|Year : 2016 | Volume
| Issue : 5 | Page : 290-298
Quality of life and associated factors among poststroke clinic attendees at a University Teaching Hospital in Nigeria
Osunwale Dahunsi Oni1, Olatunji F Aina2, Francis I Ojini3, Victor O Olisah4
1 Department of Psychiatry, Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria
3 Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
4 Department of Psychiatry, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
|Date of Web Publication||14-Sep-2016|
Osunwale Dahunsi Oni
Department of Psychiatry, Lagos University Teaching Hospital, PMB 12003, Lagos
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Quality of life (QOL) measures are effective in quantifying disease burden after stroke, more so than levels of debility. The objective of this study is to determine QOL and associated factors of stroke survivors in Lagos, Nigeria. Materials and Methods: Seventy stroke survivors (study sample) and seventy stable hypertensive patients (control sample) attending clinics at a Nigerian hospital were recruited for the study. Respondents were assessed using sociodemographic/clinical questionnaires, modified mini-mental state examination, modified Rankin Scale, schedule for clinical assessment in neuropsychiatry, and World Health Organization-QOL-BREF. Results: Mean ages of the study and control respondents were 57.43 (±9.67) years and 57.33 (±9.33) years, respectively. Each sample comprised 38 male and 32 female respondents. Stroke survivors were significantly more likely to: be unemployed (P= 0.001), pay more for healthcare (P = 0.001), consume alcohol (P = 0.02), and have physical impairments (P = 0.001) compared with control. The mean QOL scores of stroke survivors were significantly lower than controls across all spheres. Stroke survivors who were unemployed, younger, female, paying more for healthcare, more disabled, with right stroke lateralization, having comorbidities, and sexual dysfunction had significantly poorer QOL specific grades. Depression or anxiety poststroke was also associated with reduced QOL means scores. Conclusion: Besides, clinical variables such as levels of disability and stroke lesion lateralization, other factors such as unemployment, health costs, age, gender, and emotional problems influenced QOL after stroke.
Keywords: Associated factors, clinic attendees, Nigeria, poststroke, quality of life, University Teaching Hospital
|How to cite this article:|
Oni OD, Aina OF, Ojini FI, Olisah VO. Quality of life and associated factors among poststroke clinic attendees at a University Teaching Hospital in Nigeria. Niger Med J 2016;57:290-8
|How to cite this URL:|
Oni OD, Aina OF, Ojini FI, Olisah VO. Quality of life and associated factors among poststroke clinic attendees at a University Teaching Hospital in Nigeria. Niger Med J [serial online] 2016 [cited 2022 May 20];57:290-8. Available from: https://www.nigeriamedj.com/text.asp?2016/57/5/290/190602
| Introduction|| |
Stroke is a leading cause of death and neurological disability in adults, inflicting a heavy burden on affected individuals and their families. Stroke studies currently indicate that the disorder is assuming a significant dimension among noncommunicable diseases in developing countries. The burden prolonged hospitalization has on informal caregivers, economic implications of treatment costs, and losses in productivity has been previously explored.
The World Health Organization (WHO) defines quality of life (QOL) as individual perceptions of their position in life in the context of the culture and value systems, in which they live and also in relation to their goals, expectations, standards, and concerns. It is a broad ranging concept affected in a complex way by physical health, psychological state, level of independence, personal benefits, and their relationship to salient features of the environment an individual resides. When specifically related to health, it is referred to as health-related QOL (HRQOL) because there are wide valued aspects of life not generally considered as “health.” HRQOL refers to the ways in which health, illness, and medical treatment influence individual perceptions of functioning and well-being. HRQOL measures are important in quantifying disease burden and evaluating the effects of therapies.
Stroke is often catastrophic and affects most aspects of its survivor's life. Unlike other chronic disabling illnesses, the onset of stroke is sudden, leaving survivors and family ill prepared to deal with its sequele. Evaluating QOL poststroke often reveals a condition with multilayered impact, affecting even survivors with mild consequences of stroke and those who have achieved full independence in activities of daily living. Results from different studies show that emotional disorders, gender, and other demographic/clinical variables,, negatively impact QOL post stroke. Individual QOL domains have also been reported to be affected in varying degrees among stroke survivors in different populations.
There is a dearth of studies focusing on QOL among chronically ill patients in Africa generally and Nigeria in particular. Research in the aforementioned area would help guide policy formulation and qualitative treatment of people with chronic illnesses including stroke. This study looks at the QOL and associated factors of stroke survivors attending outpatient clinics at a Nigeria hospital.
| Materials and Methods|| |
This study was comparative and cross-sectional in design. Data collection was completed in 5 months (October 2013–February 2014). A total of 70 stroke survivors with an equal number of controls made up of individuals with controlled hypertension were recruited for the study. The study was carried out at the Lagos University Teaching Hospital, Lagos, Nigeria. Data of the study sample were collected consecutively from adult stroke survivors attending neurology and physiotherapy outpatient clinics while data of the control sample were consecutively collected from adult patients with a history of hypertension (and no other chronic medical problems) who have had stable blood pressure for at least 3 months prior to data collection and attending the general outpatient department clinic. Adjustments with matching for age and sex were considered before recruitment of the control sample (±2 years and same sex).
Ethical approval was obtained from the Health Research and Ethics Committee of the hospital before commencement of the study. Purpose of study, study procedure, expected duration of involvement, or whether any risk was involved was explained to participants. Other issues such as confidentiality and voluntariness regarding participation were also explained.
After obtaining written consent, stroke survivors were administered: Sociodemographic/clinical questionnaires designed by the authors, modified mini-mental state examination  (to assess degree of cognitive deficits), and modified Rankin scale , (to assess severity of stroke debility). Stroke survivors with severe cognitive deficits or having other chronic and severely debilitating medical conditions were excluded from the study. Stroke survivors were subsequently administered the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) which evaluates, classifies and measures psychopathology and behavior in adults.
The SCAN examination involves comparing the described subjective experience of respondents elicited by the interviewer against glossary description of clinical phenomenon. The elicited phenomena are then used to generate clinical diagnoses as described in the international classifications of diseases, tenth edition (ICD-10) through data imputed into the SCAN algorithm computer software. The SCAN was used in our study to diagnose emotional distress in the form of depression or anxiety disorders in stroke survivors. Finally WHOQOL BREF  questionnaire, a 26-item self-administered instrument that measures health-related quality of life with emphasis on subjective responses in the preceding two weeks was administered to stroke survivors. Controls were however administered: Sociodemographic/clinical questionnaires and the WHO QOL-BREF.
The WHO QOL-BREF consists of six spheres which include two general categories of overall health and health satisfaction and four specific domains of physical, psychological, social, and environmental health. The range of each sphere of QOL is from 0 to 100; poor QOL is indicated by numbers pointing to “0” and high quality is characterized by numbers pointing to “100.” Since scores for each QOL sphere follow a normal distribution, categorization was done around the value of the mean ± 1 standard deviation (SD), with “good” representing values greater than the mean plus one standard deviation (>+1SD); “moderate/fair” representing values equal to the mean plus or minus one standard deviation (=±1SD); and “poor” representing values less than the mean minus one standard deviation (<−1SD).
All data collected were coded and entered into the computer for analysis. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 by SPSS Inc., 233 South Wacker Drive, 11th floor, Chicago, IL. USA. Means, frequencies, and percentages were used to analyze data. Independent t-test was used to test for significance between numerical variables. Chi-square tests were used to test for significance between nominal variables when the minimal expected cell count was 1 and where at least 80% of the cells had expected values of 5 and above. The Fischer's exact test was used when the criteria for Chi-square was not met. A confidence interval of 95% was used which allows for 5% sampling error at significance of ≤0.05.
| Results|| |
[Table 1] shows comparisons of sociodemographic/clinical variables in the study and control respondents. A total of seventy study and seventy control respondents were recruited. The mean age of the study group was 57.43 (±9.67) years while that of the control group was 57.33 (±9.33) years, and the difference was not significant (P = 0.95) indicating adequate age matching. Furthermore, both study and control groups had 38 (54.3%) male respondents and 32 (45.7%) female respondents. Stroke survivors were significantly (P = 0.001) more likely to be unemployed 28 (40.0%) compared to controls 3 (4.2%) and also significantly (P = 0.001) more likely to pay more than ‚Ͷ10,000 a month for healthcare 34 (45.7%) compared to controls 5 (7.1%). Stroke survivors were also more likely to currently consume alcohol 13 (18.6%), have sexual dysfunction 16 (22.9%) and have sensory impairments 60 (85.7%) compared to controls 3 (4.3%), 4 (5.7%), and 7 (10.0%), respectively. The aforementioned differences were statistically significant (P = 0.02, P = 0.001, P = 0.001, respectively).
|Table 1: Sociodemographic/clinical variables in study and control samples|
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[Table 2] shows comparisons of mean QOL scores in the study and control samples. In the study sample, the QOL sphere with the highest mean score was overall health 59.43 (±14.83) similar to control with however a significantly higher (P 0.001) mean score 74.57 (±10.17). The physical health domain had the lowest mean score 50.56 (±12.63) among the QOL spheres in the study sample; however, the environmental health domain had the lowest 54.71 (±9.25) mean scores in the control sample. Comparing mean QOL scores in specific spheres indicates that stroke survivors had significantly lower scores in all categories when compared with control. Overall health, health satisfaction, physical, psychological, and social health domains comparisons, all had P = 0.001 levels of significance. The environmental health domain however showed P = 0.02 level of statistical significance (set level of significance being ≤0.05) when study and control sample mean QOL scores were compared.
[Table 3] shows comparisons of statistically significant sociodemographic variables and QOL grades in stroke survivors. Stroke survivors with poorer overall health QOL grades were significantly more likely to be female 14 (43.8%) and paying more than ‚Ͷ10,000 a month 14 (41.1%) for health care (P = 0.03, P = 0.01, respectively). Stroke survivors with poorer QOL psychological health were significantly (P = 0.02) more likely to be a younger. Furthermore, stroke survivors who were unemployed were significantly more likely to have poorer QOL in the spheres of: Health satisfaction 6 (21.4%), physical health 14 (50.0%), psychological health 9 (32.2%), and social health 4 (14.2%) (P = 0.03, P = 0.001, P = 0.04, P = 0.04, respectively).
|Table 3: Comparison of statistically significant sociodemographic variables and quality of life grades in stroke survivors|
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[Table 4] shows comparisons of statistically significant clinical variables and QOL grades in the study respondents. Stroke survivors with poorer QOL overall health grades were significantly (P = 0.001) more likely to have suffered right hemispheric strokes 17 (47.0%). Stroke survivors with poorer QOL health satisfaction grades were however significantly (P = 0.001) more likely to have comorbidities 7 (13.0%). Furthermore, stroke survivors with poorer QOL psychological health were significantly (P = 0.001) more likely to have suffered more recent strokes of less than a year duration 8 (28.6%). Stroke survivors with poorer QOL social health domain grades were found to significantly (P = 0.03) have sexual dysfunction poststroke 5 (31.3%) as assessed by data from sociodemographic/clinical questionnaires designed by the authors. Finally, stroke survivors with moderate-severe poststroke debility were significantly more likely to have poorer QOL grades in the: Overall health 5 (83.3%), health satisfaction 4 (66.7%), physical health 4 (66.7%), and psychological health 4 (66.7%) spheres (P = 0.001, P = 0.001, P = 0.001, P = 0.001, respectively).
|Table 4: Comparison of statistically significant clinical variables and quality of life grades in stroke survivors|
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[Table 5] shows comparisons of mean QOL scores with diagnoses of depression or anxiety in stroke survivors. Respondents with diagnoses of depression or anxiety disorders had significantly lower mean QOL scores (P = 0.001, P = 0.001, P = 0.001, P = 0.001, P = 0.014, P = 0.024) than those without such disorders across the overall, health satisfaction, physical, psychological, social, and environmental spheres, respectively.
|Table 5: Comparison of mean quality of life scores with diagnoses of depression and anxiety disorders in stroke survivors|
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| Discussion|| |
QOL measures provide a broader description of the impact of illness on various aspects of an individual's life rather than just level of debility. There is a paucity of West African studies on QOL poststroke, but research interest in this area is growing. This study hopes to fill the existing gaps in policy and improve all-round management of stroke survivors where the current emphasis of care is restricted mostly to blood pressure control and rehabilitation through physiotherapy.
In the current study, the mean age of stroke survivors was 57.43 (±9.67) years. This value is similar to the findings of other studies reviewed on stroke survivors in Nigerian tertiary hospitals. The mean ages across studies reviewed ranged from 53 (±14.3) years to 68 (±12) years.,,,,, Recent studies have shown that stroke is occurring increasingly among younger people, particularly in urban areas.,, The aforementioned is probably due to greater tendencies for a more sedentary lifestyle and adoption of diets predisposing them to stroke risk factors such as hypertension and obesity. Stroke was traditionally a condition primarily seen in men, but this gender gap is narrowing. This present study had a male to female ratio of 1.2:1 showing a slight male preponderance. Other studies have shown wider male/female ratio disparity of up to 2:1. Nigerian community household surveys also indicate higher prevalence of stroke in men.,
A greater percentage of stroke survivors were unemployed compared to control. Despite the aforementioned, a significant proportion of stroke survivors paid more monthly for healthcare. The rate of unemployment among stroke survivors (40%) was much higher than the estimated 23.9% unemployment rate in Nigeria. Considering the mean age of stroke survivors in the current study, they were probably still in their productive years and may have been breadwinners of their families. These aforementioned findings agree with Baumann et al., who reported two-third of the respondents being employed before stroke; however, afterward, more than half became unemployed or had to retire with 46% eventually having substantially reduced incomes.
In the study, a higher proportion of stroke survivors consumed alcoholic beverages compared with control, and the difference was statistically significant. This is in agreement with findings of other studies reviewed indicating substantial alcohol use among stroke survivors., These findings suggest alcohol use to still be a significant modifiable risk factor for stroke.
The mean scores in all six QOL spheres were significantly lower in stroke survivors compared with control. This is in agreement with studies reviewed.,, In this study, stroke survivors had higher mean overall health scores compared with other QOL spheres. This is in agreement with Akosile et al. and Owolabi et al., who also found fairly high QOL overall health scores in stroke survivors and both authors also suggested that acquired coping strategies may in the long-term minimize the effect of stroke on this QOL sphere. Wright  found that with time, coping strategies such as enlarging the scope of values contribute positively to the meaning of life with a disability. The QOL physical health domain mean score of stroke survivors was the lowest in this study compared with other QOL spheres. This replicates the findings of Akosile et al. and Owolabi et al., who argued that the physical sphere will probably be the first QOL domain affected by stroke. This is probably due to the sudden and often unexpected nature of stroke producing a sequele of physical debilities more so at the acute phase of the illness.
In the current study, female stroke survivors had significantly poorer QOL overall health grades. This finding is in agreement with other previous studies reviewed.,,,,, Factors such as increased poverty, reduced social support, and increased presence of comorbidities such as depression in women are possible explanations. This finding was however not replicated in other studies reviewed.,,, Jönsson et al. even found better QOL in female stroke survivors. Adjustments in methodology for factors such as prevalence rates for depression, different gender roles in activities of daily living, disparities in income, and social support may be necessary before valid conclusions can be made.
Statistical significance was recorded in the current study suggesting younger stroke survivors were more likely to have poorer QOL psychological domain grades. An increasing number of stroke survivors in Nigeria are getting younger. Owolabi and Ibrahim  in a study found more than a quarter of stroke survivors aged 40 years and below. Although there have been inconsistencies in studies reviewed between age and QOL domain scores, King  found a significant association between younger age at stroke onset and worsening QOL scores in socioeconomic domains of the QOL instrument used. The findings in this current study may not be out of place in that significance was recorded between unemployment and poor QOL psychological domain grade. Younger stroke survivors who should rather be employed (compared with older respondents that may otherwise have retired before stroke) but have been made redundant may be affected more significantly by poor psychological health.
In this study, being unemployed was significantly associated with poorer QOL in health satisfaction, physical, psychological, and social health domain grades. This result is not surprising as unemployment would affect socioeconomic status. In Nigeria where scarcely any social health benefit exists, reduced income subsequent to unemployment poststroke would predictably affect most QOL spheres. This aforementioned finding replicates other studies reviewed,,, where unemployment was also significantly associated with reduced QOL poststroke. Similarly, in the current study, stroke survivors paying more for healthcare were also significantly more likely to have poor overall health grades. This possibly indicates frustrations with out-of-pocket health care payments despite dwindling financial resources.
Right hemispheric strokes were significantly associated with poorer QOL overall health grades in the current study. More than half of the study respondents had right hemispheric strokes with all being right-handed. There have been inconsistencies across studies reviewed regarding lesion lateralization and QOL. Gbiri and Akinpelu.  found significant associations between right hemispheric strokes and poorer QOL. de Haan et al. also found that except for problems in communication resulting in poorer QOL, the QOL of stroke survivors with left sided strokes was better than those with right sided strokes. Neurological deficits such as hemineglect, spatial disorientation, and lack of awareness of illness will probably impacted more negatively on poststroke rehabilitation and hence QOL.
The presence of hypertension and diabetes comorbidity in stroke survivors was significantly associated with poorer health satisfaction grades in the current study. This is despite the fact that stroke survivors with severe cognitive impairments and other chronic debilitating medical conditions were excluded from the study. This finding is however in agreement with Gokkaya et al. and Suenkeler et al., who also reported stroke survivors with multiple comorbidities having poorer QOL. Besides higher degrees of functional impairment associated with multiple comorbidities, other factors such as increased pill load and the inconvenience of keeping multiple clinic appointments may be responsible for the aforementioned findings.
In the current study, stroke survivors interviewed within 12 months poststroke were more likely to have poorer psychological health domain grades. There have been inconsistencies across studies with regard to QOL and poststroke duration; however, some studies reviewed agreed with the aforementioned findings., Gbiri et al. also found QOL in stroke survivors to be low at onset, improve steadily to 6 months and little between 6 and 12 months. Suenkeler et al., however, recorded a gradual deterioration in most QOL domains with time. The aforementioned finding of this current study may indicate peak periods of optimal functional improvement and adoptions of coping strategies reducing the negative impact stroke might have on QOL. More studies need to be done in this regard.
Stroke survivors in the current study with sexual dysfunction were more likely to report poor QOL social domain grades. This finding is in agreement with King, recording significantly low quality of sexual life and satisfaction after stroke. It is worthy of note that the mean age of stroke survivors in the current study is 57 years and a majority were married. Consequent to stroke, survivors may be weary to carry out or request for sex from partners who may also be unwilling to oblige due to fears of precipitating another stroke in their spouses.
In the current study, stroke survivors with higher degrees of functional disability had significantly poorer QOL grades across most spheres, except the environmental and social health QOL domains. A great number of studies reviewed found independent significant associations between degree of functional impairment and worsening QOL.,,,,,, Studies by Samsa and Matchar  and Lai et al. however found only weak or no relationship, respectively, between functional disability and QOL after stroke. The findings of these two aforementioned studies may indicate that heterogeneous factors rather than just only worse levels of functional disability negatively affect QOL post stroke. Further research is warranted.
Psychiatric morbidity is a recognized cofounder in QOL measures among persons with chronic disorders such as stroke. In the current study, the presence of depression and anxiety disorders was associated with significantly lower mean scores and poorer grades in all QOL spheres. These findings replicate most of the studies reviewed indicating the presence of depression of any severity as being independent predictors of poor QOL in stroke survivors.,,,,,,, There is a paucity of studies that looked at associations between poststroke anxiety and QOL from our review. Tang et al. however found that anxiety had a negative effect on the QOL of stroke survivors independent of depression.
The cross-sectional design of the study limits inferences that can be made about the trajectory of variables measured in stroke survivors over time. However, its comparative case/control design enables measured inferences to be made. The wide range of stroke durations at interview and the exclusion of stroke survivors with more severe cognitive impairments and other severe comorbidities may affect generalizability of findings. This is however pragmatic due to the nature of diagnostic instruments administered. This aforementioned design also excludes the use of proxy responses to questionnaires. A stroke-specific QOL measure might have been used rather than a generic measure, but this would have made QOL comparisons between study and control samples problematic. The small sample recruited and the hospital-based nature of the study also limits generalizations inferable from the study.
| Conclusion|| |
Our study found that stroke survivors were significantly more likely to have economic challenges of unemployment and higher health care costs compared with control. We also found that alcohol use was still a significant risk factor towards developing stroke. These findings we hope will help governments particularly in developing countries improve social schemes to reduce out of pocket healthcare payment and improve health care promotion particularly on the dangers of heavy alcohol consumption by at risk groups for stroke. Our study also found that stroke survivors had significantly poorer QOL compared to control. Furthermore our study found that certain clinico-demographic factors including the presence of emotional disorders in the form anxiety and depression were significant identifiable association for poor QOL post stroke. Hence healthcare professionals should note that detection of these risk factors should be an integral part of post stroke management for better clinical outcomes.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Komolafe MA, Komolafe EO, Fatoye F, Adetiloye V, Asaleye C, Famurewa O, et al
. Profile of stroke in Nigerians: A prospective clinical study. Afr J Neurol Sci 2007;26:5-13.
Amu E, Ogunrin O, Danesi M. Appraisal of risk factors for stroke in Nigerian Africans. A prospective case-control study. Afr J Neurol Sci 2005;24:20-7.
Desalu OO, Wahab KW, Fawale B, Olarenwaju TO, Busari OA, Adekoya AO, et al.
A review of stroke admissions at a tertiary hospital in rural Southwestern Nigeria. Ann Afr Med 2011;10:80-5.
The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med 1995;41:1403-9.
Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993;118:622-9.
Rand D, Eng JJ, Tang PF, Hung C, Jeng JS. Daily physical activity and its contribution to the health-related quality of life of ambulatory individuals with chronic stroke. Health Qual Life Outcomes 2010;8:80.
Abubakar SA, Isezuo SA. Health related quality of life of stroke survivors: Experience of a stroke unit. Int J Biomed Sci 2012;8:183-7.
Buck D, Jacoby A, Massey A, Ford G. Evaluation of measures used to assess quality of life after stroke. Stroke 2000;31:2004-10.
Carod-Artal J, Egido JA, González JL, Varela de Seijas E. Quality of life among stroke survivors evaluated 1 year after stroke: Experience of a stroke unit. Stroke 2000;31:2995-3000.
Akosile CO, Adegoke B, Ezeife CA, Maruf FA, Ibikunle PO, Johnson OE, et al
. Quality of life and sex differences in a South-eastern Nigerian stroke sample. J Neurol Sci 2013;32:19-25.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957;2:200-15.
Farrell B, Godwin J, Richards S, Warlow C. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: Final results. J Neurol Neurosurg Psychiatry 1991;54:1044-54.
Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, et al.
SCAN. Schedules for clinical assessment in neuropsychiatry. Arch Gen Psychiatry 1990;47:589-93.
WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): Development and general psychometric properties. J Soc Sci Med 1998;46:1569-83.
The World Health Organization (WHO). Programme on Mental Health: WHOQOL User Manual. Ch. 1211. Geneva 27, Switzerland: WHO; 2004.
Olusina AK, Ohaeri JU. Subjective quality of life of recently discharged Nigerian psychiatric patients. Soc Psychiatry Psychiatr Epidemiol 2003;38:707-14.
SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago, Illinois. USA.
Cochran WG. Some methods of strengthening the common x2 tests. Biometrics 1954;10:417-51.
Mehta CR, Patel NR. IBM SPSS exact tests, IBM Corporation, Cambridge, MA, USA 2011.
Abubakar S, Sabir A. Profile of stroke seen in seen in a tertiary health centre in Nigeria. Ann Niger Med 2013;7:55-9.
Alkali NH, Bwala SA, Akano AO, Osi-Ogbu O, Alabi P, Ayeni OA. Stroke risk factors, subtypes, and 30-day case fatality in Abuja, Nigeria. Niger Med J 2013;54:129-35.
Ezeala-Adikaibe B, Onwuekwe I, Ekenze O, Madubuko K, Ofoegbu E. Stroke risk factor profile in Nigerian African women. Int J Neurol 2009;13:142-8.
Imam I, Olorunfemi G. The profile of stroke in Nigeria's federal capital territory. Trop Doct 2002;32:209-12.
Karaye KM, Nashabaru I, Fika GM, Ibrahim DA, Maiyaki BM, Ishaq NA, et al.
Prevalence of traditional cardiovascular risk factors among Nigerians with stroke. Cardiovasc J Afr 2007;18:290-4.
Owolabi LF, Shehu MY, Shehu MN, Fadare J. Pattern of neurological admissions in the tropics: Experience at Kano, Northwestern Nigeria. Ann Indian Acad Neurol 2010;13:167-70.
Danesi M, Okubadejo N, Ojini F. Prevalence of stroke in an urban, mixed-income community in Lagos, Nigeria. Neuroepidemiology 2007;28:216-23.
Onwuchekwa AC, Tobin-West C, Babatunde S. Prevalence and risk factors for stroke in an adult population in a rural community in the Niger Delta, South-south Nigeria. J Stroke Cerebrovasc Dis 2014;23:505-10.
National Bureau of Statistics; 2011. Available from: http//www.nigerianstat.gov.ng. [Last accessed on 2015 Oct 18].
Baumann M, Le Bihan E, Chau K, Nearkasen C. Association between quality of life and socioeconomic factors, functional impairments and dissatisfaction with received information and home-care services among survivors living at home two years after stroke onset. Biomed Cent J 2014;14:92.
Akinpelu AO, Gbiri CA. Quality of life of stroke survivors and apparently healthy individuals in South-western Nigeria. Physiother Theory Pract 2009;25:14-20.
Gokkaya NK, Aras MD, Cakci A. Health-related quality of life of Turkish stroke survivors. Int J Rehabil Res 2005;28:229-35.
Owolabi MO. Impact of stroke on health-related quality of life in diverse cultures: The Berlin-Ibadan multicenter international study. Health Qual Life Outcomes 2011;9:81.
Owolabi MO, Ugoya S, Platz T. Racial disparity in stroke risk factors: The Berlin-Ibadan experience; a retrospective study. Acta Neurol Scand 2009;119:81-7.
Wright BA. Physical Disability: A Psychological Approach. New York: Harper and Row; 1960.
Kapral MK, Fang J, Hill MD, Silver F, Richards J, Jaigobin C, et al.
Sex differences in stroke care and outcomes: Results from the Registry of the Canadian Stroke Network. Stroke 2005;36:809-14.
Sturm JW, Donnan GA, Dewey HM, MacDonnell RA, Gilligan AK, Thrift AG, et al
. Quality of life after stroke: The North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2004;35:2340-5.
Kwok T, Lo RS, Wong E, Wai-Kwong T, Mok V, Kai-Sing W. Quality of life of stroke survivors: A 1-year follow-up study. Arch Phys Med Rehabil 2006;87:1177-82.
Gargano JW, Reeves MJ; Paul Coverdell National Acute Stroke Registry Michigan Prototype Investigators. Sex differences in stroke recovery and stroke-specific quality of life: Results from a statewide stroke registry. Stroke 2007;38:2541-8.
Enato EF, Yovwin EO, Ogunrin OA. Assessment of health related quality of life in stroke survivors attending two healthcare facilities in Benin City, Nigeria. J Pharm Bioresources 2011;2:1.
Gurcay E, Bal A, Cakci A. Health-related quality of life in first-ever stroke patients. Ann Saudi Med 2009;29:36-40.
Rønning OM, Stavem K. Determinants of change in quality of life from 1 to 6 months following acute stroke. Cerebrovasc Dis 2008;25:67-73.
Jönsson AC, Lindgren I, Hallström B, Norrving B, Lindgren A. Determinants of quality of life in stroke survivors and their informal caregivers. Stroke 2005;36:803-8.
Owolabi LF, Ibrahim A. Stroke in young adults: A prospective study from northwestern Nigeria. ISRN Neurol 2012;2012:468706.
King RB. Quality of life after stroke. Stroke 1996;27:1467-72.
Gbiri CA, Akinpelu AO. Quality of life in Nigerian stroke survivors during the first 12 months post stroke. Hong Kong Physiother J 2012;30:18-24.
de Haan EH, Nys GM, Van Zandvoort MJ. Cognitive function following stroke and vascular cognitive impairment. Curr Opin Neurol 2006;19:559-64.
Suenkeler IH, Nowak M, Misselwitz B, Kugler C, Schreiber W, Oertel WH, et al.
Timecourse of health-related quality of life as determined 3, 6 and 12 months after stroke. Relationship to neurological deficit, disability and depression. J Neurol 2002;249:1160-7.
Hamzat TK, Peters GO. Motor function recovery and quality of life among stroke survivors in Ibadan, Nigeria. A 6-month follow-up study. Eur J Phys Rehabil Med 2009;45:179-83.
Kauhanen ML, Korpelainen JT, Hiltunen P, Nieminen P, Sotaniemi KA, Myllylä VV. Domains and determinants of quality of life after stroke caused by brain infarction. Arch Phys Med Rehabil 2000;81:1541-6.
Owolabi MO, Ogunniyi A. Profile of health-related quality of life in Nigerian stroke survivors. Eur J Neurol 2009;16:54-62.
Samsa GP, Matchar DB. How strong is the relationship between functional status and quality of life among persons with stroke? J Rehabil Res Dev 2004;41:279-82.
Lai SM, Studenski S, Duncan PW, Perera S. Persisting consequences of stroke measured by the Stroke Impact Scale. Stroke 2002;33:1840-4.
Katschnig H. Quality of life in mental disorders: Challenges for research and clinical practice. World Psychiatry 2006;5:139-45.
Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Impact of anxiety on health-related quality of life after stroke: A cross-sectional study. Arch Phys Med Rehabil 2013;94:2535-41.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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| ||International Archives of Health Sciences. 2021; 8(4): 290 |
|[Pubmed] | [DOI]|
||Impact of post-stroke disability and disability-perception on health-related quality of life of stroke survivors: the moderating effect of disability-severity
| ||Olufemi O. Oyewole,Michael O. Ogunlana,Caleb A. O. Gbiri,Kolawole S. Oritogun,Bamidele S. Osalusi |
| ||Neurological Research. 2020; : 1 |
|[Pubmed] | [DOI]|
||Frequency of anxiety after stroke: An updated systematic review and meta-analysis of observational studies
| ||Peter Knapp,Alexander Dunn-Roberts,Nimah Sahib,Liz Cook,Felicity Astin,Eirini Kontou,Shirley A Thomas |
| ||International Journal of Stroke. 2020; 15(3): 244 |
|[Pubmed] | [DOI]|
||Factors associated with health related quality of life of patients with stroke in Sri Lankan context
| ||Pramudika Nirmani Kariyawasam,Kithsiri Dedduwa Pathirana,Don Chandana Hewage |
| ||Health and Quality of Life Outcomes. 2020; 18(1) |
|[Pubmed] | [DOI]|
||Predictors of caregiver burden after stroke in Nigeria: Effect on psychosocial well-being
| ||OsunwaleDahunsi Oni,AndrewToyin Olagunju,ChristopherIzehinosen Okpataku,AdebayoRasheed Erinfolami,JosephDada Adeyemi |
| ||Indian Journal of Psychiatry. 2019; 61(5): 457 |
|[Pubmed] | [DOI]|
||Post-stroke depression: Prevalence, associated factors and impact on quality of life among outpatients in a Nigerian hospital
| ||Osunwale D. Oni,Andrew T. Olagunju,Victor O. Olisah,Olatunji F. Aina,Francis I. Ojini |
| ||South African Journal of Psychiatry. 2018; 24(0) |
|[Pubmed] | [DOI]|