Quality Of Life In Stroke Survivors Research Articles

The effect of professional reintegration of stroke survivors on their quality of life: a scoping review: Professional Integration and QoL after stroke

BackgroundProfessional reintegration is an indicator of recovery and a common goal for many stroke survivors. However, data on the effect of professional reintegration on the quality of life (QoL) of stroke survivors is scarce. AimsTo assess and synthesize the available evidence, and identify the gaps on the effect of professional reintegration on the QoL of stroke survivors. MethodsA scoping review was performed, following PRISMA-ScR guidelines. The electronic databases PubMed, ISI Web of Science, PsycINFO, and SciELO were searched for empirical, peer-reviewed, original, and full-length studies on the effect of professional reintegration on QoL of stroke survivors. The main quantitative findings were synthesized and qualitative data was explored by thematic content analysis. ResultsThe included studies, 7 quantitative, 1 qualitative, and 1 mixed-methods, were published between 2009 and 2021. The assessment of QoL was highly heterogenic but globally most studies reported a significant and positive association between return to work (RTW) and QoL, 3 to 36 months post-stroke. For some stroke survivors, being able to focus on their rehabilitation was more important for their QoL than RTW. ConclusionsThe results highlight the importance of investing in professional reintegration after stroke to improve survivors’ QoL. Further mixed-methods longitudinal research, performed in different countries and settings, with higher, homogeneous, and comparable samples, providing a broader approach to professional reintegration and the use of specific and standardized instruments to assess subjective domains of stroke survivors’ QoL, is needed.

Impact of Stroke on the Quality of Life of its Survivors

Introduction: Ischemic Stroke is due to sudden loss of blood circulation to an area of the brain, resulting in loss of neurologic function. The incidence in India ranges between 105-152/100,000 people/year. Despite all the advancements in care, stroke continues to be the 2nd leading cause of mortality and the 1st cause of long-term disability. The activities of daily living of patients with chronic stroke affect their Quality of Life (QoL). The majority of stroke survivors continue to live with disabilities, and this can have a profound impact on their QoL. Aims & Objectives: To assess the impact of stroke on the various domains of the quality of life of its survivors, who are treated by the Department of Neurological Sciences, Christian Medical College, Vellore. Methods: A descriptive study design employing a non-probability purposive sampling technique was used to recruit 90 stroke survivors. Written consent was obtained, demographic and clinical variables were collected using interviews, and the impact of stroke on its survivors was assessed using the Stroke Specific Quality of Life (SS-QoL) scale. Results: The participant's mean age group was 48.92±12.97 ranging between 26 -78 years respectively; 67.8% were males, 34.4% of them were unskilled workers, 66.7% had a thrombotic type of ischemic stroke, 56.7% had a moderate National Institutes of Health Stroke Scale grade at admission, 26.7% and 25.6% had a modified Rankin Score of 2 and 1, respectively. Among the participants, 47.8% of them had a stroke at the ages of 31-50 years, and the majority (91.1%) of them had comorbidities. The majority (44.77%) of them had a moderate QoL. Among the SS-QoL domains, the mean scores were the highest in the vision domain (4±1.26) and the lowest in the energy domain (2.47±1.25). There was a significant association between the QoL of stroke survivors and their socioeconomic status (p=0.033), type of ischemic stroke (p=0.047), and limb involvement (p=0.034). A positive correlation (p=0.00) was observed among various QoL domains. Conclusion: These findings provided not just insight into the impact of stroke on the QoL of its survivors but also emphasized the need to sensitize the healthcare care professionals to provide care during both the acute period and also continue to ensure all the domains of a good QoL is addressed during the follow-up and rehabilitation. Keywords: Ischemic Stroke, Quality of Life, Stroke Survivor

Post-stroke Cognition is Associated with Stroke Survivor Quality of Life and Caregiver Outcomes: A Systematic Review and Meta-analysis.

Disability arising from post-stroke cognitive impairment is a likely contributor to the poor quality of life (QoL) stroke survivors and their carers frequently experience, but this has not been summarily quantified. A systematic literature review and meta-analysis was completed examining the association between general and domain-specific post-stroke cognitive functioning and adult stroke survivor QoL, caregiver QoL, and caregiver burden. Five databases were systematically searched, and eligibility for inclusion, data extraction, and study quality were evaluated by two reviewers using a standardised protocol. Effects sizes (r) were estimated using a random effects model. Thirty-eight studies were identified, generating a sample of 7365 stroke survivors (median age 63.02years, range 25-93) followed for 3 to 132months post-stroke. Overall cognition (all domains combined) demonstrated a significant small to medium association with QoL, r = 0.23 (95% CI 0.18-0.28), p < 0.001. The cognitive domains of speed, attention, visuospatial, memory, and executive skills, but not language, also demonstrated a significant relationship with QoL. Regarding caregiver outcomes, 15 studies were identified resulting in a sample of 2421 caregivers (median age 58.12years, range 18-82) followed for 3 to 84months post-stroke. Stroke survivor overall cognitive ability again demonstrated a significant small to medium association with caregiver outcomes (QoL and burden combined), r = 0.17 (95% CI 0.10-0.24), p < 0.001. In conclusion, lower post-stroke cognitive performance is associated with significant reductions in stroke survivor QoL and poorer caregiver outcomes. Cognitive assessment is recommended early to identify those at risk and implement timely interventions to support both stroke survivors and their caregivers.

Non-pharmacological interventions on quality of life in stroke survivors: A systematic review and meta-analysis.

Non-pharmacological interventions have been used in the rehabilitation of stroke survivors, but their effects on stroke survivors' quality of life (QoL) are unknown. This review aimed to summarize the existing evidence regarding non-pharmacological interventions for QoL in stroke survivors and to evaluate the effectiveness of different types of interventions. We systematically searched databases including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese BioMedical Literature Database, China Science and Technology Journal Database, and Wanfang data from the earliest available records to March 2023. Randomized controlled trials which explored the effects of non-pharmacological interventions on QoL in stroke patients were included. The meta-analysis was conducted to evaluate the effectiveness of different interventions on QoL. The Review Manager 5.3 was used to conduct the meta-analysis and the revised Cochrane risk-of-bias tool was used to assess the methodological quality of trials. A total of 93,245 records were identified, and 34 articles were reviewed and summarized, of which 20 articles were included in the meta-analysis. The summary of the findings of the included studies revealed fitness training, constraint-induced movement therapy (CIMT), physical exercise, music therapy (MT), and art-based interventions may have positive effects on QoL. The fitness training improved total QoL, especially in physical domains including physical functioning (mean difference [MD] = 10.90; 95% CI [7.20, 14.59]), role physical (MD = 10.63; 95% CI [6.71, 14.55]), and global health (MD = 8.76; 95% CI [5.14, 12.38]). The CIMT had a slight effect on general QoL (standardized mean difference [SMD] = 0.48, 95% CI [0.16, 0.80]), whereas significantly improved strength (MD = 8.84; 95% CI [1.31, 16.38]), activities of daily living/instrumental activities of daily living (ADL/IADL; MD = 10.42; 95% CI [2.98, 17.87]), and mobility (MD = 8.02; 95% CI [1.21, 14.83]). MT had a positive effect on the mental health domain (SMD = 0.54; 95% CI [0.14, 0.94]). Our findings suggest that fitness training and CIMThave a significant effect on improving physical QoL, while MThas a positive effect on improving psychological QoL. Future studies may use comprehensive and multicomponent interventions to simultaneously improve the patients' physical, psychological, and social QoL.

Abstract TP255: Racism, Resilience, and Quality of Life in Black Stroke Survivors

Introduction: Stroke impairs stroke survivor (SS) quality of life (QoL). Black SS in the US also endure stress from structural, cultural, and interpersonal racism. Resilience is a dynamic process of maintaining stable functioning after an event such as stroke. This observational study aimed to assess the effects of racism and resilience on Black SS QoL. Methods: Participants were community-dwelling SS (age ≥ 18) who identified as African American or Black and experienced a stroke within 8 weeks. Baseline data collection included exposure (discrimination, vigilance, resilience), demographic, clinical, and psychosocial variables. Outcome data for QoL was gathered after 6 months. The effects of exposure variables and covariates on QoL were analyzed with multiple linear regression. Results: Participants (n=74) had a mean age of 56.2, 32% were in marital or partner relationships, and 58% were female. Most participants (84%) had ischemic stroke, with no more than mild disability (mRS 0-2 for 80%). Over half of participants had some college (32%) or a college degree (20%). The remaining 46% had a high school education or less. Work status included 32% currently working, 15% not working, 28% retired, and 24% disabled. Half reported an annual household income of &lt; $25,000, with 63% living at ≤ 200% above the US poverty level. Participants reported moderate (64%) to high (8%) perceived stress, and 14% had moderate to moderately severe anxiety. Resilience was correlated with stress (r=-.59, p&lt;.001) and anxiety (r=-.66, p&lt;.01). At 6-month follow-up (n=44), QoL domains were very low for social relations ( M =36.83, SD=17.76) and environment ( M= 35.04, SD=14.57), and moderately low for physical ( M =46.49, SD=19.22) and psychological ( M =54.39, SD=17.23). Higher vigilance and higher disability explained 23.3% of the variance in social relations QoL (F=7.545, p=.002). Higher resilience and higher socioeconomic status explained 25.7% of the variance in psychological QoL (F=5.524, p=.009). Conclusions: This sample had significant baseline socioeconomic disadvantage and increased psychosocial stress at baseline, and diminished QoL 6 months post-stroke. Future research with larger samples is warranted.

Abstract HUP11: Racism, Resilience, and Quality of Life in Black Stroke Survivors

Introduction: Stroke impairs stroke survivor (SS) quality of life (QoL). Black SS in the US also endure stress from structural, cultural, and interpersonal racism. Resilience is a dynamic process of maintaining stable functioning after an event such as stroke. This observational study aimed to assess the effects of racism and resilience on Black SS QoL. Methods: Participants were community-dwelling SS (age ≥ 18) who identified as African American or Black and experienced a stroke within 8 weeks. Baseline data collection included exposure (discrimination, vigilance, resilience), demographic, clinical, and psychosocial variables. Outcome data for QoL was gathered after 6 months. The effects of exposure variables and covariates on QoL were analyzed with multiple linear regression. Results: Participants (n=74) had a mean age of 56.2, 32% were in marital or partner relationships, and 58% were female. Most participants (84%) had ischemic stroke, with no more than mild disability (mRS 0-2 for 80%). Over half of participants had some college (32%) or a college degree (20%). The remaining 46% had a high school education or less. Work status included 32% currently working, 15% not working, 28% retired, and 24% disabled. Half reported an annual household income of &lt; $25,000, with 63% living at ≤ 200% above the US poverty level. Participants reported moderate (64%) to high (8%) perceived stress, and 14% had moderate to moderately severe anxiety. Resilience was correlated with stress (r=-.59, p&lt;.001) and anxiety (r=-.66, p&lt;.01). At 6-month follow-up (n=44), QoL domains were very low for social relations ( M =36.83, SD=17.76) and environment ( M= 35.04, SD=14.57), and moderately low for physical ( M =46.49, SD=19.22) and psychological ( M =54.39, SD=17.23). Higher vigilance and higher disability explained 23.3% of the variance in social relations QoL (F=7.545, p=.002). Higher resilience and higher socioeconomic status explained 25.7% of the variance in psychological QoL (F=5.524, p=.009). Conclusions: This sample had significant baseline socioeconomic disadvantage and increased psychosocial stress at baseline, and diminished QoL 6 months post-stroke. Future research with larger samples is warranted.

Pre‐stroke chronic cerebrovascular disease is a major determinant for response to structured cognitive rehabilitation following acute ischemic strokes

AbstractBackgroundPost Stroke Cognitive Impairment (PSCI) is seen in 40‐60% of patients with ischemic strokes. Response of patients with PSCI to structured cognitive rehabilitation is not clearly understood. We evaluated baseline variables that predict response to an eight‐week non‐pharmacological intervention among patients with mild strokes and compared the responses to non‐pharmacological intervention among acute stroke patients with and without chronic cerebrovascular disease (CVD).Method139 ischemic stroke survivors were recruited from a tertiary hospital in Singapore. All patients underwent an eight‐week structured group cognitive rehabilitation programme (Figure 1). Baseline, immediate post‐intervention (Immediate‐PI) and 6‐month post intervention (6‐month‐PI) global cognitive and quality of life (QOL) outcomes were assessed by Montreal Cognitive Assessment (MoCA) and Dementia‐Quality of Life (DemQOL). Regression analyses evaluated the influence of cognitive rehabilitation on outcomes.ResultThe mean age of subjects were 63.6 (±9.66) with 64.4% males. Baseline MoCA and DemQOL scores were 23.30 (±3.05) and 79.16 (±14.80). At Immediate‐PI, patients with more past strokes (p = 0.033) and severe white matter hyperintensities (WMH) (p = 0.048), benefited less on global cognitive outcome (Table 1). Male patients (p = 0.074) and patients with more severe WMH (p = 0.048) benefited less on QOL outcome (Table 2). At 6‐month‐PI, patients with microhemorrhages in the deep region (p = 0.002) were less likely to sustain cognitive improvement. With every past stroke experienced, patients were less likely to experience an improvement in MoCA score Immediate‐PI (OR = 2.17, 95% CI: 0.980‐4.813, p = 0.056). with severe WMH were less likely to experience an improvement in MoCA scores Immediate‐PI compared to baseline (OR = 2.13, 95% CI: 1.04‐4.38, p = 0.039). Finally, patients with microhemorrhages in the deep region were less likely to retain the improvements in MoCA at 6‐month‐PI (OR = 19.93, 95% CI: 1.04‐384, p = 0.047)ConclusionPre‐stroke CVD were associated with worse cognitive and QoL outcomes post cognitive rehabilitation. Understanding factors that result in poor response to rehabilitation will allow clinicians to better select stroke survivors for cognitive rehabilitation. Future research could build on these findings and allocate more resources to these at‐risk groups for post‐stroke care, therefore reducing the global burden of stroke and ensuring a better QOL for stroke survivors.

Quality of Life and Lifestyle Factors among Stroke Survivors and People Living With Osteoarthritis in Port Harcourt Metropolis, Rivers State

Background: Quality of life (QoL) and Lifestyle factors (LFs) are key determinants of health. Poor QoL and unhealthy lifestyles are global concerns and have been linked to stroke and osteoarthritis (OA). Aim of the Study: This study determined and compared QoL between stroke survivors and People living with osteoarthritis (PLWOA), and also established association between selected LFs and QoL of the stroke survivors and PLWOA in Port Harcourt Metropolis, Rivers State. Materials and Methods: The study adopted a comparative cross-sectional design. A multistage sampling technique was used to select 78 stroke survivors and 186 People Living with Osteoarthritis (PLWOA) from the two strata making up Port Harcourt Metropolis – Port Harcourt City Local Government Area (PHALGA) and Obio-Akpor Local Government Area (OBALGA). The World Health Organization Quality of Life Bref (WHOQoL-BREF) Scale was used to measure their current QoL while LFs (Smoking, Alcohol consumption, Physical activity, and Balanced Diet) were selected in line with WHO STEPS instrument for non-communicable diseases (NCDs) from June 2019 to January, 2000. Data were analyzed using the IBM SPSS version 24. Chi-square test statistic was used to compare the proportion of stroke survivors with very poor, poor and good QoL and that of PLWOA. Chi-square test of independence was used to determine association between LFs and QoL of the two groups, and where appropriate Fisher’s exact test. P-value ≤ 0.05 was considered statistically significant. Results: Results revealed that the proportion of stroke survivors with very poor, poor and good QoL was 18 (23.16%), 53 (67.9%), and 7 (9.0%) compared to 16 (8.6%), 53 (67.9%), and 7 (9.0%) respectively of those of PLWOA. The difference observed between these proportions was statistically significant (Chi-square = 67.097, p-value &lt;0.0001). For association between LFs and QoL, Smoking (Chi-square = 40.678, Fisher’s p-values &lt;0.0001, &lt;0.0001), Alcohol consumption (Chi-square = 26.541, Fisher’s p-values &lt;0.0001, &lt;0.0001), Physical activity (Chi-square = 13.679, Fisher’s p-values 0.001, 0.022), Balanced diet (Chi-square = 39.691, Fisher’s p-values &lt; 0.0001, 0.002) were all associated for stroke survivors and PLWOA respectively. Conclusion: Majority of stroke survivors and PLWOA had poor QoL. Association exists between LFs and QoL of stroke survivors and PLWOA in the study. There is need for government to collaborate and set up specialized healthcare facilities for stroke survivors and PLWOA in our communities.

Exercise dosage to facilitate the recovery of balance, walking, and quality of life after stroke.

Although aerobic training (AT) and resistance training (RT) are recommended after stroke, the optimal dosage of these interventions and their effectiveness on balance, walking capacity, and quality of life (QoL) remain conflicting. Our study aimed to quantify the effects of different modes, dosages and settings of exercise therapy on balance, walking capacity, and QoL in stroke survivors. PubMed, CINHAL, and Hinari databases were searched for randomised controlled trials (RCTs) evaluating the effects of AT and RT on balance, walking, and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Twenty-eight trials (n = 1571 participants) were included. Aerobic training and RT interventions were ineffective on balance. Aerobic training interventions were the most effective in improving walking capacity (SMD = 0.37 [0.02, 0.71], p = 0.04). For walking, capacity, a higher dosage (duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve) of AT interventions demonstrated a significantly greater effect (SMD = 0.58 [0.12, 1.04], p = 0.01). Combined AT and RT improved QoL (SMD = 0.56 [0.12, 0.98], p = 0.01). Hospital located rehabilitation setting was effective for improving walking capacity (SMD = 0.57 [0.06, 1.09], p = 0.03) compared with home and/or community and laboratory settings. Our findings showed that neither AT nor RT have a significant effect on balance. However, AT executed in hospital-located settings with a higher dose is a more effective strategy to facilitate walking capacity in chronic stroke. In contrast, combined AT and RT is beneficial for improving QoL. A high dosage of aerobic exercise, duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve is beneficial for improving walking capacity.

Associations among disability, depression, anxiety, stress, and quality of life between stroke survivors and their family caregivers: An Actor-Partner Interdependence Model.

To explore the effects of disability, depressive, anxiety and stress symptoms on patients' and their partners' quality of life (QoL) using the actor-partner interdependence model (APIM). A cross-sectional study using actor-partner interdependence model. We recruited 183 dyads of stroke survivors and their family caregivers in Indonesia. The World Health Organization Disability Assessment (WHODAS 2.0), Depression, Anxiety and Stress (DASS-42) and Rand Short Form Health Survey (SF-36) were used to measure disability, depressive, anxiety and stress symptoms and QoL of stroke survivors and family caregivers. The actor-partner interdependence model was tested using multilevel modelling. The actor-partner interdependence mediation model (APIMeM) was applied to estimate the direct and indirect effect. Disability had actor effects on stroke survivor's overall QoL and partner effect on family caregiver's overall QoL. More severe disability of stroke survivors was associated with a lower overall QoL of their own and that of family caregiver's overall QoL. Depressive symptoms of stroke survivors had actor effects on stroke survivors' overall QoL and partner effects on family caregivers' overall QoL. Actor and partner effects also exist on family caregiver's depression symptoms to their own overall QoL and stroke survivor's overall QoL. Moreover, higher anxiety symptoms were associated with lower levels of their own and partner's overall QoL in both stroke survivors and family caregivers. Stroke survivor's stress symptoms also negatively associated with their own and family caregiver's overall QoL. However, a family caregiver's stress without a partner effects on stroke survivor's overall QoL. The APIMeM analysis showed that disability of stroke survivors directly decreased their own overall, physical (PCS) and mental QoL (MCS). Also, disability mediated by stroke survivor's depression, anxiety and stress symptoms decreased both stroke survivor's and family caregiver's physical (PCS) and mental QoL (MCS). The findings suggest that stroke survivors and family caregivers may influence each other during the caregiving process and social life. The disability of stroke survivors, and the depression, anxiety and stress symptoms of stroke survivors and family caregivers affect their own QoL and their partners' QoL. Disability of stroke survivors directly decreased their own overall, physical (PCS) and mental QoL (MCS). Also, it indirectly via stroke survivor's depression, anxiety and stress symptoms decreased both stroke survivor's and family caregiver's physical (PCS) and mental QoL (MCS). Dyadic actor-partner interdependence models have shown promising potential to predict the QoL among patients and family caregivers. The dyadic effects of disability, depression, anxiety and stress symptoms on the QoL of stroke survivors and family caregivers can be applied to guide the future development of nursing intervention addressed decreasing depression, anxiety and stress symptoms to optimize health outcomes among stroke survivors and their family caregivers.

The Impact of Stroke on the Quality of Life (QOL) of Stroke Survivors in the Southeast (SE) Communities of Nigeria: A Qualitative Study

Purpose: This study aims to explore the Quality of Life (QOL) amongst ten stroke survivors in the SE communities of Nigeria. Design: Qualitative study using semi-structured interviews. Interpretative phenomenological analysis (IPA) was utilized. Setting: Medical institutes in the southeast communities of Nigeria. Participants: 10 participants ranging in age from 29 to 72 years old. Stroke is typically a life-changing catastrophe, claiming over 55 million lives and disabling 44 million people each year. According to the research, stroke incidence has decreased by 42% in high-income nations worldwide but has increased by 100% in low-income areas such as Africa. Surviving a stroke can be a long-term process that impacts numerous elements of an individual’s life. Stroke-related QOL is a major health care issue in Nigeria that has received insufficient attention. The primary objective for survivors is to improve their QOL. Thus, it is critical to understand the true impact of stroke on the QOL of stroke survivors from their perspective. Individual, semi-structured, in-depth interviews with 10 stroke survivors were conducted. An IPA approach shaped the interview process and the analysis of the data. Three main themes arose from the data: an ‘unfamiliar self’ which illuminated the altered body (unpredictable body), the ‘recovery of the embodied self’ (the transitional stage of recovery) and the ‘reconstruction of the embodied self, which reflected a continuous process of belonging and becoming. The impact of stroke on survivors’ QOL was twofold: negative and positive. The physical dimension had the largest detrimental impact on the survivors’ QOL, according to the findings. Spirituality, on the other hand, had the most positive impact on survivors’ QOL in Nigeria’s southeast communities.

The effects of racism and resilience on Black stroke- survivor quality of life: Study protocol and rationale for a mixed-methods approach

IntroductionStroke, a life-threatening stressor, often negatively impacts stroke-survivor (SS) quality of life (QoL). Annual age-adjusted incidence and death rates for stroke are significantly higher among Black Americans than among White Americans. Racism, a significant stressor, occurs at structural, cultural, and interpersonal levels and contributes to health disparities for Black SS. Resilience, a dynamic process of positive adaptation to significant stress, is impacted by factors or resources both internal and external to the individual. This study aims to examine the effects of experiences of racism and resilience on Black SS QoL during early stroke recovery. This article presents the study protocol.Methods and analysesThis will be a prospective observational mixed-methods study. Black community-dwelling adults who are within 4 weeks of a stroke will be eligible for inclusion. Baseline measures will include the exposure variables of experiences of racism and resilience. Covariates measured at baseline include sociodemographic variables (age, sex, marital status, education, income, health insurance, employment status, number of people in household, residential address), clinical variables (date and type of stroke, inferred Modified Rankin Scale, anxiety and depression screening), and psychosocial variables (COVID-19 stress, perceived stress, mindfulness). The outcome variable (QoL) will be assessed 6-months post-stroke. Multiple-level linear regression models will be used to test the direct effects of experiences of racism, and the direct and indirect effects of resilience, on QoL. Qualitative data will be collected via focus groups and analyzed for themes of racism, resilience, and QoL.DiscussionRacism can compound the stress exerted by stroke on Black SS. This study will occur during the COVID-19 pandemic and in the aftermath of calls for social justice for Black Americans. Experiences of racism will be measured with instruments for both “everyday” discrimination and vigilance. Sociodemographic variables will be operationalized to assess specific social determinants of health that intersect with structural racism. Because of the long-standing history of racism in the United States of America (USA), cultural influences and access to resources are central to the consideration of individual-level resilience in Black SS. Study results may inform the development of interventions to support Black SS QoL through enhanced resilience.

Indirect effects of social support and hope on quality of life via emotional distress among stroke survivors: A three-wave structural equation model.

ObjectivesStroke survivors are prone to functional impairments and reduced quality of life (QoL). This study examined the mediating role of social support and hope in the relationships between functional impairment, emotional distress, and QoL.MethodsA total of 188 stroke survivors in Hong Kong completed assessments on functional impairment, social support, and hope at baseline, with follow-up measurements of emotional distress at 2 months and QoL at 8 months. Structural equation modeling with bootstrapping was used to analyze the direct and indirect effects of functional impairment on emotional distress and QoL via the mediating factors of social support and hope.ResultsThe partial cascading model provided an adequate fit to the data. Functional impairment had significant negative direct effects on hope and physical QoL and social support had significant positive direct effects on hope and physical QoL. Social support had a significant positive indirect effect on physical QoL via hope and perceived stress and on psychosocial QoL via hope and depression. Functional impairment and hope had a significant negative interaction effect on perceived stress.ConclusionThe findings support a mediating role for hope in the relationship between social support and QoL in stroke survivors. The protective effect of hope on perceived stress was stronger among patients with greater functional impairment.

The type and dosage of exercise therapy to facilitate the recovery from stroke for balance, walking and quality of life: a systematic review and meta-analysis of randomized controlled trials

Abstract Background Exercise therapy (aerobic or resistance therapy) could have a beneficial effect on balance, walking and quality of life (QoL). Objective This systematic review and meta-analysis aimed to quantify the effects of different modes, dosages and setting of exercise therapy on balance, walking capacity and QoL in stroke survivors. Methods We searched PubMed, CINHAL and Hinari to identify randomized controlled trials (RCT) that investigated the effects of aerobic (AT) and/or resistance therapy (RT) on balance, walking and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Results We included 27 RCT comprising 1,549 chronic stroke survivors. Any modality was effective to improve balance. There was high-level evidence that AT interventions were most effective in improving walking capacity (SMD=0.36 [0.06, 0.66], p=0.02). Both AT, and AT combined with RT were effective to improve QoL (SMD=0.39 [0.09, 0.69], p=0.01). RT programs were not effective to improve walking and QoL. For walking capacity, a lower volume weekly (&amp;lt;60 minutes/session or &amp;lt;3 session/week) and higher intensity (&amp;gt;60% heart rate reserve; rate of perceived exertion (6–20) &amp;gt;14) of AT and RT exercises demonstrated significant higher effect. Hospital located rehabilitation settings trended to improve walking (SMD=0.23 [0.00, 0.45], p=0.05), when compared to home/community and laboratory settings. Conclusions In chronic stroke, in particular AT executed in hospital located settings, with a lower volume and high intensity seems more effective strategy to facilitate walking capacity and improve QoL and should thus be incorporated into rehabilitation programs for stroke. Funding Acknowledgement Type of funding sources: None.

Quality of life of stroke survivors: A cross-sectional study of association with functional independence, self-reported fatigue and exercise self-efficacy.

Stroke is a leading cause of disability and one of the most debilitating conditions especially in the developing world. Rehabilitation focuses on improving functional ability which may enhance quality of life (QoL). The aims of this study were to investigate the association between QoL and each of functional independence (FI), self-reported fatigue (SRF) and exercise self-efficacy (ESE) in stroke survivors. This is a descriptive cross-sectional survey, documenting QoL, FI, SRF and ESE of stroke survivors seen at the physiotherapy outpatient clinics of two health care facilities in Oyo state, Nigeria. Descriptive and inferential statistics were used to analyse the data with significance level set at 0.05. Participants were 110 stroke survivors (64 males; 46 females) aged 60.9 ± 11.9 years. Significant associations were found between QoL and each of FI and ESE (p < 0.01) while no significant association was observed for SRF. FI strongly predicts good QoL in stroke survivors (OR = 16.34; p < 0.01) and high ESE is a determinant of QoL (OR = 6.46; p = 0.04). Stroke survivors with SRF were less likely to report good QoL. Functional independence and exercise self-efficacy were directly associated with QoL and were also major predictors of good QoL in stroke survivors.

Abstract P232: Patient and Caregiver Agreement on Stroke Survivor Quality of Life in the Year After Stroke Onset

Background: The burden of post-stroke disability falls on both stroke survivors and their caregivers. To better understand patient and caregiver perspectives on post-stroke quality of life (QoL), we explored their agreement on a QoL testing instrument in the year after an ischemic stroke. Methods: This is a secondary analysis of the IMS-III trial. The primary outcome are scores of the 5 domains of the EQ-5D-3L during the year after stroke onset. We included pairs of EQ-5D-3L scores obtained from both the patient and their proxy to determine the level of agreement and Cohen’s Kappa for the individual domains. Results: There were 1,042 instances of a paired EQ-5D-3L during the first year of follow-up, derived from six study visits described in Table 1. The agreement between patient and proxy was highest for the Mobility and Self-Care domains of the EQ-5D-3L (Table 2), achieving a Kappa of 0.7407 and 0.7567, respectively. The agreement for the Anxiety/Depression domain of the EQ-5D-3L was lowest, with a Kappa of 0.6009 (Table 2). Conclusion: In the year after ischemic stroke, the agreement between patients and their caregivers was highest for the motor domains of QoL and lowest for the mental health domain. Depression and anxiety are known to be under-diagnosed and under-treated after stroke. Further research is warranted to explore the reasons for less agreement between patient and caregiver perception of the stroke survivor’s mental health QoL after ischemic stroke.

Efficacy of transcranial direct current stimulation and over-ground walking task on functional mobility and quality of life of stroke survivors

Introduction: High proportion of stroke survivors have impaired functional mobility and decrease in overall quality of life (QoL). Transcranial direct current stimulation (tDCS) (non-invasive brain stimulation) and over-ground walking task (OGWT) (functional task-oriented training) have been suggested to improve functional mobility and QoL of stroke survivors. Hence, this study determined the efficacy of tDCS (anodal and cathodal) with OGWT on functional mobility and QoL of stroke survivors. Materials and methods: Seventy eight (78) stroke survivors were randomised into three groups: anodal group (anodal tDCS with OGWT); cathodal group (cathodal tDCS with OGWT) and control group (OGWT only). Participants had two sessions of intervention per week for six weeks. Functional mobility was assessed using 10 meter walk test (10MWT) measuring steps, time and velocity while QoL was measured using Stroke Specific QoL (SSQoL) scale. Significance level was set at p &lt; 0.05. Results: Participants (46 males) were aged 56.78 ± 10.24 years. The groups were matched for functional mobility and QoL at baseline and only work/productivity domain of SSQoL showed statistically significant difference (p = 0.028). Each group showed statistically significant improvement between baseline and post-intervention scores of items in functional mobility (p ≤ 0.001) and total SSQoL (p ≤ 0.001). Anodal group showed better statistically significant improvement in step (p = 0.008), time (p = 0.024), velocity (p = 0.001) and total SSQoL (p = 0.016) among the groups when the mean differences were compared. Conclusion: tDCS with OGWT is efficacious in improving functional mobility and QoL of stroke survivors. Specifically anodal tDCS with OGWT showed better clinical improvement in step, time, velocity and QoL in stroke survivors.

Measuring Quality of Life in Stroke Survivors

Introduction: The number of patients living with the consequences of stroke is increasing worldwide due to the improving stroke care and the modern differentiated treatment options for ischemic stroke – thrombolysis and thrombectomy. Hence, a significant interest has arisen in quality of life (QOL) measurement in post-stroke patients. Objectives. Measuring QOL in stroke survivors can be achieved by using various generic and stroke specific questionnaires. All tools should assess different domains of health such as physical acting, communication, daily activities and others. This article describes the most commonly used scales for measuring post-stroke QOL. Methods. We searched the PubMed electronic databases with the keywords — Quality of life, Stroke, Measuring for the period from January 2000 to May 2020. Results. Various generic and specific scales for quality of life measuring are available. The advantages of the specific scales include high accuracy and detailed information for the assessed domains. The limitations are due to numerous items, long evaluation time and high dependency on patient’s compliance. The generic scales give the ability to compare the QOL in patients with different diseases. The disadvantage is lack of detailed information for the health status in certain disease or condition. Conclusion. Measuring the different aspects of QOL in post-stroke patients is powerful tool in order to focus the further efforts to the most affected domains. A combination between generic and stroke-specific measure might be considered in order to overcome the limitations. The choice of measuring scales must be balanced in the terms of lengthy and repetitive surveys.

Post-stroke Quality of Life Index: A quality of life tool for stroke survivors from Sri Lanka

BackgroundBurden of stroke is rising due to the demographic and epidemiological transitions in Sri Lanka. Assessment of success of stroke-management requires tools to assess the quality of life (QOL) of stroke survivors. Most of currently used QOL tools are developed in high-income countries and may not reflect characteristics relevant to resource-constrained countries. The aim was to develop and validate a new QOL tool for stroke survivors in Sri Lanka.MethodsThe COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist was referred. A conceptual framework was prepared. Item generation was done reviewing the existing QOL tools, inputs from experts and from stroke survivors. Non-statistical item reduction was done for the 36 generated items with modified-Delphi technique. Retained 21 items were included in the draft tool. A cross sectional study was done with 180 stroke survivors. Exploratory Factor Analysis was done and identified factors were subjected to varimax rotation. Further construct validity was tested with 6 a-priori hypothesis using already validated tools (SF-36, EQ-5D-3 L) and a formed construct. Internal consistency reliability was assessed with Cronbach alpha.ResultsFour factors identified with principal-component-analysis explained 72.02% of the total variance. All 21 items loaded with a level > 0.4. The developed tool was named as the Post-stroke QOL Index (PQOLI). Four domains were named as “physical and social function”, “environment”, “financial-independence” and “pain and emotional-wellbeing”. Four domain scores of PQOLI correlated as expected with the SF-36, EQ-5D Index and EQ-5D-VAS scores. Higher domain scores were obtained for ambulatory-group than the hospitalized-group. Higher scores for financial-independence domain were obtained for the group without financial-instability. Five a-priori hypothesis were completely proven to be true. Cronbach-alpha level ranged from 0.682 to 0.906 for the four domains.ConclusionsThere is first evidence for sufficient construct validity of the PQOLI as a valid QOL tool for measuring the QOL of stroke survivors with satisfactory internal consistency reliability.

Community Integration and Quality of Life: Stroke Survivors as Recipients of Rehabilitation by Village Health Volunteers (VHVs) in Thailand

This study investigated the effectiveness of rehabilitation services provided by trained Village Health Volunteers (VHVs) on community integration and quality of life (QOL) for stroke patients in Thailand. Community integration and QOL were measured before receiving rehabilitation and at three months post-intervention. Twenty-five stroke subjects from four rehabilitation centers were recruited by purposive sampling. The statistics used were descriptive and paired t-test. The community integration scores increased significantly (p < .05) from pre-test (mean = 9.80 ± 3.96) to post-test (mean = 11.44 ± 4.68). The QOL scores also significantly (p < .05) increased from pre-test (mean = 71.44 ± 8.38) to post-test (mean = 84.88 ± 12.07). Results demonstrate that rehabilitation services provided by trained VHVs can promote community integration and QOL for stroke survivors.