J Korean Acad Nurs.  2010 Aug;40(4):533-541. 10.4040/jkan.2010.40.4.533.

Structural Equation Modeling on Quality of Life in Stroke Survivors

• Suh M
• Choi-Kwon

• KMID: 1073075
• DOI: http://doi.org/10.4040/jkan.2010.40.4.533

Abstract

PURPOSE
This study was designed to test structural equation modeling of the quality of life of stroke survivors in order to provide guidelines for development of interventions and strategies to improve their quality of life.
METHODS
The participants in the study were patients who visited the neurology outpatient department of a tertiary hospital in Seoul between June 25 and October 15, 2009. Data collection was carried out through one-on-one interviews. Demographic factors, functional independence, social support, nutritional status, post-stroke biobehavioral changes and quality of life were investigated.
RESULTS
The final analysis included 215 patients. Fitness of the hypothetical model was appropriate (chi-square=111.5, p=.000, GFI=.926, AGFI=.880, RMSA=.068, NFI=.911, CFI=.953). Functional dependency, social support and post-stroke biobehavioral changes were found to be significant explaining variance in quality of life. Post-stroke biobehavioral changes had the strongest direct influence on quality of life. Nutritional status had an indirect effect on the quality of life.
CONCLUSION
To improve the quality of life of stroke survivors, comprehensive interventions are necessary to manage post-stroke biobehavioral changes, and strengthening social support networks that can contribute to enhancing the quality of life of stroke survivors.

Keyword

Stroke; Quality of life; Depression; Nutritional status; Social support

MeSH Terms

Aged
Demography
Depression
Fatigue
Female
Humans
Interviews as Topic
Male
Middle Aged
*Models, Psychological
Nutritional Status
Pain
*Quality of Life
Sleep Deprivation
Social Support
Stroke/*psychology
*Survivors

Figure

• 

  Figure 1 Research framework.

• 

  Figure 2 Path diagram for the hypothetical model. *p<.05; **p<.01. X1=Age; X2=Level of education; X3=Economical status; X4=Functional dependency; X5=Instrumental support; X6=Emotional support; X7=Structural support; Y1=Nutritional status; Y2=Depression; Y3=Fatigue; Y4=Quality of sleep; Y5=Post-stroke pain; Y6=Quality of life.

Reference

1. Alves de Rezende CH, Coelho LM, Oliveira LM, Penha SN. Dependence of the geriatric depression scores on age, nutritional status, and haematologic variables in elderly institutionalized patients. The Journal of Nutrition, Health & Aging. 2009. 13:617–621.

2. Carod-Artal FJ, Egido JA. Quality of life after stroke: The importance of a good recovery. Cerebrovascular Disease. 2009. 27:204–214.

3. Carod-Artal FJ, Ferreira Coral L, Trizotto DS, Menezes Moreira C. Poststroke depression: Prevalence and determinants in Brazilian stroke patients. Cerebrovascular Disease. 2009. 28:157–165.

4. Carod-Artal J, Egido A, González L, Varela de Seijas E. Quality of life among stroke survivors evaluated 1 year after stroke. Stroke. 2000. 31:2995–3000.

5. Chang S, Park Y, Youn J. Study on relations of variables-attributions of somatic symptoms, fatigue, chronic pain and depression in the elderly. Journal of Korean Academy of Nursing. 2003. 33:26–33.

6. Choi-Kwon S, Choi J, Kwon S, Kang D, Kim J. Factors that affect the quality of life at 3 year post-stroke. Journal of Clinical Neurology. 2006. 2:34–41.

7. Choi-Kwon S, Han S, Kwon S, Kim J. Poststroke fatigue: Characteristics and related factors. Cerebrovascular Disease. 2005. 19:84–90.

8. Choi-Kwon S, Kim H, Kwon S, Kim J. Factors affecting the burden on caregivers of stroke survivors in South Korea. Archives of Physical Medicine and Rehabilitation. 2005. 86:1043–1048.

9. Gonzales R. Central pain: Diagnosis and treatment strategies. Neurology. 1995. 45:12 Suppl 9. S11–S16.

10. Guigoz Y, Vellas B, Garry P. Assessing the nutritional status of the elderly: The mini nutritional assessment as part of the geriatric evaluation. Nutrition reviews. 1996. 54:S59–S65.

11. Kim E, Lee J. Factors influencing health-related quality of life in elderly who visited a senior center: With activity of daily living, quality of sleep and depression. Journal of the Korean Gerontological Society. 2009. 29:425–440.

12. Kim H, Park Y. A study on life style, functional condition, depression and perceived health status of stroke patient at home. Journal of the Korean Public Health Association. 2003. 29:127–139.

13. Kim I, Seo M, Kim K, Cho N. The Relationship between the characteristics of social support and post-stroke depression. Korean Journal of Rehabilitation Nursing. 1999. 2:206–214.

14. Kim J. Post-stroke depression, anxiety, emotional incontinence, anger proness and fatigue. Journal of the Korean Neurological Association. 2005. 23:1–8.

15. Kim J, Choi-Kwon S. Poststroke depression and emotional incontinence: Correlation with lesion location. Neurology. 2000. 54:1805–1810.

16. Kim J, Kang H, Kim W, Wang M, Chang C. Factors affecting the quality of life in stroke patient at home. Korean Journal of Rehabilitation Nursing. 2006. 9:49–55.

17. Klit H, Finnerup N, Jensen T. Central post-stroke pain: Clinical characteristics, pathophysiology, and management. Lancet Neurology. 2009. 8:857–868.

18. Kohatsu W. Nutrition and depression. Explore. 2005. 1:474–476.

19. Lee H. Adjustment of middle-aged people with hemiplegia after stroke. 2006. Seoul: Seoul National University;Unpublished doctoral dissertation.

20. Lee H, Lim J. Structural equation modeling and AMOS 16.0. 2009. Seoul: Bupmoonsa.

21. Lee M, Choh A, Demerath E, Knutson K, Duren D, Sherwood R, et al. Sleep disturbance in relation to health-related quality of life in adults: The Fels Longitudinal Study. The Journal of Nutrition, Health & Aging. 2009. 13:576–583.

22. Lee S, Chung H. Brain neurologic disorder and depression in elderly. Journal of Korean Geriatric Psychiatry. 2003. 7:131–142.

23. Leppavuori A, Pohjasvaara T, Kaste M, Erkinjuntti T. Insomnia in ischemic stroke patients. Cerebrovascular Disease. 2002. 14:90–97.

24. Lim S. Structural model for quality of life in stroke patients. 2002. Seoul: Kyung Hee University;Unpublished doctoral dissertation.

25. Mitchell P, Powell L, Blumenthal J, Norten J, Ironson G, Pitula C, et al. A short social support measure for patients recovering from myocardial infarction: The ENRICHD Social Support Inventory. Journal of Cardiopulmonary Rehabilitation. 2003. 23:398–403.

26. Park J, Kwon Y. Standardization of Korean version of Mini-Mental State Examination. Journal of Neuropsychiatry Association. 1989. 28:508–513.

27. Skilbeck C, Wade D, Hewer R, Wood V. Recovery after stroke. Journal of Neurology, Neurosurgery, and Psychiatry. 1983. 46:5–8.

28. Snyder-Halpern R, Verran J. Instrumentation to describe subjective sleep characteristics in healthy subjects. Research in Nursing & Health. 1987. 10:155–163.

29. So W, Marsh G, Ling W, Leung F, Lo J, Yeung M, et al. The symptom cluster of fatigue, pain, anxiety and depression and the effect on the quality of life of women receiving treatment for breast cancer: A multicenter study. Oncology Nursing Forum. 2009. 36:E205–E214.

30. Staub F, Bogousslavsky S. Post-stroke depression or fatigue? European Neurology. 2001. 45:3–5.

31. Sterr A, Herron K, Dijk D, Ellis J. Time to wake-up: Sleep problems and daytime sleepiness in long-term stroke survivors. Brain Injury. 2008. 22:575–579.

32. Suh M, Choi-Kwon S. Sleep-wake disturbance in post-stroke patients. Journal of Korean Biological Nursing Science. 2009. 11:23–31.

33. UNC Biobehavioral laboratory. 2008. School of Nursing. University of North Carolina;from http://nursing.unc.edu/departments/research/bbl/index.html.

34. Van de Port I, Kwakkel G, Schepers V, Heinemans C, Lindeman E. Is fatigue an independent factor associated with activities of daily living, instrumental activities of daily living and health-related quality of life in chronic stroke? Cerebrovascular Disease. 2007. 23:40–45.

35. Whyte E, Mulsant B. Post stroke depression: Epidemiology, pathophysiology and biological treatment. Biological psychiatry. 2002. 52:253–264.

36. Williams L, Weinberger M, Harris L, Clark D, Biller J. Development of a stroke-specific quality of life scale. Stroke. 1999. 30:1362–1369.

37. Winward C, Sackley C, Metha Z, Rothwell P. A population-based study of the prevalence of fatigue after transient ischemic attack and minor stroke. Stroke. 2009. 40:757–761.