Determinants of Quality of Life of Post Stroke Survivors Across Countries: A Review of the Literature

Author/ Theoretical/ Research Methodology Analysis and results Conclusions Implications for future Implications for practice
Date Conceptual Question(s)/ research
Framework Hypotheses

Wong Improving The objective of It involved a cross-sectional A total of 366 individuals who had It concluded that it is Future research should It implies the adoption of a
et al. overall this research investigation conducted experienced a stroke participated in essential to incorporate conduct longitudinal holistic care approach that
(2021) health- was to evaluate among stroke survivors this study, with an average age of 59  routine malnutrition studies to examine the includes addressing not only
related the profiles of receiving care at post-stroke ± 11 years. The most frequently screening, personalized long-term effects of functional abilities but also
quality of Health-Related clinics in three public hospitals reported health challenges were speech therapy interventions targeting the overall HRQoL of stroke
life Quality of Life located in the states of related to mobility (85%), followed by programs, strategies to HRQoL in stroke survivors. This involves
(HRQoL) (HRQoL) and Pahang and Terengganu, usual activities (82%), pain/discomfort prevent recurrent survivors. This would incorporating interventions
should also investigate the Malaysia. The evaluation of (63%), anxiety/depression (51%), and strokes, and the help determine the for malnutrition screening,
become factors Health-Related Quality of Life self-care (41%). Various factors were promotion of physical sustainability and speech therapy, prevention
part of the associated with (HRQoL) was carried out identified as being associated with activity within existing durability of the of recurrent strokes, and
stroke HRQoL in using the EuroQol-5 different dimensions of HRQoL. rehabilitation improvements observed physical activity promotion
treatment individuals who dimension-5 levels These factors included malnutrition interventions. These in HRQoL outcomes. into rehabilitation plans.
and have assessment tool. To gather risk (in relation to mobility, usual interventions should be Moreover, comparative
rehabilitatio experienced a relevant information, an activities, and self-care), individuals consistently studies can be
n process stroke. interviewer-administered using wheelchairs (self-care and implemented and conducted to compare
goals. survey was conducted. usual activities), speech impairment strengthened to the HRQoL profiles of
Descriptive analyses were (usual activities and pain/discomfort), effectively improve the stroke survivors in
performed to examine the the number of stroke episodes (self- HRQoL of individuals Malaysia with those in
HRQoL profiles, while multiple care and pain/discomfort), body mass who have experienced a other regions or
logistic regression analyses index, physical activity level, and stroke in Malaysia. countries. This would
were conducted to identify types of strokes (usual activities). Age provide a broader
factors associated with and the use of a proxy were perspective and help
HRQoL. Both crude and associated with anxiety/depression, identify potential cultural
adjusted odds ratios were while factors such as employment or contextual factors
reported. status and smoking were linked to influencing HRQoL.
mobility.

Mei et People The objectives It conducted a cross-sectional It found that the average utility index It concluded that stroke Future research should The identified influencing
al. living in of this research study using baseline data and VAS scores for stroke patients patients residing in rural continue to explore the factors of the EQ-5D utility
(2022) rural areas were to from the Henan Rural Cohort were found to be 0.885 (SD, 0.204) areas of China HRQoL of patients with index and domain-specific
generally examine the study, including a total of and 68.39 (SD, 17.31), respectively. experienced a stroke in rural areas. scores in patients with stroke
 have worse potential factors 1,709 stroke patients aged
HRQoL that influence 36–79 years out of the overall
than those the health- cohort population (n =
living in related quality 39,259). The health-related
urban areas of life (HRQoL) quality of life (HRQoL) of
and its specific these stroke patients was
domains among assessed using the Chinese
stroke patients version of the European
residing in rural Quality of Life Five Dimension
areas of China. Five Level Scale (EQ-5D-5L),
which encompasses mobility,
self-care, usual activities,
pain/discomfort, and
anxiety/depression.
Additionally, a visual analog
scale (VAS) was employed to
evaluate the overall HRQoL.
Tobit regression models,
generalized linear models,
and binary logistic regression
models were constructed to
identify potential factors
influencing the EQ-5D utility
index, as well as factors
impacting each specific
domain and VAS score.
The most commonly reported issues
were pain/discomfort (PD, 35.2%)
and mobility (MO, 30.4%).
Regression models indicated that
factors such as illiteracy, low monthly
income, low intensity of physical
activity, and the presence of
conditions such as diabetes, anxiety,
depression, or poor sleep quality
were significantly associated with
lower utility index and VAS scores
among stroke patients. Moreover,
older age, female gender, alcohol
consumption, smoking, high-fat diet,
higher BMI, and longer duration of
living with stroke were also found to
be significantly associated with
various dimensions of the EQ-5D
questionnaire.
diminished health- This study's findings provide valuable insights for
related quality of life emphasize the designing targeted
(HRQoL), with importance of interventions. Nurses can
pain/discomfort being addressing the specific play a crucial role in
the most commonly needs of this population developing and
reported concern. Lower and the necessity for implementing these
educational attainment, systematic interventions. For instance,
reduced monthly management. Additional nurses can focus on
income, decreased research can delve promoting healthy lifestyles
intensity of physical deeper into the factors among patients with stroke,
activity, diabetes, that influence HRQoL in such as providing education
anxiety, depression, and rural areas and identify on diet, exercise, and
poor sleep quality were specific interventions smoking cessation.
identified as predictors that can improve patient Additionally, they can
of lower health utility outcomes. address mental health issues
index and VAS scores. by offering counseling
These factors also had services or facilitating
an impact on the scores support groups. Improving
of each EQ-5D domain. sleep quality can also be a
It is crucial to implement targeted area for
systematic management intervention, and nurses can
of stroke patients in provide education on sleep
rural areas through hygiene practices and assist
national public health with sleep management
services. strategies.

Muslim The The objective It used a type of analytic It was found that both age and It concluded that both Conducting longitudinal The findings of this study can
ah, relationship was to examine observation research with a occupation had a significant impact age and occupation had studies could provide a help in developing
Sulistyo between the correlation cross-sectional design. The on utility scores, highlighting their a significant impact on deeper understanding individualized care plans for
rini, & stroke between the researchers evaluated the importance in determining the overall utility scores. However, of the impact of age and stroke patients. By
Shafira. patients’ quality of life of quality of life of the patients by quality of life. However, the variables factors such as gender, occupation on utility considering the influence of
(2023) quality of individuals who employing the EQ-5D-5L of gender, marital status, and marital status, and scores over time. This age and occupation on utility
life and have questionnaire. It education did not exhibit a statistically education did not would enable scores, healthcare
sociodemo experienced encompassed a sample size significant influence on the utility demonstrate a researchers to observe professionals can tailor
graphic strokes and of 44 participants diagnosed value. Additionally, the results significant influence on any changes or trends interventions and strategies
 factors. sociodemograp with ischemic strokes. To obtained from the Visual Analog the utility value. in the relationship to enhance the quality of life
hic elements at analyze the gathered data, Scale (VAS) test indicated that Moreover, the outcomes between these factors for patients in different age
the Tlogosari they employed statistical patient characteristics did not exert a of the VAS test and the quality of life groups and occupational
Kulon Health techniques such as the Mann- significant effect on the VAS value, indicated that among stroke patients. settings.
Center. Whitney U test and the implying that factors such as gender, sociodemographic Future research should
Kruskal-Wallis test. age, marital status, and education did characteristics of the also explore additional
not significantly impact the subjective patients did not have a sociodemographic
assessment of health status. These significant effect on the factors that might
findings provide valuable insights into VAS value. These influence utility scores,
the relationship between various findings hold potential such as income level,
sociodemographic factors and health value in shaping health social support, and
outcomes, aiding in the development policies, health access to healthcare
of targeted interventions and insurance decisions, services.
healthcare policies. and serving as reliable
sources of
pharmacoeconomic
data.

Lourenç The factors The A descriptive correlational The study found that several factors, It concluded that the Future studies should The study implied to conduct
o et al. determine researchers study examined the quality of including sociodemographic (age, long-term health consider evaluating holistic assessments,
(2021) QoL of aimed to life (QoL) perception among widowhood, education), economic consequences of stroke mental health, including considering social,
stroke explore the stroke survivors in a (income), and clinical (stroke type, present a significant depression, as it is a economic, and health-related
survivors. influential community-based setting. The comorbidities, functional score) concern for stroke significant contributor to factors when developing
factors that study followed a consecutive factors, were associated with a lower survivors, their families, health-related quality of individualized care plans for
contribute to case-series design, including quality of life (QoL) in stroke caregivers, and society. life (HRQoL) in stroke stroke survivors. This
the quality of individuals who had survivors. The perception of QoL Therefore, prioritizing survivors. Examining comprehensive approach
life (QoL) experienced a stroke and had among survivors is influenced by the measurement of the impact of mental can help address specific
among stroke been under the care of a multiple factors, such as being HRQoL in stroke health on QoL could needs and facilitate
survivors single public primary health widowed, related to older age, survivors is crucial for provide valuable interventions that improve
residing in a center, specifically the "Tavira functional decline, and lack of social healthcare insights for intervention QoL outcomes. It also
community that Primary Health Centre," support. Additionally, economic professionals. The strategies. Additionally, implied a collaboration with
accurately located in the southern region factors such as monthly family study's findings indicate conducting future interdisciplinary teams and
represents the of Portugal known as Algarve. income and clinical factors like the that various social, studies with long-term advocates for policy changes
population of One hundred two stroke number of vascular risk factors, type economic, and health- follow-up assessments that address financial
Algarve, survivors participated in the of stroke, evolution, and chronic related factors influence can help determine the barriers to treatment,
located in the study, and their QoL was mRankin score were also found to be patients' subjective well- stability or changes in rehabilitation, and preventive
 southern region assessed using the
of Portugal. Portuguese version of the
World Health Organization
Quality of Life instrument.
associated with QoL. Through
multivariate analysis, it was
determined that the chronic mRankin
score significantly predicted QoL in
the physical, psychological, and
general domains. At the same time,
family income emerged as a predictor
in the environmental domain. These
findings highlight the influence of
various sociodemographic, economic,
and health-related factors on the QoL
of individuals post-stroke.
being. However, further QoL perceptions over measures for stroke
investigations with larger time in stroke survivors. survivors.
sample sizes must This would provide a
examine the relationship better understanding of
between quality of life the evolving needs and
(QoL) and clinical and interventions required
socio-economic for sustained
variables. improvement in QoL.

Charfi The clinical The study's A cross-sectional study was The study found that anxiety was It concluded that the Future research should It implied the need to
et al. association objective was to performed, involving a cohort observed in 55.1% of the patients, presence of anxiety and include longitudinal implement routine screening
(2021) s of evaluate the of 147 patients who had while depression was detected in depression after a studies to assess the and assessment protocols
depression occurrence of experienced a stroke within 67.3% of them. These emotional stroke has a negative long-term prevalence for anxiety and depression in
and anxiety anxiety and the previous year. The disturbances were found to be more impact on functional and impact of anxiety stroke patients. Identifying
and its depression screening for anxiety and prevalent during the first six months ability. These findings and depression beyond these emotional
effects on within the initial depression was conducted following the stroke. Notably, can be valuable in the first year post- disturbances early on can
functional year following a using the Arabic version of the depression was more commonly identifying patients who stroke. This would facilitate timely interventions
outcomes stroke while HAD scale, while the modified observed among male individuals. are at higher risk of provide a more and improve patient
in stroke also examining Rankin scale was utilized to Additionally, advanced age and experiencing comprehensive outcomes. Moreover, it also
patients. their evaluate the level of disability educational attainment beyond unfavorable emotional understanding of the highlights the need to
associations resulting from the stroke. secondary level were found to be outcomes. trajectory of emotional facilitate smooth care
with clinical and correlated with post-stroke anxiety. Consequently, this disturbances and their transitions for stroke
functional Furthermore, post-stroke anxiety and information can aid in effects on functional patients, ensuring continuity
factors. depression were significantly more designing suitable outcomes. Further of care and monitoring
prevalent in cases where the infarcts interventions to address investigation is needed emotional well-being during
affected the territory of the Sylvian their specific needs. to explore the the post-stroke period. This
and anterior cerebral artery. The underlying mechanisms could include, actively
presence of motor deficit during the and risk factors engaging in follow-up visits,
initial neurological examination and associated with post- providing ongoing
subsequent neurological sequelae stroke anxiety and assessment, and assisting in
were significantly associated with depression. This can care coordination to prevent
 depression. Both anxiety and help identify modifiable and address any worsening
depression were identified as factors that can be of anxiety or depression
significant predictors of functional targeted for preventive symptoms.
disability over the course of 12 interventions.
months following the stroke.

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