The importance of psychological factores: The Restore4Stroke Patient Cohort study

Background: Stroke is a leading cause of mortality and disability in the Western world and can lead to limitations in the patient’s physical, psychological, and psychosocial functioning. To know how we can help these stroke patients to adapt to the consequences of their condition, we need to know which patients are vulnerable and at risk of poor long-term quality of life (QoL). It is hypothesized that psychological factors, such as personality and coping styles, play an important role in successful adaptation to the adverse consequences of stroke and regaining QoL, and these factors may be amendable to treatment. Aims: The aims of this thesis were to investigate the course of quality of life (QoL) in stroke patients and to determine factors predicting QoL with special interest in psychological factors. Methods: A multicenter longitudinal cohort study was conducted: the Restore4Stroke Patient Cohort study. In total, 395 stroke patients were included and 5 assessments were executed: in the acute phase, and at 2 months, 6 months, 12 months and 24 months post stroke. The main outcome was QoL, and this was investigated with generic measures of participation, emotional functioning and subjective well-being and with a measure of stroke-specific QoL. Results: With respect to the first aim it was found that most recovery of QoL takes place in the first six months post stroke. In the second year post stroke no significant changes in any QoL domain were found. The frequency of participation declines after a stroke in comparison with the pre-stroke situation. This decrease in frequency of participation was most apparent in vocational activities and less in leisure and social activities. Further analysis showed that not all patients experience the same degree of recovery of HRQoL. Four trajectories for both physical and psychosocial HRQoL post stroke were revealed: high, low, recovery and decline of HRQoL. Regards the second aim, we found that psychological factors were strongly related with QoL. Positive psychological factors, like acceptance and perceived benefits of the stroke and self-efficacy, were independently related with higher levels of QoL. Negative psychological factors, like neuroticism, passive coping, and hopelessness were independently related with lower levels of QoL. Conclusion: The findings in the present thesis have led to new insights regarding the long-term course of QoL post stroke and the significant influence of psychological factors on QoL. Professionals should become more aware of the role of psychological factors during rehabilitation and of the fact that patients differ from each other in terms of personality, illness cognitions and coping styles. We should shift towards personalized healthcare in which we tailor the management and treatment of each patient to his or her individual characteristics, instead of just following protocols. The results from the present thesis have led to the development of a course for paramedics in which professionals gain insight into the role of psychological factors on adaptation in terms of QoL and in how these factors could be taken into account during general stroke care without changing them.