A study on the quality of life among stroke survivors: A cross sectional study

Background: The World Health Organization defines - Health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” 
Methodology: A cross sectional study on 96 patients with stroke aged more than 30 years was carried out NIMS Hospital, Jaipur for a period of 4 months from 1st January 2018 to 30th April 2018. 
Results: Out of 96 patients, Mean quality of score of patients with stroke was 65.04±9.982 there was significant difference seen in quality of life score according to sex, side of lesion, duration of stroke, socioeconomic status, occupation and hypertension. 
Conclusions: It can be said that quality of life is a multidimensional concept. As stroke cases is among the most devastating of health aspect, having multiple and profound effects upon all aspects of life, hence evaluation of quality of life is very important. Each and every effort should be made to improve these aspects and in turn to activity daily living (ADL) and improve the overall quality of stroke patients.


Introduction
Stroke is defined according to the World Health Organization (WHO) as Rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 h or longer or leading to death, with no apparent cause other than of vascular origin. Global burden of disease reported 9.4 million deaths in India of which 619000 Stroke and DALY 28.5 million. The prevalence of stroke in India, rural area is around 84-262/1,000,000 and urban 334-424/100,000. [1] Even though there is rise in death many surviving stroke patients are disabled and need help in activities of daily living which must be provided by family members, the health system, or other social institutions. Stroke has multitude of negative consequences on an individual's life ranging from death, loss of independence, etc. [2] Quality of life (QOL) defined as (WHO) "Individual's perceptions of their position in life in context of the culture and value systems in which they live and in relation to their goals, standards, expectations, and concerns." [3] QOL should not be confused with the concept of standard of living, which is based primarily on income. Instead, standard indicators of the QOL include not only wealth and employment but also the built environment, physical and mental health, education, recreation and leisure time, and social belonging. [4] Studies have shown that QOL among stroke patients has a detrimental effect on both short-and long-term health related QOL and that disability is a strong determinant of health-related QOL. [5] The assessment of QOL among these patients can be helpful in developing more comprehensive interventions for improvement and provide be rehabilitative services. Stroke symptoms such as headaches and dizziness may indicate a number of conditions other than stroke. It is often the speed of symptom development that indicates stroke. People experiencing strokes may not notice symptoms themselves: The stroke may make them appear dazed, "spaced-out," or confused. Common stroke symptoms include sudden are difficulty speaking, dizziness, headache, hearing difficulty, paralysis, vision problems, and weakness. Stroke survivors often describe sudden dizziness, and, in some cases, the most painful headaches of their lives. The sudden appearance of debilitating headaches should always be checked, especially if the person has no history of migraine headache. [6] A multidimensional approach is necessary to measure QOL. QOL assessment includes at least four dimensions:-Physical, psychological, social health, and environment. Journal of Medical Research and Innovation, Vol 5, Iss 1

Aims and objectives
The aim and objectives are as follows: 1. To assess the QOL among stroke patients. 2. To assess the functional and social activities among stroke patients.

Materials and Methods
Material and methods will be discussed under following headings.

Study area
This study was conducted at the NIMS Hospital, Jaipur, Rajasthan.

Type of study
This was hospital-based cross-sectional study.

Study period
The study was from January 1, 2018, to April 30, 2018.

Study population
All stroke patients who were registered at the NIMS Hospital, Jaipur, during the above-mentioned study period.

Inclusion criteria
The following criteria were included in the study: 1) Stroke patients aged 40 years and above.
2) Duration of stroke more than 1 year (Time since diagnosis and initiation of treatment).

Exclusion criteria
The following criteria were excluded from the study: 1) Patients with severely ill and not able to communicate. 2) Patients who did not give consent for participation in the study.

Estimation of sample size
For estimation of sample size, the mean and standard deviation of QOL score. Formula for estimating a proportion with absolute precision will be used to calculate sample size. Where, n = Sample size. Z = Level of significance. result in a sample of required sample size 96 will be covered.

Method of collection of data
Prior informed written consent in the local language was taken from all the patients included in the study.
For those who were illiterates, the consent was read out and explained to them in their language and consent was obtained by taking their signature in the consent form.
All patients under the study were personally interviewed and administered the questionnaire.  health. The responses given by the participants for each question (item) in the questionnaire were coded in a positive direction (higher score denotes higher QOL). These score were considered as the raw score. The frequency and percentages are described for each of the score and for each item/ questionnaire and are presented in Table 2.1.

Age
We have arbitrarily classified age into <45 years, 46-65 years and more than 66 years.

Sex
We have classified into male and female.

No Education
The person who cannot read and write with understanding in any language.

Schooling
The person who can read in any school level, that is Primary school A person who has studied in any class between 1 st and 5 th standard.
Middle school A person who has studied anywhere between 6 th and 8 th standard.

High school
The person who has studied 9 th and 10 th passed.

Intermediate
The person who has studied 11 th and 12 th passed.

Graduate
The person who has done a degree or diploma course.

Postgraduate
The person who has done a postgraduate degree course.

Type of family
Nuclear family Married couple and their children, while they are still regarded as dependents.

Joint family
It consists of a number of married couples and their children who live together in the same household. All the men are related by blood and the women of the household are their wives, unmarried girls and widows of the family kinsmen.

Three generation family
It is a household where there are representatives of three generations, related to each other by direct descent. It occurs usually when young couples are unable to find separate housing accommodation and continue to live with their parents and have their own children.

Socio-economic status
Socio-economic status of the urban family was assessed using Modified Kuppuswamy's method of socio-economic scale, which is based on the following three characteristics of the family.
1. Educational status of the head of the household 2. Type of occupation of the head of the household 3. Monthly income of the family.

Marital status
We have classified marital status into married, unmarried, divorced, and widowed.

Place of residence (locality)
We have classified patients into urban and rural according to their permanent residence.

Religion
We have classified religion into Hindu, Muslim, Christian, and Others.

Side of lesion
We have classified into right MCA infarct and left MCA infarct.

Diet
We have classified into vegetarian and mixed type of diet.

Alcoholism
We have classified into ever consumed and never consumed.

Smoking
We have classified into ever smoked and never smoker.

Observation and Results
Results of the study have been presented under the following headings: 1. Representation of QOL in various demographic factors.

Descriptive summary for the various items
according to four domains of QOL.

Association of QOL with respect to various factors
In the present study, the mean QOL of study subjects was 65.04 ± 9.982. We observed that QOL of study subjects were high in the age group of 45 years or lesser group (66.09 ± 7.726) and less in the age group of 46 to 65 years (64.81 ± 10.711)

Social Relationship
Only 11.5% of the stroke patients had a satisfied personal relationship and 4% had a satisfied sexual life. Around 48% of the stroke patients described to have a satisfied social support.

Environment Domain
Around 84.4% of stroke patients had either little to moderate financial support. Almost 91.7% of the stroke patients received either little or moderate information and skills for day -to-day life. Only 46.9% of the stroke patients had little opportunity for leisure activities. Only 52.1% half of the stroke patients were satisfied with their home environment. Majority i.e. 74% described their access to health and social care to be satisfied. Majority, i.e.55.2% described that they had a moderate amount of feeling of safe place in their daily life. Only 57.3% of stroke patients describe to have a architectural barrier (physical environment) for healthy living. Only 59.9% of stroke patients describe to have satisfied with transports service.

Conclusion
It can be said that quality of life is a multidimensional concept. As stroke cases is among the most devastating of health aspect, having multiple and profound effects on all aspects of life; hence, evaluation of QOL is very important. QOL depends on patients with physical, social, psychological, and environmental aspects. Each and every effort should be made to improve these aspects and, in turn, to activity daily living and to improve the overall quality of stroke patients.

Recommendations
It is important to establish the reasons behind the inability of rehabilitation to reach those people who cannot afford to go to the local health centers. The required patient to staff levels for effective rehabilitation during in-patient physiotherapy needs to be investigated to improve health delivery to patients post-stroke.