Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc
Journal website http://www.neurores.org

Original Article

Volume 7, Number 3, June 2017, pages 46-58

Health-Related Quality of Life in Stroke Survivors at the University Hospital of the West Indies

Figures

Figure 1.
Figure 1. Seed of life model (SOLM). The seed of life model shows that the human is like a matryoshka doll. The spiritual sphere comprising of the spirit and the soul domains of quality of life represent the inner most protected core dolls. The physical sphere comprising of the physical, psycho-emotional and cognitive domains represent the outermost dolls that are vulnerable to external damage such as that caused by stroke.
Figure 2.
Figure 2. Difference between mean HRQOLISP scores in each domain of QOL for stroke patients and apparently healthy adults at the UHWI. As shown stroke patients were doing significantly worse in all domains except the spiritual interaction domain. Sp-Spirit: spiritual sphere; Sp-Phys: physical sphere; SpInt: spiritual interaction domain; Spirit: spirit domain; Phys: physical domain; Psyc: psycho-emotional domain; Cog: cognitive domain; Psyc: psycho-emotional domain; Phys: physical domain.
Figure 3.
Figure 3. Mean HRQOL scores within each subtype of ischemic stroke. Large vessel and cardioembolic strokes were associated with lower HRQOL mean score when compared to small vessel arteriosclerotic subtype.
Figure 4.
Figure 4. Variables that were significantly associated with worse HRQOL in stroke patients at UHWI. (a) Decreasing mean HRQOL with increasing stroke severity as measured by NIHSS (P = 0.0046). (b) Decrease in mean QOL if depression was present (P = 0.0040). (c) Decrease in mean QOL if the patient had a prior stroke (P < 0.05). (d) Decrease in mean QOL if the HRQOLISP was being completed by a proxy (P < 0.05).
Figure 5.
Figure 5. The relationship between stroke severity and HRQOL. An increase in stroke severity as measured by the admission NIHSS is associated with a linear decline in mean HRQOL.
Figure 6.
Figure 6. Mean NIHSS within each stroke subtype using the TOAST classification for ischemic stroke. Patients with large artery occlusion and cardioembolic subtypes had significantly higher NIHSS at admission than patients with small artery occlusion subtype of stroke.
Figure 7.
Figure 7. PHQ-9 scores in patients with stroke versus healthy adults. Patients with stroke (blue) consistently had higher PHQ-9 scores than the healthy adults (red). This represents the greater prevalence of depression among stroke survivors when compared to a reference healthy population.

Tables

Table 1. Baseline Demographics and Clinical Information on Stroke Survivors and Apparently Healthy Adults (AHAs)
 
VariableStroke patients (%) (n = 50)AHA (%) (n = 50)Test of significance (P)
Age, years, mean ± SD61 ± 17.860 ± 13.10.740
Gender
  Male25 (50%)15 (30%)0.066
  Female25 (50%)35 (70%)
Race
  Black41 (82%)47 (94%)0.242
  Mixed3 (6%)2 (4%)
  Indian1 (2%)1 (2%)
  Asian1 (2%)0
Occupation
  Retired22 (44%)14 (28%)0.586
  Teachers5 (10%)2 (4%)
  Unemployed4 (8%)4 (8%)
Education
  None2 (4%)2 (4%)0.586
  Primary21 (42%)20 (38%)
  Secondary16 (32%)22 (44%)
  Tertiary11 (22%)7 (14%)
Cardiovascular risk factors
  Hypertension45 (90%)50 (100%)0.500
  Diabetes7 (14%)6 (12%)0.368
  Dyslipidemia11 (22%)12 (24%)0.121
  Atrial fibrillation4 (8%)4 (8%)0.500
  HTN + DM6 (12%)6 (12%)0.620
  HTN + DYS11 (22%)12 (24%)0.500
  HTN + DYS + DM15 (30%)9 (18%)0.121
  Smoking (former and current)17 (34%)16 (32%)0.973
Baseline depression2 (4%)4 (4%)0.678
Newly diagnosed depression
  Mild (5 - 9)10 (20%)3 (6%)0.0079
  Moderate-severe (10 - 19)9 (18%)2 (4%)

 

Table 2. Difference Between Mean HRQOL in Stroke Survivors Versus Apparently Healthy Adults (AHAs)
 
DomainsStroke patients, mean (SD)AHAs, mean (SD)Mean difference (95% CI)T valueP value
Physical sphere
  Physical72.1 (14.52)82.3 (12.76)-10.2 (-15, -4)-3.750.0003
  Psychoemotional73.3 (13.45)80.8 (11.68)-7.44 (-12.4, - 2.44)-2.950.004
  Cognitive71.1 (13.78)81.3 (10.81)-10.2 (-15, -5.23)-4.100.0001
  Ecosocial interaction73.5 (10.47)77.4 (9.80)-3.9 (-7.83, -0.11)-1.920.057
Spiritual sphere
  Soul76.7 (10.76)82.0 (8.17)-5.3 (-9.14, -1.55)-2.800.006
  Spirit71.8 (16.04)79.8 (10.36)-8.0 (-13.38, -2.66)-2.970.0037
  Spiritual interaction70 (20.24)76.9 (17.84)-6.9 (-14.44, 0.70)-1.80.07
HRQOL physical sphere72.5 (10.36)80.6 (8.62)-8.1 (-11.7, -4.15)-4.160.0001
HRQOL spiritual sphere72.8 (13.5)79.6 (10.1)-6.74 (-11.5, -2.00)-2.820.005
HRQOL sum72.7 (9.80)80.0 (7.8)-7.35 (-10.87, -3.8)-4.140.0001

 

Table 3. Correlation of Stroke-Specific Variables With Mean HRQOL
 
VariableStroke survivors (%) (n = 50)Mean HRQOLTest of significance (P)
Prior stroke15 (30%)68.2< 0.05
No prior stroke35 (70%)74.5
Stroke subtype
  Large artery occlusion9 (18%)66.40.125
  Cardioembolic2 (4%)67.8
  Small artery occlusion38 (76%)74.2
  Other1 (2%)80.8
  Undetermined00
Newly diagnosed depression
  Mild (5 - 9)10 (20%)70.10.0040
  Moderate-severe (10 - 19)9 (18%)62.8
NIHSS at admission
  < 8 (mild)41 (82%)74.30.0389
  8 - 14 (moderate)6 (12%)65.2
  > 17 (severe)3 (6%)65.2
Compliance
  Prescribed antiplatelets42 (84%)72.7< 0.05
  Complaint with antiplatelets26 (59%)75.0
  Prescribed antihypertensives44 (88%)72.0
  Compliant with antihypertensives32 (73%)73.1
Physical rehabilitation
  < 4 weeks35 (75%)71.80.79
  > 4 weeks15 (30%)74.4