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Youkee D, Deen GF, Sackley C, Lisk DR, Marshall I, Soley-Bori M. Quality of life and quality-adjusted life years after stroke in Sierra Leone. Int J Stroke 2024:17474930241249589. [PMID: 38651761 DOI: 10.1177/17474930241249589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Stroke is a leading cause of mortality and negatively affects health-related quality of life (HRQoL). HRQoL after stroke is understudied in Africa and there are no reports of quality-adjusted life years after stroke (QALYs) in African countries. We determined the impact of stroke on HRQoL after stroke in Sierra Leone. We calculated QALYs at 1 year post-stroke and determined sociodemographic and clinical variables associated with HRQoL and QALYs in this population. METHODS A prospective stroke register was established at the two-principal adult tertiary government hospitals in Freetown, Sierra Leone. Participants were followed up at 7, 90 days, and 1 year post-stroke to capture all-cause mortality and EQ-5D-3L data. QALYs were calculated at the patient level using EQ-5D-3L utility values and survival data from the register, following the area under the curve method. Utilities were based on the UK and Zimbabwe (as a sensitivity analysis) EQ-5D value sets, as there is no Sierra Leonean or West African value set. Explanatory models were developed based on previous literature to assess variables associated with HRQoL and QALYs at 1 year after stroke. To address missing values, Multiple Imputation by Chained Equations (MICE), with linear and logistic regression models for continuous and binary variables, respectively, were used. RESULTS EQ-5D-3L data were available for 373/460 (81.1%), 360/367 (98.1%), and 299/308 (97.1%) participants at 7, 90 days, and 1 year after stroke. For stroke survivors, median EQ-5D-3L utility increased from 0.20 (95% CI: -0.16 to 0.59) at 7 days post-stroke to 0.76 (0.47 to 1.0) at 90 days and remained stable at 1 year 0.76 (0.49 to 1.0). Mean QALYs at 1 year after stroke were 0.28 (SD: 0.35) and closely associated with stroke severity. Older age, lower educational attainment, patients with subarachnoid hemorrhage and undetermined stroke types all had lower QALYs and lower HRQoL, while being the primary breadwinner was associated with higher HRQoL. Sensitivity analysis with the Zimbabwe value set did not significantly change regression results but did influence the absolute values with Zimbabwe utility values being higher, with fewer utility values less than 0. CONCLUSION We generated QALYs after stroke for the first time in an African country. QALYs were significantly lower than studies from outside Africa, partially explained by the high mortality rate in our cohort. Further research is needed to develop appropriate value sets for West African countries and to examine QALYs lost due to stroke over longer time periods. DATA AVAILABILITY The Stroke in Sierra Leone anonymized dataset is available on request to researchers, see data access section.
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Affiliation(s)
- Daniel Youkee
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | | | - Durodami R Lisk
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Iain Marshall
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Marina Soley-Bori
- School of Life Course & Population Sciences, King's College London, London, UK
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Kaseke F, Gwanzura L, Musarurwa C, Gori E, Nyengerai T, Kaseke T, Stewart A. Factors influencing survival outcomes in patients with stroke in Zimbabwe: A 12-month longitudinal study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.02.24305220. [PMID: 38633793 PMCID: PMC11023643 DOI: 10.1101/2024.04.02.24305220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background In this longitudinal study, we aimed to determine factors influencing survival outcomes among patients with stroke over a 12-month period. The investigation sought to uncover influential determinants to enhance the precision of prognostic assessments and inform targeted interventions for individuals affected by strokes. Methods Employing a longitudinal study design, participants were observed for 12 months from baseline, censoring survivors at the endpoint. The dataset originated from a comprehensive study involving stroke patients treated at three referral hospitals in Zimbabwe: Parirenyatwa, Sally Mugabe, and Chitungwiza Central Hospital. The primary outcome variable, the duration of survival until death, was measured in days from the initiation of stroke treatment. Gompertz parametric regression analysis was utilized for data modeling following Accelerated Failure Time (AFT) model diagnostics. Results In our study, 188 stroke patients were enrolled at baseline. However, 51 patients were excluded from the analysis due to either missing information or loss to follow-up. Among the remaining 137 patients who were tracked over a 12-month period, 42% were censored, and 58% were deceased. Individuals utilizing 'Free Service (older than 65/pensioners/retirees)' hospital bill payment methods showed a decreased risk of death (HR: 0.4, 95% CI: 0.20, 0.80), suggesting a protective effect compared to cash paying patients. Those with a secondary school level education displayed a significantly lower risk of death (HR: 0.2, 95% CI: 0.04, 0.69) compared to those without formal education. Age was a significant factor, with individuals aged 45-65 and those over 65 years showing higher adjusted hazard ratios (HR: 4.9, 95% CI: 1.80, 13.25; HR: 5.5, 95% CI: 1.92, 15.95, respectively) relative to those below 45 years of age. Housing status revealed a protective effect for those residing with parents/relatives (adjusted HR: 0.4, 95% CI: 0.20, 0.66), while individuals with a 'Very severe' functional outcome showed an increased hazard (adjusted HR: 4.9, 95% CI: 1.12, 21.33). Conclusion The study findings demonstrate that hospital bill payment methods, housing status, educational attainment, functional outcome, and age significantly affect survival outcomes among stroke patients. This highlights the need to consider socio-demographic and clinical variables in the development of prognostic assessments and targeted interventions for individuals recovering from stroke.
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Affiliation(s)
- Farayi Kaseke
- Department of Physiotherapy, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Lovemore Gwanzura
- Department of Laboratory diagnostic and investigative sciences Department of Medical Laboratory Sciences, Faculty of Medicine, University of Zimbabwe, Zimbabwe
| | - Cuthbert Musarurwa
- Department of Biomedical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Elizabeth Gori
- Department of Medical Biochemistry, Molecular Biology and Genetics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | | | - Timothy Kaseke
- Zimbabwe AIDS Prevention Project (ZAPP), Harare, Zimbabwe
| | - Aimee Stewart
- Department of Physiotherapy. University of The Witwatersrand, Johannesburg, South Africa
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Physical function, depressive symptoms, and quality of life with post-acute stroke care. Collegian 2023. [DOI: 10.1016/j.colegn.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Ransley G, Zimba S, Gadama Y, Saylor D, Benjamin L. Trends and Clinical Characteristics of HIV and Cerebrovascular Disease in Low- and Middle-Income Countries (LMICs) Between 1990 and 2021. Curr HIV/AIDS Rep 2022; 19:548-565. [PMID: 36264482 PMCID: PMC9759508 DOI: 10.1007/s11904-022-00627-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF THE REVIEW To describe trends and clinical characteristics of HIV and cerebrovascular disease between 1990 and 2021 in LMICs and identify the gaps in our understanding. RECENT FINDINGS In the era of antiretroviral therapy (ART), people living with HIV (PLWH) live longer and risk excess cerebrovascular events due to ageing and HIV-driven factors. Despite the highest burden of HIV infection in low-to-middle income countries, there is underreporting in the literature of cerebrovascular events in this population. We systematically reviewed published literature for primary clinical studies in adult PLWH and cerebrovascular disease in LMICs. The clinical phenotype of cerebrovascular disease among PLWH over the last three decades in LMICs has evolved and transitioned to an older group with overlapping cerebrovascular risk factors. There is an important need to increase research in this population and standardise reporting to facilitate understanding, guide development of appropriate interventions, and evaluate their impact.
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Affiliation(s)
- George Ransley
- grid.83440.3b0000000121901201National Hospital for Neurology and Neurosurgery, University College London Foundation Trust, London, UK
| | - Stanley Zimba
- grid.79746.3b0000 0004 0588 4220Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Yohane Gadama
- grid.11956.3a0000 0001 2214 904XDivision of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa ,grid.419393.50000 0004 8340 2442Malawi-Liverpool Wellcome Trust Clinical Research Program, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Deanna Saylor
- grid.79746.3b0000 0004 0588 4220Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia ,grid.21107.350000 0001 2171 9311Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Laura Benjamin
- grid.83440.3b0000000121901201National Hospital for Neurology and Neurosurgery, University College London Foundation Trust, London, UK ,grid.83440.3b0000000121901201MRC LMCB, University College London, Gower Street, London, WC1E 6BT UK
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Soto-Vidal C, Calvo-Fuente V, Muriel-García A, Gallego-Izquierdo T, González-Alted C, Pacheco-da-Costa S. Responsiveness of the Spanish Version of Newcastle Stroke-Specific Quality of Life Measure (NEWSQOL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10034. [PMID: 34639337 PMCID: PMC8507955 DOI: 10.3390/ijerph181910034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the responsiveness of the Spanish version of the Newcastle Stroke-specific Quality of Life measure (NEWSQOL) to assess quality of life in Spanish people after suffering a stroke. DESIGN A prospective observational study was conducted to assess the responsiveness of the Spanish version of NEWSQOL. The sample contained 128 patients who filled in the questionnaires before and after a physical therapy intervention. The responsiveness was assessed with p-values using the effect size (ES) and the standardized response means (SRMs) of the change. Besides, two other external criteria were used to distinguish patients who improved with the treatment from those who remained stable. This classification was based on one functional independence measure (the Barthel Index) and one disability measure (the modified Rankin Scale). RESULTS There was a statistically significant correlation (Spearman's coefficient = p < 0.01) between the domains of the Spanish version of NEWSQOL in relation to the Barthel Index and the modified Rankin Scale. All domains showed between marked-to-mild change responsiveness except sleep and relationships; mobility (ES 0.66 and SRM 0.92) and activities of daily living (ES 0.75 and SRM 0.87) were markedly responsive; communication (ES 0.38 and SRM 0.61) was moderately responsive; and pain, vision, cognition, feelings, emotions and fatigue were mildly responsive (ES 0.21-0.41 and SRM 0.23-0.44). CONCLUSION The Spanish version of NEWSQOL shows between marked and mild responsiveness to measure the perception of QoL in post-stroke patients. Therefore, its use can be suitable for evaluation studies, clinical trials and clinical practice.
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Affiliation(s)
- Concepción Soto-Vidal
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Victoria Calvo-Fuente
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Alfonso Muriel-García
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Tomás Gallego-Izquierdo
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | | | - Soraya Pacheco-da-Costa
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
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Sadlonova M, Wasser K, Nagel J, Weber-Krüger M, Gröschel S, Uphaus T, Liman J, Hamann GF, Kermer P, Gröschel K, Herrmann-Lingen C, Wachter R. Health-related quality of life, anxiety and depression up to 12 months post-stroke: Influence of sex, age, stroke severity and atrial fibrillation - A longitudinal subanalysis of the Find-AF RANDOMISED trial. J Psychosom Res 2021; 142:110353. [PMID: 33421630 DOI: 10.1016/j.jpsychores.2020.110353] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stroke can negatively impact the health-related quality of life (HRQoL). Anxiety or depression after stroke have been associated with poorer HRQoL, higher mortality and greater dependence in activities of daily living. We aimed to analyze HRQoL, anxiety and depressive symptoms in patients with and without atrial fibrillation (AF) up to 12 months post-stroke. METHODS Find-AFRANDOMISED was a prospective, randomized multicenter study, which included 398 patients ≥60 years with acute cerebral ischemia. HRQoL data were collected using the 3-level EuroQol-5D (EQ-5D-3L) and Stroke Impact Scale (SIS-16). Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). The severity of stroke was measured using the modified Rankin Scale (mRS). RESULTS In this study (mean age 72.7 ± 7.5 years, 40.2% females), there was a significant improvement in HRQoL using EQ-5D-3L after 3 months (β = 0.37, p < .01), 6 months (β = 0.43, p < .01) and 12 months (β = 0.44, p < .01) post-stroke compared to baseline. HADS anxiety scores after 3 months (β = -0.22, p < .01) and 12 months (β = -0.28, p < .01) were significantly reduced. Older patients reported reduced HRQoL and more depressive symptoms. Females indicated lower HRQoL and more anxiety. mRS score at baseline was an independent predictor for HRQoL. There was a significant but small effect of AF on EQ-5D-3L and on HADS anxiety. CONCLUSIONS Patients showed significant improvement in HRQoL and reduced anxiety after 3 and 12 months after stroke. We could demonstrate that the severity of stroke as well as sex and age impact long-term post-stroke HRQoL. CLINICAL TRIAL REGISTRATION Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01855035.
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Affiliation(s)
- Monika Sadlonova
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany; Department of Thoracic- und Cardiovascular Surgery, University of Göttingen Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Partner site Göttingen, Germany.
| | - Katrin Wasser
- Department of Neurology, University of Göttingen Medical Center, Göttingen, Germany
| | - Jonas Nagel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - Mark Weber-Krüger
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Sonja Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Timo Uphaus
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jan Liman
- Department of Neurology, University of Göttingen Medical Center, Göttingen, Germany
| | - Gerhard F Hamann
- Department of Neurology and Neurorehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Pawel Kermer
- Department of Neurology, University of Göttingen Medical Center, Göttingen, Germany; Department of Neurology, Nordwest-Krankenhaus Sanderbusch, Sande, Germany
| | - Klaus Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Partner site Göttingen, Germany
| | - Rolf Wachter
- DZHK (German Center for Cardiovascular Research), Partner site Göttingen, Germany; Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany; Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
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Bello UM, Chutiyami M, Salihu D, Abdu SI, Tafida BA, Jabbo AA, Gamawa A, Umar L, Lawan A, Miller T, Winser SJ. Quality of life of stroke survivors in Africa: a systematic review and meta-analysis. Qual Life Res 2020; 30:1-19. [PMID: 32712933 DOI: 10.1007/s11136-020-02591-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Functional impairments and socioeconomic constraints associated with stroke affect quality of life (QoL). With limited care and social support resources, there is a greater anticipated decline in QoL among stroke survivors in Africa. This study aims to examine post-stroke QoL, properties of outcome measures adopted and predictors of the QoL among African stroke survivors. METHODS African Journals Online, CINAHL, PsychINFO, PubMed and Web of Science databases were searched from inception to February 2020. Methodological quality was assessed using the Agency for Healthcare Research and Quality (ARHQ) methodology checklist for observational studies. RESULTS Twenty-eight studies recruiting 2572 (76.4%) stroke survivors and 795 (23.6%) healthy volunteers were included. Studies were conducted in eight African countries between 2007 and 2019. Methodological quality of studies was good. Overall, stroke survivors reported a low QoL. Six studies comparing QoL between stroke survivors and healthy controls were pooled for meta-analysis. Results showed a biased-adjusted standardised mean difference (Hedges's g) of 1.13 (95% CI 0.71 to 1.56; p < 0.001), indicating better QoL among healthy controls. Only 4 (14.3%) studies used translated or cross-culturally adapted QoL assessment tools. The most commonly reported predictor of QoL was post-stroke disability (35.8% of studies) which is followed by depression (28.6%) and stroke severity (28.6%). CONCLUSIONS Overall, African stroke survivors reported comparatively lower QoL as compared to age-matched healthy controls. This highlights the need for cross-culturally validated assessment tools and more robust post-stroke QoL evaluation across the African continent. To improve QoL of stroke survivors in Africa, early interventions should focus on reducing disability and depression associated with stroke. PROSPERO registration number: CRD42019137653.
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Affiliation(s)
- Umar Muhammad Bello
- Yobe State University Teaching Hospital, Damaturu, Yobe State, Nigeria.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Muhammad Chutiyami
- Faculty of Human Sciences, Macquarie University, Sydney, Australia. .,Shehu Sule College of Nursing and Midwifery Damaturu, Damaturu, Yobe State, Nigeria.
| | - Dauda Salihu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Sham'un Isah Abdu
- Physiotherapy Department, Kazaure General Hospital, Kazaure, Jigawa State, Nigeria
| | | | - Abdulhamid Ardo Jabbo
- Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Adamu Gamawa
- Physiotherapy Department, Bauchi State Specialist Hospital, Bauchi, Bauchi State, Nigeria
| | - Lawan Umar
- Physiotherapy Department, Federal Medical Centre, Azare, Bauchi State, Nigeria
| | - Aliyu Lawan
- Department of Rehabilitation Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Stanley John Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Soto-Vidal C, Pacheco-da-Costa S, Calvo-Fuente V, Fernández-Guinea S, González-Alted C, Gallego-Izquierdo T. Validation of the Spanish Version of Newcastle Stroke-Specific Quality of Life Measure (NEWSQOL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4237. [PMID: 32545844 PMCID: PMC7345147 DOI: 10.3390/ijerph17124237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Stroke causes a wide variety of clinical manifestations that may have a negative impact on quality of life. Therefore, it is very important to use specific instruments for measuring quality of life in individuals who suffered a stroke. The aim of this study was to develop a psychometrically validated Spanish version of the Newcastle stroke-specific quality of life measure (NEWSQOL). METHODS A psychometric validation of the Spanish version of the NEWSQOL questionnaire was carried out in 159 patients. The reliability (intraclass correlation coefficient and Cronbach's alpha coefficient), validity (factorial analysis and Spearman's coefficient), feasibility (response rate), and the ceiling and floor effects were calculated. RESULTS Internal consistency showed that Cronbach's alpha coefficient was 0.93. The test-retest reliability was high or excellent for all domains (range 0.71-0.97 p < 0.001). The response rate of the questionnaire was 100% and the average administration time was 20.5 (±7.2) min. No ceiling effect was detected and two domains (pain and vision) may have a significant potential for floor effect. Construct validity showed that all the variables are important enough to keep them all in the questionnaire. Concerning convergent construct validity, a high correlation was found with the Nottingham Health Profile, the Barthel Index, and the Modified Rankin Scale. CONCLUSION The Spanish version of the NEWSQOL questionnaire is reliable, valid, and feasible to evaluate quality of life in the Spanish population.
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Affiliation(s)
- Concepción Soto-Vidal
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
| | - Soraya Pacheco-da-Costa
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
| | - Victoria Calvo-Fuente
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
| | - Sara Fernández-Guinea
- Department of Experimental Psychology, Complutense University of Madrid, 28040 Madrid, Spain;
| | | | - Tomás Gallego-Izquierdo
- Department of Nursing and Physiotherapy, University of Alcala, 28871 Madrid, Spain; (C.S.-V.); (V.C.-F.); (T.G.-I.)
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Chimatiro GL, Rhoda AJ, De Wit L. Stroke patients' outcomes and satisfaction with care at discharge from four referral hospitals in Malawi: A cross-sectional descriptive study in limited resource. Malawi Med J 2019; 30:152-158. [PMID: 30627348 PMCID: PMC6307053 DOI: 10.4314/mmj.v30i3.4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Stroke is the fourth leading cause of mortality and disability in Malawi. There is paucity of studies reporting on acute stroke functional outcomes, quality of life and satisfaction with care among patients with stroke. This study aimed to determine stroke outcomes and satisfaction with care in the country's central hospitals. Methods A descriptive cross-sectional study, recruiting 114 adult patients with stroke and their caregivers, was done. FIM, EQ-5D-5L, SASC and C-SASC were used to collect data. Univariate associations were assessed using the Kruskal-Wallis Test for categorical variables and the Wilcoxon Rank Sum Test for continuous variables. Results With 79% of the original study sample taking part, there was improvement in patients' functional status at discharge compared to on admission with notable improvement in self-care (p<0.001), sphincter control (p<0.001), locomotion (p<0.001), and social cognition (p<0.001), but no significant improvement in transfers (p=1.000), and communication (p=0.865). Satisfaction with care was high, with no significant differences between males and females (p=0.415), age in years (p=0.397), and distance to the clinic (p=0.615). Satisfaction ratings were also high from caregivers' responses and their scores were not associated with age (p=0.663) or distance to the hospital (p=0.872). Quality of life was poor, most patients were either unable or had severe limitation in functional dimensions of mobility (22(28%), self-care (19(25%) and performance of usual activities (25(33%). Every additional year in age was associated with average of 0.36 decrease in quality of life score coefficient, −0.36 (95% CI: −0.63; −0.10); p=0.008. Conclusion Patients with stroke experience improvement in functional outcomes on discharge compared to on admission. Patients and caregivers were satisfied with care provision despite having poor quality of life post stroke treatment. There is need to focus proven interventions on areas of stroke care that can impact patients' quality of life in resource limited settings.
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Affiliation(s)
- George Lameck Chimatiro
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, South Africa
| | - Anthea J Rhoda
- Deputy Dean Teaching and Learning, Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, South Africa
| | - Liesbet De Wit
- Vrije Universiteit Brussel, Department of Public Health, Belgium
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Ramos-Lima MJM, Brasileiro IDC, de Lima TL, Braga-Neto P. Quality of life after stroke: impact of clinical and sociodemographic factors. Clinics (Sao Paulo) 2018; 73:e418. [PMID: 30304300 PMCID: PMC6152181 DOI: 10.6061/clinics/2017/e418] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/23/2018] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The aim of the study was to analyze the impact of ischemic stroke on health-related quality of life (QoL) and associate this event with individuals' clinical and sociodemographic characteristics. METHODS We investigated the clinical and demographic aspects of stroke patients. The Modified Rankin Scale, National Institutes of Health Stroke Scale (NIHSS) and the Stroke Specific Quality of Life Scale (SS-QoL) were used for correlation analysis. RESULTS Among 131 patients with ischemic stroke, 53.4% of patients presented with moderate to severe disability on the Rankin Scale. According to the SS-QoL, several QoL domains were compromised. QoL was significantly negatively correlated with the values of the Rankin and NIHSS scales, indicating lower QoL among people with worse functional status and greater clinical severity of stroke (p<0.001). The use of orthosis and total anterior circulation infarct subtype of stroke led to a more marked reduction in QoL. CONCLUSION The present study described an inversely proportional relationship between the severity of stroke, disability and QoL. The use of orthosis also had a negative impact on QoL. Early identification of these factors could promote better interventions for individuals with ischemic stroke, minimizing disabilities and improving QoL.
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Affiliation(s)
| | | | | | - Pedro Braga-Neto
- Centro de Ciencias da Saude, Universidade Estadual do Ceara, Fortaleza, CE, BR
- Divisao de Neurologia, Departamento de Medicina Clinica, Universidade Federal do Ceara, Fortaleza, CE, BR
- *Corresponding author. E-mail:
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Seremwe F, Kaseke F, Chikwanha TM, Chikwasha V. Factors associated with hospital arrival time after the onset of stroke symptoms: A cross-sectional study at two teaching hospitals in Harare, Zimbabwe. Malawi Med J 2017; 29:171-176. [PMID: 28955428 PMCID: PMC5610291 DOI: 10.4314/mmj.v29i2.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Late presentation to hospital after onset of stroke affects management and outcomes of the patients. This study aimed to determine the factors associated with time taken to present to hospital after the onset of acute stroke symptoms. Methods A descriptive cross sectional study was conducted at two teaching hospitals in Zimbabwe. Participants included patients admitted with stroke and their relatives. A self-administered questionnaire was used to collect information on history of stroke occurrence and time taken to present to hospital. Data was analysed for means, frequencies, percentages and Odds ratios. Results Less than half (33%) of the participants were able to recognize symptoms of stroke. Not having money to pay for hospital bills was a predictor of late hospital presentation (OR =6.64; 95% CI, (2.05–21.53); p=0.002). The other factors, though not statistically significant included not perceiving stroke as a serious illness (OR = 2.43; 95% CI (0.78–5.51); p=0.083) and unavailability of transport (OR=2.33; 95% CI (0.71–7.56); p=0.161). Predictors for early presentation included receiving knowledge about stroke from the community (OR=0.46; 95% CI (0.15–1.39); p=0.170); seeking help at the hospital (OR=0.50; 95% CI (0.18–1.37); p=0.177) and having a stroke while at the workplace (OR =0.46; 95% CI (0.08–2.72); p=0.389). Conclusions Regarding stroke as an emergency that does not require prerequisite payment for services at hospitals and improved community awareness on stroke may improve time taken to present to hospital after the onset of stroke symptoms.
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Affiliation(s)
| | - Farayi Kaseke
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Theodora M Chikwanha
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Vasco Chikwasha
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Charfi N, Trabelsi S, Turki M, Mâalej Bouali M, Zouari L, Dammak M, Ben Thabet J, Mhiri C, Mâalej M. [Impact of physical disability and concomitant emotional disturbances on post-stroke quality of life]. Encephale 2016; 43:429-434. [PMID: 27663046 DOI: 10.1016/j.encep.2016.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/25/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The physical and/or psycho-cognitive changes after stroke may lead to a decline in the quality of life (QOL) of patients. The aims of our study were to evaluate the QOL of stroke survivors and to investigate its relationships with the physical disability degree and the emotional disorders (anxiety and depression). METHODS We conducted a cross-sectional study, which included 147 patients, followed for stroke that had occurred over the past year, in the outpatient neurology department at the university hospital Habib Bourguiba of Sfax (Tunisia). For each patient, we collected socio-demographic characteristics and clinical and therapeutic data. The quality of life of our patients was assessed using the SF-36 scale. The HAD scale was used to screen for anxiety and depression, whereas the modified Rankin scale was used to measure the degree of disability. RESULTS The average age of our patients was 60.58 years. The overall mean score of the SF-36 ranged from 20.81 to 89.81 with an average of 55.27. Impaired QOL was found in 68% of patients. The study of the dimensional average scores revealed that only two dimensions of the SF-36 were not altered: physical pain and life and relationship with others. The physical component was slightly more altered than the mental component (41.4 and 42.9 respectively). A minimal disability was found in 32% of patients, while a moderate and severe disability was found in 19% and 21.1% of patients. Anxiety was detected in 55.1% of patients and depression in 67.3% of them. Impaired mental component QOL was significantly correlated with the presence of anxiety (P=0.008) and depression (P<<0.05). The severe degree of disability had a significant negative impact on all areas of QOL except that of life and relationships with others. CONCLUSION It appears from our study that among the important effects of stroke is the constant deterioration of QOL in its various dimensions. The occurrence of emotional disturbances such as anxiety and depression and the degree of physical disability seem to be predictors of QOL impairment. Therefore, special attention should be given to such patients at higher risk of decline in their QOL.
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Affiliation(s)
- N Charfi
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie.
| | - S Trabelsi
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | - M Turki
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | | | - L Zouari
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | - M Dammak
- Service de neurologie, CHU Habib Bourguiba, Sfax, Tunisie
| | - J Ben Thabet
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | - C Mhiri
- Service de neurologie, CHU Habib Bourguiba, Sfax, Tunisie
| | - M Mâalej
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
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