Quality of life and positive person-centred rehabilitation.

Quality of life (QoL) assessment is important when monitoring over time the recovery of survivors living at home, two years after stroke onset. The associations between Newcastle Stroke-Specific Quality of life (newsqol) domains, socioeconomic factors and satisfaction with information and home-care services were analysed. This problem remains partially addressed though positive and optimal supports may improve post-stroke’ quality of life.
Methods. Stroke-survivors admitted to all hospitals in Luxembourg 18 months or more previously were identified using the only care-expenditure-reimbursement national system database. The clinical diagnosis was confirmed. Ninety four patients aged 65 years and living at home were interviewed to gather socioeconomic characteristics and satisfaction with information and home-care services, and newsqol assessing 11 scores. Data were analyzed using multiple linear sex-age-adjusted regression models.
Results. About 50% of patients had low education and lower income. Functional impairments were common: sensory (45%), motor (35%), memory (32%), language (31%), and vision (20%). Patients with education (<12th grade) or lower income had low values for most newsqol domains. In opposite, patients who were working had better values for pain, mental feelings and sleep domains than did retired people. The self-rate quality of life was markedly low, especially for the domains of interpersonal relationship, sleep, cognition, mental feelings, and pain. Patients who were dissatisfied with information and home-care received had rather low values for several newsqol domains. Dissatisfaction with accuracy of information received, information about stroke and its consequences/change over time; help received, lack of coordination between services, and possibility of receiving help when necessary were related with low values for most domains. Dissatisfaction with the possibility of receiving help was also associated with mobility and self-care. Dissatisfaction with information about consequences/change over time of stroke linked with the vision domain. Dissatisfaction with information received about help correlated with mental feelings, interpersonal relationships, emotion, and fatigue. Being confident about where to get information about stroke, looking after someone who has had a stroke if needed, or about financial help, and being confident about who to contact from community services if needed were slightly associated with communication, mental feelings and interpersonal relationships only.
Conclusions. Post-stroke patients had major alterations in quality of life that reflected depressive symptoms, which should be appropriately treated. Our results further raise the question concerning the needs and satisfaction of stroke-survivors living at home in terms of information and care services as well as interactions with social and medical carers according to recovery stage and possible relapse over time. The changing nature of needs at different stages of recovery may not be paid sufficient attention. A telephone service could help. Use of IT technology has been proposed to promote positive person-centred rehabilitation. It has been shown, with Telestroke, that videoconference calls can help to reduce stress, provide reassurance about the secondary effects of treatment, improve compliance with prescriptions, and yield valuable information about services.