Living in Latvia after stroke: the association between functional, social and personal factors and the level of self-perceived disability—a cross-sectional study

• Published in: BMJ open 2016-06, Vol.6 (6), p.e010327-e010327
• Main Authors: Bērziņa, Guna, Smilškalne, Baiba, Vētra, Anita, Stibrant Sunnerhagen, Katharina
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adolescent; Adult; Clinical Medicine; Cross-Sectional Studies; Disabled Persons - psychology; disease; Female; Functional factors; General & Internal Medicine; global burden; Humans; independence measure; inpatient rehabilitation; ischemic-stroke; Klinisk medicin; Latvia; Male; Middle Aged; Mortality; Outcome; Participation; participation poststroke; Perceived disability; Personal factors; Population; position paper; quality-of-life; Questionnaires; regional burden; Regression Analysis; Rehabilitation; Rehabilitation Medicine; Retrospective Studies; Self Care; Self Concept; Social factors; Socioeconomic Factors; Stroke; Stroke - psychology; Stroke Rehabilitation - psychology; systematic analysis; Time Factors; Young Adult
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2015-010327

ObjectiveTo investigate how functional, social and personal factors are associated with self-perceived level of disability in the chronic phase of stroke in a Latvian stroke population. The consequences of stroke can vary greatly and often leads to long-term disability that, according to the WHO definitions, depends on the interaction between the person and his/her context.DesignCross-sectional study with retrospective data gathering.SettingCommunity-dwelling persons who received specialised in-patient rehabilitation after stroke in Latvia.ParticipantsOf 600 persons after stroke who were identified through hospital register and selected for the study, 255 were included in the analysis.Primary and secondary outcome measuresThe medical information and discharge data of the Functional Independence Measure (FIM) was extracted from medical records. Participants filled out a questionnaire on sociodemographic information and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), either in Latvian or Russian, depending on their wish when contacted for their oral agreement to participate. Stepwise multiple regression analysis was conducted to find a model that best explains the variance in WHODAS 2.0 scores.ResultsThe models explained 23–43.5% of variance in outcomes. The best explained WHODAS 2.0 domains were ‘mobility’ and ‘self-care’. The significant factors were level of independence in ‘self-care’, ‘locomotion’ and ‘communication’ according to FIM, as well as working status, time since rehabilitation, age, gender, living alone or in family and preferred language.ConclusionsFunctional, social and personal factors are of similar importance when explaining self-perceived disability in the chronic phase of stroke. Some, but not all, of the factors are modifiable by the healthcare system. Therefore, a complex approach and involvement of medical, social and political systems is needed.