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ASSESSMENT OF QUALITY OF LIFE AND FUNCTIONAL MOBILITY OF

STROKE PATIENTS IN A HOME-BASED SETTING

Research supervisor
DR. KOMAL AHMED

HEAD SUPERVISOR
PROF. DR. MUHAMMAD SALMAN BASHIR

Submitted By
MUBEENA HAFEEZ F2018241520
AREEJ FATIMA F2018241523
IQRA JAMIL F2018241481
RABIA JAMIL F2018241482
KIRAN SHEHZADI F2018241125
MANZA BATOOL F2018241517

DOCTOR OF PHYSIOTHERAPY
Session 2018-2023

School of Health Sciences

University of Management and Technology
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DEDICATION

We, hereby declare that all the information in this thesis is the result of our concerted efforts and

our original work. This research work, to the best of our knowledge and belief, reproduces no

material previously published or written, or that has been accepted for the award of any other

degree or diploma, except where due acknowledgement has been made in the
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ACKNOWLEDGEMENT

First and foremost, praise and thanks to the Almighty for His showers of blessings throughout

our research project to complete the research successfully.

We would like to express our deep and sincere gratitude to our MAM KOMAL AHMED from

University of Management and Technology. She has taught us the methodology to carry out the

research and to present the research work. It’s a great privileged and honor to work under the

guidance of our respected mam.

We would like to pay our regards to our dearest parents for their prayers, care and sacrifices for

our education and preparing us for our future. Special thanks to the participants for helping us

achieving our results.

Furthermore, we would like to express our gratitude towards our Respective institute, University

of Management and Technology for giving us opportunity to study in this prestigious institute.

Special thanks to our Groupmates for helping us throughout the project

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DECLARATION

We declare that that the research project ASSESSMENT OF QUALITY OF LIFE AND
FUNCTIONAL MOBILITY IN STROKE PATIENTS IN A HOME BASED SETTING is based on
our own work carried out during our study under the supervision of Dr. KOMAL AHMED We
assert that statements made, and conclusions drawn are an outcome of our research work. We
further certify that the work contained in the report is original and has been done by us under the
general supervision of our supervisor.

The work has not been submitted to any other institution for any other degree in this university.

We have followed the guidelines provided by the university in writing the report.

Whenever we have used materials (data, theoretical analysis, and text) from other sources, we

have given due credit to them in the text of the report and have given their details in the

references.

Researcher’s Signatures

MUBEENA ABDULHAFEEZ
AREEJ FATIMA
RABIA JAMIL
IQRA JAMIL
KIRAN SHAHZADI
MANZA BATOOL
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APPROVAL CERTIFICATE

Research Project entitled ASSESSMENT OF QUALITY OF LIFE AND FUNCTIONAL MOBILITY

IN A STROKE PATIENTS IN A HOME BASED SETTING is accepted by the faculty of School of

Health Sciences, University of Management and Technology, Lahore, in partial fulfillment of the

requirement for the degree of Doctor of Physiotherapy.

Supervisor
Dr. KOMAL AHMED

Head Supervisor
Dr. RABIA JAWA
(Chairperson of department of physical medicine & rehabilitation)

Head Supervisor (Director SHS)

Prof. Dr. MUHAMMAD SALMAN BASHIR
(Dean, School of Health Sciences)
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List of Tables

Table 4.1 Descriptive Statistics…………………………………………………………...38

Table 4.2 Occupation……………………………………………………………………...39
Table 4.3 Education……………………………………………………………………….40
Table 4.4 Duration of stroke………………………………………………………………41
Table 4.5 Affected side of body……………………………………………………………42
Table 4.6 BMI……………………………………………………………………………....43
Table 4.7 Gender………………………………………………………………………..….44
Table 4.8 Age…………………………………………………………………………….....45
Table 4.9 Motor Assessment scale interpretation………………………………………..46
Table 4.10 Stroke Specific Quality of Life scale interpretation…………………………47
Table 4.11 Correlation between MAS and SSQOL………………………………………48
Table 4.12 Correlation between BMI and MAS……………………………………….....49
Table 4.13 Correlation between BMI and SSQOL…………………………………….....50
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List of figures:

Figure 1 Occupation………………………………………………………………………..39
Figure 2 Education………………………………………………………………………….40
Figure 3 Duration of stroke ………………………………………………………………..41
Figure 4 Affected side of body……………………………………………………………...42
Figure 5 BMI………………………………………………………………………..………43
Figure 6 Gender…………………………………………………………………………..…44
Figure 7 Age…………………………………………………………………………………46
Figure 8 Pie chart of Motor Assessment Scale…………………………………………….47
Figure 9 Pie chart if Stroke Specific Quality of Life………………………………………48
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TABLE OF CONTENTS

DEDICATION.............................................................................................................3
ACKNOWLEDGEMENT..........................................................................................4
DECLARATION.........................................................................................................5
APPROVAL CERTIFICATE....................................................................................6
ABSTRACT...............................................................................................................10
CHAPTER 1.............................................................................................................. 11
INTRODUCTION.....................................................................................................11
1.1 Background......................................................................................................... 11
1.2 Problem Statement:............................................................................................ 21
1.3 Significance:.........................................................................................................21
1.4 Objectives:........................................................................................................... 21
1.5 Hypothesis:.......................................................................................................... 21
CHAPTER 2.............................................................................................................. 23
LITERATURE REVIEW........................................................................................ 23
CHAPTER 3.............................................................................................................. 31
METHODOLOGY................................................................................................... 31
3.1 Research design:................................................................................................31
3.2 Sample/ participants:..........................................................................................32
3.3 Data collection techniques:.................................................................................32
3.3.1 Tool....................................................................................................................32
3.3.2 Data, collection, procedure:............................................................................ 33
3.4 Analysis technique:................................................ Error! Bookmark not defined.34
3.5 Ethical consideration.......................................................................................... 35
CHAPTER 4.............................................................................................................. 36
RESULTS.................................................................................................................. 36
CHAPTER 5.............................................................................................................. 51
DISCUSSION AND LIMITATION........................................................................ 51
5.1 Discussion.............................................................................................................51
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5.2 Limitation:........................................................................................................... 53
CHAPTER 6.............................................................................................................. 54
CONCLUSION AND RECOMMENDATION...................................................... 54
6.1 Conclusion:.......................................................................................................... 54
6.2 Recommendation:............................................................................................... 54
Appendices.................................................................................................................56
REFERENCES..........................................................................................................63
PLAGIRIASM REPORT ………………………………………………………………………………………………………..64
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ABSTRACT

BACKGROUND: Stroke, a leading cause of disability and death, disrupts independence and

well-being. Prolonged rehabilitation is vital for daily functioning and societal involvement,

underscoring the significance of functional mobility in curtailing healthcare expenditures.

OBJECTIVE: Aim of our study is that to assess the quality of life and functional mobility of

stroke patients in a home-based setting.

METHODOLOGY: This cross-sectional survey was conducted after approval from the ethical

committee. In this study 193 chronic stroke patients aged 21-60 years including both genders and

are living in home-based setting who are not taking any kind of intervention or rehabilitation

were included with non-probability, non-convenience sampling technique. Stroke specific

quality of life and Motor Assessment Scale were used to measure quality of life and motor

functions of stroke survivors. The data were analyzed through SPSS version 21.0

RESULTS: According to our study, Males were at greater risk of disturbed quality of life with a

correlation value of p=0.00, there is a positive link between the functional mobility and quality

of life in stroke patients.

CONCLUSION: This study concludes that functional mobility significantly impacts the quality

of life of elderly stroke patients in various settings. Maintaining physical function is vital for

overall well-being, and the findings highlight the importance of functional independence and

long-term rehabilitation for a better quality of life.

KEY WORDS: Stroke patients. functional mobility, quality of life, home based setting, stroke

specific, Motor movements.

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Chapter 1

INTRODUCTION:

1.1 BACKGROUND:

Stroke is the third leading cause of disability and is the second most leading cause of global

mortality after ischemic heart disease, accounting for about 10.2% of global deaths in the year

2016. Stroke is a leading cause of disability and can affects patient’s quality of life and

independence. Studies indicate that among stroke patients 30% suffer permanent disability, and

20% require long-term care. (Richardson, M., et al. 2021)

Complications of stroke include weakness in the limbs, decreased physical endurance,

sensory deficits, dysphagia, aphasia, loss of coordination, cognitive impairment, anxiety, and

depression. This can adversely affect quality of life of stroke survivals. It is critical to remain

functional mobile after stroke to combat disability following stroke. In addition, the majority of

survivors have motor impairments, which are linked to a decline in quality of life and functional

ability to carry out activities of daily living (ADL). The cost of care and treatment may then

become a burden to caregivers. (Bethoux, F., P. Calmels and V. Gautheron 2022)

Stroke is one of the leading causes of disability in Pakistan. It is a life-threatening emergency

condition where every second counts. 30% stroke patients suffer permanent disability, and 20%

require long-term care. So, it is important to study stroke, its symptoms, prevalence, recovery

from stroke, its long-term care, disability from stroke, after effects and challenges faced by

survivors and its caregivers.

Walking disability is a major concern among patients undergoing post stroke rehabilitation

because the inability to walk considerably compromises their functionality and quality of life.
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Following rehabilitation, stroke patients are frequently at risk of functional deterioration, which

increases their vulnerability to falls, dependence on daily living activities, and mental difficulties.

Stroke causes sufficient decrease in quality of life (QoL) even among those who have no

disability after stroke. Multiple risk factors, such as age, gender, dependence on daily living

activities or disabilities, social support, depression, institutionalization, and diabetes, have been

linked to lower QoL in stroke patients in various populations. Due to these shortcomings,

patient-centered outcomes including functional status and health-related quality of life (HRQOL)

are becoming more and more important in clinical studies (4) Karakaya, M. G., et al. (2019).

By studying quality of life and functional mobility of chronic stroke patients in a home-based

setting we will be able to have a conclusion about if long term rehabilitation is necessary or

patient may recover without any intervention. It will reduce health costs and provide valuable

information to health care providers. (5) Kei, C. P., N. A. M. Nordin and A. F. A. Aziz (2020). "

Statistical Analysis:

For BMI calculation:

 Formula: weight (kg) / [height (cm)2 /100**2]

 SPSS (for data analysis)

 Stroke Specific Quality of life scale (SSQOL)

 Motor Assessment scale (MAS)

Defining Stroke:

Stroke, often referred to as a cerebrovascular accident, happens when the blood supply to the

brain is cut off. According to the World Health Organization (WHO), a cerebrovascular accident

(CVA) or stroke is defined as “a cerebrovascular disease with clinical signs of focal disorders of

brain function, that develops rapidly, with symptoms lasting 24 h or more or leading to death,
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with no other apparent cause than a vascular origin”. Chronic stroke is defined as a period of

recovery that takes place at least 4-12 months after the initial stroke event. (6) Shaomin Chen,

Chang Lv, Jiaozhen Wu, 2021

Types of stroke:

There are two main types of stroke.

1. Ischemic stroke: these are caused when a blood vessel that supplies the brain becomes

blocked. Blockage is due to thrombus or embolus. Ischemic stroke is further classifies

into thrombotic stroke and Embolism stroke. (hen, Y.-C., et al. 2023)

2. Hemorrhagic stroke: these are caused by bleeding when a blood vessel that supplies
brain ruptures. It is further classified into Intracerebral hemorrhage (bleeding is from the

blood vessel within the brain) and Subarachnoid hemorrhage (bleeding is in the

subarachnoid space between the brain and the membranes. (7) hen, Y.-C., et al. (2023)

Causes:

Stroke is caused by a sudden blockage in the flow of blood to the brain and by bleeding.

Cerebral vessel is blocked by a thrombosis in the vessel and by an embolus to the vessel.

Embolus formation is due to atrial fibrillation, valvular heart disease and carotid stenosis. (9)

Symptoms:

 Weakness or sensory loss on the opposite (contra-lateral) side of the lesions causing

stroke

 Homonyms hemianopia that is loss of visual field on the opposite side of stroke

 Aphasia occurs if stroke occurs on the same side as the speech center
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 Cognitive defects like confusion

 Urinary incontinence

 Legs more than arm weakness

 Limb ataxia

Risk Factors:

 Hypertension

 Diabetes

 Hyperlipidemia

 Tobacco smoking

Diagnostic tests: The best initial test in any type of stroke is a CT scan of the head without

contrast. The most accurate test is MRI.

Treatment:

The best initial therapy for a non-hemorrhagic stroke is

 Less than 3 hours since onset of stroke is thrombolytic

 More than 3 hours since onset of stroke is aspirin

 For hemorrhagic stroke no initial treatment (10)

Over the past three decades, there has been a rise in the prevalence of stroke, with low-income

nations reporting an annual increase of 14.3%. Significant differences in the prevalence,

morbidity, and mortality rates associated with stroke have been noted in various geographic

locations and regions, particularly in nations with varying socioeconomic level. (11)
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The rate of stroke per 100,000 in Pakistan is 250 and is one of the leading causes of disability

in Pakistan. It is a life-threatening emergency condition where every second counts. 30% stroke

patients suffer permanent disability, and 20% require long-term care. So, it is important to study

stroke, its symptoms, prevalence, recovery from stroke, its long-term care, disability from stroke,

after effects and challenges faced by survivors and its caregivers. (12)

Strokes can affect sufferers’ independence and cause disability. Moreover, they may present

concurrently with other medical issues. The cost of care and treatment may then become a

burden to caregivers. Complications of stroke include the following: weakness in the limbs,

decreased physical endurance, sensory deficits, dysphagia, aphasia, loss of coordination,

cognitive impairment, anxiety, and depression. Studies indicate that among stroke patients 30%

suffer permanent disability, and 20% require long-term care.

Walking disability is a major concern among patients undergoing post stroke rehabilitation

because the inability to walk considerably compromises their functionality and quality of life.

The most frequent disability following a stroke is hemiplegia, which results in upper extremity

(UE) dysfunction. UE impairment is linked to activity restriction and a lower quality of life in

terms of one's health. (13)

Following rehabilitation, stroke patients are frequently at risk of functional deterioration,

which increases their vulnerability to falls, dependence on daily living activities, and mental

difficulties. It is critical to remain functional mobile after stroke to combat disability following

stroke. In addition, the majority of survivors have motor impairments, which are linked to a

decline in quality of life and functional ability to carry out activities of daily living (ADL).
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Furthermore, almost 70.0% of patients with stroke are reported to suffer from functional

disabilities. Lower limb motor function, a prerequisite for performing routine activities of daily

life, is often impaired after stroke, causing restrictions in functional mobility. Lower limb

spasticity is a common consequence of stroke, and results from a combination of upper motor

neuron syndromes. (14)

Stroke causes sufficient decrease in quality of life (QoL) even among those who have no

disability after stroke. Age, sex, stroke type, stroke side, duration after onset, stroke severity,

functional status, lower extremity (LE) motor function, balance function, cognition function, and

depression have all been identified as potential predictors of QOL outcomes in patients with

stroke.

Multiple risk factors, such as age, gender, dependence on daily living activities or disabilities,

social support, depression, institutionalization, and diabetes, have been linked to lower QoL in

stroke patients in various populations. Due to these shortcomings, patient-centered outcomes

including functional status and health-related quality of life (HRQOL) are becoming more and

more important in clinical studies. The physical, psychological, and social facets of life that may

be impacted by alterations in health conditions are together referred to as HRQOL. (15)

A reliable, valid and reliable measure of Stroke specific HRQOL across the range of stoke

symptoms and severity, Stroke Specific Quality of Life scale (SS-QOL) is used. Stroke specific

Quality of life (SS-QOL) scale is 49 item scale. It has 12 domains. It includes following domains

energy, family roles, language, mobility, mood, personality, self-care, social roles, thinking,

upper extremity functions, vision, and work/productivity. Highest score is 245.

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One-third of stroke survivors have a lasting disability, making stroke one of the most

common causes of adult disability. One of the most prevalent and long-lasting impairments after

a stroke is upper limb paralysis. Activities of daily living (ADLs) and quality of life (QOL) are

frequently significantly impacted by the loss of motor control in the upper limb. 85% of patients

with acute strokes that occurred more than six months ago and 55% to 75% of those patients

have upper-limb problems that interfere in ADLs. (16)

Due to physical malfunction, daily activities are restricted, and the majority of stroke patients

have little opportunity for social engagement that lowers quality of life. Additionally, depression

may develop in stroke patients as a result of diminished motivation. Depression causes loss of

interest and delight, as well as anxiety, fear, hostility, sadness, and rage, all of which have a

detrimental effect on stroke patients' functional recovery and rehabilitation.

A comprehensive indicator of the burden of an illness from the perspective of the person with

a handicap is health-related quality of life (HRQL). The HRQL of people with chronic stroke has

recently been shown to substantially correlate with physical function measures as improved

motor function, balance function, gait, and independence in completing basic and instrumental

activities of daily living. It is known if regular physical activity (PA) is linked to better HRQL in

those who have had strokes.

Regular PA can lower morbidity, avoid recurrent stroke, and prevent the onset of secondary

illnesses such obesity, depression, fractures, osteoarthritis, and osteoporosis. PA for this

population is crucial since 30% of people who have had a stroke are at risk of having another one,

making it extremely important. PA threshold of 1,000 kcal per week is recommended while
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patients usually engage in substantially less PA than healthy people, maybe as a result of their

motor disability. (17)

The HRQL of older patients who engage in regular moderate-intensity physical activity (PA)

has been shown to be higher than that of those patients who engage in less physical activity.

Additionally, it has been discovered that participating in PA improves patients' HRQL who have

chronic conditions, arthritis, and results in healthier days for those who have had a stroke.

An increased risk of stroke was linked to lower socioeconomic level. Motor function issues,

post-stroke psychological distress, and limitations on daily routine, leisure, and employment

activities can all affect one's health. Combining social and material factors with cerebral vascular

disease has an impact on health. A study found that three years after a stroke, impairment was

still very common. Psychological distress following a stroke is linked to decreased quality of life

(QoL), functional restrictions, and healthcare utilization. (18)

Motor function of stroke patients is assessed through Motor Assessment Scale (MAS). Motor

functions are reduced following stroke due to neurological involvement. The symptoms of a right

hemisphere stroke may include left-sided weakness or paralysis and sensory impairment and left

hemisphere stroke includes right side weakness or paralysis. So, to access motor function, MAS

is used. It is a task-oriented approach to assess motor function in stroke patients. The MAS is a

test that measures 8 different aspects of motor performance as well as one item that measures

muscle tone. Total score of MAS is 48.

80% of stroke patients show motor deficits, which can include loss of balance and gait.

Because they affect people's capacity to conduct ADLs, these issues are crucial rehabilitation

goals because they also have a negative impact on communal activities. The majority of
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activities of daily living (ADLs), such as eating, dressing, and personal care, which heavily rely

on upper extremity function, are severely disabled after a stroke. (19)

Functional limitations affect patient mood and quality of life in addition to impairing motor

function and ADLs. So, throughout the rest of their lives, stroke survivors frequently take part in

a rehabilitation programme. However, impediments to continuing therapy include an initially

delayed recovery that results in lost motivation, the burden of medical bills, and the hospital's

advised discharge.

Previous studies have demonstrated the effects of various rehabilitation programs, such as

robotic-assisted rehabilitation, neuromuscular electric stimulation, extracorporeal shock wave,

mirror therapy, and bilateral leg exercises in improving motor control among stroke patients.

However, most patients are unable to complete these treatments because of the prohibitive cost

of the equipment, which subsequently limits their recovery. Home-based rehabilitation programs,

which are safe, inexpensive, and easy-to-implement, have been developed for stroke

rehabilitation using different technologies.

In a home-based setting, stroke survivors are not receiving any kind of treatment or

rehabilitation. Although they are functionally mobile patients but they are not as active as before

experiencing stroke. So, we assume that their motor functions as well as their quality of life will

be poor. They are inactive because of impaired balance and co-ordination, fatigue, and decrease

confidence in mobilizing. When a stroke occurs, it damages the areas of the brain that control

muscle movement and the signals between the brain and the muscles can become weakened or

lost. Hence, there is weakness or paralysis of the limbs. (20)

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Social isolation is another cause of delayed recovery as patient loses hope and is socially

disconnected. He considers himself useless and helpless. Long term rehabilitation is very

necessary to prevent reoccurrence of stroke and functional impairment. Also, the burden on

hospitals and family caregivers is reduced. If patient is not receiving any rehabilitation, it is

likely to be readmitted in hospital and may be long term hospital stay will be required to survive

and minimize disability. This will lead to hospital burden and hospital cost will increase.

Government expenditures will be high if right treatment to stroke survivors is not provided. (21)

This study addresses the lack of research on assessing the quality of life and functional

mobility of stroke patients in a home-based setting. By studying quality of life and functional

mobility of chronic stroke patients in a home-based setting we will be able to have a conclusion

about if long term rehabilitation is necessary for patient or patient may recover without any

intervention. It will reduce health costs and provide valuable information to health care providers.

We have considered stroke patients that are in a home-based setting and are not receiving any

kind of treatment or rehabilitation to check their functional mobility and QOL. We have included

chronic stroke patients of 4-12 months who are in a home-based setting and are not receiving any

kind of treatment. We are considering patients from old homes, nurse houses and residential

areas. We assume that their functional mobility and quality of life may be lowered as stroke

patients need long term rehabilitation to avoid any disability and emotional disturbances.

1.2 Statement of problem:

Stroke is a disabling global health problem. Strokes can affect sufferers’ independence and

cause disability. This can adversely affect quality of life and functional mobility of stroke

survivors. Functional decline after stroke due to neurological defect, immobility, psychological
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factors like depression can cause further health deterioration. The cost of care and treatment may

then become a burden to caregivers.

1.3 Significance:

Stroke is a common, serious, and disabling global health-care problem. By studying quality

of life and functional mobility of chronic stroke patients in a home-based setting we will be able

to have a conclusion about if long term rehabilitation is necessary or patient may recover without

any intervention. It will reduce health costs and provide valuable information to health care

providers. Physiotherapist role will be defined and their vital contribution to the stroke survivors

will be clear. After recovery stroke survivor can live a healthy life by carrying out ADLs and

plays productive role in society.

1.4 Objective:

Aim of our study is that to assess the quality of life and functional mobility of stroke patients in a

home-based setting.

1.5 Hypothesis:

• NULL HYPOTHESIS:

There is no significant relation in the quality of life and functional mobility of stroke

patients in a home-based setting.

• ALTERNATE HYPOTHESIS:

There is significant relation in the quality of life and functional mobility of stroke patients

in a home-based setting.

Chapter 2
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LITERATURE REVIEW:

2.1 Case Study 1

A study was conducted in 2023 to compare home-based rehabilitation and hospital-based

rehabilitation for stroke patients in post-acute care stage. Result of this study shows that Home-

based rehabilitation was less intensive and prolonged than hospital-based rehabilitation, but it

was nevertheless able to significantly enhance patients with PAC strokes' quality of life. In

comparison to home-based rehabilitation, hospital-based rehabilitation provided more and longer

treatment sessions and thus produced superior QOL results and 94% patients had better QOL.

(Yu-Chung Chen, Willy Chou…..2023)

2.2 Case Study 2

A study was conducted to evaluate upper extremity function by Fugl-Meyer Assessment

Scoring Using Depth-Sensing Camera in Hemiplegic Stroke Patients. Due to the fact that

recovery of UE impairment is noticeable in the first 6 to 12 months following the

commencement of the stroke and can continue gradually up to one year later, appropriate therapy

is advised for maximum recovery throughout this time. Result showed only 30% of stroke

survivors received outpatient stroke rehabilitation, which is less than predicted. This might be

linked to obstacles including expenses, travel, and limited usage of public transit because of

disability. Additionally, developing nations have few adequate rehabilitation facilities, and the

utilization of outpatient rehabilitation facilities is probably relatively low. (Won-Seok Kim,

Sungmin Cho…...2018)

2.3 Case Study 3

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A study was conducted to evaluate the increase in the functional capacity and quality of life

among stroke patients by family caregiver empowerment program based on adaptation model.

This research proves a significant difference in functional capacity and quality of life between

the two groups and between pre-test and sixth months after intervention (P < 0.05). The quality

of life of the intervention group in the sixth month after intervention was better than that of the

control group (33.40 ± 3.65 vs 30.60 ± 2.78) with a significant difference (P < 0.05). Its finding

includes that the patients' functional abilities and quality of life were significantly better six

months after the intervention thanks to CEP-BAM. Nine out of ten functional capacity domains

in the intervention group after CEP-BAM increased, although two of those domains (eating and

dressing) significantly increased in the six months after CEP-BAM. (Kelana Kusuma

Dharma……2018)

2.4 Case Study 4

A study was conducted to for older Adults Living following in Care Homes. Results from a

National Data Linkage Study in Wales was conducted. Its findings include 7.0% (n = 6055) of

86,602 people had a stroke in the year before entering a care facility. Within a year of moving

into a care facility, the incidence of stroke was 26.2 per 1000 person-years [95% confidence

interval (CI) 25.0, 27.5]. Prior stroke was linked to an increased risk of incident stroke after

entering a care facility (sub distribution hazard ratio: 1.83; 95% confidence interval: 1.57; 2.13);

and 30-day mortality after stroke (odds ratio: 2.18; 95% confidence interval: 1.59; 2.98). People

who have had a stroke within the preceding 12 months are more likely to have an incident stroke

and to die from it when they enter a care facility. (Stephanie L. Harrison PhD, Gregory Y.H. Lip

MD…..2022)

2.5 Case Study 5

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A study was conducted to know the effectiveness of a home-based exercise program among

patients with lower limb spasticity following stroke. This study shows that at 6- and 12-months

following discharge, there were significant differences between the control and intervention

groups in terms of spasticity severity, motor function, walking capacity, and ADL. ADL and

lower limb spasticity were considerably improved in the intervention group. HREPro is effective

for rehabilitation of patients with lower limb spasticity post-stroke and has favorable home

application. (Shaomin Chen, Chang Lv, Jiaozhen Wu…….2020)

2.6 Case Study 6

A study was conducted to check effectiveness of home-based technologies for stroke

rehabilitation. This study includes that Games, tele rehabilitation, robotics, virtual reality, sensors,

and tablets are among the technology categorized in this systematic review as being used for at-

home stroke rehabilitation. According to the study of the user studies, home-based technologies

for rehabilitation could provide a number of advantages, including strengthening patients'

activities of daily living and enhancing patients' motor abilities and rehabilitation quality on par

with conventional therapies. 832 potentially pertinent articles were found throughout the search,

and 31 of those were chosen for in-depth research. (Yu Chen, Kingsley Travis Abel…...2018)
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2.7 Case Study 7

A study was conducted to check if additional therapy promotes a continued pattern of

improvement in upper-limb function and independence post-stroke. It shows that all of the

patients displayed a pattern of steady advancement in their independence in daily living activities

and upper-limb motor function. These results show the value of continuous post-stroke

rehabilitation for stroke survivors living in the community, regardless of their initial functional

condition. This study showed a pattern of ongoing motor function improvement in the upper

limbs with subsequent therapy. Late subacute and chronic post-stroke patients with low,

moderate, and high residual upper-limb motor function benefited further from two programs of

individualized and intense upper-limb therapy. The transition to a greater degree of motor

function and re-engagement in the community were made possible by these advances. (AG

Thompson-Butel PhD, SK Ashcroft MCEP……2023)

2.8 Case Study 8

A study was conducted to check if home-based exercises are as effective as equivalent

doses of center-based exercises for enhancing walking speed and balance after stroke. In this

research results shows that there were 609 participants throughout 9 trials. High-quality evidence

from random-effects meta-analyses showed that exercises performed at home and in a gym have

comparable effects on walking speed (MD -0.03 m/s, 95% CI -0.07 to 0.02) and balance (MD 0

points, 95% CI -1 to 2). Results for participation (MD -5 points, 95% CI -19 to 10) and mobility

(SMD -0.4, 95% CI -1.3 to 0.4) were not exact. After a stroke, the benefits of home-based

prescribed exercises on walking speed, balance, mobility, and engagement are anticipated to be
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similar to those of center-based exercises at equivalent dosages. (Lucas R Nascimento, Rafaela

JS Rocha…...2022)

2.9 Case Study 9

A study was conducted to evaluate the increase in walking ability among stroke patients

through post-acute care rehabilitation. This research shed light on how high-intensity therapy can

improve post-stroke walking function. Even though most stroke patients were able to walk again

after PAC rehabilitation, a sizeable percentage of them still had limited mobility at home or in

the community. Important indicators of post stroke walking performance include balance, age,

leg strength, nutritional health, and upper limb function. Balance, age, leg strength, nutritional

status, and upper limb function before post-acute care rehabilitation are predictors of walking

performance after stroke. (Chan-Lin Chu, Tsong-Hai Lee……2022)

2.10 Case Study 10

A study was conducted to know the experience of stroke patients and caregivers during

hospital-to-home transitional care. Its findings include that Stroke survivors' and care givers

experiences during hospital-to-home transitional care are a dynamic process with significant

difficulties in each stage. These findings have significance for health care systems and

policymakers in terms of creating a supportive environment for effective hospital-to-home

transitional care. To assist stroke survivors and their care givers in facilitating their hospital-to-

home trajectory, collaboration with healthcare professionals, easily accessible rehabilitation

services and follow-up support after discharge, as well as readily available community and social

support, are warranted to be integrated into transitional care. (Shuanglan Lin PhD, Chunli

Wang…….2022)
 28

2.11 Case Study 11

A study was conducted to check the acceptability of In-Home Ambient Sensors for Activity

Recognition and Assessment Post-Stroke. All participants were able to comprehend the projected

advantages and therapeutic consequences of this sensor despite privacy concerns. Since most

participants in Demiris et al.'s study (2009) saw the benefit and purpose of monitoring, this is

consistent with earlier work. The depth sensor and created algorithm will be incorporated into a

bigger home-based sensor system for people who have had strokes and other ailments in future

study. (Rachel Proffitt……2022)

2.12 Case Study 12

A study was conducted to check the feasibility and preliminary effects on physical function

and quality of life by combining Aerobic Exercise and Virtual Reality-Based Upper Extremity

Rehabilitation Intervention for Chronic Stroke. This study shows that it seems possible to

combine AEx and VR-UE therapy in a clinical study context. Large effects on VO2peak,

perceived strength, and overall stroke recovery were produced by the combined intervention of

AEx+DDP, but medium benefits were produced on UE impairment, cognitive function, and

perceived memory in chronic stroke. We find that a brief period of vigorously conducted AEx

can produce clinically significant effects in chronic stroke patients. Combining AEx with stroke

rehabilitation techniques may strengthen the responsiveness to the intervention while also

igniting a positive feedback loop that results in decreased disability, improved function, and

improved quality of life. (Ryan E. Ross PhD, Emerson Hart OTR/L……2022)

 29

2.13 Case Study 13

A study was conducted to evaluate the effectiveness of community-based stroke

rehabilitation. Results show that community rehabilitation teams for stroke patients were

successful in enhancing their functional and psychological recovery after a stroke. Importantly,

these improvements persisted six months after programme discharge. When access to outpatient

treatments is restricted, a home-based, multidisciplinary rehabilitation programme tailored

specifically for stroke should be taken into account. (Marina Richardson, Nerissa Campbell,

Lawson …...2018)

Our study addresses the lack of research on assessing the quality of life and functional

mobility of stroke patients in a home-based setting. By studying quality of life and functional

mobility of chronic stroke patients in a home-based setting we will be able to have a conclusion

about if long term rehabilitation is necessary for patient or patient may recover without any

intervention. It will reduce health costs and provide valuable information to health care providers.

2.14 Case 14:

A study was conducted to know the effect of physiotherapy in stroke rehabilitation. The

Bobath technique was chosen (n =67%), followed by a 'eclectic' approach (n =31%). This

investigation revealed four theoretical elements underlying current practice in neurological

physiotherapy: the promotion of normal movement, tone control, function promotion, and

movement recovery with compensatory optimization. Many of these assumptions, such as the

amount of time spent on function preparation, the automatic translation of movement into

function, carryover outside of therapy, and the manner in which tasks should be executed,

deserve more debate within the physiotherapy profession. (Sheila lennon…………2018)

 30

2.15 Case 15

A study was conducted on stroke rehabilitation. Constraint-induced movement therapy and

robotics are two potentially useful treatment options for arm motor rehabilitation. Fitness

training, high-intensity therapy, and repetitive-task training are all promising strategies that could

help improve aspects of gait. Repetitive task training may also help with transfer functions.

Occupational therapy can improve daily activities; however, data on the clinical effects of

various cognitive rehabilitation and aphasia and dysarthria techniques is limited. (Prof Peter

Langhorne, PhD…………2019)

2.1 Research Gap:

There is lack of research on quality of life and functional mobility of stroke patients in a

home-based setting. By studying quality of life and functional mobility of chronic stroke patients

in a home-based setting we will be able to have a conclusion about if long term rehabilitation is

necessary or patient may recover without any intervention. It will reduce health costs and

provide valuable information to health care providers.

 31

Chapter 3

Methodology

3.1 Research Design:

Our study design is cross sectional study

3.2 Sample:

 Sampling Strategy:

Non randomized convenient sampling technique is being used in our study. Our

sample size is 193.

 Inclusion Criteria:

We included participants of age between 21-60 years. Both genders male and

female were included in our study. Participants had experienced a stroke between 4-

12 months prior to the study. Both hemorrhagic and ischemic stroke patients were

included in our study. Participants were resided in their own homes or in a home

environment where no rehabilitation program were being implemented

 Exclusion Criteria:

Exclusion criteria includes unstable medical condition like myocardial infarction,

deep vein thrombosis, acute renal failure, or needs for further surgery or medical care

and having comorbid conditions like cancer, chronic kidney disease, diabetes, atrial

fibrillation.
 32

 Sample Size:

Our sample size is 193.

Confidence Level (e.g., 95%) 95%

One Sample, Continuous Outcome (m)

Standard deviation of outcome (s) 4

Margin of Error (E) 0.58

Sample Size Required 183

Attrition? Enter Percentage Expected to be Lost/Missing Data 5%

Sample Size Required, Accounting for Attrition 193

3.3 Data Collection tools/ sampling measure:

3.3.1 Data Collection Tools:

Our study utilized the following validated and reliable tools to gather data on the

quality of life and functional mobility of stroke patients in a home-based rehabilitation

setting

 Motor Assessment Scale: The Motor Assessment Scale were employed to

evaluate motor function, including mobility, muscle strength, coordination, and

balance, in stroke patients. Reliability. 87% overall agreement between raters

(mean correlation r = 0.95; maximum agreement = balanced sitting (r = 0.99);

least agreement = sitting to standing (r = 0.89). Sitting arm raise (no. of rises; r =
 33

0.33*) has adequate convergent validity. Convergent Validity: seated forward

reach (cm, r = 0.54**) *p < 0.05 ** p < 0.01

 Stroke-Specific Quality of Life: The Stroke-Specific Quality of Life (SS-QOL)

scale were utilized to measure the impact of stroke on participants' quality of life

across various domains, including physical, psychological, and social well-being.

The SS-QOL ratings were well associated (r = 0.92), indicating good test-retest

reliability. The SS-QOL ratings were well associated (r = 0.92), indicating good

test-retest reliability. This approach of assessing dependability is only applicable

if the phenomenon being measured by the scale is known to be stable across the

interval between evaluations. Each SSQOL questionnaire item had a high

convergent validity within the domain in which it was included, with rp values

ranging from 0.800 to 0.990.

3.3.2 Data Collection Procedure

Data were collected from various nursing houses, old age homes, and private residences in

Lahore. Our data collection phase involved administering the selected data gathering tools

through face-to-face interviews, online surveys, or questionnaires. Data was collected using the

Motor Assessment Scale and Stroke-Specific Quality of Life scale. Informed consent was

obtained from participants. Data collection occurred at their respective locations. 2 months’ time

frame was required to complete our data collection.

 34

3.4 Data Analysis:

Descriptive Statistics provided measures such as means, standard deviations, and

frequencies to describe the characteristics of the study sample, including demographic

information and the distribution of variables. Independent t-test or Mann-Whitney U test

were used to compare the mean scores or ranks of two groups (e.g., different types of stroke

or different age groups) for variables related to quality of life and functional mobility. Chi-

square test examined the association between categorical variables, such as gender or

comorbidities, and variables related to quality of life and functional mobility. Multiple

regression analysis test assessed the impact of multiple independent variables (e.g., age,

gender, duration of rehabilitation) on dependent variables related to quality of life and

functional mobility, while controlling for potential confounding factors.

Data was analyzed from SPSS version 21.0. Data was analyzed upon completion of data

collection; the collected data was subjected to statistical analysis. Descriptive statistics and

appropriate inferential tests were used to analyze the data and draw meaningful conclusions.

The results obtained from the data analysis in the study "Assessment of Quality of Life and

Functional Mobility of Stroke Patients in a Home-Based setting" were carefully examined

and interpreted within the context of the research objectives. The focus was on evaluating the

impact of home-based rehabilitation on quality of life and functional mobility outcomes for

stroke patients. Data was interpreted through the findings related to quality-of-life measures

and functional mobility outcomes were discussed, highlighting any significant differences

observed. Limitations and biases that may have influenced the results are also acknowledged

and discussed. The interpretation of our results aims to contribute to the understanding of

quality of life and functional mobility of stroke patients in a home-based setting and inform
 35

about any significant difference observed in stroke patients who are not taking any

intervention.

3.5 Ethical Considerations

Informed consent was obtained from each participant before his involvement in the

study. Participants were provided the detailed information about the study, including its

purpose, procedures, potential risks, and benefits. They were having the opportunity to ask

questions and clarify any concerns before voluntarily providing consent.

 36

Chapter 4

RESULTS

DESCRIPTIVE STATISTICS:

Age, Gender, Weight, Height, BMI, Occupation, education, duration of stroke, affected

side of the body, Motor assessment score (MOS), Quality of life score (QOL): The summary of

statistics is calculated such as minimum, maximum, mean, and standard deviation for these

continuous variables. This helps in understanding the central tendency and variability of these

measures within the dataset.

The dataset of 193 patients exhibits diverse characteristics. Following are the Mean and standard

deviation of Age (54.91±4.384), Gender (1.12±0.331), weight(2.46±0.568), height (4.16±1.619),

BMI (28.7347± 2.56178)mean and SD 7.1140 ± 5.95622 Motor assessment score covers 0-28

points with mean and SD7.1140 ± 5.95622 whereas quality of life ranges 0 to 245with mean and

SD 81.8497 ±7.57072

Frequencies and Percentages:

Age: Most respondents fall within the age range of 50 to 60 years, while a smaller proportion fall

within age range of 35 to 49.

BMI Range: The distribution of BMI categories shows that 5.70% were normal weight, 94.3%

had overweight.

Gender: The dataset includes 12.44% female and 87.56% Male respondents.
 37

Level of Education: The educational distribution shows that different education of respondents

in a home-based setting, mostly data taken from males and females. Patients are BA 13.9%,

Metric 9.3%, FA 11.92 %, Middle 25.39%, MS 8.81%, BS 7.5% and 22.80% others

Duration of Stroke: patients suffering 4-7months of stroke 57.51% while the rest of having

stroke for about 8-12 months with percentage of 42.49%.

Pie Charts:

The bar charts provide visual representations and peak of the categorical distributions,

highlighting the proportions of each category within the dataset for various variables.

Overall, these results offer insights into the characteristics of the respondents in the dataset, their

demographics, Duration of stroke, and affected side. Additionally, conducting further statistical

tests or analyses to explore relationships between variables or to address specific research

questions can be considered from the dataset.

Correlation among Scales:

Correlation between MAS and SSQOL scale shows a significant positive correlation is observed

between Quality of Life (SSQOL) scores and MAS (p < 0.000).

Correlation between BMI and Scales: A substantial negative link between Body Mass Index

(BMI) and the motor assessment scale, which measures the quality of life after a stroke, was

found (p 0.01). Body Mass Index (BMI) and Quality of Life have a substantial negative

association, according to research comparing the two variables (p 0.01). The motor assessment

scale and Body Mass Index (BMI) did not significantly correlate with each other, according to

the correlation study.

 38

DESCRIPTIVE STATISTICS

N MINIMUM MAXIMUM MEAN S.D

AGE 193 35 62 54.91 4.384

GENDER 193 1 2 1.12 .331

WEIGHT 193 1 3 2.46 .568

BMI 193 22.46 35.45 28.7347 2.56178

HEIGHT 193 1 6 4.16 1.619

Table 4.1 summarizes the characteristics of a data set. It provides descriptive statistics for
variables including Age (mean + std. deviation : 54.91±4.384),Gender (mean + std. deviation
1.12±0.331), weight (mean and std. deviation: 2.46±0.568), height (mean and std. deviation
4.16±1.619), BMI (mean and std. deviation: 28.7347± 2.56178).

OCCUPATION

Occupation Frequency Percent

TEACHER 52 26.9%

DEALER 36 18.7%

LABOR 14 7.3%

CLERK 10 5.2%

DRIVER 8 4.1%

PAINTER 22 11.4%

OTHERS 51 26.4%

TOTAL 193 100.0%

 39

Table 4.2 shows different occupation status of respondent’s frequency and percentage
distribution. From the total of 193 respondents (N=193), the frequency
(n=52+36+14+10+8+22+51=193) and percentage (%=26.9+18.7+7.3+5.2+4.1+11.4+26.4=100)

PIE CHART REPRESENTATION:

Figure 1

Pie chart shows the frequencies among different occupations, teacher 26.94%, others 26.42%,
Dealer 18.65%, painter 11.40%, labor 7.25%, clerk 5.18% and driver 4.15%
 40

EDUCATION

Education Frequency Percent

BA 27 27

Metric 18 18

FA 23 23

Middle 49 49

MS 17 17

BS 15 15

others 44 44

Total 193 193

4.3 Table shows different education status of respondent’s frequency and percentage distribution.

From the total of 193 respondents (N=193), the frequency (n=27+18+23+49+17+15+44=193)

and percentage (%=14.0+9.3+11.9+25.4+8.8+7.8+22.8=100.0%).

Figure 2
 41

Pie chart shows different education of respondents in a home based settings, mostly data taken

from males and females. Patients are BA 13.9%, Metric 9.3%, FA 11.92 %, Middle 25.39%, MS

8.81%, BS 7.5% and 22.80% others. Highest percentage of middle educated and lowest

percentage of BS.

DURATION OF STROKE

Duration of stroke Frequency Percent

4-7 111 57.5%

8-12 82 42.5%

Total 193 100.0%

4.4 Table shows duration of stroke status of respondent’s frequency and percentage distribution.

From the total of 193 respondents (N=193), the frequency (n=111+82=193) and percentage

(%=57.5+42.5=100.0).

Figure 3

Pie chart indicates 57.51% have stroke from 4-7 months 42.49% have stroke from 7- 12 months
AFFECTED SIDE OF THE BODY
 42

Affected side of body Frequency Percent

left 39 20.2

Right 154 79.8

Total 193 100.0

4.5 Table indicates affected side of body of respondent’s frequency and percentage distribution.

From the total of 193 respondents (N=193) frequency of left sided and right sided of body

(n=39+154=193). And percentage (%=20.2+79.8=100.0).

Figure 4

 Pie chart shows characteristic right side of the body affected with stroke about 79.79%.
 43

BMI

BMI Frequency Percent

Overweight 182 94.3%

Normal 11 5.7%

Total 193 . 100.0%

4.6 Table indicates BMI of respondent’s frequency and percentage distribution. From the total of
193 respondents (N=193) frequency of normal and overweight (n=182+11=193) and percentage
(%=94.3+5.7=100.0)

Figure 5

 Highest percentage of overweight and lowest percentage of normal weight.

 Pie chart shows that the percentage of male patients is 87.56% and the percentage of females is

12.44%.
 44

GENDER

Gender Frequency Percent

Male 169 87.6%

Female 24 12.4%

Total 193 100.0%

4.7 Table indicates gender of respondent’s frequency and percentage distribution. From the total
of 193 respondents (N=193) frequency of male and female (n=169+24=193) and percentage is
(%=87.6+12.4=100.0).

Figure 6

Figure shows that majority of participants were male 87.56% and less participants were females
12.44%.
 45

AGE

Age Frequency Percent

35 1 .5%
40 1 .5%
45 6 3.1%
47 4 2.1%
48 4 2.1%
49 7 3.6%
50 8 4.1%
51 8 4.1%
52 8 4.1%
53 11 5.7%
54 14 7.3%
55 31 16.1%
56 18 9.3%
57 8 4.1%
58 13 63.7%
59 18 9.3%
60 33 17.1%
Total 193 100.0%

Table 4.8 indicates Age of respondent’s frequency and percentage distribution. From the total of 193
respondents (N=193) frequency (n=1+1+6+4+4+7+8+8+8+11+14+31+18+8+13+18+33=193) and
percentage (%=.5+.5+3.1+2.1+2.1+3.6+4.1+4.1+4.1+5.7+7.3+16.1+9.3+4.1+6.7+9.3+17.1=100.0)
 46

Figure 7

 Pie chart shows least age 35 and highest 60 which is 17.10

MOTOR ASSESSMENT SCALE INTERPRETATIONS

MAS scale Frequency Percent

0-14 Severe 11 5.7%

15-28 Moderate 182 94.3%

Total 193 100.0%

Table 4.9: shows the interpretations of MAS scale, most of the patients activity lie moderately

affected.
 47

PIE CHART OF MOTOR ASSESSMENT SCALE INTERPRETATION

Figure 8

• 94.30% Patients showed moderate level of disability

• 5.70% patients showed severe level of disability

ASSESSMENT OF SSQOL SCALE

SSQOL scale Frequency Percent

49-98 Severe 7 3.6%

99-147 Moderate 186 96.4%

Total 193 100.0%

Table 4.10: indicates 96.4% of the patients lie in moderate category of the SSQOL scale and

5.70% patients showed severe level of disability

 48

PIE CHART OF SSQOL SCALE:

Figure 9

 94.30% patients lie in moderate level of impaired quality of life

 5.70% patients lie in severe level of impaired quality of life.

CORRELATION

TOTAL MOTOR TOTAL STROKE

ASSESSMENT SPECIFIC
SCALE QUALITY OF LIFE
SCALE

1 .789**
Pearson Correlation
TOTAL motor
Sig. (2-tailed) 193
assessment scale
N 193

Total stroke specific .000

Pearson Correlation
scale 0.789 1
Sig. (2-tailed)
193
N
193
 49

Table 4.11 presents the correlation analysis between MOTOR ASSESSMENT SCALE and

SSQOL scale (N=193). The Pearson Correlation coefficient between the two variables is 0.031

(p = 0.00), indicating a significant correlation and vice versa.

Correlation between BMI and MAS Scales

Correlations
BMI TOTAL MOTOR
ASSESSMENT SCALE
BMI Pearson 1 -.132
Correlation
Sig. (2-tailed) .066
N 193 193
TOTAL MOTOR Pearson -.132 1
ASSESSMENT SCALE Correlation
Sig. (2-tailed) .066
N 193 193

Table 4.12 shows the correlation between BMI scores and the motor assessment Scale (N=193).

The Pearson Correlation coefficient between BMI score and motor assessment Scale and vice

versa is -0.132 (p = 0.066), indicating a significant negative correlation.

 50

Correlation between BMI and SSQOL scale:

Correlations
BMI TOTAL STROKE SPECIFIC
QUALITY OF LIFE SCALE
BMI Pearson 1 -.191**
Correlation
Sig. (2-tailed) .008
N 193 193
TOTAL STROKE Pearson -.191 **
1
SPECIFIC Correlation
QUALITY OF Sig. (2-tailed) .008
LIFE SCALE N 193 193
**. Correlation is significant at the 0.01 level (2-tailed).

Table 4.13 shows the correlation between BMI scores and SSQOL scale (N=193). The Pearson

Correlation coefficient between BMI score and SSQOL scale and vice versa is -.191 (p = 0.008),

indicating a significant positive correlation.

 51

Chapter 5

DISCUSSIONS AND LIMITATIONS:

5.1 Discussions:

The current study was aimed to determine the functional mobility and quality of life among

stroke patients in home-based setting. A cross sectional study was conducted in which 193

chronic stroke patients were recruited by non-randomized sampling techniques. Participants were

recruited based on our requirements. The study was carried out in different old homes and

nursing homes, Bint Fatima Old Age Home, The Second Home, Bilqis Edhi Home and Bahria

Home and in different homes.

In demographics majority of the patients were above 50 years old. About 26.1 % are

teachers. Education of patients in a home-based setting are mostly middle educated 24.6 % males

and females. It also gives information of other patients that are BA 13.6%, metric 9.0%, FA

11.6 %, MS 8.5%, BS 7.5% and 22.1 others. The highest duration of 4 to 7 months than the 8

to12 months 4to 7 (111f +55.8%) and 8-12 (82f +41.2%). The study indicates highest prevalence

of Right side of body affected (77.4%) than left side of the body.

The study discussed that the motor function and quality of life deteriorate in home-based

setting. We can interpret that therapy is essential to improve functional mobility and quality of

life among stroke patients. The previous researches have discussed the importance of

rehabilitation in stroke patients to improve quality of life among stroke patients. This study help

us to determine whether therapy is needed to improve quality of life or stroke patients can heal

without need of therapy. Stroke is a common, serious, and disabling global health-care problem.

By studying quality of life and functional mobility of chronic stroke patients in a home-based
 52

setting we will be able to have a conclusion about if long term rehabilitation is necessary or

patient may recover without any intervention. It will reduce health costs and provide valuable

information to health care providers.

Physiotherapist role will be defined and their vital contribution to the stroke survivors will

be clear. After recovery stroke survivor can live a healthy life by carrying out ADLs and plays

productive role in society. Aim of our study is that to assess the quality of life and functional

mobility of stroke patients in a home-based setting.

Our study utilized the following questionnaire tools to gather data on the quality of life and

functional mobility of stroke patients in a home-based rehabilitation setting. First was Motor

Assessment Scale, employed to evaluate motor function, including mobility, muscle strength,

coordination, and balance, in stroke patients. Second was Stroke-Specific Quality of Life (SS-

QOL) scale, utilized to measure the impact of stroke on participants' quality of life across various

domains, including physical, psychological, and social well-being

There is lack of research on quality of life and functional mobility of stroke patients in a

home-based setting. By studying quality of life and functional mobility of chronic stroke patients

in a home-based setting we will be able to have a conclusion about if long term rehabilitation is

necessary or patient may recover without any intervention. It will reduce health costs and

provide valuable information to health care providers. There is a positive correlation between

motor assessment scale and stroke specific quality of life.

 53

5.2 Limitations:

 To inform future practice, several significant trials of rehabilitation practice and

innovative therapies (e.g., stem-cell therapy, repeated trans-cranial magnetic stimulation,

virtual reality, robotic therapies, and pharmacological augmentation) are under underway.

The study was limited to explore the correlation between cognitive impairment and

quality of life among stroke patients.

 The study limitation is the fact that the functional mobility and quality of life was

assessed through motor assessment scale and stroke specific quality of life questionnaire.

We can use other scales like Mini Mental Scale and National Institutes of Health Stroke

Scale which help to determine cognitive function and severity of the stroke respectively.

Through stroke severity we can easily assess functional mobility and quality of life of

that person.

 Our sample size was 193 which is also a limitation for our study. In future, it should be

large enough so we can have accurate result.

 Other limitation is our study is cross sectional study

 The study did not assess the functional mobility and quality of life in participants who

have co morbid conditions like diabetes, heart disease and pulmonary complications.
 54

Chapter 6

CONCLUSIONS AND RECOMMEDATIONS:

6.1 Conclusion:

This study concludes that functional mobility significantly impacts the quality of life of

both male and female elderly suffering from stroke residents in nursing homes Old age home and,

home based patients without physiotherapy. Maintaining physical functions is crucial for

enhancing their overall quality of life and functional mobility. Precise assessments of functional

mobility and quality of life shed light on the complex relationship between functional mobility

and overall quality of life in the nursing home context. The findings emphasize the importance of

functional independence in determining the quality of life. So long-term rehabilitation is

necessary to carry out ADLs and play a vital role in a society. Functional mobility is necessary

for better quality of life and reducing health care costs related to disability.

6.2 Recommendations:

 It is recommended that researchers should investigate the effectiveness of different social

engagement initiatives in improving functional mobility and quality of life in stroke

patients.

 It is recommended that researchers should explore how environment of nursing homes,

old homes and private resident influence the health of stroke patients.
 55

 It is recommended that researchers should investigate the effectiveness of different

exercise programs, and social engagement initiatives in improving functional mobility

and quality of life.

 It is recommended that researchers should conduct comparative studies to examine

differences in functional mobility and quality of life between different types of long-term

care facilities or between residents who continue to live at home with diff commodities

such as cardiac diseases, HTN, diabetes, stroke, etc.

 56

APPENDICES

QUESSTIONNARE:

DEMOGRAPHICS

Name: Age : Gender :

Height: weight: BMI

Occupation: Education: Affected side:

Duration of stroke:

MOTOR ASSESSMENT SCALE

0: None

1: Severe difficulty

2: Moderate difficulty

3: Mild difficulty

4: Slight difficulty

5: Without difficulty

6: Normal

7: Hand movements
 57

MOTOR ASSESSMENT SCALE

1: Supine to side lying. 0 1 2 3 4 5 6 7

2: Supine to sitting over side of bed .

3: Balance sitting

4: Sitting to standing

5: Walking

6: Upper arm function

7: Hand movements

STROKE SPECIFIC QUALITY OF LIFE SCALE

SS- QOL

 Total help – Couldn’t do it at all – Strongly agree 1

 A lot of help – A lot of trouble – Moderately agree 2

 Some help – Some trouble – Neither agree nor disagree 3

 A little help – A little trouble – Moderately disagree 4

 58

 No help needed – No trouble at all – Strongly disagree 5

ENERGY

1. I felt tired most of the time. 1 2 3 4 5

2. I had to stop and rest during the day. 1 2 3 4 5

3. I was too tired to do what I wanted to do. 1 2 3 4 5

FAMILY ROLES

1. I didn’t join in activities just for fun with my family . 1 2 3 4 5

2. I felt I was a burden to my family . 1 2 3 4 5

3. My physical condition interfered with my personal life 1 2 3 4 5

LANGUAGE

1. Did you have trouble speaking? For example, get stuck, 1 2 3 4 5

stutter, stammer, or slur your words?

2. Did you have trouble speaking clearly enough to use the 1 2 3 4 5

telephone?
 59

3. Did other people have trouble in understanding what your 1 2 3 4 5

said?

4. Did you have trouble finding the word you wanted to say? 1 2 3 4 5

5. Did you have to repeat yourself so others could understand 1 2 3 4 5

you?

MOBILITY

1. Did you have trouble walking? (If patient can’t walk, go to 1 2 3 4 5

question 4 and score questions 2-3 as 1).

2. Did you lose your balance when bending over to reaching for 1 2 3 4 5
something?

3. Did you have trouble climbing stairs? 1 2 3 4 5

4. Did you have to stop and rest more than you would like 1 2 3 4 5
when walking or using a wheelchair?

5. Did you have trouble with standing? 1 2 3 4 5

6. Did you have trouble getting out of a chair? 1 2 3 4 5

MOOD

1. I was discouraged about my future . 1 2 3 4 5

2. I wasn’t interested in other people or activities . 1 2 3 4 5

3. I felt withdrawn from other people . 1 2 3 4 5

4. I had little confidence in myself . 1 2 3 4 5

 60

5. I was not interested in food . 1 2 3 4 5

PERSONALITY

1. I was irritable . 1 2 3 4 5

2. I was inpatient with others . 1 2 3 4 5

3. My personality has changed 1 2 3 4 5

SELF CARE

1. Did you need help preparing food? 1 2 3 4 5

2. Did you need help eating? For example, cutting food or 1 2 3 4 5

preparing food?

3. Did you need help getting dressed? For example, putting on 1 2 3 4 5

socks or shoes, buttoning buttons, or zipping?

4. Did you need help taking a bath or a shower? 1 2 3 4 5

5. Did you need help to use the toilet? 1 2 3 4 5

SOCIAL ROLES

1. I didn’t go out as often as I would like . 1 2 3 4 5

2. I did my hobbies and recreation for shorter periods of time 1 2 3 4 5

than I would like.
 61

3. I didn’t see as many of my friends as I would like . 1 2 3 4 5

4. I had sex less often than I would like . 1 2 3 4 5

5. My physical condition interfered with my social life . 1 2 3 4 5

THINKING

1. I was hard for me to concentrate . 1 2 3 4 5

2. I had trouble remembering things . 1 2 3 4 5

3. I had to write things down to remember them . 1 2 3 4 5

UPPER EXTREMITY FUNCTION

1. Did you have trouble writing or typing? 1 2 3 4 5

2. Did you have trouble putting on socks? 1 2 3 4 5

3. Did you have trouble buttoning buttons? 1 2 3 4 5

4. Did you have trouble zipping a zipper? 1 2 3 4 5

5. Did you have trouble zipping a zipper? 1 2 3 4 5

VISION

1. Did you have trouble seeing the television well enough to 1 2 3 4 5

enjoy a show?
 62

2. Did you have trouble reaching things because of poor 1 2 3 4 5

eyesight?

3. Did you have trouble seeing things off to one side? 1 2 3 4 5

WORK/ PRODUCTIVITY

1. Did you have trouble doing daily work around the house? 1 2 3 4 5

2. Did you have trouble finishing jobs that you started? 1 2 3 4 5

3. Did you have trouble doing the work you used to do? 1 2 3 4 5
 63

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