Stroke is “a focal (or sometimes general) neurological impairment of sudden onset, and lasting more than 24 hours (or leading to death), and of presumed vascular origin” [
A total of 86% of people who have suffered a stroke have some type of disability, mostly mobility problems, followed by 39% who have communication problems and 34% who suffer from learning problems [
An individual’s quality of life is worse after a stroke, and in most cases they need help in their day-to-day living, which in turn affects the quality of life of family members [
Little evidence that compares the consequences of hemorrhagic and ischemic strokes has been obtained to date. The existing studies have focused on searching for biomarkers that differentiate both typologies, on risk factors, and even on the risk of mortality that each type presents [
Thirty people participated in the study, of whom 20 were male and 10 were female. All of them were patients at the Hospital specializing in this type of conditions in the Biscay (Basque Country, Spain) public network. The mean age of the participants was
Sociodemographic characteristics of the sample.
Total group ( |
Ischemic group ( |
Hemorrhagic group ( |
Statistics | |||||||
---|---|---|---|---|---|---|---|---|---|---|
% | % | % | df | |||||||
Sex | ||||||||||
Men | 20 | 66.7 | 15 | 50.0 | 5 | 16.7 | 0.714 | 1 | .398 | .431 |
Women | 10 | 33.3 | 6 | 20.0 | 4 | 13.3 | ||||
Current marital status | ||||||||||
Married | 15 | 50.0 | 11 | 36.7 | 4 | 13.3 | 0.476 | 3 | .924 | .394 |
Single | 10 | 33.3 | 7 | 23.3 | 3 | 10.0 | ||||
Widowed | 2 | 6.7 | 1 | 3.3 | 1 | 3.3 | ||||
Cohabiting | 3 | 10.0 | 2 | 6.7 | 1 | 3.3 | ||||
Education | ||||||||||
Less than primary | 1 | 3.3 | 1 | 3.3 | 0 | 0.0 | 1.439 | 4 | .837 | .348 |
Primary | 13 | 43.3 | 9 | 30.0 | 4 | 13.3 | ||||
High school | 7 | 23.3 | 5 | 16.7 | 2 | 6.7 | ||||
A levels | 5 | 16.7 | 4 | 13.3 | 1 | 3.3 | ||||
Graduate studies or Master/PhD | 4 | 13.3 | 2 | 6.7 | 2 | 6.7 | ||||
Where they live | ||||||||||
Own home | 24 | 80.0 | 18 | 60.0 | 6 | 20.0 | 1.429 | 1 | .232 | .329 |
Relative’s home | 6 | 20.0 | 3 | 10.0 | 3 | 10.0 | ||||
Who they live with | ||||||||||
Alone | 7 | 23.3 | 6 | 20.0 | 1 | 3.3 | 1.074 | 1 | .300 | .393 |
With others | 23 | 76.7 | 15 | 50.0 | 8 | 26.7 | ||||
M | SD | M | SD | M | SD | df | ||||
Age | 65.00 | 15.00 | 67.90 | 11.74 | 58.22 | 20.03 | 1.664 | 28 | .107 | 0.66 |
Note:
The purpose of the study was explained to all participants, who gave written consent and understood that their participation was voluntary. The study was approved by the Ethics Committee at the University of Deusto and the Ethics Committee of the Basque public health network and conforms to the ethical guidelines of the 1975 Helsinki Declaration.
The study employed a pre-post design. A total of 30 patients who were undergoing rehabilitation out of a total of 182 people between June 2016 and February 2017 participated in the study (see Figure
Sample selection.
The data in the Basque health survey referring to the application of the SF-36 questionnaire [
The “housework” and “work” domains had very high internal consistency (
The mean (M) and standard deviation (SD) were used to describe the data in the case of interval or ratio variables, and the frequency and percentage were used for nominal variables. For making intergroup and intragroup comparisons, exact tests were used by applying SPSS-V22 [
Table
Differences between stroke typology at the two times of evaluation, and comparison of the changes over time in WHO-DAS-II and TUG.
WHO-DAS-II | Intergroup comparison | Intragroup comparison | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
(all participants) | |||||||||||||||||||
Hemorrhagic | Ischemic | Hemorrhagic | Ischemic | Baseline | Eight weeks | ||||||||||||||
M | SD | M | SD | M | SD | M | SD | M | SD | M | SD | ||||||||
Cognition | 12.8 | 23.1 | 5.00 | 6.3 | .156 | 0.58 | 7.8 | 13.7 | 2.4 | 3.4 | .096 | 0.69 | 7.3 | 13.7 | 4.0 | 8.1 | .180 | .362 | 0.25 |
Mobility | 64.6 | 32.2 | 70.8 | 35.6 | .656 | 0.18 | 21.5 | 19.8 | 33.6 | 27.4 | .243 | 0.48 | 69.0 | 34.2 | 30.0 | 25.7 | <.001 | .430 | 1.19 |
Self-care | 44.4 | 17.4 | 47.6 | 31.0 | .774 | 0.12 | 21.1 | 16.9 | 19.0 | 21.0 | .793 | 0.10 | 46.7 | 27.3 | 19.7 | 19.6 | <.001 | .333 | 0.97 |
Getting along | 5.6 | 8.3 | 1.2 | 4.0 | .058 | 0.79 | 0.9 | 2.8 | 0.8 | 3.6 | .941 | 0.03 | 2.5 | 5.8 | 0.8 | 3.4 | .150 | .134 | 0.27 |
Housework | 68.9 | 42.8 | 51.6 | 48.1 | .360 | 0.37 | 71.1 | 42.3 | 68.4 | 44.0 | .877 | 0.06 | 57.1 | 46.4 | 69.3 | 42.7 | .260 | .143 | 0.21 |
Soc. par | 49.1 | 16.8 | 53.6 | 15.1 | .475 | 0.29 | 43.5 | 7.2 | 43.4 | 18.6 | .988 | 0.01 | 52.2 | 15.5 | 43.5 | 15.9 | .010 | .392 | 0.50 |
Total | 39.8 | 12.6 | 37.8 | 13.3 | .704 | 0.15 | 26.9 | 10.0 | 27.5 | 13.6 | .906 | 0.05 | 38.5 | 12.9 | 27.3 | 12.4 | <.001 | .542 | 0.92 |
22.6 | 9.2 | 26.5 | 11.2 | .267 | 0.36 | 15.9 | 6.8 | 16.9 | 8.2 | .751 | 0.13 | 25.3 | 10.6 | 16.6 | 7.7 | <.001 | .672 | 1.10 |
Note. Soc. par: social participation. The “Work” domain was eliminated because none of the participants were working at the time of the evaluation; M: mean; SD: standard deviation;
No statistically significant data were observed either at baseline or at follow-up regarding mobility as assessed by the TUG (Table
Table
Differences between stroke typology at the two evaluation times, and comparison of changes over time in SF-36.
SF-36 | Intergroup comparison | Intragroup comparison | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
(All participants) | |||||||||||||||||||
Hemorrhagic | Ischemic | Hemorrhagic | Ischemic | Baseline | Eight weeks | ||||||||||||||
M | SD | M | SD | M | SD | M | SD | M | SD | M | SD | ||||||||
PF | 20.6 | 18.6 | 18.8 | 26.2 | .854 | 0.07 | 59.4 | 22.0 | 54.1 | 22.5 | .557 | 0.24 | 19.3 | 23.8 | 55.7 | 22.1 | <.001 | -.120 | 1.06 |
RP | 2.8 | 8.3 | 9.5 | 20.1 | .346 | 0.38 | 27.8 | 36.3 | 16.7 | 29.9 | .389 | 0.35 | 7.5 | 17.5 | 20.0 | 31.8 | .080 | -.085 | 0.33 |
BP | 69.2 | 26.6 | 55.1 | 37.4 | .316 | 0.41 | 68.9 | 33.5 | 57.9 | 35.4 | .435 | 0.31 | 59.4 | 34.7 | 61.2 | 34.6 | .692 | .625 | 0.06 |
GH | 61.6 | 13.5 | 56.6 | 19.3 | .487 | 0.28 | 71.3 | 16.8 | 63.7 | 21.4 | .353 | 0.38 | 58.1 | 17.7 | 66.0 | 20.2 | .060 | .303 | 0.35 |
V | 67.2 | 14.4 | 46.4 | 22.9 | .018 | 0.99 | 60.6 | 22.1 | 60.9 | 24.1 | .975 | 0.01 | 52.7 | 22.7 | 60.8 | 23.1 | .070 | .452 | 0.34 |
SF | 37.5 | 31.2 | 33.3 | 41.5 | .788 | 0.11 | 65.3 | 32.3 | 54.8 | 38.2 | .478 | 0.29 | 34.6 | 38.2 | 57.9 | 36.3 | <.001 | .449 | 0.59 |
RE | 96.3 | 11.1 | 68.2 | 44.1 | .072 | 0.74 | 81.5 | 37.7 | 71.4 | 46.3 | .569 | 0.23 | 76.7 | 39.3 | 74.4 | 43.5 | .790 | .379 | 0.05 |
MH | 71.1 | 20.3 | 56.6 | 18.3 | .064 | 0.76 | 81.8 | 13.6 | 73.1 | 23.1 | .303 | 0.42 | 61.0 | 19.7 | 75.7 | 20.8 | <.001 | .373 | 0.65 |
PCS | 27.7 | 4.0 | 29.3 | 9.25 | .624 | 0.20 | 38.3 | 8.7 | 35.6 | 7.6 | .400 | 0.34 | 28.8 | 8.0 | 36.4 | 7.9 | <.001 | .114 | 0.72 |
MCS | 54.7 | 8.46 | 44.0 | 10.3 | .011 | 1.10 | 52.6 | 13.7 | 49.2 | 13.1 | .525 | 0.26 | 47.2 | 10.9 | 50.2 | 13.1 | .190 | .498 | 0.25 |
Note. PF: physical functioning; RP: role—physical; BP: bodily pain; GH: general health; vitality; SF: social functioning, RE: role—emotional; MH: mental health; PCS: physical component summary; MCS: mental component summary; M: media; SD: standard deviation;
Table
Comparison between stroke group and normative group.
SF-36 | Normative ( |
Stroke pretest ( |
Stroke posttest ( |
|||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Normative vs. pretest | Normative vs. posttest | |||||||||||
M | SD | M | SD | M | SD | |||||||
Physical functioning | 86.5 | 21.4 | 19.3 | 23.8 | 55.7 | 22.1 | 17,15 | <.001 | 3.14 | 7.86 | <.001 | 1.44 |
Role—physical | 86.4 | 31.0 | 7.5 | 17.5 | 20.0 | 31.8 | 13.93 | <.001 | 2.55 | 11.70 | <.001 | 2.14 |
Body pain | 75.6 | 25.7 | 59.4 | 34.7 | 61.2 | 34.6 | 3.44 | <.001 | 0.63 | 3.05 | <.001 | 0.56 |
General health | 65.8 | 19.8 | 58.1 | 17.7 | 66.0 | 20.2 | 2.12 | .033 | 0.39 | -0.05 | .956 | 0.01 |
Vitality | 64.4 | 19.4 | 52.7 | 22.7 | 60.8 | 23.1 | 3.29 | .001 | 0.60 | 1.01 | .311 | 0.18 |
Social functioning | 87.7 | 20.1 | 34.6 | 38.2 | 57.9 | 36.3 | 14.36 | <.001 | 2.63 | 8.06 | <.001 | 1.47 |
Role emotional | 90.8 | 26.1 | 76.7 | 39.3 | 74.4 | 43.5 | 2.94 | .003 | 0.54 | 3.42 | <.001 | 0.63 |
Mental health | 76.7 | 17.5 | 61.0 | 19.7 | 75.7 | 20.8 | 4.90 | <.001 | 0.89 | 0.31 | .755 | 0.06 |
PCS | 50.0 | 10.0 | 28.8 | 8.0 | 36.4 | 7.9 | 11.59 | <.001 | 2.12 | 7.43 | <.001 | 1.36 |
MCS | 50.0 | 10.0 | 47.2 | 10.9 | 50.2 | 13.1 | 1.53 | .126 | 0.28 | -0.10 | .913 | 0.02 |
Note. PCS: physical component summary; MCS: mental component summary; M: mean; SD: standard deviation;
Comparison between stroke and normative data.
The objective of this study was to compare the possible differences that exist with respect to the level of functionality and perception of health-related quality of life, depending on the type of stroke suffered, evaluated at two different points in time, and to compare the data on the perception of health-related quality of life obtained for the stroke group with the data obtained for the normative group. These factors have been analyzed by [
Regarding the degree of disability at the baseline, it was observed that for most domains, the hemorrhagic stroke group obtained higher scores than the ischemic stroke group, which therefore reflects that the former had a greater degree of disability. However, eight weeks later both groups had improved, while the differences between them regarding the degree of disability had decreased. The hemorrhagic stroke group improved more than the ischemic stroke group, although these differences were not statistically significant. When both groups were compared over time, there were trend differences in all domains except for the domains of “getting along” and “housework.”
Regarding mobility, no differences were observed at baseline between the groups, nor were there intergroup differences at the 8-week follow-up. However, there were statistically significant intragroup differences; that is, both groups improved their mobility.
Regarding the health-related quality of life, at baseline it was seen that the hemorrhagic stroke group scored higher than the ischemic group did and, therefore, the perception of health-related quality of life was somewhat better in this first group. However, if the mean scores of both groups were compared at baseline to the normative scores of a general population group from the same sociocultural context [
At the 8-week follow-up, the scores from both groups tended to become similar. While the members of the ischemic stroke group had improved their perception of health-related quality of life, those in the hemorrhagic stroke group had a worse perception, although these data were not statistically significant. An improvement in the perception of quality of life was observed in most of the domains of the SF-36 at eight weeks in both groups. However, the scores were still below the normative scores (except in the cases previously referred to as “general health” and “mental health”), indicating that this group had a health handicap. During the study design and recruitment of participants’ process, only 30 of the 182 patients admitted could participate in the study. Noting the number of patients who could not participate in the study because of the effects of their strokes should encourage further research into this area, in order to better understand this disease and propose treatments that foster the autonomy and quality of life of these people.
Awareness of these differences means that intervention protocols and specialized rehabilitation guidelines can be developed, accelerating the patients’ recovery process. The data obtained in this study indicated that patients admitted after suffering a hemorrhagic stroke should receive treatment aimed at reducing their degree of disability, while for patients who have suffered an ischemic stroke the priorities should be psychological treatment to gain a better perception on health-related quality of life and walking exercises to improve mobility. However, due to the small size of the sample, it is necessary to take these indications with caution and more studies are necessary.
In future studies, it would be appropriate to increase the number of participants to obtain better statistical power. In addition, it would also be opportune the chance to balance the comparison groups by typologies, as well as by gender.
In conclusion, the study has yielded an understanding of functionality levels and the perception of health-related quality of life referred to two types of stroke, where both had similar profiles, and their health was highly compromised with respect to the normative population. Although both groups showed an improvement in their functionality and quality of life over time, after two months they still presented scores below the norm, which indicates that substantial improvement remains to be done.
The data used to support the findings of this study are available from the corresponding author upon request.
The authors declare that they have no conflicts of interest.
We are grateful to the 30 patients for their participation, to the hospital for its availability, and to the University of Deusto for the award of the FPI grant to fund this project.