Abstract
The aims were to follow stroke patients over time with respect to general pain, shoulder pain, weight loss, and health related quality of life (HRQOL), the latter also in stroke survivors' informal caregivers.
Methods
During a 1 year period, 416 first-ever stroke patients were included in the population based Lund Stroke Register; 327 survivors were followed up after four months and 305 one year later. Baseline assessments included weight, height (to calculate Body Mass Index), functional status (NIH Stroke Scale), plasma/serum albumin, prealbumin, and glycosylated hemoglobin (HbA1c). After four months, assessments included functional status (Barthel Index), HRQOL (SF-36), pain (visual analogue scale [VAS]), shoulder pain (clinical examinations and questionnaires), weight, albumin, and prealbumin. One year later the same parameters were examined, with addition of geriatric depression scale (GDS-20), and HbA1c.
Results
Patients' physical function deteriorated over time, but they improved in socio-emotional and mental domains of HRQOL. Surprisingly, caregivers had lower scores than patients in emotional and mental domains, indicating strain. In patients, depression was the most important determinant of HRQOL. Although prevalence of pain decreased over time, after 16 months a fifth had moderate-severe pain; across the entire study period one third experienced moderate to severe pain. Almost one third of patients developed shoulder pain, which mostly was moderate to severe and restricted daily life activities. Impaired arm motor function and low general status were the major determinants for shoulder pain. Weight loss >3 kg was found in a quarter of the patients at both follow-ups and appeared to be a marker of malnutrition. Major risk factors of weight loss >3 kg were eating difficulties, haemorrhagic stroke, low social participation, and low prealbumin.
Conclusions
Stroke patients need enhanced attention in post acute care regarding nutritional status, pain, and depression. An intervention program towards patients and their informal caregivers would have a potential to improve their life after stroke.
Methods
During a 1 year period, 416 first-ever stroke patients were included in the population based Lund Stroke Register; 327 survivors were followed up after four months and 305 one year later. Baseline assessments included weight, height (to calculate Body Mass Index), functional status (NIH Stroke Scale), plasma/serum albumin, prealbumin, and glycosylated hemoglobin (HbA1c). After four months, assessments included functional status (Barthel Index), HRQOL (SF-36), pain (visual analogue scale [VAS]), shoulder pain (clinical examinations and questionnaires), weight, albumin, and prealbumin. One year later the same parameters were examined, with addition of geriatric depression scale (GDS-20), and HbA1c.
Results
Patients' physical function deteriorated over time, but they improved in socio-emotional and mental domains of HRQOL. Surprisingly, caregivers had lower scores than patients in emotional and mental domains, indicating strain. In patients, depression was the most important determinant of HRQOL. Although prevalence of pain decreased over time, after 16 months a fifth had moderate-severe pain; across the entire study period one third experienced moderate to severe pain. Almost one third of patients developed shoulder pain, which mostly was moderate to severe and restricted daily life activities. Impaired arm motor function and low general status were the major determinants for shoulder pain. Weight loss >3 kg was found in a quarter of the patients at both follow-ups and appeared to be a marker of malnutrition. Major risk factors of weight loss >3 kg were eating difficulties, haemorrhagic stroke, low social participation, and low prealbumin.
Conclusions
Stroke patients need enhanced attention in post acute care regarding nutritional status, pain, and depression. An intervention program towards patients and their informal caregivers would have a potential to improve their life after stroke.
| Original language | English |
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| Qualification | Doctor |
| Awarding Institution |
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| Supervisors/Advisors |
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| Award date | 2007 Feb 23 |
| Publisher | |
| ISBN (Print) | 978-91-85559-04-6 |
| Publication status | Published - 2007 |
Bibliographical note
Defence detailsDate: 2007-02-23
Time: 13:00
Place: Room F3, Lund University Hospital
External reviewer(s)
Name: Blomstrand, Christian
Title: Professor
Affiliation: Sahlgrenska Akademin, Göteborgs Universitet
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<div class="article_info">Ann-Cathrin Jönsson, Ingrid Lindgren, Björn Hallström, Bo Norrving and Arne Lindgren. <span class="article_issue_date">2005</span>. <span class="article_title">Determinants of quality of life in stroke survivors and their informal caregivers</span> <span class="journal_volume">vol 36</span> <span class="journal_pages">pp 803-808</span>. <span class="journal_distributor">Stroke</span></div>
<div class="article_info">Ann-Cathrin Jönsson, Ingrid Lindgren, Björn Hallström, Bo Norrving and Arne Lindgren. <span class="article_issue_date">2006</span>. <span class="article_title">Prevalence and intensity of pain after stroke: a population based study focusing on patients' perspectives</span> <span class="journal_volume">vol 77</span> <span class="journal_pages">pp 590-595</span>. <span class="journal_distributor">J Neurol Neurosurg Psychiatry</span></div>
<div class="article_info">Ingrid Lindgren, Ann-Cathrin Jönsson, Bo Norrving and Arne Lindgren. <span class="article_issue_date">2007</span>. <span class="article_title">Shoulder pain after stroke. A prospective population-based study</span> <span class="journal_volume">vol 38</span> <span class="journal_pages">pp 343-348</span>. <span class="journal_distributor">Stroke</span></div>
<div class="article_info">Ann-Cathrin Jönsson, Ingrid Lindgren, Bo Norrving and Arne Lindgren. <span class="article_issue_date"></span>. <span class="article_title">Weight loss after stroke. A population-based study from Lund Stroke Register.</span> (submitted)</div>
Subject classification (UKÄ)
- Neurology
Free keywords
- Medicin (människa och djur)
- Medicine (human and vertebrates)
- weight loss
- shoulder pain
- health related quality of life
- stroke
- outcome
- pain
