Quality of life and functioning of patients in domestic conditions after

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WELLNESS AND AGE
CHAPTER XVI
1
Balneotherapy Department, Department of Rehabilitation,
Physiotherapy and Balneotherapy, Faculty of Health Sciences,
Medical University of Lublin,
Zakład Balneoterapii, Katedra Rehabilitacji,
Fizjoterapii i Balneoterapii,
Wydział Nauk o Zdrowiu Uniwersytetu Medycznego w Lublinie
2
Department of Diagnostic Imaging
in Zofia Zamoyski Tarnowska Regional Hospital in Tarnobrzeg
Zakład Diagnostyki Obrazowej Wojewódzkiego Szpitala
im. Zofii z Zamoyskich Tarnowskiej w Tarnobrzegu
3
Department of Anaesthesiology and Intensive Care in Zofia Zamoyski
Tarnowska Regional Hospital in Tarnobrzeg
Oddział Anestezjologii i Intensywnej Terapii
Wojewódzkiego Szpitala im. Zofii z Zamoyskich Tarnowskiej
w Tarnobrzegu
4
Laser therapy - Specialized Medical Cosmetic Training, Tarnobrzeg
Laseroterapia - Specjalistyczne Szkolenia Medyczno-Kosmetyczne
Tarnobrzeg
GUSTAW WÓJCIK1,2, JOLANTA PISKORZ3, DANUTA BURDZY4
Quality of life and functioning of patients
in domestic conditions after ischemic stroke
Jakość życia i funkcjonowanie chorych w warunkach domowych
po udarze niedokrwiennym mózgu
Keywords: ischemic stroke, quality of life, neurological deficit
Słowa kluczowe: udar niedokrwienny mózgu, jakość życia, deficyt neurologiczny
INTRODUCTION
Stroke, according to WHO, is a clinical syndrome characterized by the sudden
onset of symptoms of focal or generalized disorder of brain function that persist
longer than 24 hours and do not have a cause other than vascular. Strokes are a very
important medical as well as social problem, because they are one of the main causes of severe and chronic disability, and even death. Estimated data suggests that
WELLNESS AND AGE
strokes annually, affect 15 million people worldwide, while about 1/3 of them die
[1]. Among the causes of death strokes are in third place, right after cardiovascular
diseases and cancer. Stroke is one of the most common causes of disability and
death in the adult population. The vast majority of strokes, as many as 85% is formed on the ischemic substrate caused by thrombosis or embolism, the remainder
being hemorrhagic stroke, caused by the damage to the vessel wall [2].
Ischemic strokes are a major cause of severe and chronic disability, which is of
particular social importance. Frequently the result is not death but the emergence of
disabled patients, which involves huge costs, including costs associated with health
care and the lost production capacity. Ischemic stroke accounts for about 80-88% of
all strokes, the remaining 12-20% are hemorrhagic stroke [3]. In Poland, annually
about 80 000 people suffer from stroke, most of whom are men. In Europe, every
year there are about 2.5 million new victims of stroke. Statistics show that approximately 60% of patients after stroke show stable signs of focal brain damage. In these
patients the presence of hemiparesis, decreased independence in performing activities of daily living, aphasia, and often the symptoms of depression are detected[4,5].
Cerebrovascular diseases are one of the most common causes of death and disability, half of the patients lose efficiency due to the large neurological deficit, and 20%
are not able to live independently. The stabilization of the neurological condition
after stroke, in most patients occurs within five weeks of illness and of functional
state - within 3 months. Neurological greatest improvement occurs in the first 6
weeks, and functional one lasts 2 weeks longer [6,7]. The problems of stroke patients tend to increase after finished treatment in hospital. Coping with the difficulties of everyday life, drastic loss of performance, loss of existing social status, lack
of support in the family and helplessness in the face of basic life problems cause
increasing isolation of the patient from the outside world and reduce social contacts.
Capturing all of these limitations and help in overcoming these problems could radically change the situation of the patient. Quality of life is a broad concept and covers
all areas of functioning of the patient, which are important to him: physical and
motor skills, mental state, somatic sensations and social situation and economic
conditions. Quality of life assessment can be regarded as an image of human life
situation relating to a part of life compared to the specified ideal pattern, and at the
same time being the subject of their desire [8]. In other words, it is the difference
between their hopes and expectations, and the current experiences of a person [9].A
history of stroke, according to most researchers, reduces the quality of life of patients both in functional and psychological well-being [10]. Functional dimension
refers to the activity of the patient in the areas referred to in the definition of health
by the WHO, World Health Organization, in the physical, mental and social spheres,
while mental well-being refers to the cognitive appraisal of individual areas of life,
and life as a whole and it is most often expressed through a sense of satisfaction or
dissatisfaction [11]. The main factors reducing the quality of life are: a reduction in
physical fitness, depression and lack of social support [9,10]. These data mostly
come from cross-section studies. There is little information on the changes in quality
of life after stroke with time of onset and the factors influencing this process. Does
the functional quality of life undergo further changes despite the earlier stabiliza192
Gustaw Wójcik, Jolanta Piskorz, Danuta Burdzy
tion? Research carried out by Schuling et al. [12] shows that the quality of life after
stroke does not change between 8 and 26 weeks of illness, but in terms of the certain
areas it deteriorates. On the other hand Kauhanen et al. [13] indicate that between 3
and 12 months after the incidence of stroke physical functioning improves. This
period was characterized but no change in terms of social functioning, vitality and
emotional state.
AIM OF WORK
The aim of the study is to assess the quality of life of patients staying at home
after ischemic stroke. In addition, the work attempts to find answers to the questions
set forth below:
1. Whether and to what extent are patients after ischemic stroke dependent on
others to perform basic life functions?
2. Is the quality of life significantly differentiated by evaluating the performance of patients after stroke?
3. Is movement independence an important determinant of satisfaction in patients after stroke?
4. What factors affect the long-term improvement in the quality of life of patients after stroke?
MATERIAL AND METHODS
Patients who were qualified for the study were over 18 years of age and met the
criteria for ischemic stroke (I 63 according to ICD-10). Exclusion criterion was the
lack of consent to participate in research, the deterioration of their health due to
respiratory-circulatory disorders or death of the patient.
The study group consisted of patients after ischemic stroke, who were treated in
hospital neurological ward, and after treatment were discharged and currently reside
at home. Patients were divided into groups according to the time elapsed since the
onset of the disease. Specified time intervals were: 2 years, 4 years, 6 years and
more than 6 years. Respondents are mainly residents of the district of Opole Lubelskie. Group of respondents was formed out of 64 patients after ischemic stroke. In
addition, the study population was divided by gender, where 35.94% were women,
and 64.06% men. Another criterion was the age of patients. The most numerous
group in this regard were people aged over 70, and in the age group of 60-69. Less
large group of patients was that of aged 50-59 (14.06%). The smallest group among
the respondents were people aged up to 49 years (3.12%). The research tool was a
self prepared survey. The study was conducted in 2015.
RESULTS
The study shows that the most commonly stroke occurred in patients aged above
70 years of age (n = 28; 43.75%), less frequently, because at 37.50% (n = 24) of
respondents cerebral infarction occurred in people aged 60-69, and in 15.63% (n =
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WELLNESS AND AGE
10) aged 50-59 years. The least frequently strokes occurred in people under 49 years
of age 3.13% (n = 2), as shown in Fig. 1.
Figure 1 Percentage of respondents including age range in which stroke occurred
The largest group of respondents consisted of patients in whom the stroke occurred 2 years earlier (n = 22; 34.38%) and 4 years earlier (n = 22; 34.38%). Respondents whose period after the onset of stroke came to 6 years accounted for 14.06%
of the studied group (n = 9). While 17.18% of respondents (n = 11), were patients in
whom the stroke occurred more than six years earlier (Fig. 2).
Figure 2 Percentage of respondents
in terms of time elapsed from the occurrence of stroke
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Most often the respondents in the assessment of their mobility required partial
help of others (n = 39; 60.94%) and 4.68% (n = 3) of the respondents were completely independent. Unfortunately, more than 1/3 of the respondents, which accounted
for 34.38% (n = 22) were entirely dependent on others and required assistance with
mobility (Fig. 3).
Figure 3 Percentage of respondents with regard to the assessment of mobility
The majority of respondents did not use the orthopedic equipment (45,31%),
while 32.81% of respondents were using elbow crutches or a walker. Every fourth
person after stroke (25.00%) was forced to use a wheelchair, and 4.69% other facilities.
Frequently, respondents ate meals alone (n = 36; 56.25%) and 37.50% (n = 24)
patients needed help when eating. In the case of paralysis of both upper limbs some
patients - 6.25% (n = 4) were not able to eat by themselves and require feeding, (Fig.
4).
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WELLNESS AND AGE
Figure 4 Percentage of respondents with regard to the assessment of eating
Respondents most often did poorly in maintaining personal hygiene and needed
help from others (n = 34; 53.13%). Small percentage of the surveyed - 14.06% (n =
9) performs hygienic actions by themselves, and 32.81% (n = 21) were dependent on
others (Fig. 5).
Figure 5 Percentage of respondents with regard
to the evaluation of coping with the maintenance of personal hygiene
The study shows that 35.94% (n = 23) patients were using the toilet alone, while
23.44% (n = 15) of respondents went to the toilet with the help of others. Slightly
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more than 40,62% (n = 26) of respondents remained permanently in bed and was
forced to use the chamber pot or diapers (Fig. 6).
to the evaluation of coping with the satisfying physiological needs
Respondents usually had partial mobility problems (n = 35; 54.69%) and 40.62%
(n = 26) of respondents remained in bed, and only 4.69% (n = 3) were independent
(Fig. 7)
to the evaluation of coping with mobility
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WELLNESS AND AGE
The most frequently, respondents required a little help with dressing (n = 32;
50.00%) and 42.19% (n = 27) of respondents were not able to get dressed, required
the help of another person. Only 5 patients (7.81%) of all the respondents were
among the people who were in this respect independent, (Fig. 8).
to the evaluation of coping with dressing
DISCUSSION
The above results of patients after ischemic stroke clearly indicate a loss of performance and overall functioning, what moreover, is consistent with the results of
other authors.
Activities of daily living that tend to be simple to healthy people, grow into a
problem to disabled individuals. Obstacles encountered every day often disorganize
or prevent the achievement of the desired goal. The severity of symptoms of the
disease, especially motor failure, significantly restricts the social and professional
contacts and very often contributes to dissatisfaction with their own situation, which
is widely understood quality of life [8,9].
Considering the independence of patients in our study, the majority of care for
these people was exercised by the family, 9.38% of the patients were under the care
of social institutions, and only 1.55% operated independently. Family environment,
as the most natural to the greatest extent affects the extent and quality of the functioning of a disabled person. Studies have shown that quality of life was significantly better among respondents who were independent as far as mobility was concerned compared with subjects who require partial or complete assistance. Often in
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patients despite preserved intellectual ability, motor dysfunction causes mental breakdown and consequent withdrawal from many areas of social and family life.
According to data obtained from this research it is that most patients ranges up to
2 years after the onset of stroke, which may indicate a growing problem associated
with the adverse effects of environmental influence and occupational health wrong
workplace hygiene. Fewer patients found themselves in groups in which a long time
has elapsed from the occurrence of myocardial infarction of brain tissue but here an
upward trend proportional to age was observed, which may indicate that the quality
of care for these patients is high.
The results showed that patients after stroke required partial help of others
(60.94%), while 4.68% of the respondents were independent but, unfortunately,
34.38% were totally dependent on others. The study also assessed self-reliance while eating. Most frequently, respondents ate their own meals (56.25%), while 37.50%
of people needed help and 6.25% were not able to eat alone. Respondents most often
needed help from others in personal hygiene (53.13%), while 14.06% of patients
were able to do it alone, and 32.81% were dependent on others. The study shows
that 35.94% of respondents were using the toilet alone, while 23.44% of people went
to the toilet with the help of other people, and 40,62% of the respondents remained
in bed and used the chamber pot or diaper pants. Most often patients after stroke
needed a little help with dressing (50.00%), while 42.19% of people could not get
dressed and required the help of other people, and 7.81% of the respondents were
independent in this matter.
Studied aspects of life after stroke are related to basic physical activities, roles
and maintaining contact with the external environment. They are therefore areas
which should be given special emphasis in the process of post-hospital rehabilitation.
In an official document of the 2007 Kjellstrom et al. [14] emphasize the importance and the rank of universal access to rehabilitation of all patients after stroke, the
need for it in the early hours of the patient's stay in hospital, conducting rehabilitation by a multidisciplinary team who establish the goal to regain independence in
performing basic activities of daily living. This is a continuation of the first declaration of 1995 and the confirmation of the position of the European Federation of
Neurological Societies. Such a course of conduct is necessary as rehabilitation is an
essential element of modern treatment and its course should be a complex and adapted process for successive periods (flaccid, spastic, chronic), and it should depend on
the type of stroke [4,15,16 ]. Rehabilitation of patients carried out in the framework
of rehabilitation camps using specialized kinesiotherapeutic methods contributes
significantly to the improvement in gross motor (movement) and small one (manual
dexterity) [11]. On the other hand, the improvement of motor functions of the patient prevents withdrawal from social life. Recovery of the ability to walk independently produces improvement in activities of daily living, and restores the independence to some degree. On the other hand, patients who have improved are more
willing to participate in therapy. The support of family and friends also works motivating, which is used by medical personnel to enable relatives to become active in
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WELLNESS AND AGE
improvement actions. Unfortunately, the presence of cognitive or emotional impairment sometimes causes more helplessness of patients than the motor deficit and
could be crucial to the quality of life of the patient [17].
The authors are aware of the limitations since patients were assessed at different
times of the stroke incident, although we tried to apply our results to the analysis
closest to our idea.
CONCLUSIONS
1. Most patients after ischemic stroke are partially or completely dependent on
others in performing even the most basic life functions.
2. It was found that in patients after stroke their quality of life is significantly differentiated, mainly due to the assessment of efficiency and independence in performing basic activities of life.
3. Our study showed that the satisfaction of respondents was significantly better
among respondents who were independent in mobility compared with subjects
who required partial or complete assistance.
4. Reducing dependence in activities of self-service and transport, rehabilitation of
speech and the early diagnosis and treatment of depression may increase the
chances of stroke patients for long-term improvement in their quality of life.
REFERENCES
1. Bergen D.C., Silberberg D. Nervous system disorders: a global epidemic. Arch.
Neurol. 2002; 59, 1194-6
2. Wójcik G., Piskorz J. Klinimetryczne metody oceny chorych po udarach mózgu
w planowaniu rehabilitacji w populacji osób dorosłych. Hygea Public Health,
2015; 50(1): 54-58.
3. Piskorz J., Wójcik G. Wczesna rehabilitacja pacjentów po udarze niedokrwiennym mózgu. Medycyna Ogólna i Nauki o Zdrowiu 2014; 20(4): 351-355.
4. Duncan P.W. i wsp.: Management of Adult Stroke Rehabilitation Care: a clinical
practice guideline. Stroke 2005; 36: 100–143
5. Messe S.R., i wsp.: Quality Standards Subcommittee of the American Academy
of Neurology. Neurology 2004; 62: 1042–1050.
6. Jaracz K. Kozubski W: Jakość życia chorych po udarze w świetle badań empirycznych. Aktualności Neurologiczne, 2008, 2: 35-44.
7. Krawczyk M., Kliniczne efekty intensywnego leczenia ruchem pacjentów po
przebytym udarze mózgu, Neurologia i Neurochirurgia Polska, 2002; (2): 41-60.
8. Cirstea M.C., Lewin F.: Compensatory strategies for reaching in stroke. Brain
2000; 123: 940–953
9. Czernicki J., Brola W.: Jakośćżycia chorych po udarze mózgu. Postępy Rehabilitacji 1999; 13: 37-40
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10. Legwant Z., Usprawnianie czynnościowe chorych po udarach mózgu. Studia
medyczne w Akademii Świętokrzyskiej, Kielce 2004; (2): 133-136.
11. Rutkowski J.: Badania jakości życia. W: S. Róg (red.). Jakość życia i warunki
bytu. Polskie Towarzystwo Statystyczne, Warszawa 1991 s. 33-46.
12. Schuling J., Greidanus J., Meyboom-De Jong B.: Measuring functional status of
stroke patients with the Sickness Impact Profile. Disability Rehabilitation. 1993;
15: 19–23.
13. Kauhanen M.L., Korpelajnen J.T. Domains et determinants of quality of life
after stroke caused by brain infarction. Arch Phys Med Rehabil 2000; 81: 14411546.
14. Kjellstrom T., Norrving B., Shatchkute A.: Helsingborg Declaration 2006 on
European stroke strategies. Cerebrovasc. Dis. 2007, 23, 231–241.
15. Jarema M.: Badania jakości życia jako alternatywna forma oceny stanu pacjenta.
Nowa Medycyna 1996; 3: 15-17.
16. Sacco R.L., Adams R., Albers G. i wsp.: Guidelines for prevention of stroke in
patients with ischemic stroke or transient ischemic attack. A statement for the
American Academy of Neurology affirms the value of this guideline. Circulation
2006; 113: 409–449.
17. Postępowanie rehabilitacyjne po udarze mózgu. Raport Zespołu Ekspertów Narodowego Programu Profilaktyki i Leczenia Udaru Mózgu. Neur Neurochir Pol
2001; supl 6: 11-27.
REFERENCES
The aim of the study was to determine the quality of life of patients staying at
home after ischemic stroke. The study group consisted of patients (64), who have
had ischemic stroke and are staying at home. Among the respondents 35,94% were
women, and 64.06% men. The research tool was a self prepared survey. Studies
have shown that patients usually required partial help of others - 60.94%. Only
4.68% of respondents enjoyed autonomy and 34.38% of patients were completely
dependent on other people. Statistical analysis showed that quality of life was significantly better among respondents who were independent in mobility compared with
subjects who required partial or complete assistance. Quality of life is significantly
differentiated by evaluating the efficiency of stroke patients and their independence
in basic activities of life.
STRESZCZENIE
Celem pracy było określenie jakości życia chorych przebywających w warunkach domowych po dokonanym udarze niedokrwiennym mózgu. Grupę badaną
stanowili pacjenci (64), którzy przebyli niedokrwienny udar mózgu i przebywają w
domu. Wśród respondentów 35,94%, stanowiły kobiety, zaś 64,06%, mężczyźni.
Narzędziem badawczym była ankieta własnego autorstwa. W badaniach wykazano,
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WELLNESS AND AGE
iż najczęściej chorzy wymagali częściowej pomocy osób drugich - 60,94%. Tylko
4,68% ankietowanych cieszyło się samodzielnością a 34,38% chorych było całkowicie uzależnionych od innych osób. Analiza statystyczna wykazała, że jakość życia
była istotnie lepsza wśród ankietowanych, którzy byli samodzielni ruchowo w porównaniu z badanymi, którzy wymagali częściowej lub całkowitej pomocy innych
osób. Jakość życia jest istotnie różnicowana przez ocenę sprawności chorych po
udarze mózgu i ich niezależności w podstawowych czynnościach życiowych.
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Quality of life and functioning of patients in domestic conditions after

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