Evaluation of Health-Related Quality of Life Associated with Provision of Healthcare to Stroke Patients Living at Home in Japan

Sayuri Kaneko^1*, Masako Kanekawa²

¹School of Nursing, Nagoya City University, Nagoya, Japan.
²Tohoku University Graduate School of Medicine, Sendai, Japan.

DOI: 10.4236/health.2015.79126                

Abstract

Objective: As stroke mortality rates decline in Japan, a large proportion of disabled stroke survivors living in their homes are supported by informal caregivers or formal healthcare services. To evaluate the impact of healthcare provision on outcome of stroke patients living at home, this study investigated the associations of long-term care and health-related quality of life (HRQOL) in patients 1 year after stroke onset. Methods: Data on patient and caregiver characteristics, HRQOL of patients, and healthcare services for those living at home were prospectively collected from 426 patients with stroke at baseline and 12 months. Using general measures of HRQOL, namely, Short Form-36 (SF-36) and EuroQOL 5 dimension (EQ-5D), multivariate regression models were used to determine the contribution of variables to changes in HRQOL scores from discharge to the first year after stroke. Results: Five domains of SF-36—role-physical, vitality, social functioning, role- emotional, and mental health—were significantly improved 1 year after stroke. Factors affecting changes in the five domains of HRQOL were age, independence in activities of daily living, and cognitive function. Home care service was positively associated with role-physical, social functioning, and role-emotional. In addition, home rehabilitation and home bathing services were positively associated with social functioning. Conclusion: This study clarified that improvements of HRQOL 1 year after stroke were associated with use of home-based services involving home care service, home rehabilitation, and home bathing services. The use of home-based services contributed to the improved welfare of patients living at home.

Keywords

Stroke, Health-Related Quality of Life, Long-Term Care, Healthcare

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Haacke, C., Althaus, A., Spottke, A., Siebert, U., Back, T. and Dodel, R. (2006) Long-Term Outcome after Stroke Evaluating Health-Related Quality of Life Using Utility Measurements. Stroke, 37, 193-198. http://dx.doi.org/10.1161/01.STR.0000196990.69412.fb
[2]	Gray, L.J., Sprigg, N., Bath, P.M.W., Boysen, G., De Deyn, P.P., Leys, D., O’Neill, D. and Ringelstein, E.B., for the TAIST Investigators (2007) Sex Differences in Quality of Life in Stroke Survivors Data from the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST). Stroke, 38, 2960-2964. http://dx.doi.org/10.1161/STROKEAHA.107.488304
[3]	J?nsson, A.-C., Lindgren, I., Hallstr?m, B., Norrving, B. and Lindgren, A. (2005) Determinants of Quality of Life in Stroke Survivors and Their Informal Caregivers. Stroke, 36, 803-808. http://dx.doi.org/10.1161/01.STR.0000160873.32791.20
[4]	Gargano, J.W. and Reeves, M.J., for the Paul Coverdell National Acute Stroke Registry Michigan Prototype Investigators (2007) Sex Differences in Stroke Recovery and Stroke-Specific Quality of Life Results from a Statewide Stroke Registry. Stroke, 38, 2541-2548. http://dx.doi.org/10.1161/STROKEAHA.107.485482
[5]	Carod-Artal, J., Egido, J.A., González, J.L. and de Seijas, E.V. (2000) Quality of Life among Stroke Survivors Evaluated 1 Year after Stroke Experience of a Stroke Unit. Stroke, 31, 2995-3000. http://dx.doi.org/10.1161/01.STR.31.12.2995
[6]	Gall, C., Franke, G.H. and Sabel, B.A. (2010) Vi-sion-Related Quality of Life in First Stroke Patients with Homonymous Visual Field Defects. Health and Quality of Life Outcomes, 8, 33. http://www.hqlo.com/content/8/1/33 http://dx.doi.org/10.1186/1477-7525-8-33
[7]	van Exel, N.J., Scholte op Reimer, W.J. and Koopmanschap, M.A. (2004) Assessment of Post-Stroke Quality of Life in Cost-Effectiveness Studies. The Usefulness of the Barthel Index and the EuroQoL-5D. Quality of Life Research, 13, 427-433. http://dx.doi.org/10.1023/B:QURE.0000018496.02968.50
[8]	Patel, M.D., Tilling, K., Lawrence, E., Rudd, A.G., Wolfe, C.D.A. and Mckevitt, C. (2006) Relationships between Long-Term Stroke Disability, Handicap and Health-Related Quality of Life. Age Ageing, 35, 273-279. http://dx.doi.org/10.1093/ageing/afj074
[9]	Takemasa, S., Nakagoshi, R., Murakami, M., Uesugi, M., Inoue, Y., Gotou, M. and Naruse, S. (2014) Factors Affecting Quality of Life of the Homebound Elderly Hemiparetic Stroke Patients. Journal of Physical Therapy Science, 26, 301-303. http://dx.doi.org/10.1589/jpts.26.301
[10]	Pan, J.H., Song, X.Y., Lee, S.Y. and Kwok, T. (2008) Longitudinal Analysis of Quality of Life for Stroke Survivors Using Latent Curve Models. Stroke, 39, 2795-2802. http://dx.doi.org/10.1161/STROKEAHA.108.515460
[11]	Kitahama, S., Takemasa, S. and Shimada, T. (2003) Effect of Long-Term Care Insurance on Psychological States of Its Clients and Care-Burden of Their Caregivers. Bulletin of Faculty of Health Sciences Kobe University School of Medicine, 19, 15-24.
[12]	Cabinet Office Government of Japan (2013) White Paper on Aging Society in 2013. http://www8.cao.go.jp/kourei/whitepaper/w-2013/zenbun/index.html
[13]	Health Labour and Welfare Statistics Association (2014) Trend of Long-Term Healthcare and Welfare. Journal of Health and Welfare Statistics, 61, 141-167.
[14]	Kim, J.N. and Shiwaku, K. (2012) The Effect of Utilization of In-Home Services and the Changes in Levels of Care Needs of Frail Persons (2002-2004). Results of a Two-Year Follow-Up Study. Journal of Rural Medicine, 7, 6-14. http://dx.doi.org/10.2185/jrm.7.6
[15]	Suzuki, I., Yanagi, H. and Tomura, S. (2007) A Study of Factors Related to Activities of Daily Living of the Elderly Receiving In-Home Service Longitudinal Study Using Functional Independence Measures. Japanese Society of Public Health, 54, 81-88.
[16]	Kono, A. and Kanagawa, K. (2000) Functional Changes in One-Year and Related Factors among Community-Dwelling Frail Elderly. Japanese Society of Public Health, 47, 508-516.
[17]	de Vries, G.E., Jorritsma, W., Dijkstra, P.U., Geertzen, J.H.B. and Reneman, M.F. (2014) The Construct Va-lidity of the Short Form-36 Health Survey for Patients with Nonspecific Chronic Neck Pain. International Journal of Rehabilitation Research, 38, 137-143. http://dx.doi.org/10.1097/MRR.0000000000000102
[18]	Fukuhara, S. and Suzukamo, Y. (2004) Manual of SF-36v2 Japanese Version. Institute for Health Outcome & Process Evaluation Research, Kyoto.
[19]	The EuroQol Group (1990) EuroQol—A New Facility for the Measurement of Health-Related Quality of Life. Health Policy, 16, 199-208. http://dx.doi.org/10.1016/0168-8510(90)90421-9
[20]	Tsuchiya, A., Ikeda, S., Ikegami, N., Nishimura, S., Sakai, I. and Fukuda, T. (2002) Estimating an EQ-SD Population Value Set. The Case of Japan. Health Eco-nomics, 11, 341-353. http://dx.doi.org/10.1002/hec.673
[21]	Chijiiwa, N., Miyagawa, T., Tokuhara, N., Suenaga, H., Imamura, Y. and Takemasa, S. (2002) Sequential Changes of ADL and Factors Affecting Them in the Homebound Post-Stroke Residual Disabled. Bulletin of Faculty of Health Sciences Kobe University School of Medicine, 18, 1-12.
[22]	Malone, M., Hill, A. and Smith, G. (2002) Three-Month Follow Up of Patients Discharged from a Geriatric Day Hospital. Age and Ageing, 31, 471-475. http://dx.doi.org/10.1093/ageing/31.6.471
[23]	Wilma, M. and Jane, V. (2003) Quality of Life during and after Inpatient Stroke Rehabilitation. Stroke, 34, 801-805. http://dx.doi.org/10.1161/01.STR.0000057978.15397.6F
[24]	Suzukawa, M., Shimada, H., Watanabe, S., Kobayashi, K. and Suzuki, T. (2011) The Relationship between Physical Performances and ADLs Decline during 6 Months in Frail Elderly People Utilizing Long-Term Care Insurance. Rigakuryohogaku, 38, 10-16.
[25]	Jonathan, W.S., Richard, H.O., Helen, M.D., Geoffrey, A.D., Richard, A.L.M. and Amanda, G.T. (2002) Brief Comprehensive Quality of Life Assessment after Stroke: The Assessment of Quality of Life Instrument in the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke, 33, 2888-2894. http://dx.doi.org/10.1161/01.STR.0000040407.44712.C7
[26]	Makiseko, H., Abe, T., Onuma, T. and Shimada, H. (2009) Factors Associated with Continuous Home Care Services and Effects of Home-Visit Rehabilitations Service in Older Individuals Requiring Home Care: Cluster Randomization trial. Rigakuryohougaku, 36, 382-388.