EQOL Journal (2020) 12(2):
ORIGINAL ARTICLE
Psychosocial parameters as determinants of return to work among stroke survivors
Pascal Chidera Uzoh1 • Adebisi I. Hammed2 ✉ • Ezekiel Onyemechi2 • Chigozie O. Obaseki2 • Susan O. Kubeyinje2
Received: 7th June, 2020 |
DOI: 10.31382/eqol.201203 |
Accepted: 15th September, 2020 |
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© The Author(s) 2020. This article is published with open access. |
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Abstract
This study investigated the psychosocial parameters as determinants of return to work among stroke survivors. This study involved 49 stroke survivors. Hospital Anxiety and Depression Scale (HADS) was used to determine the levels of anxiety and depression of the subjects. Equally,
✉aiadebisi@yahoo.com
1University of Nigeria, Faculty of Health Sciences and Technology, College of Medicine, Department of Medical Rehabilitation, Enugu, Nigeria
2University of Benin, Teaching Hospital, Department of Physiotherapy, Benin City, Nigeria
therapy had no significant (p > 0.05) influence on
Keywords psychosocial properties • work and stroke survivors.
Introduction
Cerebrovascular accidents also known as stroke is defined as a rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain (Sims & Muyderman, 2009). According to the authors, this could be due to ischemia, which is a lack of blood flow, caused by blockage (thrombosis or arterial embolism) or hemorrhage, which is leakage of blood into the brain. The physical manifestation is paresis or paralysis of the muscles of the body limbs of the contralateral side, otherwise known as the hemiparetic or hemiplegic side. It is very imperative to note that patients afflicted with stroke are faced with a lot of challenges. Diminish functional capacity, motor activity intolerance, joints pain, muscle atrophy, partial paralysis, residual gait deviation, anxiety, job/economic stress are common challenges associated with stroke (Gordon, 2004). Stroke is the second leading cause of death and the major cause of disa-
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EQOL Journal (2020) 12(2):
bility worldwide (Petrea, Beiser, Seshadri, Kelly- Hayes, Kase, & Wolf, 2009). Stroke remains one of the most devastating of all neurological diseases, often causing death or gross physical impairment or disability (Kernan et al., 2014). In addition to being a major health care and economic problem, stroke also affects the patient’s quality of life (Carol et al., 2012). Overall life satisfaction and quality of life as well as economic circumstances have been shown to improve with a successful return to work after stroke (Vestling, Tufvesson & Iwarsson, 2003). Despite advances in the acute management of stroke globally, a large proportion of stroke patients are left with significant impairments and decreased psychosocial functioning (Ugboh & Hammed, 2017).
Stroke survivors are often left with physical impairments that limit functional abilities and also result to depression (Mayo,
Moreover, a significant study conducted in India shows that among stroke survivors, 62% were employed before the stroke, but only 20% were still working after the event, with half changing jobs after the stroke (Baker, Marshak, Rice & Zimmerman, 2001). Besides, a study conducted by Wolf, Omar, and Alistair (2009) reported that functional recovery is estimated to be completed within 15 to 20 weeks of the stroke onset. Equally, Kernan et al. (2014)
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submitted that most of stroke survivors have chronic movement disabilities which are mainly due to residual hemiparesis in the limbs. The disability that mostly occurs following stroke could practically affect every aspect of the survivor’s life, including their ability to perform the job they held before the occurrence of stroke. Furthermore, a past study has shown that only a small percentage of stroke survivors can return to
Method
This was a correlational survey study of the psychosocial variables as determinants of return to work among stroke survivors. The population for this study included 98 stroke survivors who were receiving physiotherapy treatments at the University of Nigeria Teaching Hospital and 82 Division Military Hospital, Enugu State, Nigeria. 49 subjects were selected from the entire population for this research work. They were recruited using the disproportionate stratified random sampling technique. The population was firstly stratified into the
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EQOL Journal (2020) 12(2):
where one piece of the paper was picked at a time and the name on the piece of paper picked was recorded. This process continued until the desired sample size was obtained. However, patients with other neurological deficits or with any other disabilities were excluded from the study.
In 1983, Zigmond and Snaith developed the Hospital Anxiety and Depression Scale (HADS) to determine the levels of anxiety and depression that a patient might experience. The HADS is a fourteen- item scale from which seven of the items relate to anxiety while the other seven relate to depression. Each item on the questionnaire is scored from
Ethical approval was sought and obtained from the Medical Research and Ethics Committee of the University of Nigeria Teaching hospital,
Descriptive statistics of percentage, frequency, mean, and standard deviation were used to summarize the demographic characteristics of the subjects. The difference between stroke survivors that returned to work and those that did not return to work was established using Pearson’s
Results
As reflected in Table 1, the depression score for the subjects that returned to work (8.20±2.97) was significantly lower
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EQOL Journal (2020) 12(2):
Table 1. Comparison of variables between subjects that returned to work and those that did not return to work (N =49)
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Returners to work |
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Variable |
n(%) |
n(%) |
ꭓ² |
p |
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Gender |
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Male |
7(14.3) |
24(49.0) |
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0.25 |
0.62 |
Female |
3(6.1) |
15(30.6) |
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Occupation |
|
|
|
|
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Retired |
0(0) |
6(12,2) |
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|
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Trader |
6(12.2) |
11(22.5) |
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|
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Civil Servant |
4(8.2) |
11(22.4) |
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7.04 |
0.22 |
Driver |
0(0) |
2(4.1) |
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|
|
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Military |
0(0) |
6(12.2) |
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|
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Farming |
0(0) |
3(6.1) |
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|
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M±SD |
M±SD |
t |
p |
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Age |
54.70±3.59 |
56.20±6.67 |
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0.02 |
|
Depression |
8.20±2.97 |
27.21±15.37 |
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<0.00 |
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Quality of Life |
196.40±15.01 |
139.49±34.78 |
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7.78 |
<0.00 |
Anxiety |
2.10±2.64 |
13.18±9.04 |
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<0.00 |
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Duration of Stroke |
3.50±1.18 |
2.30±0.97 |
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2.96 |
0.53 |
Duration of Physiotherapy |
3.30±1.07 |
2.01±1.00 |
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3.42 |
0.80 |
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Discussion |
Treger et |
al., 2009) and disability |
(Grammenos, |
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2003). |
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A total number of 49 stroke survivors in Enugu metropolis participated in this study. Most of the subjects in the present study were males. This may imply that more males within this age range tend to suffer a stroke. Although literature appears conflicting on the prevalence of stroke based on gender categories. Some studies equally had similar reports of more males than female stroke survivors (Kernan et al., 2014; Ibeneme et al., 2016). However, other studies reported more female stroke survivors than their male counterparts (Wolf et al., 2009; Vestling et al., 2003). Besides, Baker et al. (2001) opined that stroke appears to be generally more prevalent among males but the trend reverses at an older age. This therefore may be hinged upon to attempt an explanation on the higher prevalence of stroke among males in this present study especially given the fact that the mean age of the participants was 55.9years. The study of Peters et al. (2012) on Nigerian stroke survivors found out that only one- third of the 101 participants returned to work. Likewise, the findings of Lang, Kienitz, Wetzel and Rollnik (2011) among German stroke survivors showed that only
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Moreover, there was a significant difference between depression, anxiety and quality of life of stroke survivors that returned to work and those that did not return to work in the present study. This agrees with some studies (Dagher, Hofferth, & Lee, 2014; Corbière et al., 2015; Bonner, Pillai, Sarma, Lipska, Pandian, & Sylaja, 2016). Similarly, the findings of Bonner et al. (2016), on Indian stroke survivors showed that stroke survivors that returned to work have lower depressive and anxiety scores than those that did not return to work. This suggests that there is an association between a return to work and depression and anxiety. This may imply that stroke survivors that return to work tend to engage in activities of daily living that have a better quality of life and higher income. This is not a surprise because stroke survivors that return to work tend to live a healthier life, engage in their hobbies and associate more with their friends and family, thus reducing depressive and anxiety scores associated with stroke. Likewise, the study of Haghgoo et al. (2014) is also in congruency with the present finding. There is a negative association between depression and activities of daily living performance (Haghgoo et al., 2013; Nijboer et al., 2013). It can thus be extrapolated from the findings above, that activity of daily living performance; better income, and quality of life could
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EQOL Journal (2020) 12(2):
indirectly influence the ability to return to work through compacting depression and anxiety. The study of Vestling et al. (2003) among Sweden stroke survivors is also in agreement with the findings above. The authors found out in their study that stroke survivors that stayed out of their work and activities of daily living because of their health condition suffered depression and had higher depression scores.
Furthermore, improvement in independence with activities of daily living seems to indirectly increase the likelihood of returning to work among stroke survivors through depression and anxiety scores in this study. This confirms Saeki, You, Isemura, Abel, Seki and Noguchi (2000)’s findings that independence with activities of daily living has an important influence on whether a stroke survivor would return to work or not. Also, the result of this study shows a linear significant relationship between quality of life and return to work. It is in agreement with some studies that evaluated determinants of return to work among stroke survivors (Tse et al., 2017; Ntsiea et al., 2013; Rollnik et al., 2011; Trygged et al., 2011). The findings of Tse et al. (2017) among Australian stroke survivors showed that stroke survivors that returned to work have higher scores for quality of life than those that did not return to work. The work of Ntsiea et al. (2013) on South African stroke survivors conducted in Gauteng province is strongly in congruency with the results of the present study. They found out that the stroke survivors that returned to work have a better quality of life and engaged in activities with more vitality than their counterpart that did not return to work. This may imply that the stroke survivors that had better quality of life may have not only had better income but improved participation and reintegration that could foster their greater fulfillment in life than their counterparts that did not return to work. Quality of life has been shown to have a positive correlation with income (Walker et al., 2014; Chetty et al., 2016), nutritional status (Rasheed et al., 2014; Yen et al., 2013) participation in functional activities (Ekechukwu, Olaleye & Hamzat, 2017). This by implication means that stroke survivors that returned to work would have a better quality of life.
Conclusion
It was concluded that the level of depression, anxiety, and quality of life can substantially predict return to work or otherwise among stroke survivors. Therefore, health professionals should develop and incorporate
strategies to enhance the quality of life, prevent depression and anxiety in the management of stroke survivors. Also, there is a need for the education of caregivers and families of stroke survivors on the importance of social support and community reintegration on the
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How to cite this article:
Uzoh, P., Hammed, A. I., Onyemechi, E., Obaseki, C. O., & Kubeyinje, S. O.
APA:(2020). Psychosocial parameters as determinants of return to work among stroke survivors. Excercise and Quality of Life, 12(2),
Uzoh, Pascal Chidera, et al. "Psychosocial parameters as determinants of
MLA:return to work among stroke survivors." Excercise and Quality of Life 12.2 (2020):
Uzoh, Pascal Chidera, Adebisi I. Hammed, Ezekiel Onyemechi, Chigozie O.
Chicago: Obaseki, and Susan O. Kubeyinje. "Psychosocial parameters as determinants of return to work among stroke survivors." Excercise and Quality of Life 12,
no. 2 (2020):
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