05), social function (SF; p < 0.001), role-emotional (RE; p < 0.01), mental health (MH; p < 0.01), and mental component summary (MCS; p < 0.001) scores of HRQoL. DWMH was independently associated with all of the above five SF-36 scores (p < 0.05) in linear regression analysis. These findings suggest that DWMH has a significant impact on the HRQoL of stroke survivors. The importance of DWMH in the long-term HRQoL in lacunar stroke warrants further investigation.

Determining quality of life in stroke survivors

Post-stroke health-related quality of life (HRQoL) reflects a comprehensive view of subjective health and a measure of a person’s perceived physical, mental and social health following stroke. Generic scales may enable comparisons between groups of patients with a diverse range of conditions, although they may underestimate the effect of stroke owing to its limited content validity. Stroke-specific HRQoL measures were designed to assess relevant domains that are important to stroke patients. The Stroke Impact Scale, the Stroke Specific Quality of Life scale and The Burden of Stroke Scale are specific HRQoL instruments developed in the last decade. Demographic factors, comorbidity, stroke severity, disability and psychosocial factors (e.g., post-stroke depression and social support) are significant predictors of HRQoL in stroke survivors. Stroke caregiver burden and HRQoL are inversely correlated. HRQoL measures are increasingly used to evaluate the effect of some therapeutic interventions in stroke survivors.

Cerebral microbleeds and quality of life in acute ischemic stroke

This study evaluated the impact of cerebral microbleeds (CMBs) on the health-related quality of life (HRQoL) in 458 Chinese patients with first or recurrent acute ischemic stroke. HRQoL was assessed with the Short Form-36 (SF-36). Univariate analysis showed the presence of lobar CMBs to be negatively correlated with patients' physical functioning (PF; p < 0.01), social function (SF; p < 0.01), and role-emotional (RE; p < 0.05) scores. Subsequent linear regression analysis revealed lobar CMBs to be independently associated with the PF and SF scores (p < 0.05). The limitations of this study include the exclusion of patients with more severe stroke, the lack of longitudinal assessments, the use of a generic rather than stroke-specific HRQoL scale, and the less than optimal sensitivity of the CMB measurement. The study findings suggest that CMBs have a significant impact on the HRQoL of stroke survivors.

Effects of Exercise on Quality of Life in Stroke Survivors

One of the major consequences after stroke is the deterioration in health-related quality of life (HRQOL). Three previous systematic reviews indicated that exercise has limited to no effect in improving HRQOL in stroke survivors. The objective of this meta-analysis was to update the evidence on exercise and HRQOL in stroke survivors with additional new information on randomized controlled trials that have been published since these 3 previous reviews. MEDLINE, Cumulated Index to Nursing and Allied Health Literature, EMBASE, and SportsDiscus databases were searched for randomized controlled trials reporting the effects of exercise on HRQOL in stroke survivors from 1950 to March 2010. The methodological quality of each study was appraised using the Physiotherapy Evidence Database scale. Standardized mean difference was used to compute effect size and subgroup analysis was conducted to test the consistency of results across the subgroups with different characteristics. A total of 1101 citations was identified and 9 studies met all criteria for a total sample of 426 stroke survivors. Eight studies were rated as good quality (ie, Physiotherapy Evidence Database scale ≥5). This meta-analysis provided evidence that exercise can have a small to medium effect on HRQOL outcomes (standardized mean difference, 0.32, P<0.01) at postintervention but not at follow-up after exercise was terminated (standardized mean difference, 0.17, P=0.12). No adverse events related to exercise were reported. The results provide moderate support for the use of exercise to improve HRQOL in stroke survivors. However, the challenge for researchers is identifying effective strategies for sustaining these effects postintervention.