Baylor College of Medicine, Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
J Neurosci Nurs. 2013 Jun;45(3):147-54. doi: 10.1097/JNN.0b013e31828a410b.
Because treatment for stroke has improved, individuals are living longer with the effects of a stroke. The resulting long-term impairment can affect both stroke survivors' and their caregivers' health-related quality of life (HRQOL). Few studies have examined the HRQOL of stroke survivors and their caregivers greater than 2 years poststroke. The stroke survivors and their spousal caregivers (n = 30 dyads) who had previously completed a 12-month study after discharge from inpatient rehabilitation were assessed at 3-5 years poststroke. The HRQOL and related outcomes were measured for stroke survivors and caregivers. Data from baseline to 12 months were used in conjunction with data from this study. Linear mixed models were used to analyze the change in repeated measures over time. Multiple linear regression was used to analyze the relationship of generic HRQOL to related psychosocial outcomes. The stroke survivors were an average of 4.68 years poststroke. The mean age for stroke survivors and caregivers was 70.8 and 64.9 years, respectively. Most stroke survivors were men (80%) and non-Hispanic White (70%). Among stroke survivors, depression decreased from baseline to 12 months (p = .04) but increased from 12 months to the end of follow-up (p = .003). The caregivers' depression decreased from baseline to all time points (p = .015). Stroke-specific HRQOL showed statistically significant (p < .03) decreases between 12 months and end of follow-up. Increased number of illnesses and older age were associated with caregivers' lower physical HRQOL score (p = .004). Higher depression was associated with lower mental HRQOL score for both caregivers and stroke survivors (p = .003 and p = .011, respectively). Both stroke survivors and caregivers continue to experience negative stroke-related health outcomes for many years after the initial stroke; some of these outcomes even worsen over time. These findings illustrate the need for ongoing psychological and medical evaluation for both long-term stroke survivors and caregivers. Development and testing of targeted behavioral interventions are also warranted.
由于中风的治疗已经有所改善，患者的寿命得以延长，但仍会受到中风的影响。由此导致的长期损伤会影响中风幸存者及其护理人员的健康相关生活质量（HRQOL）。很少有研究调查中风幸存者及其配偶护理人员在中风后超过 2 年的 HRQOL。本研究评估了 30 对中风幸存者及其配偶护理人员（共 60 人），这些人在住院康复后完成了 12 个月的研究，他们在中风后 3-5 年时进行了评估。对中风幸存者及其护理人员进行了 HRQOL 及相关结局的测量。将基线到 12 个月的数据与本研究的数据结合使用。使用线性混合模型分析随时间重复测量的变化。使用多元线性回归分析一般 HRQOL 与相关心理社会结局的关系。中风幸存者的平均发病时间为 4.68 年。中风幸存者和护理人员的平均年龄分别为 70.8 岁和 64.9 岁。大多数中风幸存者为男性（80%）和非西班牙裔白人（70%）。在中风幸存者中，抑郁症状从基线到 12 个月时有所下降（p =.04），但从 12 个月到随访结束时有所增加（p =.003）。护理人员的抑郁症状从基线到所有时间点都有所下降（p =.015）。中风特异性 HRQOL 在 12 个月和随访结束时之间显示出统计学上显著的（p <.03）下降。护理人员的躯体 HRQOL 评分与患病数量增多和年龄较大有关（p =.004）。较高的抑郁与护理人员和中风幸存者的心理 HRQOL 评分较低有关（p =.003 和 p =.011）。中风幸存者及其护理人员在中风后多年仍会持续经历与中风相关的负面健康结局，有些结局甚至会随时间恶化。这些发现表明，需要对长期中风幸存者及其护理人员进行持续的心理和医学评估。还需要开发和测试针对特定人群的行为干预措施。
