HRQOL MD Thesis Dr OWOLABI MO submit clean_AV5amended for Bibliothek amended without CV

128 Pages·2010·0.97 MB·English

Aus der Klinik für Neurologie
der Medizinischen Fakultät Charité – Universitätsmedizin Berlin

DISSERTATION

IBADAN –BERLIN BICULTURAL COMPARATIVE STUDY
OF QUALITY OF LIFE IN STROKE PATIENTS USING A
NEW INSTRUMENT (HRQOLISP)

zur Erlangung des akademischen Grades

Doctor medicinae (Dr.med.)

vorgelegt der Medizinischen Fakultät
Charité - Universitätsmedizin Berlin

von

Dr. Mayowa Ojo OWOLABI

MBBS, MWACP, FMCP(Neurology)

aus Aisegba-Ekiti , Nigeria.

0
Gutachter: 1. Prof. Dr.med. A. Villringer

2. Prof. Dr. med. R. Haberl

3. Priv.-Doz. Dr. B. Pleger

Datum der Promotion: 16.05.2010

1
TABLE OF CONTENTS

Contents Pages
Title Page 0,1
Table of Contents 2-5
List of abbreviations and acronyms 6-9

1. CHAPTER ONE : INTRODUCTION AND LITERATURE 11-33
REVIEW
1.1 Definition of Stroke and Stroke-related Disorders 11-12
1.2 Stroke: A Brief Historical Perspective 12-13
1.3 The Epidemiology of Stroke 13 -14
1.4 Types of Stroke 14-18
1.4.1 Ischemic Stroke 14-17
1.4.2 Hemorrhagic Stroke 17-18

1.5 Risk Factors For Stroke 19-21
1.5.1 Non-modifiable Risk Factors 19
1.5.2 Well-Documented Modifiable Risk Factors 19-20
1.5.3 Less Well- Documented or Potentially Modifiable Risk Factors 20-21
1.5.4 Risk factors for stroke in the young [< 45 years] 21
1.5.5 Precipitating factors for stroke 21

1.6 Diagnosis of Stroke 21-25
1.6.1 Clinical evaluation 21-23
1.6.2 Computerised Tomography 23
1.6.3 Magnetic Resonance Imaging [MRI] 23
1.6.4 Ultrasound techniques 23-24
1.6.5 Magnetic Resonance Angiography [MRA] 24
1.6.6 CT Angiography [CTA] 24
1.6.7 Catheter Cerebral Angiography 24
1.6.8 Other Investigations 25

1.7 The Concepts of Health and HRQOL 25-26
2
1.8 The Features of a Good HRQOL Measure For Stroke 26-28
1.8.1 Validity 26-27
1.8.2 Reliability 27
1.8.3 Responsiveness 27
1.8.4 Precision 28
1.8.5 Appropriateness 28
1.8.6 Acceptability 28
1.8.7 Proxy suitability/validity 28
1.8.8 Interpretability 28
1.8.9 Duality of administration mode 28

1.9 Review of Existing HRQOL Measures For Stroke 28-30

1.10 Effect of Stroke on Quality of Life 31-33
1.10.1 What is known 31-32
1.10.2 What needs to be known 32-33

2. METHODOLOGY 34 - 41
2.1 Objectives of the study 34
2.1.1 General objective 34
2.1.2 Specific Objectives 34
2.2 Participants and Methods 34
2.2.1 Study sites 34
2.2.2 Sample Size 35
2.2.3 Study design 35
2.2.4 Inclusion Criteria For The Study Population 35
2.2.5 Exclusion Criteria For The Study Population 36
2.3 Hypotheses 36
2.4 Assumption 36
2.5 Ethical clearance 36
2.6 The Protocol 37
2.6.1 The Stroke-specific questionnaire 37-38
3
2.6.2 Further assessment instruments 38
2.6.3 Procedure of test administration 38-39
2.7 Data analysis 39-40
2.8 Limitations 40
2.9 Declaration of Interests 40
2.10 Level of Involvement 40
2.11 Acknowledgements 41

3. RESULTS 42- 78
3.1 Demographic Characteristics 42-50
3.2 Clinical Characteristics 50- 55
3.3 Instrument’s Psychometric Parameters and HRQOL Profile 56- 75
3.4 Determinants of HRQOL 76- 78

4. DISCUSSION 79-90
4.1 Demographic Characteristics 79-80
4.2 Clinical Characteristics 80- 82
4.3 Instrument’s Psychometric Parameters and HRQOL Profile 83-86
4.4 Determinants of HRQOL 87- 89
4.5 Conclusions 89
4.6 Recommendations 89-90

5. SUMMARY 91-92
ZUSAMMENFASSUNG 9 2 - 9 4

6. REFERENCES 95 -107

7. Appendix I : The Questionnaire (HRQOLISP) 108-116

8. Appendix II : The Questionnaire, Control Version 117-125

4
9. Appendix III: Occupational Stratification 126

11. Erklärung 1 27

12. Lebenslauf und Publikationliste 128-144

5
LIST OF ABBREVIATIONS

ACE Angiotensin Converting Enzyme

ADL Activities of daily living

AF Atrial Fibrillation

AHA American Heart Association

ANOVA Analysis of variance

ADC Apparent Diffusion Coefficient

BOLD Blood Oxygen Level Dependent imaging

CADASIL Cerebral Autosomal Dominant Arteriopathy with

Subcortical Infarct and Leucoencephalopathy

CADASILM Cerebral Autosomal Dominant Arteriopathy with

Subcortical Infarct and Leucoencephalopathy with

hemiplegic Migraine.

CBF Cerebral Blood Flow
CIND Cerebral Infarction No Deficit
CITS Cerebral Infarction with Transient Symptoms].
CMRO Cerebral Metabolic Rate for Oxygen
2
CSF Cerebrospinal Fluid
CT Computerized Tomography
CTA Computerized Tomography Angiography
DALYs Disability Adjusted Life Years
ECG Electrocardiography
6
EEG Electroencephalography
EuroQol Europe Quality of Life Scale
FLAIR Fluid-Attenuated Inversion Recovery
GDS Geriatric Depression Scale
HDL-C High Density Lipoprotein Cholesterol
HOPES Heart Outcome Prevention Evaluation Study
HRQOL Health-Related Quality of Life
HRQOLISP Health-Related Quality of Life in Stroke Patients
ICA Internal Carotid Artery
ICIDH International Classification of Impairments, Disabilities
and Handicaps
IL-1 Interleukin 1
LDL-C Low Density Lipoprotein Cholesterol
LIPID Long-Term Intervention with Pravastatin in Ischaemic
Disease
MELAS Mitochondrial Myopathy, Encephalopathy, Lactic
Acidosis and Stroke
MRI Magnetic Resonance Imaging
MRA Magnetic Resonance Angiography
MRS Magnetic Resonance Spectroscopy
NEWSQOL Newcastle Stroke-Specific Quality of Life Measure
PCA Posterior Cerebral Artery
7
PET Positron Emission Tomography
PON-1 Paraoxonase-1
PROGRESS Perindopril Protection Against Recurrent Stroke Study
PSED Post Stroke Emotional Disorders
QALYs Quality Adjusted Life Years
QOL Quality of Life
RIND Reversible Ischemic Neurological Deficit
SAH Subarachnoid Hemorrhage
SAQOL-39 Stroke and Aphasia Quality of Life Scale-39
SEC Socioeconomic Class
SF-36 Medical outcome Scale, Short Form -36
SHEP Systolic Hypertension in Elderly Program
SIP Sickness Impact Profile
SPECT Single- Photon Emission Computerized Tomography
SPSS Statistical Package for the Social Sciences
SSS Siriraj stroke score
STROKELE Stroke Levity
SSQOL Stroke-Specific Quality of Life Scale
TIA Transient Ischemic Attack
TNFα Tumour Necrosis Factor alpha
UCH University College Hospital, Ibadan
WHO World Health Organisation
8
WHOQOL World Health Organisation Quality Of Life

9