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O.L.G. Atigossou1, F. Ouédraogo2, A.S. Honado3, E. Alagnidé4, T.G. Kpadonou4, C.S. Batcho5
1Centre Hospitalier Universitaire Départemental de l'Ouémé et du Plateau (CHUD-OP), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Ecole Supérieure de Kinésithérapie, Cotonou, Benin, 2Faculté des Sciences de la Santé d'Abomey-Calavi, Ecole Supérieure de Kinésithérapie, Cotonou, Benin, 3Centre Hospitalier Universitaire Départemental de l'Ouémé et du Plateau (CHUD-OP), Rehabilitation, Porto-Novo, Benin, 4Centre National Hospitalier Universitaire (CNHU-HKM), Faculté des Sciences de la Santé d'Abomey-Calavi, Department of Physical Medicine and Rehabilitation., Cotonou, Benin, 5Laval University-CIRRIS, Center for Interdisciplinary Research in Rehabilitation and Social Integration CIRRIS, Quebec, Canada, Rehabilitation, Québec, Canada
Background: Stroke is one of the leading causes of acquired physical disability worldwide. It leads to many physical and psychosocial consequences such as activity limitations, affective disorders and poor quality of life (QoL). About two-thirds of stroke survivors (SS) continue to suffer from sensorimotor impairments affecting their daily activities, even six months after stroke onset. Because of this devastating situation, SS often experience social isolation that favors the onset of affective disorders, mainly post-stroke depression (PSD) and/or post-stroke anxiety (PSA). PSD and PSA are known to be related to poor functional recovery and poor QoL. For efficient management of stroke rehabilitation toward better social reintegration of SS in low and middle income countries, it appears important to understand how affective disorders influence activity limitations and QoL in this context. Unfortunately to our knowledge, data on affective disorders, activity limitations and QoL of chronic SS in Benin are scarce.
Purpose: To evaluate how depression and anxiety influence activity limitations and QoL of chronic SS in Benin.
Methods: One hundred and seventy six chronic SS [113 males; mean age (±SD): 56.47 ±10.46 years old; median time since stroke (25th - 75th percentile): 36 (14 - 60) months] participated in the study. We used the Barthel Index (BI) to assess post-stroke activity limitations. Participants were screened for depression and anxiety symptoms using the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). Euroqol-5 Dimensions-3 Levels (EQ-5D-3L) was used to assess QoL in five dimensions for which we have determined for each patient the EQ-5D-3L summary score. EQ-5D-3L also includes a visual analog scale (VAS) allowing respondents to report their perceived health status. Sociodemographic data were recorded and presented as means and standard deviations (SD) or in percentage. Multiple linear regressions were performed with sociodemographic variables and HDRS and HARS scores (independent variables) with BI, EQ-5D-3L summary score, EQ-VAS scores (dependent variables) separately to determine influence of affective disorders on activity limitations and patients’ QoL. Pearson (or Spearman) correlation coefficients were used to determine the relationship between the main variables.
Results: Depression was reported in 48.90% (mild depression), in 19.90% (moderate depression), and in 11.90% (severe depression) of patients. Minor anxiety was observed in 43.80%, while 46% of the sample presented major anxiety. The first model of regression (R²= 0.60) showed that depression (β=-0.53; p<0.0001) and anxiety (β=-0.35; p<0.0001), were associated with activity limitations. The second (R²=0.57) showed that depression (β=-0.49; p<0.0001) and anxiety (β=-0.37; p<0.0001) were associated with EQ-VAS. The third model (R²=0.33) showed that occupational status (β=0.23; p=0.007), depression (β= -0.23; p<0.0001) and anxiety (β=-0.29; p=0.001) were associated with EQ-5D-3L summary score. Depression (r=-0.69; p<0.0001) and anxiety (r=-0.59; p<0.0001) were linked to activity limitations. Depression (r=-0.66; p<0.0001) and anxiety (r=-0.59; p<0.0001) were linked to EQ-VAS. Depression (r=-0.40; p<0.0001) and anxiety (r=-0.42; p<0.0001) were linked to EQ-5D-3L summary score.
Conclusion(s): Affective disorders seem to influence activity limitations and QoL in Beninese SS.
Implications: This study draws the attention of health professionals to the importance of managing emotional disorders.
Funding, acknowledgements: This study was funded from own funds
Keywords: Activity limitations, Post-Stroke Depression - Post-Stroke Anxiety, Quality of Life, chronic stroke survivors
Topic: Neurology: stroke
Did this work require ethics approval? Yes
Institution: CHUDOP, Porto-Novo, Benin.
Committee: Chudop local committee
Ethics number: N°1610/2014CHD-OP/DIR/SAAE/SAF/SG/DGAP/SA
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