Quality of life after aneurysmal subarachnoid haemorrhage

Abstract

The general aim of this thesis was to increase our understanding of quality of life (QoL) after aneurysmal subarachnoid haemorrhage (SAH), and the most important determinants of QoL, in order to tailor appropriate rehabilitation programs and thereby enhance their effectiveness. We reviewed the literature on the determinants of QoL among aneurysmal SAH patients. Based on the International Classification of Functioning, Disability, and Health (ICF) model of the World Health Organization1, we found determinants related to Body Structure & Function (e.g. fatigue and mood), Activity (e.g. physical disability and cognitive complaints) and Personal factors (e.g. female gender, higher age, neuroticism and passive coping) to be consistently related to worse QoL after aneurysmal SAH. Participation has not been studied as a determinant of QoL after SAH. Thus far, predominantly generic QoL measurements have been used. The results of this thesis show that the Stroke Specific Quality of Life (SS-QoL) scale is valid in SAH patients, and can be used in a multi-disciplinary (rehabilitation) care setting as well as in research. Cognitive complaints occur often after SAH and are related to cognitive impairments, physical impairment and depressive symptoms, of which depressive symptoms were the strongest predictor. The association between cognitive complaints and underlying cognitive impairments is weak, which had already been suggested in earlier studies in SAH, ischemic stroke, and traumatic brain injury. Also fatigue occurs very often after SAH and is persisting over time.Passive coping, anxiety or depressive symptoms are important determinants of fatigue. Almost half of the variance of health-related QoL (HRQoL) can be explained with cognitive complaints, cognitive impairments and passive coping. Thus, by introducing the psychological aspects (cognitive complaints and impairments, and passive coping), we were able to predict HRQoL after SAH much better than a previous meta-analysis.SAH patients experience lower psychosocial than physical HRQoL. Return to work is a very important determinant for life satisfaction after SAH. Return to work after SAH depends mainly on age, initial neurologic condition, residual physical disability and depression, and the preservation of cognitive and sensorimotor functions. A structured screening of the physical, cognitive and emotional functioning early after discharge, as in our outpatient clinic, could be an important way to detect these problems. As a clinician, I would recommend every medical centre specialised in treatment of SAH patients to arrange such a multidisciplinary outpatient clinic. Then, after collecting information about the patients physical, cognitive and emotional functioning, a tailored rehabilitation program can be recommended by the rehabilitation physician, which can be carried out at the rehabilitation department of a hospital or at a rehabilitation centre in the patients’ neighbourhood. For research, such a specialised multidisciplinary outpatient clinic also offers a great opportunity to collect information about patients with SAH, and therefore can further increase our understanding of long-term problems after SAH.