Stroke Specific Quality Of Life Research Articles

Gait Function and its Association with Functional Independence, Quality of Life, and Community Reintegration in Stroke Survivors.

Background and Aims: The major outcome of stroke rehabilitation is the recovery of the ability to walk. However, a large proportion of stroke survivors are discharged to the community with gait deficiency which impairs their functional independence, and quality of life increasing the burden of care on caregivers especially their lack of functioning in the community. This study assessed the gait functional performance in community-dwelling stroke survivors and explored its association with functional independence, quality of life, and community reintegration in community-dwelling stroke survivors. Materials and methods: This study involved 115(59 males and 56 females) community-dwelling stroke survivors. Their gait functional performance was assessed using the 10-meter walk test (10MWT) while their functional independence was assessed with the functional independence measure (FIM). Their quality of life (QoL) was assessed using the Stroke-specific QoL scale while community functioning and productivity were assessed using the community integration questionnaire (CIQ). Their scores on the assessments were compared with the normative data of their age and sex-matched healthy individuals. Data was analysed using Spearman’s correlation coefficient and Chi-Square at p<.05. Results: Participants’ ages ranged between 27 to 78 years (mean=60.48±37.84 years). More participants (56.7%) had right hemispheric lesions and 43.3% had lesions in the left hemisphere. Their gait function, functional independence performance, QoL, and community reintegration functions were significantly (p<0.05) lower than their age and sex-matched normative data. There was a significant (p<0.05) association and relationship between their gait functional performance and each of the functional independence performance, QoL, community reintegration, and productivity. Conclusion: Gait functional performance in community-dwelling stroke survivors is significantly lower than in age and sex-matched healthy individuals and it is significantly associated with low functional independence performance, low quality of life, poor community functioning, and lack of productivity in stroke survivors, Abnormal gait pattern is related to poor functional independence, poor quality of life and low productivity.

Health-Related Quality of Life Among Patients With Stroke: A Cross-Sectional Study.

To assess levels and predictive factors of health-related quality of life (HRQOL) among stroke patients. The study employed a cross-sectional predictive correlational design. Levels of HRQOL were assessed using the Stroke-Specific Quality of Life (SS-QOL) scale, and the Hospital Anxiety and Depression Scale was employed to assess psychological aspects among 209 Saudi stroke patients. The analysis included demographic and medical variables to comprehensively explore influencing factors. A two-step hierarchical multiple regression analysis was performed. The overall SS-QOL summary score (49 items) showed a mean score of 94.4 (SD = 8.1), indicating poor functioning. Nine predictor variables were found to significantly predict HRQOL levels, including age (β = -0.212, p ≤ .001), female (β = -5.33, p ≤ .001), unmarried (β = 2.48, p ≤ .001), low gross monthly income (GMI) (β = -9.02, p ≤ .001), medium GMI (β = -8.36, p ≤ .001), having a medical history of hypertension (β = 2.7, p ≤ .01), time since stroke (β = 3.26 p ≤ .001), and being a probable case of anxiety (β = -4.29, p ≤ .001) and/or depression (β = -2.75, p ≤ .001). These variables collectively explained ~76% of the variance in HRQOL scores (adjusted R2 = .762, F (16,192) = 42.6, p ≤ .001). Stroke patients exhibited poor HRQOL levels influenced by various factors. Clinicians should consider these predictors and intervene early to enhance HRQOL among patients at risk, emphasizing the importance of optimizing patient outcomes.

Effects of Circuit Class Training Versus Individual, Task Specific Training on Upper Extremity Function in Chronic Stroke Patients

Background: Stroke is a leading contributor to disability globally, emphasizing the need for effective rehabilitation techniques. Circuit class training (CCT) and individual, task-specific training (ITST) have emerged as potential approaches for enhancing upper extremity function in stroke survivors. Comparative analyses of their efficacy, especially among chronic stroke patients, are scant. Objective: This study aimed to evaluate and compare the impacts of CCT and ITST on upper extremity spasticity, motor function, and quality of life in individuals with chronic stroke. Methods: In a randomized controlled trial, 36 chronic stroke patients were allocated to either CCT or ITST groups. Participants were aged 45-70 years, had experienced a single stroke episode, and were at least 6 months post-stroke, with specific inclusion criteria regarding spasticity and motor function levels. The interventions were delivered for 1.5 hours daily, five days a week, over eight weeks. Outcomes were measured using the Modified Ashworth Scale (MAS) for spasticity, Functional Independence Measure for Upper Extremity (FMA-UE) for motor function, and Stroke-Specific Quality of Life (SS-QOL) scale for quality of life, analyzed using SPSS version 25. Results: Post-intervention, both CCT and ITST participants exhibited significant improvements in their outcomes. MAS scores showed a reduction in spasticity, with average improvements not significantly differing between the groups. FMA-UE scores increased by an average of 10 points in both groups, indicating enhanced motor function without a significant difference between the groups (p > 0.05). SS-QOL scores improved by an average of 20 points in each group, reflecting better quality of life, with no significant intergroup difference observed. Conclusion: The study concludes that CCT and ITST are equally effective in ameliorating upper extremity spasticity, motor function, and quality of life among chronic stroke patients. The selection between CCT and ITST can thus be personalized based on patient preferences, available resources, and logistical considerations, maintaining rehabilitation efficacy.

Abstract 79: Twelve-Year Trends in Ninety-Day Stroke Outcomes and Ethnic Differences From a Population-Based Study

Background: Stroke outcomes may be changing over time with improved acute stroke therapy, secondary prevention, and post-acute care. At the same time, stroke mortality has declined suggesting more people are living with stroke disability. No US population-based data exists on trends in outcomes. The objective was to investigate trends and ethnic differences in 90-day stroke outcomes in a population-based study. Methods: First-ever ischemic strokes in the population-based Brain Attack Surveillance in Corpus Christi Project (2009-2020, n=1,449) were included. 90-day outcomes included function (activities of daily living (ADL)/instrumental ADL), cognition (modified mini-mental state exam), NIHSS, and quality of life (Stroke-Specific Quality of Life (SS-QoL)). Linear regression with multiple imputation and inverse probability weighting was used to model adjusted associations between time, ethnicity, the interaction of time and ethnicity and outcomes. Results: Median age was 66; 61% Mexican American (MA). Trends in 90-day function overtime were roughly quadratic (Figure) and the change in the ethnic difference was significant among reference groups (p-value&lt0.01). Trends in NIHSS were linear with no change in the ethnic difference (p-value=0.51). Trends in cognition were approximately cubic and the change in the ethnic difference was significant within reference groups (p-value=0.03). Trends in QOL were stable with no change in the ethnic difference. Conclusion: Recent improvements in 90-day post-stroke functional and cognitive outcomes in MAs have resulted in reduced disparities. Factors contributing to favorable trends in outcomes in this group should be further studied.

Comparing the Effectiveness of Mindfulness-based Stress Reduction Training and Powell’s Cognitive Rehabilitation on Improving the Quality of Life of Stroke Patients

Background: Stroke is a type of neurological disorder that can be attributed to a central vascular cause. Stroke can affect the patient’s performance in daily activities and quality of life (QoL). Research indicates a decrease in the quality of life in stroke patients due to cognitive and emotional damage. Objectives: The present study compared the effect of two group approaches, mindfulness training based on stress reduction and Powell’s cognitive rehabilitation, on improving the quality of life of stroke patients. Methods: This semi-experimental study used a pretest-posttest design with a control group and a follow-up period. The sample consisted of 36 eligible stroke patients selected in a targeted and simple random manner. The patients were divided into two intervention groups and one control group. The tools used were a demographic information questionnaire and a Stroke-specific QoL (SS-QOL) scale. Data were analyzed with SPSS software (version. 26). Chi-square, repeated measures analysis of variance, and Bonferroni statistical tests were applied at a significance level of P 0.05). The mindfulness intervention had a higher effect on quality of life on average. Still, statistically, none of the interventions were effective in improving quality of life (P > 0.05), and there was no significant difference between the effect of mindfulness-based methods and cognitive rehabilitation on improving quality of life (P > 0.05). Conclusions: Mindfulness training increases behavioral responses related to attention as the basis of all cognitive activities. Also, mindfulness exercises improve cognitive skills and, by affecting the cognitive system, increase the capacity and ability of the information processing system and improve the quality of life.

Factors predicting stroke specific quality of life in post stroke aphasia

Background: Understanding the factors that predict stroke-specific QoL in post-stroke aphasia patients in Pakistan is crucial for developing targeted interventions and improving the rehabilitation process. Objective: To determine the factors predicting the stroke-specific quality of life in post-stroke aphasia. Methodology: This cross-sectional analytical study was conducted over 18 months from June 2021 to December 2022 at RHS Rehabilitation Centre Islamabad Pakistan. A total of n=134 independent participants with fluent and non-fluent aphasia at least six months post-stroke, and able to follow one-step commands were included in the study through a non-probability convenient sampling technique. The stroke-specific quality of life (SS-QoL) scale was used to assess the quality of life in the participants, while the list of predictors was developed from the literature. SPSS version 21 was used for statistical analysis. Result: A multiple regression was run to predict the quality of life from marital status, gender, family status, patient's socioeconomic status, types of strokes, types of aphasia, and comorbidities. These variables statistically significantly predicted quality of life {F(13,120)=10.366, p<0.001}. All variables cause 47.8% (Adj. R2=0.478) variance in stroke-specific quality of life in aphasia patients. Conclusion: The male gender, married marital status, middle and upper socioeconomic status, ischemic stroke compared to hemorrhagic stroke, fluent aphasia, and cardiac disease compared to other comorbidities positively affect the quality of life in post-stroke aphasia patients. However, age and the family system did not show any impact on the quality of life. Keywords: aphasia; diabetes; quality of life; stroke

Effects of baclofen administered to reduce muscle spasm on balance maintenance, gait ability and quality of life in stroke patients

This study aimed to investigate the impact of Baclofen on balance, gait, functional independence, and quality of life in ischemic stroke patients. Thirty patients diagnosed with ischemic stroke by a rehabilitation medicine specialist were randomly assigned to either an experimental group that underwent exercise therapy in conjunction with Baclofen or a control group that received conventional exercise therapy without Baclofen. In this study, Berg Balance Scale, Timed Up and Go, and 10-Meter Walk Test were used to evaluate balance and walking ability. Functional Independence Measure was employed to assess functional independence, and Stroke-Specific Quality of Life was used to evaluate the quality of life. The experimental results revealed statistically significant improvements in all evaluation measures for both groups when comparing post-test to pre-test. However, in comparisons between groups, all test items in the experimental group that combined Baclofen with exercise therapy were significantly higher than those in the control group. In conclusion, these results suggest that integrating Baclofen into exercise therapy rehabilitation programs could be a promising approach to enhance recovery outcomes for patients recovering from ischemic stroke.

Cultural adaptation and validation of the Arabic version of the short 12-item stroke-specific quality of life scale.

Given the excessive length and inconsistent validity of the existing long stroke-specific quality of life (SS-QOL) scales, there is a need to validate a shorter measuring tool. The aim of this study was to validate the Arabic version of the short 12-item SS-QOL (SS-QOL-12-AR) and examine its validity measures and psychometric properties. Additionally, the study aimed to assess the QOL after stroke and identify the sociodemographic and clinical factors that influence it in Lebanon. A cross-sectional study was conducted. The SS-QOL-12-AR structure was validated, and its reliability and internal consistency were assessed. The scale's specificity and sensitivity were evaluated and then compared with those of other SS-QOL scales. The correlation between each item and the overall scale were examined, and its convergent validity was evaluated. A total of 172 stroke survivors were included. The SS-QOL-12-AR structure was validated with a solution of two factors, with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.850 and a significant Bartlett's test of sphericity (p < 0.001). The Cronbach's alpha of the scale was 0.917. According to ROC curve analysis, the optimal cut-off point for distinguishing between lower and better QOL was 32.50. At this cut-off, the sensitivity and specificity were 70.0% and 71.2%, respectively. The area under the curve was 0.779 (95% CI 0.704-0.855, p < 0.001). The SS-QOL-12-AR demonstrated a strong and highly significant correlation with existing versions of the SS-QOL, confirming its convergent validity. 61.6% of stroke survivors had a lower QOL, which was significantly associated with poor stroke prognosis, increased physical dependence, current smoking, and alcohol abstinence. The SS-QOL-12-AR exhibits strong validity and reliability, demonstrating excellent psychometric properties. The scale holds potential for application in clinical practice and research settings, enabling the measurement of stroke-related consequences and evaluation of management outcomes.

The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye.

The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL. This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI). The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores. Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.

Measurement Properties of the Stroke-Predischarge Occupational Therapy Assessment.

There is no comprehensive predischarge occupational therapy assessment tool in South Korea. The objective of this study was to determine Stroke-Predischarge Occupational Therapy Assessment (S-POTA) validity and reliability. Twenty-seven occupational therapists (OTs) assessed 97 patients with stroke. Concurrent validity was evaluated by comparing S-POTA scores with stroke-specific quality of life (SS-QOL). Discriminant validity was evaluated by comparing S-POTA scores between outpatient and readmitted groups, and a receiver operating characteristic analysis was conducted. The test-retest was conducted twice in 20 patients, and the inter-rater test was conducted with two OTs per patient. S-POTA positively correlated with SS-QOL. S-POTA rating differs significantly across outpatients and readmitted groups. All S-POTA areas under curve values ranged from .70 to .85, and cut-off points were derived. Cronbach's α for internal consistency was .953, the intraclass correlation coefficient for test-retest was .990, and .987 for inter-rater reliability. The results suggest S-POTA is a reliable tool for efficient implementation of discharge planning.

Impact of Botulinum Toxin Along with Task-Specific Training in Post-Stroke Quality of Life in Focal Hand Dystonia

Objective: To investigate the impact of BOTOX, along with task-specific training, on focal hand dystonia in post-stroke patients and to determine the correlation between quality of life and motor outcomes in upper extremity dystonic patients. Methodology: A quasi-experimental involving 20 patients, study was conducted at Holy Family Hospital (HFH), Chambeli Institute of Rehabilitation in Rawalpindi, and Neurocounsel Clinic in Islamabad. A convenient sampling technique was utilized to select participants for inclusion in the study. Assessments were conducted at four time points: baseline (0 weeks), 4 weeks, 8 weeks, and 12 weeks. The assessment tools used were the Abductor Digiti Minimi Abduction (ADDA) test, Modified Ashworth Scale (MAS), and Stroke-Specific Quality of Life (SS-QoL) questionnaire. Repeated measures ANOVA was employed to analyze mean differences in data across various weeks. The associations between scales were evaluated using Spearman's rho and Pearson correlation coefficients, based on different variables. Results: The mean age was 42.7 ± 10.45 years. The study included 14 males and 6 females. Repeated measures ANOVA indicated a significant difference between MAS scores for upper extremity and quality of life in post-stroke dystonic patients, with a p-value of 0.001**. A strong positive correlation coefficient was found between MAS and SS-QoL through Spearman's correlation analysis, with a p-value of less than 0.05. Conclusion: The administration of Type a Botulinum toxin, coupled with task-specific training, not only exhibited improvements in upper limb motor outcomes but also in the quality of life of focal hand dystonic patients after a stroke.

Prevalence and determinants of post-stroke sleep disorders: a cross-sectional hospital-based study.

Post-stroke sleep disorders (PSSD) are an important part of post-stroke disability. PSSD is neglected as a part of stroke rehabilitation. We aimed to study the prevalence and determinants of PSSD in a hospital based, single center setting. In a cross-sectional study, adult patients (≥ 18years) with stroke (one month to one year after the onset), were enrolled in the study. Demographic, clinical, radiological, and motor and functional disabilities were assessed. Sleep quality was assessed with Pittsburg Sleep Quality Index (PSQI) and STOP BANG questionnaire (for obstructive sleep apnea [OSA]). Patients with poor sleep quality (PSQI > 5) were analyzed for risk factors. A total of 103 patients were recruited in the study period (January 2021 to June 2022). The self-reported prevalence of PSSD was 16% which increased to 72% when thePSQI was administered. High risk of OSA was present in 33%. In bivariate analysis, factors associated with PSQI > 5 were involvement of ≥ 2 lobes, lower body mass index (BMI), worse modified Rankin Scale (mRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Stroke Specific Quality of Life (SSQoL). In multivariate analysis, only depression was associated with PSQI > 5 (OR: 1.3 (1.0; 1.7); p-value = 0.03). PSSD had a prevalence of 72%. In multivariate analysis, the factor associated with PSQI > 5 was worse HAM-D score.

Translation and adaptation of the stroke-specific quality of life scale into Swahili.

Stroke care requires a patient-centred, evidence-based and culturally appropriate approach for better patient clinical outcomes. Quality of life necessitates precise measuring using health-related quality measures that are self-reported and language appropriate. However, most of the self-reported measures were devised in Europe and therefore not considered contextually appropriate in other settings, more so in Africa. Our study aimed to produce a Swahili version by translating and adapting the stroke-specific quality of life (SSQOL) scale among people with stroke in Kenya. We used a questionnaire translation and cross-cultural adaptation. The pre-validation sample of 36 adult participants was drawn from 40 registered people with stroke, from the Stroke Association of Kenya (SAoK). Quantitative data were collected using both English and Swahili versions of the SSQOL scale. The mean, standard deviation (s.d.) and overall scores were calculated and are presented in tables. The back translation revealed a few inconsistencies. Minor semantic and equivalence alterations were done in the vision, mood, self-care, upper extremity function and mobility domains by the expert review committee. Respondents indicated that all questions were well-understood and captured. The stroke onset mean age was 53.69 years and the standard deviation was 14.05. The translated version of the Swahili SSQOL questionnaire is comprehensible and well-adapted to the Swahili-speaking population. The SSQOL has the potential to be a useful outcome measure for use in Swahili-speaking patients with stroke.

Individuals with stroke three months after hospital discharge reported worse quality of life during the COVID-19 pandemic

PurposeTo compare quality of life (QOL) of individuals with stroke three months after hospital discharge, using generic and specific QOL measures, before and during the COVID-19 pandemic. MethodsIndividuals, who were admitted to a public hospital, were recruited and evaluated before (G1) and during (G2) the COVID-19 pandemic. The groups were matched for age, sex, socio-economic status, and levels of stroke severity (National Institutes of Health Stroke Scale) and functional dependence (Modified Barthel Index). After three months of hospital discharge, they were evaluated and compared using generic (Short-form Health Survey 36: SF-36) and specific (Stroke Specific Quality of Life: SSQOL) QOL measures. ResultsSeventy individuals were included (35 in each group). Statistically significant between-group differences were found for both total SF-36 (p=0.008) and SSQOL (p=0.001) scores, indicating that individuals reported worse QOL during the COVID-19 pandemic. Furthermore, G2 also reported worse generic QOL related to the SF-36 domains of physical functioning, bodily pain, general health perception, and emotional role limitations (p < 0.01) and worse specific QOL related to following SSQOL domains: Family roles, mobility, mood, personality, and social roles (p < 0.05). Finally, G2 reported better QOL related to energy and thinking (p < 0.05) SSQOL domains. ConclusionIn general, individuals with stroke, who were evaluated during the COVID-19 pandemic three months after hospital discharge, reported worse perceptions of QOL in several domains of both generic and specific QOL measures.

Abstract 81: Quality Of Life Trajectory In Stroke Survivors And Their Effect On Caregivers, One Year After Discharged From Rehabilitation Hospitals: A Longitudinal Study

Introduction: A stroke survivor’s Quality of life (QOL) could be associated with the caregiver’s anxiety, depression and burden. The identification of specific trajectories in stroke survivors and their associations with caregivers’ outcomes, would be helpful for developing more tailored interventions for survivors and caregivers within the first year after the stroke onset. The aims of this study were to: identify the distinct trajectories of the stroke specific QOLs of stroke survivors discharged from rehabilitation hospitals; examine the associations between the stroke survivors’ QOL trajectories and the caregivers’ anxiety, depression and burden over time; and identify the predictors of the survivors’ QOL trajectories. Methods: This is a longitudinal, multicentre prospective study. Were recruited 415 stroke survivors and their caregivers, after the patients’ discharge from one of 20 rehabilitation hospitals located in central and southern Italy and were followed up every 3 months for 1 year. Results: Stroke survivors had similar trajectories in the physical dimensions of QOL, unlike psychological dimensions, where emerge two distinct trajectories of change in the QOL stroke survivor. The first trajectory (86%) included those who started with greater levels of QOL and improved slightly to markedly in all psychological domains, with this improvement decelerating over time. The second trajectory (14%) comprised those who started with lower overall levels of psychological QOL and experienced a linear worsening in Memory and Communication and no changes in Emotion and Participation. The impact of the distinct stroke survivors’ QOL trajectories on caregiver variables, such as burden, anxiety, and depression were examined. Caregivers experienced linear decreases in anxiety ( p &lt; .001)during the first year post-stroke, while burden ( p = .086)and depression ( p = .057)did not significantly change over time. Conclusion: Preventing the risk factors of a stroke survivor from causing a deterioration in QOL is a fundamental role in public health. Adopting precautionary strategies, for those who present certain risk factors for survivors’ discharged from rehabilitation hospitals, could lead to an improvement in the burden and depression of the caregiver.

Reliability and validity of Stroke specific quality of life Urdu version - A preliminary approach

Aim: To measure reliability, validity, and psychometric properties of Urdu version of Stroke-Specific Quality of Life scale. Methodology: A longitudinal cross-sectional observational survey was conducted from March 2019 to February 2020. The sample size was calculated by using Rao soft and non-probability convenient sampling technique was used to raise the sample. For translation purpose, the original English version of SSQOL was translated into Urdu by National Language Promotion Department, Govt. of Pakistan.96 stroke survivors filled the final SSQOL Urdu version twice within seven-day period. Data was analyzed by using Spearman and Pearson correlation, Cronbach’s alpha, Intra-class Correlation Coefficient (ICC) at their threshold values, independent t-test, and One-way ANOVA at p &lt; 0.05. Results: The SSQOL-U exhibited acceptable to excellent internal consistency with Cronbach’s alpha= 0.943 with ICC= 0.84-0.93. In comparison ceilings effects were higher than floor effects. Results also established high test-retest reliability in all domains had Spearman’s rho scores &gt;0.8 except for Energy, family, and Mood. An acceptable item to scale correlation convergent validity with rp values ranged between 0.81–0.97. Practical Implication: The SSQOL-U will be utilized by practitioners and researchers across the country to accurately measure patient reported quality of life in post stroke patients. Conclusion: SS-QOL-U showed adequate psychometric properties. SS-QOL-U was found reliable and valid tool to measure the quality of life in Urdu-speaking patients having subacute and chronic stroke. Key words: Stroke, validity, reliability, Stroke specific quality of life

Cross-cultural translation, adaptation, and validation of the stroke-specific quality of life (SSQOL) scale 2.0 into Amharic language

BackgroundThe stroke-specific quality of life 2.0 (SSQOL 2.0) scale is a valid, reliable instrument which has been widely used as a patients reported outcome measure among stroke survivors. However, the SSQOL scale has not been validated and used in any Ethiopian language. This study aimed to translate, culturally adapt, and test the psychometric properties of the SSQOL scale 2.0 in Amharic, which is the official and working language with about 34 million (23%) speakers in Ethiopia.MethodsThe adapted English version of the SSQOL 2.0 scale was translated into Amharic and then back-translated to English. An expert committee translated and created a final Amharic version of SSQOL (SSQOL-AM) scale. Pre-field testing (pilot and cognitive debriefing) was conducted with 15 post-stroke subjects. The SSQOL-Am was administered to 245 stroke survivors from four referral hospitals to determine the psychometric properties. Cronbach’s alpha and Intra-class correlation coefficient were used to calculate the internal consistency and test–retest reliability, spearman’s correlation for the convergent validity of the SSQOL-Am scale. The Standard Error of Measurement (SEM), Minimum Detectable Change (MDC), Bland Altman Limit of Agreement (LOA), Confirmatory Factor Analysis, and Exploratory Factor Analysis were also determined.ResultsThe SSQOL-Am demonstrated excellent test–retest reliability (ICC = 0.93), internal consistency (Cronbach’s alpha = 0.96), SEM 0.857, MDC 1.94, and good LOA. As postulated, the mobility domain of the tool demonstrated a significantly strong correlation with the physical function domain of the SF-36 (rho = 0.70, p < 0.001).ConclusionsThe SSQOL-Am is a valid and reliable outcome measure. The tool can be used in both clinical practice and research purposes with Amharic speaking post-stroke survivors.

Construction and Validation of the 17-Item Stroke-Specific Quality of Life Scale (SS-QOL-17): A Comprehensive Short Scale to Assess the Functional, Psychosocial, and Therapeutic Factors of QOL among Stroke Survivors.

(1) Background: The exiting stroke-specific quality of life (SS-QOL) measure scales are limited by their excessive length, inconsistent validity, and restricted breadths of assessment. The objectives of this study were to construct and validate a comprehensive short SS-QOL scale to assess stroke-related outcomes and QOL and determine the socioeconomic, sociodemographic, and pharmacotherapeutic predictors of QOL among stroke survivors. (2) Methods: The novel 17-item SS-QOL scale (SS-QOL-17) was constructed with the aim of providing a well-balanced measuring tool to depict QOL widely while ensuring the simplicity of administration. (3) Results: The SS-QOL-17 structure was validated over a solution of three factors with a Kaiser-Meyer-Olkin measure of sampling adequacy = 0.894 and a significant Bartlett's test of sphericity (p &lt; 0.001). The Cronbach's alpha of the SS-QOL-17 was 0.903. Better QOL was correlated to financial wellbeing (beta 0.093, p &lt; 0.001), and medication adherence (beta 0.305, p = 0.004), whereas reduced QOL was correlated to older age (beta -0.117, p = 0.014), illiteracy (beta -6.428, p &lt; 0.001), unemployment (beta -6.170, p &lt; 0.001), and higher amount of prescribed medication (beta -1.148, p &lt; 0.001). (4) Conclusions: The SS-QOL-17 is a valid and reliable tool with promising psychometric properties. It is useful in clinical practice and research settings to evaluate the post-stroke therapeutic and rehabilitation outcomes.

Tongdu Xingshen acupuncture and moxibustion combined with cognitive training in treatment of post-stroke mild cognitive impairment: a randomized controlled trial

To compare the clinical effect of Tongdu Xingshen (promoting the governor vessel and regaining consciousness) acupuncture and moxibustion combined with cognitive training and the simple cognitive training for post-stroke mild cognitive impairment (PSMCI). Eighty-four patients with PSMCI were randomly divided into an observation group and a control group, with 42 cases in each group (3 cases in the observation group and 2 cases in the control group dropped off). The observation group was treated by Tongdu Xingshen acupuncture and moxibustion combined with cognitive training, acupuncture was given at Baihui (GV 20), Sishencong (EX-HN 1), Shenting (GV 24), etc., and moxibustion was given at Shenting (GV 24) , Baihui (GV 20), Shendao (GV 11), Fengfu (GV 16) and Xinshu (BL 15). The control group was only given cognitive training. All the above treatment was given once a day, 5 times a week, for 4 consecutive weeks. The scores of Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), activity of daily living (ADL) and stroke-specific quality of life (SS-QOL) were compared between the two groups before treatment, after treatment, 4 weeks and 12 weeks after treatment. After treatment, 4 weeks and 12 weeks after treatment, the MoCA, MMSE and SS-QOL scores of the two groups were all higher than those before treatment (P<0.05), and the ADL scores were lower than those before treatment (P<0.05). In the observation group, the MoCA and MMSE scores were higher than those of the control group after treatment, 4 weeks and 12 weeks after treatment (P<0.05), and the SS-QOL score was higher than that of the control group 12 weeks after treatment (P<0.05). Both Tongdu Xingshen acupuncture and moxibustion combined with cognitive training and simple cognitive training can improve cognitive function, daily living ability and quality of life in patients with PSMCI, and the combined therapy is superior to simple cognitive training in improving cognitive function and long-term quality of life in patients with PSMCI.

Effect of Power Training on Quality of Life in Chronic Stroke Survivors

Background: Power training is a concept where power can be best improved with the help of resistance exercise, that is, equivalent to 60% of 1RM. Along with this resistance, the exercise is to be done with maximum speed, that is, as fast as possible, which is equivalent to 33–60% of the maximum movement velocity without resistance. Power training is used for lower motor neuron lesion; but to work more on weakness for chronic stroke individuals and to improve their quality of life (QOL), power training is used for chronic stroke, that is, upper motor neuron lesion. Objectives: The objective was to assess the effect of power training along with conventional treatment protocol on QOL in chronic stroke survivors. Materials and Methods: A comparative study was carried out using convenient sampling technique during 3 months in Krishna Hospital. A total of 40 patients were subjected Group A (20 subjects) who received conventional treatment protocol and Group B (20 subjects) who underwent power training along with conventional treatment protocol. Protocol was conducted for 3 days per week (alternate days) for 6 weeks. Pre- and post-test results were assessed using Stroke-Specific QOL Scale and Modified Barthel’s Index as outcome measures. Results: Significant, very significant, and extremely significant correlations were observed for combination of power training and conventional treatment protocol when compared to conventional treatment alone. Conclusion: This study concluded that the combination of conventional treatment protocol and power training for chronic stroke survivors improved their QOL.