Life situation 5 years after subarachnoid haemorrhage

OBJECTIVES

Subarachnoid haemorrhage (SAH) has high mortality and morbidity among survivors. SAH mainly affects young people and may result in long-term disabilities such as decreased Health-related Quality of Life (HRQoL), mental health and cognitive function. The aim of this study was to investigate the life situation 5 years after a SAH including physical/emotional status, participation and HRQoL.

MATERIALS & METHODS

In this cross-sectional descriptive study, a mail survey was sent to all persons treated at a neurosurgery unit in Gothenburg, Sweden, for non-traumatic SAH in 2009-2010, approximately 5 years post-SAH. The survey included questions regarding HRQoL; EuroQol 5-Dimensions (EQ-5D), the impact of the SAH; Stroke Impact Scale (SIS), Occupational Gaps Questionnaire and participation in society; Impact of Participation and Autonomy (IPA).

RESULTS

Forty-two 5 year survivors were sent the survey, of whom 26 (62%) responded (59 years old, range 33-85). The participants had generally low HRQoL and scored low in the domain of anxiety and depression. Many reported problems with emotions, fatigue, memory and executive function, but few problems with physical condition. However, nearly all participants reported to have an acceptable level of participation and 64% were independent in their daily life.

CONCLUSIONS

In this 5-year follow-up after SAH, the participants reported to have a greater number of hidden disabilities compared to physical problems, whereas most had acceptable participation in society. A yearly follow-up after a SAH could be suggested aiming to improving the cognitive and mental health.

The impact of physical function on participation in the first year post-stroke

OBJECTIVES

Studies have investigated predictors of participation and showed that fewer depressive symptoms, physical independence, and age could predict the level of participation after stroke. Association between self-assessed functions and perceived levels of participation over time is not yet known. The aim of this study was to investigate perceptions of participation and how this related to background characteristics and self-assessed rehabilitation outcomes, at 1, 6, and 12 months post-stroke.

MATERIALS AND METHODS

To capture experienced functioning and participation, a self-assessment questionnaire, the Stroke Impact Scale (SIS), was used at 1, 6, and 12 months post-stroke. Possible variables with impact on perceived participation were investigated with logistic regression: perceived physical functions, memory and thinking, emotion and communication (SIS), as well as background characteristics. In addition, directions, distributions, and strength of correlations between each independent variable and the participation domain were analyzed using scatterplots.

RESULTS

Participation scores were widely distributed during the first year post-stroke. Significant associations were only found between perceived Physical score and participation during the first year post-stroke (1 month, n=92, P<.001; 6 months, n=79, P=.001; 12 months, n=78, P=.002). A moderate-to-high participation score was observed in combination with a high level of perceived emotional health and cognitive skills, at 1, 6, and 12 months.

CONCLUSIONS

The findings indicate that to improve participation during the first year post-stroke, physical functioning as well as emotional and cognitive health can be important areas of concern when forming rehabilitation interventions.

Stroke treated at a neurosurgical ward: a cohort study

OBJECTIVES

Little is known about the long-term recovery of patients treated with neurosurgery after stroke. This study aimed to explore the recovery of patients with first-time stroke treated in a neurosurgical ward, including their function, the presence of disability and life situation at admission, discharge and 4 years later.

METHODS

In this cohort study, 28 subjects (average age 55 years) were included. All had first-time stroke and were treated at the neurosurgical ward consecutively for 18 months. Baseline characteristics were identified, and follow-up home visits (n = 13) were performed 4 years post-stroke to explore the life situation, health status and recovery.

RESULTS

At admission, the median Glasgow Coma Scale score was 8 (range 3-15). Craniectomy or craniotomy was performed on 12 of the subjects. Average hospitalization time was 58 days. Two subjects died during the hospital stay, and an additional five died before the follow-up. Significant improvement in function from discharge to follow-up was noted: four of 13 were back at work, two were in need of personal assistance and one lived in a nursing home. Follow-up questionnaires showed a relatively high level of participation and independence.

CONCLUSIONS

Patients with stroke who were admitted to a neurosurgical ward had a low mortality rate during the acute treatment, and at 4 years post-stroke, the survival rate was 75%. The level of disability and dependence at discharge was high, but at 4 years post-stroke, there was both measurable and self-perceived improvement in function.