Factors Affecting Quality of Life for Patients with Cerebrovascular Accident in Middle Euphrates Neuroscience Center in Al-Najaf Al –Ashraf City

 

SaharAdham Ali¹, Ahmed Salih Al-Qadi²

¹Assistant Professor, Adult Nursing Department, Faculty of Nursing, University of Babylon.

²MSc., Adults Nursing, Faculty of Nursing, University of Babylon.

 

ABSTRACT:

Background: Cerebrovascular accident (CVA) is one of the most common medical emergency condition known as the fourth leading disease for death in the United States after cardiac disease, cancer and chronic respiratory diseases. It is the most popular disabling neurological disease. Objective: This study aimed to identify the factors affecting the quality of life for patients suffering from Cerebrovascular accident. Methodology: Crosssectional descriptive design was selected to achieve the objective to study the factors affecting quality of life (QOL) for patients diagnosed with Cerebrovascular accident in outpatient department in Middle Euphrates Neuroscience center in Al-Najaf Al- Ashraf City, for the period between 27October 2015 and 30 August 2016. Non probability (purposivesample) from (N=80) patients with Cerebrovascular accident were selected to participate in the study. Data was collected by using a questionnaire which was adopted and developed by the researchers, it consist three parts. Validity of the questionnaire obtain by (19) experts, while there liability obtained by using statistical method. Results: The majority of the samples were married male between (59-69) 0f age group. The overall quality of life level of the Cerebrovascular accident patient who participate in the study was moderate. Conclusion: The QOL for CVA patients were affected by the following risk factors :( age, occupation, educational level, chronic diseases, type of Cerebrovascular accident and the duration of the disease play as highly affecting factors related to the patient’s quality of life. Recommendation: Guided protocols may be needed to handle the initial weeks of rehabilitation to improve and minimize complication.

 

 

 

INTRODUCTION:

Cerebrovascular accident is the most popular disabling neurological disease , nearly about 800 thousand for now cerebrovascular accident cases occurs annually, and approximately 130,000 people die every year from this condition in the United States¹. The factors that affect the quality of life (QOL) vary between old patients and young patients.

 

Many factors have been pointed to influence the patients QOL, which can be extended to motor impairment, physical dysfunction, or dependency in activity of daily living (ADL), the presence of depression, cognitive impairment, and speech disturbances. Young patients with cerebrovascular accident were up to 10% of the all cases with distinct cause when matched with old people². Risk factors is anything that increasing the chance of having CVA, some risk factors can be modified, while the others cannot  , such as age , old person are more liable to get disease than the other age group ³, ethnicity ,gender and family history also play as  a strong risk factors⁴.Commonly men are at higher risk than women , people with positive family health history are more likely to exposed to disease ⁵.The patients'  health status and the specific dimensions of life such as physical, psychological, and social were affected post- cerebrovascular accident the QOL has been reported to not only be lower than QOL in the  non- cerebrovascular accident  population, but also to decrease further in the first year after disease⁶.World health organization defined Quality of life as one’s perception of  their position in life, within the context of their culture and value systems, in relation to goals, expectations, standards and concerns, and is influenced by physical health, psychological state, level of independence, social relationships, relationships to the environment and comprising spiritual, religious and personal beliefs ⁷. 

 

 

OBJECTIVES OF THE STUDY:

This study aimed to identify the risk factors affecting the quality of life of patients with cerebrovascular accident.

 

METHODOLOGY:

Design of the Study:

Cross-sectional descriptive design was selected to achieve the objective to study the factors affecting quality of life for patients with cerebrovascular accident which started between 27Oct. 2015 and 8 Aug. 2016. Non probability (purposive) sample of 80 patients (50) male and (30) female was selected to participate in the study. Structured questionnaire was adopted and developed by the researchers for this purpose after intensive review of related literatures.

RESULTS:

 

High (mean of scores equal or more than 2.34), moderate (mean of scores 1.67-2.33), low (mean of scores (1-1.66)

Figure 1: Distribution of the study sample according to their responses to the quality of life domains.

 

Table 1: Distribution of the Study Sample according to their Demographical characteristics.

 

Table 2: Distribution of the Study Sample related to their Clinical Data

 

The result of figure1: presented that the scores of the quality of life of the majority of the study sample were highly affected regarding the following domains: (energy and activity), plus movement; while moderate affect presented related to the family relationship, speaking, mood, self-management, social role, thinking, upper extremities function, vision, and work/ productive, and low effect score recorded for personality domain.

 

Table 3: Association between the Cerebrovascular accident patient’s quality of life and their demographical characteristics.

This table presented revealed that there is a highly –significant  relationship between the patient’s quality of life and  their  age , and occupation at P- value (less than 0.01); on the other hand , the results  indicated  that there is a significant relationship between the patient’s quality of life and their educational level  at P-value (less than 0.05) , while no significant  relationship presented  between the patient’s quality of life and their gender , marital status , at P-value (more than 0.05).

 

Table 4: Association between patients’ quality of life and their clinical data.

Clinical data	Rating and intervals	Quality of life			Chi-square value	d.f.	p-value
		Low	Moderate	High
Duration of Disease / years	Less Than 1 Year	19	13	13	17.75	4	0.001 HS
	1-6	9	8	12
	7 And More	5	0	1
Types Of CVA	Ischemic	27	15	17	23.72	4	0.001 HS
	Hemorrhagic	6	6	7
	Transient ischemic attack	0	0	2
Chronic Diseases	No chronic diseases	2	2	4	49.66	22	0.001 HS
	Hypertension	12	3	11
	Hypertension and diabetes mellitus	11	11	5
	Hypertension, diabetes mellitus, and heart failure	3	1	0
	Hypertension, diabetes mellitus, heart failure, and coronary heart diseases	1	1	1
	Hypertension, diabetes mellitus, heart failure, and renal failure	1	0	0
	Hypertension, diabetes mellitus, and coronary heart diseases	0	1	0
	Hypertension, and heart failure	2	0	1
	Hypertension, and coronary heart diseases	0	1	0
	Hypertension, and renal failure	0	0	1
	Diabetes mellitus	1	0	2
	Heart failure	0	1	1
Smoking	No	21	13	18	0.28	2	0.868 NS
	Yes	12	8	8
BMI	Normal weight	6	5	3	1.351	4	0.853 NS
	Over weight	23	13	19
	Obese	4	3	4
Health problems	No complications	9	8	18	38.93	30	0.127 NS
	Headache	7	7	2
	Headache and brain attack	1	0	0
	Headache and  UTI	2	1	0
	Headache and pneumonia	2	0	0
	Headache and bed sores	1	0	0
	Headache and shoulder pain	6	2	2
	Headache and DVT	0	1	0
	UTI	1	0	0
	UTI and shoulder pain	0	0	1
	Pneumonia	0	1	1
	Pneumonia and shoulder pain	1	0	2
	Shoulder pain	3	1	0

 

Table (5) Association between patients’ overall quality of life domains and therisk factors

Main studied domains	Statistical Para-meters	Energy and activity	Family relationship	Speaking	Movement	Mood	Personality	Self-management	Social role	Thinking	Upper extremities functions	Vision	Productivity
Overall QOL	Pearson correlation	0.789	0.777	0.671	0.768	0.597	0.724	0.880	0.730	0.738	0.844	0.500	0.746
	p-value	0.001 HS	0.001 HS	0.001 HS	0.001 HS	0.001 HS	0.001 HS	0.001 HS	0.001 HS	0.001 HS	0.001 HS	0.001 HS	0.001 HS
	Regression	0.80	0.80	0.75	0.82	0.62	0.75	0.90	0.73	0.75	0.84	0.54	0.79

HS (p-value less than 0.01)

 

 

 

DISCUSSION:

The results in table (1) shows that the higher percentage 22(27.5%) of the study sample were between (59-69) years of age, 50(62.5%) were males, This result was parallel with the finding of the study, which is carried out in Iraq to study the quality of life for patients with CVA, which  stated that the majority of the CVA patients were males (70%) within (61≥) years , increasing the risk of CVA with elderly men is almost twice as likely as women ⁸. Individuals who are married and have low educational level were label to expose to determining quality of life and associated factors in patients with CVA⁷. This result  agree with our finding which pointed out high percentage 98 (94.2%) of sample were married, and 68 (65.4%) were illiterate, It is clear that the patients of the same age were often married when compare with those with early age group, Poor awareness of low educational people may lead to expose to CVA at any time because they cannot correctly decide when they need counseling or medical help related to knowledge deficit to classified all symptoms and indicators that they need counseling or medical help, so they easy expose to CVA. This finding is presented in the table shows that highest percentage 26 (32.5%) were housewives and this result agrees with the results which are obtained from the study which find out that the highest percentage of the participant were housewives (N=50), 8(36.0%)⁸. The majority of the sample who visit the neuroscience center in Al -Najaf city were illiterate and housewives because the services of the center cover wide extended area in the middle Euphrates

 

The results related to residency shows that, the most of the sample 43(53.8%) were urban area residency, this result was agree with a study which presented that the 72% of the sample were city resident. The lifestyle of the person in the urban area has more risk factors, related to complicated and difficult expensive life, which play as stressors affected person’s life⁹.

 

The results regarding duration of disease show that the highest percentage (56.3%) of illness duration was from (6 months to less than one year). This result was supported by a study which   emphasized that CVA duration mainly which distributed from  6 to 7 months act as one of the risk factors which affecting the quality of life  of diseased person.¹⁰

 

The results show that the majority of the participant(73.7%)  were diagnosed with ischemic CVA, This results agree with many studies which  presented  that ischemic CVA take the highest percent than hemorrhagic CVA¹¹, another study shows that (34 patients out of 50) had the ischemic type (68%). While thirty two percent of the patients (16 patients out of 50) had the hemorrhagic type of CVA (32%), also they emphasized that cerebral ischemic CVA was detected in 36 (72%) patients, and cerebral hemorrhage in 14 (36%) patients¹².

 

The results of table (2) presented that (33.8%) of the sample suffer from diabetes mellitus and hypertension as a chronic disease , diabetes mellitus is more frequent in the older group than in the younger group of patients with CVA. This result is agrees with many previous studies which find out that most common comorbidity was hypertension^{13, 14, 15}. The elevation in  blood pressure effected  the arteries and can create weak points  that  may be ruptured  easily or thin spots accumulated  with blood and protruded  out from the artery wall (which known as  aneurysm). Hypertension and changeable blood vessels are the main cause of the hemorrhagic CVA, ischemic CVA produced narrowing or blockage of blood vessels in the brain tissue which leads to cutoff the blood flow to the brain and it is tissue. When the patients with diabetes mellitus end up with high glucose level in their blood, on the other hand their tissues cannot receive enough energy. Furthermore, the high glucose may be due to collection of the fat on the inner wall of the blood vessels. This clot may be accumulated and produce narrow or block in the artery or vein (blood vessels) of the brain or neck, cutting off blood flow, produce low oxygen supply to the brain which may causing CVA.

 

Results of the table (2) show that (65%) of the study sample are nonsmokers. This result is in agreement with ¹⁶ who emphasized in their study that people with smoking history were (23.7%). which is not play as a risk factor for patient with stroke¹⁶.

 

The results show that most of the study samples were overweight (68.8%). This result is agrees with study which explain that obesity can increase the risk of stroke  due to inflammation caused by excess of  fatty tissue which can produce low blood flow and elevate the risk to blockage ,which consider the main cause of  stroke¹⁷.

 

Related to the patient’s health problems the results indicated that headache is more frequent in the study sample, (16) patients (20%) from the complications after stroke. This result agrees with the study which presented that headache is indicated as a popular symptom post stroke but the incidence rate is unknown, many studies deal with headache when associated by different cerebrovascular lesions¹⁸. Regarding to the pneumonia the majority of the study sample (97.5%) of the patients with stroke has no pneumonia. These findings agree with study, which find out that stroke related pneumonia incidence and possible risk factors, 11 (13.4%) patients developed stroke associated pneumonia from 82 stroke patients admitted to medical wards¹⁹.

 

In addition to the stroke, the higher percentage (1.25%) of study samples were with brain attack. This result is supported by a study which carried out upon (5027) patients; they found that seizures happened in (2.7%) of them and the Seizures attaches become common phenomenon post stroke, approximately (2–20%) of all stroke patients²⁰. Also this result is supported by Navarro, he mention that, 14 (1.3%) had epileptic seizure after stroke ²¹.

 

Concerning shoulder Pain complications, the study sample have shoulder pain. This result is supported by a study which emphasize that the majority of the stroke patients experience almost one episode of shoulder pain during their first year of disease²².

 

Also this result may come along with another study which reveals that high correlation between shoulder pain and older age after stroke.  The reason of shoulder pain could be spasticity which can lead to reduced activity and can delay rehabilitation and affect the patient general condition²³. In regards to urinary tract complications, the highest percent of the study sample (1.25%) had urinary tract infection (UTI). This result agree with previous study which find out that (10%) of 87 subject in his study had urinary tract infection²⁴.

 

The study findings indicate that the overall assessments of patients’ quality of life was moderate (table 4). The results presented that statistically high significant relationship at level p < 0.01 between all the Quality of life domains and age, occupation, duration of disease, type of CVA, and chronic disease, which play as a risk factors affecting quality of life. Regarding age groups the results show that there is a highly significant relationship between the age and the moderate quality of life domains. This result is supported by a study which reported that, a significant relationship between alteration of the quality of life for patients with CVA and their age, while no relationship found between patients gender and marital status.

 

Regarding educational levels the results shows a significant relationship between education and alteration of the quality of life the person's quality of life, low educational statue will affected the personal power, and self-efficacy which affected the people's beliefs in their ability to influence events that effect their life, this belief is foundation of human motivation, performance and emotional well-being¹³.

 

Also the results show that there is a highly significant relationship between the occupational status and the quality of life. Many study found that there is a significant relationship between patients occupational status and their quality of life, work is an important part of human life, social statues depends on three factors, power, weather, and prestige, which maintain the human satisfaction for his life²⁵.

 

No-significant relationship found between the residential area and the quality of life

The results of table (4) show that there is a highly significant relationship between the duration of disease, type of stroke which consider as risk factors which affecting human life ¹¹. A high significant relationship between the patients' quality of life and chronic disease such as (hypertension and diabetes mellitus) at P-value (less than 0.01). A paralled study reported that there is a significant relationship between the associated diseases and the quality of life and patients with CVA¹³.

 

CONCLUSIONS:

The quality of life for patients with CVA were significantly affected by age, occupation educational level as demographical risk factors , on the other hand chronic diseases, type of stroke and it is duration play as highly risk factors which is affecting human life

 

RECOMMENDATIONS:

There is great need for guided protocols to handle the initial weeks of rehabilitation to improve and maintain patients quality of life by assessing the patient’s needs according to the factors which affecting the client life and offering guiding, consulting, and referrals if needed.

 

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Accepted on 16.05.2017        © RJPT All right reserved