On functions, abilities and quality of life after subarachnoid haemorrhage : occupational therapy aspects

Abstract: This investigation addresses functions/impairments, abilities/disabilities and quality of life (QoL) in a consecutive series of non-hospitalised long-term survivors (2,5-12 years) of subarachnoid heamorrhage (SAH). The investigated parameters of functions/impairments were: motor, language, perceptual and memory functions. Abilities/disabilities studied were: activities of daily living (ADL) including both personal- and instrumental ADL, working and leisure capacities. Quality of life was assessed using a double visual analogue scale. Occurrence of depression was registered using a self-rating scale.A questionnaire focusing motor and language impairments, personal ADL, work and leisure activities was initially mailed to 324 subjects. The vast majority answered the questionnaire. Ten hospitalised subjects could not validly report their functions and abilities and were by that reason excluded.In a follow-up investigation up to 247 long-term non-hospitalised subjects were investigated by a physician and an occupational therapist. A total of 82% had at least one impairment. The majority (73%) had memory impairment and among these subjects equal proportions (about 50%) had impairments of long- and short-term memory. Forty-five percent were perceptually impaired, while motor impairment occurred for 25% and aphasia in 10%. Only a small minority (9%) were, according to self-reports, regarded as being to some extent disabled in personal ADL. The corresponding numbers of disabled in instrumental ADL, leisure and working- capacity were 52%, 48% and 40%. Depression was found in 22% - among whom the majority had minimal or mild depression. Overall QoL was judged to be unchanged or increased in 62% and, therefore, decreased in 38%.As expected impairments to a significant degree caused disabilities. None of the 5 different categories of impairments were associated with mood (depressed/not depressed) and QoL (decreased/not decreased). Occurrence of depression was significantly associated with different aspects of disabilities. In contrast among a series of instrumental ADL-variables, leisure and working capacity, QoL was influenced negatively only by decreased ability to act sociably and, to a minor extent, by depressed mood.Judging from the extent of decreased quality of life, it appears that nearly 40% of all non-hospitalised former victims of SAH have not coped successfully with the impact of the SAH. A follow-up program aiming at optimising the coping process of SAH-victims is, therefore, outlined.