Quality of Life of Adults Participating in a Rehabilitation Program Following a Stroke

Research Article

Austin Med Sci. 2016; 1(2): 1009.

Quality of Life of Adults Participating in a Rehabilitation Program Following a Stroke

de Oliveira MR¹* and D’Oliveira A Jr²

¹Hospital SARAH Brasília, School of Medicine, Federal University of Bahia, Brazil

²Department of Medicine of Bahia - Federal University of Bahia, Brazil

*Corresponding author: Marcos Roberto de Oliveira, Neurological Rehabilitation Sector SARAH Network of Rehabilitation Hospitals - Hospital SARAH Brasília, DF, Brazil

Received: June 22, 2016; Accepted: August 29, 2016; Published: September 02, 2016


Objective: To evaluate the self-perceived Health-Related Quality of Life (HRQoL) of adults participating in a rehabilitation program following Stroke.

Methods: Conducted quasi-experimental study, no control group, evaluated the quality of life of patients after CVA at admission and at the discharge of a rehabilitation program, using the following instruments: the Stroke Impact Scale (SIS), the Functional Independence Measure, the modified Rankin Scale, the Geriatric Depression Scale, the Hospital Anxiety and the Depression Scale (HADS), and a sociodemographic questionnaire.

Results: Twenty-five patients were evaluated, 11 men and 14 women. Their mean age was 48 years and the mean time of the lesion was 17.2 months. After the program, increases were found in physical performance, functional performance and in all the domains of the SIS except for the communication domain.

Conclusion: The patient participation in the rehabilitation program, suggests gains in physical and functional performance and in the individual’s perceptions of HRQoL following Stroke.

Keywords: Health-related quality of life; Stroke; Rehabilitation; Disability


Stroke is defined by the World Health Organization (WHO) as “rapidly developing clinical signs of focal disturbance of cerebral function, with symptoms lasting 24 hours or longer”. It is the second cause of death worldwide and the leading cause of acquired disability in adults [1]. The overall incidence of Stroke in the

Latin American and Caribbean populations is 140 per 100,000 inhabitants [2]. Disabilities include impaired motor function, limitations in Activities of Daily Living (ADL), possible cognitive impairment and language disorders, depression and restrictions to social interaction, consequently affecting an individual perception of their quality of life [3].

Health-Related Quality of Life (HRQoL) is defined as the qualitative value attributed to the period of life that follows changes caused by lesions, according to functional states, perceptions, and social opportunities that are affected by disease, injury, treatment or public actions [4]. In addition to the physical, mental, and social aspects, there are new considerations relating to personal perceptions, personal beliefs, religiousness, and spirituality that need to be incorporated into the health-related concept [3,5]. This statement defines Health-Related Quality of Life (HRQoL) as a construct that focusses on the respondent’s subjective perception and consists of physical, mental, and social dimensions [6].

Studies have demonstrated improvements in physical and functional performance and in states of depression and anxiety following participation in rehabilitation programs. However, it is unsure whether these gains are maintained over time [7]. There is evidence that social support, realistic expectations, education, appropriate guidance to reduce the burden of patients’ caregivers in the months following Stroke increase the success of a rehabilitation program [8,9].

Therefore, the objective of the present study was to identify the factors that affect self-perceived HRQoL following a CVA in patients participating in a neurological rehabilitation program in a public rehabilitation hospital, and to evaluate possible sociodemographic, clinical and functional variables that could be predictive of the therapeutic responses.

Methods design

Quasi-experimental study, no control group, was conducted to evaluate self-perceived HRQoL in patients participating in a public neurological rehabilitation program following a CVA. The study was conducted at the SARAH Rehabilitation Hospital in the city of Salvador, Bahia, Brazil. A convenience sample was obtained of consecutive patients admitted to the rehabilitation program between March and October 2012 who met the study inclusion criteria. A total of 64 patients with sequelae following Stroke were admitted to the rehabilitation program and, of these, 25 fulfilled the inclusion criteria and agreed to participate in the study.


The inclusion criteria consisted of: a diagnosis of ischemic or hemorrhagic Stroke, confirmed by clinical evaluation and radiological findings on computed tomography and/or magnetic resonance imaging, and being at least 16 years of age.

Patients with any other associated neurological diseases or concomitant severe systemic diseases (uncontrolled hypertension, severe cardiomyopathies, coronary disease, heart arrhythmias and uncontrolled diabetes) were excluded, as well as patients with moderate to severe cognitive deficits as measured according to the Mini-Mental State Examination (MMSE) and those with moderate to severe aphasia or behavioral abnormalities.

The study was approved by the ethical review board of the SARAH network of rehabilitation hospitals, and all the participants provided written consent.

HRQoL was correlated with the patient’s clinical, functional and psychosocial status at two different time points: at admission to the rehabilitation program and at discharge from the hospital (after 4-6 weeks in hospital).

Outcome measures

HRQoL was measured using the Stroke Impact Scale (SIS), version 3.0 9. This scale consists of 8 domains (strength, hand function, mobility, activities of daily living -ADL and Instrumental Activities of Daily Living [IADL], memory and thinking, communication, emotion and participation/role function). The scores for each domain range from 0 to 100, with higher scores reflecting better HRQoL. The SIS also contains a question that independently measures the patient’s overall perception with respect to his/her recovery following the CVA, with scores ranging from 0 (no recovery) to 100 (full recovery). Each domain consists of 4-11 questions graded from 5 to 1 in accordance with the degree of difficulty, time spent and the amount of strength used. Functional data were obtained using the motor portion of the Functional Independence Measure (FIM) scale, version 4.0, consisting of items in which physical functions are evaluated. This instrument takes into consideration the individual status at that specific moment, with a maximum total score of 91 points [10,11]. For each item, the individual’s degree of independence in performing a certain task is graded, resulting in a score that ranges from 1 (completely dependent) to 7 (completely independent). Higher total scores reflect a greater degree of independence. The modified Rankin Scale (mRS), which measures patients’ overall functional independence, was also applied. This scale classifies results into 7 different graded categories: 0 (no symptoms at all), 1 (no significant disability despite symptoms), 2 (slight disability); 3 (moderate disability); 4 (moderately severe disability); 5 (severe disability) and 6 (dead). Higher scores reflect greater disability.

The presence of depression was investigated using the Hospital Anxiety and Depression Scale (HADS). In this study, only the 7-item depression section was used (HADS-D), with each item scoring from 0 to 3 according to the severity of symptoms. Scores ≥ 9 indicate the presence of depression. In elderl y patients (those over 65 years of age), the 15-item Geriatric Depression Scale (short form) (GDS-15) was used, with scores ≥ 6 being associated with depression.

The sociodemographic data collected consisted of sex, age, marital status, socioeconomic condition (mean monthly income and socioeconomic class), schooling and employment status.

The clinical data collected referred to the type of CVA (ischemic or hemorrhagic), the side of the brain affected and the time of lesion (acute/subacute ≤ 6 months or chronic > 6 months). All data were collected from electronic patient charts.

Statistical analyses

The data were treated descriptively and inferentially after having been stored in an Excel® 2003 database and analyzed using the R software program, version 2.15.2. A descriptive analysis was performed to identify the general and specific characteristics of the study sample, with results being expressed as absolute/relative frequencies, means, standard deviations, and medians. The Shapiro-Wilk test was used to test the normality of the data distribution. To compare means prior to and following the intervention, Student’s t-test or the Wilcoxon non-parametric test was used for paired samples. Significance level was defined at 5% throughout analysis.


The sociodemographic characteristics of the participants and their comorbidities are shown in (Table 1). The study sample consisted of 14 women (56%) and 11 men (44%), with ages that ranged from 18 to 73 years (48.0 ± 15.2 years, mean ± standard deviation). Time since Stroke ranged from 2 to 60 months (mean 17.2 months), with 7 patients in the acute/subacute phase (28%) and 18 in the chronic phase (72%). Nineteen patients had hemiparesis on the left side (76%) and 6 on the right side (24%). All were able to walk, either alone or with support.