School of Physical Therapy, Texas Woman's University, Dallas.
Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaya.
J Geriatr Phys Ther. 2019 Oct/Dec;42(4):E77-E84. doi: 10.1519/JPT.0000000000000196.
Poor quality of life (QoL) is a well-recognized consequence after stroke. Quality of life is influenced by a complex interaction between personal and environmental factors. Most previous investigations of the QoL after stroke have focused on personal factors, for example, physical deficits directly resulting from stroke. The influence of environmental factors, including social participation, is relatively understudied partly due to its high variation across different sociocultural contexts. The purpose of this study was to investigate the determinants of QoL among older adults with stroke living in an urban area of a developing country.
This cross-sectional observational study included 75 older adults who were at least 3 months poststroke and 50 age-matched healthy controls. Depressive symptoms were quantified using the World Health Organization Quality of Life Brief version (WHOQoL-BREF). Physical function was examined using Functional Ambulation Category, grip strength, 5 times Sit-to-Stand test, and Box and Block tests. The Montreal Cognitive Assessment and visual-manual reaction time were used to index cognitive function. Depressive symptom was quantified using the Patient Health Questionnaire-9. The Barthel Index and Fatigue Severity Scale were used to quantify activity limitation. Social participation and environmental participation were assessed using the Assessment of Life Habit and Craig Hospital Inventory of Environment Factors, respectively. Linear stepwise regression models were used to determine explanators for WHOQoL-BREF domain scores.
Individuals with stroke demonstrated significantly worse QoL on all WHOQoL-BREF domains compared with healthy controls. Stroke was a strong determinant for QoL and explained 16% to 43% of variances. Adding other outcome measures significantly improved the robustness of the models (R change = 12%-32%). The physical, psychological, social, and environmental domains of WHOQoL-BREF were all explained by the LIFE-H scores (β = -10.58, -3.37, 4.24, -5.35, respectively), while psychological, social, and environmental domains were explained by Montreal Cognitive Assessment scores (β = .47, 0.78, 0.54, respectively).
Social participation and cognition were strong determinants of QoL among urban-dwelling older adults with stroke. Social and recreational activities and cognitive rehabilitation should therefore be evaluated as potential strategies to improve the well-being of older adults affected by stroke.
生活质量（QoL）差是中风后的一种公认后果。生活质量受到个人和环境因素复杂相互作用的影响。大多数关于中风后 QoL 的既往研究都集中在个人因素上，例如中风直接导致的身体缺陷。环境因素的影响，包括社会参与，相对研究较少，部分原因是其在不同社会文化背景下差异很大。本研究旨在调查生活在发展中国家城市地区的中风老年人的生活质量决定因素。
本横断面观察性研究纳入了 75 名中风后至少 3 个月的老年患者和 50 名年龄匹配的健康对照者。使用世界卫生组织生活质量简表（WHOQoL-BREF）量化抑郁症状。使用功能性步行分类、握力、5 次坐站测试和方块-木块测试评估身体功能。使用蒙特利尔认知评估和视觉-手动反应时间来评估认知功能。使用患者健康问卷-9 量化抑郁症状。使用巴氏指数和疲劳严重程度量表分别量化活动受限。使用生活习惯评估和克雷格医院环境因素量表评估社会参与和环境参与。使用线性逐步回归模型确定 WHOQoL-BREF 各领域评分的解释因素。
与健康对照组相比，中风患者在所有 WHOQoL-BREF 领域的生活质量均明显较差。中风是生活质量的一个重要决定因素，可解释 16%至 43%的差异。加入其他结局指标可显著提高模型的稳健性（R 变化=12%至 32%）。WHOQoL-BREF 的身体、心理、社会和环境领域均由 LIFE-H 评分解释（β=-10.58、-3.37、4.24、-5.35），而心理、社会和环境领域由蒙特利尔认知评估评分解释（β=0.47、0.78、0.54）。
社会参与和认知是城市中风老年患者生活质量的重要决定因素。因此，社会和娱乐活动以及认知康复应作为改善受中风影响的老年患者幸福感的潜在策略进行评估。
