Status Quo And Its Influencing Factors Of Quality Of Life Among Stroke Patients Based On ICF Theory Framework

ObjectiveThe objective of this study was to investigate the status quo of stroke patients’ quality of life and to explore its influencing factors,so as to provide a basis for medical staff to develop more tailor-made interventions,thus improving quality of life of stroke patients.MethodsThis study employed a mixed-method design.It comprised two sections.1.Quantitative study on quality of life and its influencing factors in patients with stroke:convenient sampling method was used to select stroke patients in three rehabilitation wards of two hospital settings from a comprehensive tertiary care hospital in Qingdao between September 2019 and January 2020.The self-designed general data questionnaire,Chinese stroke scale,the Chinese version of World Health Organization Disability Assessment Schedule 2.0(self-administered),Hospital Anxiety and Depression Scale,Craig Hospital Inventory of Environmental Factors,Stroke-Specific Quality of Life Scale were used for the survey.Descriptive analysis,two-sample independent t-test,one-way ANOVA,Pearson correlation analysis,and multiple linear hierarchical regression analysis were performed using SPSS Statistics software(version 25.0).2.Qualitative interview research on influencing factors of quality of life in patients with stroke: the purposive sampling method was employed to select stroke patients in three rehabilitation wards of two hospital settings from a comprehensive tertiary care hospital in Qingdao between December 2020 and January 2021 as interviewees.Content analysis was used to extract the meaningful concepts from the content of the interviewees,and then the extracted meaningful concepts were linked to the corresponding ICF categories according to the link rules proposed by Cieza A et al.To form the ICF category pool of influencing factors of quality of life of stroke patients.Results1.The first part is the result of quantitative research.(1)A total of 238 stroke patients were included in this study.Most of them were male(68.1%),with an age range of 29 to 87 years and average age of(60.23±10.93)years.(2)The lowest score of quality of life of stroke patients was 82 points,the highest was228 points,and the total score of quality of life was(163.47±34.06).The scores of each dimension were as follows: energy(9.36±3.42),family role(8.75±2.90),language(20.02±5.63),activity ability(19.79±7.97),mood(15.77±4.17),personality(10.21±2.55),self-care(16.52±6.21),social role(15.55±5.29),thinking(8.81±2.98),upper limb function(17.53±5.95),vision(13.51±1.96),and work/productivity(7.66±3.54).(3)Results of the univariate analysis showed that there were significant differences in quality of life scores among stroke patients with different gender,age,education level,average monthly income,number of chronic diseases,and course of disease(P < 0.05).Additionally,there were no significant differences in marital status,living status,place of residence,medical fee payment method,stroke type,and first-episode / recurrent(P > 0.05).(4)Pearson correlation analysis showed that the scores of quality of life were negatively correlated with the scores of severity of neurological deficit(r =-0.703,P < 0.01),anxiety(r=-0.268,< 0.01),depression(r =-0.585,P < 0.01),activity(r =-0.675,P < 0.01),participation(r =-0.705,P < 0.01),and environmental factors(r =-0.248,P < 0.01).(5)Multiple linear hierarchical regression analysis showed that the severity of neurological deficit(β =-0.320),participation(β =-0.251),depression(β =-0.242),activity(β =-0.199),education level(β = 0.123),course of disease(β =-0.099)and number of chronic diseases(β =-0.086)were the predictors of quality of life among stroke patients.The seven factors collectively explained 72.4% of the total variation in quality of life(F=52.815,P<0.001).2.The second part is the result of qualitative research.(1)A total of 19 study subjects were included,of whom 7(36.8%)were female and 12(63.2%)were male.The age range was 38～86 years old,and the average age was(62.53±12.01)years.(2)A total of 204 meaningful concepts were extracted from the interview contents of stroke patients and linked to 75 related ICF categories,including 23 items of body function(b),3 items of body structure(s),24 items of activity,and participation(d)and 25 items of environmental factors(e).Among them,the five categories with the highest frequency were: d450 walking(79.0%,n = 19),b134 sleep function(52.6%),b710 mobility of joint functions(47.4%),b280 sensation of pain(42.1%),e580 health services,systems and policies(42.1%).Moreover,there are three other meaningful concepts cannot be linked to ICF categories,namely,delay in seeking treatment,COVID-19,and fear of falling.Conclusion1.Our results showed that the stroke patients’ quality of life is at a moderate level and needs to be further improved.2.The quality of life of stroke patients is influenced by multiple factors,such as body function and structure,activity and participation,personal factors,and environmental factors.To improve the quality of life of stroke patients,medical staff should comprehensively consider these influencing factors and carry out interventions in an omni-direction,multi-angle,and targeted way.