Top

BMC Neurology

Published in:

Open Access 01-12-2020 | Stroke | Research article

Self-rated health over the first five years after stroke

Authors: Kerstin Bjälkefur, Salmir Nasic, Eric Bertholds, Katarina Jood, Åsa Rejnö

Published in: BMC Neurology | Issue 1/2020

Abstract

Background

Self-rated health (SRH) focuses on the patient’s own perception, and represents an important patient-reported outcome. The aim was to investigate SRH one to 5 years after stroke, follow the development over time and search for factors associated with SRH.

Methods

Consecutive stroke patients admitted to Stroke Units at the Skaraborg Hospital, Sweden were included 2007–2009 (n = 2190). Patient-reported outcomes were collected annually over 5 years using a postal questionnaire. SRH was assessed by the question about general health from SF-36. Factors associated with SRH were investigated by multiple logistic regression analysis.

Results

Response-rate was > 90% at all time points. Overall, 40.2, 41.9, 40.7, 45.0 and 46.3% of the patients reported good SRH, 1 to 5 years after stroke. Performance in activities of daily living (ADL) was strongly associated with good SRH; 49.8 and 14.7% after 1 year in independent and dependent survivors respectively, p < 0.001. In independent survivors 1 year after stroke, good SRH was positively associated with female sex (OR = 2.0; p = < 0,001), physical activity (OR = 2.14; p = < 0,001), car driving (OR = 2.25; p = < 0,001), and negatively associated with age (OR = 0.99; p = < 0,001), pain (OR = 0.49; p = < 0,001), depression (OR = 0.30; p = < 0,001), and self-perceived unmet care needs (OR = 0.39; p = < 0,001). In dependent survivors, depression (OR = 0.23; p = < 0,001) and age (OR = 0.96; p = < 0,05), were negatively associated with good SRH 1 year after stroke. Similar patterns were observed throughout the follow-up.

Conclusion

The proportion stroke survivors reporting their health as good is slightly increasing over time. After stroke, SRH is associated with pain, depression, ability to perform activities and self-perceived unmet care needs, indicating that efforts to support stroke survivors in the chronic phase after stroke should concentrate on targeting these factors.

Available only for authorised users

Sullivan M, Karlsson J, Ware JE Jr. The Swedish SF-36 Health Survey--I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med. 1995;41(10):1349–58.CrossRef

Hillen T, Davies S, Rudd AG, Kieselbach T, Wolfe CD. Self ratings of health predict functional outcome and recurrence free survival after stroke. J Epidemiol Community Health. 2003;57(12):960–6. https://doi.org/10.1136/jech.57.12.960.CrossRefPubMedPubMedCentral

Hackett ML, Duncan JR, Anderson CS, Broad JB, Bonita R. Health-related quality of life among long-term survivors of stroke: results from the Auckland stroke study, 1991–1992. Stroke. 2000;31(2):440–7. https://doi.org/10.1161/01.str.31.2.440.CrossRefPubMed

Anderson C, Laubscher S, Burns R. Validation of the short form 36 (SF-36) health survey questionnaire among stroke patients. Stroke. 1996;27(10):1812–6.CrossRef

Mavaddat N, Sadler E, Lim L, Williams K, Warburton E, Kinmonth AL, et al. Perceptions of self-rated health among stroke survivors: a qualitative study in the United Kingdom. BMC Geriatrics. 2018;18(1):81. https://doi.org/10.1186/s12877-018-0765-8.CrossRefPubMedPubMedCentral

WHO. WHOQOL: Measuring Quality of Life. https://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/ (2020). Accessed 29 Aug 2020.

Skåner Y, Nilsson GH, Sundquist K, Hassler E, Krakau I. Self-rated health, symptoms of depression and general symptoms at 3 and 12 months after a first-ever stroke: a municipality-based study in Sweden. BMC Fam Pract. 2007;8:61. https://doi.org/10.1186/1471-2296-8-61.CrossRefPubMedPubMedCentral

Mavaddat N, Van der Linde R, Savva GM, Brayne C, Mant J. What determines the self-rated health of older individuals with stroke compared to other older individuals? A cross-sectional analysis of the Medical Research Council Cognitive Function and Aging Study. BMC Geriatrics. 2013;13:85. https://doi.org/10.1186/1471-2318-13-85.CrossRefPubMedPubMedCentral

Johansson SE, Midlov P, Sundquist J, Sundquist K, Calling S. Longitudinal trends in good self-rated health: effects of age and birth cohort in a 25-year follow-up study in Sweden. Int J Public Health. 2015;60(3):363–73. https://doi.org/10.1007/s00038-015-0658-y.CrossRefPubMed

10.

Af Sillén U, Nilsson J-Å, Månsson N-O, Nilsson PM. Self-rated health in relation to age and gender: influence on mortality risk in the Malmö preventive project. Scand J Public Health. 2005;33(3):183–9. https://doi.org/10.1080/14034940410019235.CrossRefPubMed

11.

Sundquist J, Johansson SE. Self reported poor health and low educational level predictors for mortality: a population based follow up study of 39,156 people in Sweden. J Epidemiol Community Health. 1997;51(1):35–40.CrossRef

12.

Araújo ÉF, Viana RT, Teixeira-Salmela LF, Lima LAO, CDCdM F. Self-rated health after stroke: a systematic review of the literature. BMC Neurol. 2019;19(1):221. https://doi.org/10.1186/s12883-019-1448-6.CrossRefPubMedPubMedCentral

13.

Jönsson A-C, Delavaran H, Iwarsson S, Ståhl A, Norrving B, Lindgren A. Functional status and patient-reported outcome 10 years after stroke: the Lund stroke register. Stroke. 2014;45(6):1784–90. https://doi.org/10.1161/strokeaha.114.005164.CrossRefPubMed

14.

Tuomilehto J, Nuottimäki T, Salmi K, Aho K, Kotila M, Sarti C, et al. Psychosocial and health status in stroke survivors after 14 years. Stroke. 1995;26(6):971–5. https://doi.org/10.1161/01.STR.26.6.971.CrossRefPubMed

15.

Riksstroke: Stroke and TIA. The Riksstroke Annual Report 2013. TIA, acute stroke and 3 month follow-up after stroke. [Stroke och TIA. Riksstrokes årsrapport 2013. TIA, Akut stroke, 3 månadersuppföljning efter stroke]. In: Riksstroke; 2014: 166.

16.

Rejnö Å, Nasic S, Bjälkefur K, Bertholds E, Jood K. Changes in functional outcome over five years after stroke. Brain Behav. 2019;9(6):e01300. https://doi.org/10.1002/brb3.1300.CrossRefPubMedPubMedCentral

17.

Who Monica Project Principal Investigators. The World Health Organization Monica project (Monitoring trends and determinants in cardiovascular disease): A major international collaboration. J Clin Epidemiol. 1988;41(2):105–14. https://doi.org/10.1016/0895-4356(88)90084-4.CrossRef

18.

Delpont B, Blanc C, Osseby GV, Hervieu-Begue M, Giroud M, Bejot Y. Pain after stroke: a review. Rev Neurol (Paris). 2018;174(10):671–4. https://doi.org/10.1016/j.neurol.2017.11.011.CrossRef

19.

Sperlich S, Tetzlaff J, Geyer S. Trends in good self-rated health in Germany between 1995 and 2014: do age and gender matter? Int J Public Health. 2019;64(6):921–33. https://doi.org/10.1007/s00038-019-01235-y.CrossRefPubMed

20.

Larsen LP, Johnsen SP, Andersen G, Hjollund NH. Determinants of self-rated health three months after stroke. J Stroke Cerebrovasc Dis. 2016;25(5):1027–34. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.12.014.CrossRefPubMed

21.

Löfmark U. Stroke with a focus on the elderly : From a gender and socioeconomic perspective, vol. 57. Umeå: Umeå University, Family Medicine, Department of Public Health and Clinical Medicine; 2007.

22.

Norlander A. Activity and participation long term after stroke, vol. 71. Lund: Lund University, Faculty of Medicine; 2019.

23.

Olaiya MT, Cadilhac DA, Kim J, Nelson MR, Srikanth VK, Andrew NE, et al. Long-term unmet needs and associated factors in stroke or TIA survivors. Neurology. 2017;89(1):68–75. https://doi.org/10.1212/wnl.0000000000004063.CrossRefPubMed

24.

McKevitt C, Fudge N, Redfern J, Sheldenkar A, Crichton S, Rudd AR, et al. Self-reported long-term needs after stroke. Stroke. 2011;42(5):1398–403. https://doi.org/10.1161/STROKEAHA.110.598839.CrossRefPubMed

25.

The National Board of Health and Welfare. National guidelines for stroke care. Support for governance and management. [Nationella riktlinjer för vård vid stroke. Stöd för styrning och ledning]. Stockholm: National Board of Health and Welfare; 2018. p. 116.

26.

World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4. https://doi.org/10.1001/jama.2013.281053.CrossRef

Title: Self-rated health over the first five years after stroke
Authors: Kerstin Bjälkefur
Salmir Nasic
Eric Bertholds
Katarina Jood
Åsa Rejnö
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Stroke
Care
Published in: BMC Neurology / Issue 1/2020
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-020-01956-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Self-rated health over the first five years after stroke

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Paroxysmal extreme pain disorder in family with c.3892G > T (p.Val1298Phe) in the SCN9A gene mutation – case report

Patients with mild traumatic brain injury and acute neck pain at the emergency department are a distinct category within the mTBI spectrum: a prospective multicentre cohort study

A rare case of anti-LGI1 limbic encephalitis with concomitant positive NMDAR antibodies

Non breathing-related sleep fragmentation and imaging markers in patients with atherosclerotic cerebral small vessel disease (CSVD): a cross-sectional case-control study

Neuroimaging pattern and pathophysiology of cerebellar stroke-like lesions in MELAS with m.3243A>G mutation: a case report

Unruptured aneurysmal clipping complicated by delayed and refractory vasospasm: case report