Eating Difficulties Among Nigerian Community-dwelling Stroke Survivors: Prevalence, Correlates, and Association with Quality of Life

Overview

Journal BMC Public Health

Publisher Biomed Central

Date 2025 Feb 7

PMID 39920650

Authors

Adekola B Ademoyegun

Adebukola G Ibitoye

Wasiu A Rasaq

Oluwafunmilayo A Adeniyi

David O Fabuluje

Israel A Ojo

Taofeek O Awotidebe

Chidozie E Mbada

Affiliations

Soon will be listed here.

Abstract

Background: Eating ability is central to human existence and survival, societal acceptance, life satisfaction, and social participation. Although eating difficulties (EDs) are common after stroke, few studies are reporting their impact on the quality of life (QoL) of stroke survivors. This study aimed to assess the prevalence, correlates, and association of EDs with QoL among stroke survivors.

Methods: A cross-sectional study on 233 (Mean age: 59.6 ± 10.9 years; 52.8% female) Nigerian community-dwelling stroke survivors attending rehabilitation at three public hospitals was conducted. The Minimal Eating Observation Form- version II and WHOQOL-BREF were used to collect data on EDs and QoL respectively. Socio-demographic, stroke-related, and clinical characteristics of patients were assessed using structured questionnaires. The association of EDs with each domain of WHOQOL-BREF (physical health, psychological health, social relationships, environmental health, perceived health status, and overall QoL) was assessed with hierarchical regression analyses.

Results: The majority (60.9%) of stroke survivors had at least one form of ED. Among the three types of EDs assessed, difficulty with energy/appetite (45.1%) was the most prevalent, followed by difficulty with ingestion (43.8%) and deglutition (40.8%). The results showed that EDs were associated with haemorrhagic stroke (r = 0.158; p = 0.016), right-sided hemiplegia (r = 0.172; p = 0.008), increasing stroke severity (r = 0.466; p < 0.001), increasing co-morbidity (r = 0.384; p < 0.001), poor oral health (r = 0.511; p < 0.001), poor mental health (r = 0.260; p < 0.001), poor affected grip strength (r= -0.157; p = 0.016), poor nutritional status (r= -0.362; p < 0.001), low functional ability (r= -0.415; p < 0.001), and low social support (r= -0.257; p < 0.001). After adjustments, EDs independently explained 10.7% of the variance in psychological health (β= -0.467; p < 0.001), 4.7% in social relationships (β= -0.308; p < 0.001), 2.4% in perceived health status (β= -0.221; p = 0.002), and 7.4% in overall QoL (β= -0.383; p < 0.001). However, the variance accounted for by EDs in physical and environmental health domains was insignificant.

Conclusion: The prevalence of EDs among Nigerian community-dwelling stroke survivors is high, which is associated with many stroke-related and clinical factors. Meanwhile, increasing in EDs is independently associated with reduced QoL among stroke survivors using WHOQOL-BREF. Emphasis on screening and management of EDs in stroke rehabilitation protocols may assist in improving survivors' QoL.

References

Westergren A . The Minimal Eating Observation Form-Version II Revisited: Validity and Reliability. J Nurs Meas. 2019; 27(3):478-492. DOI: 10.1891/1061-3749.27.3.478. View

Westergren A, Lindholm C, Mattsson A, Ulander K . Minimal eating observation form: reliability and validity. J Nutr Health Aging. 2009; 13(1):6-12. DOI: 10.1007/s12603-009-0002-4. View

Carlsson E, Ehrenberg A, Ehnfors M . Stroke and eating difficulties: long-term experiences. J Clin Nurs. 2004; 13(7):825-34. DOI: 10.1111/j.1365-2702.2004.01023.x. View

Lee Y, Won M . Mediating Effects of Rehabilitation Motivation between Social Support and Health-Related Quality of Life among Patients with Stroke. Int J Environ Res Public Health. 2022; 19(22). PMC: 9690434. DOI: 10.3390/ijerph192215274. View

Tan L, Lim Y, Ho P, Lim L, Lim Y, Low J . Understanding Quality of Life for Palliative Patients With Dysphagia Using the Swallowing Quality of Life (SWAL-QOL) Questionnaire. Am J Hosp Palliat Care. 2021; 38(10):1172-1176. DOI: 10.1177/1049909121992532. View

Bendsen B, Jensen D, Westmark S, Krarup A, Riis J, Melgaard D . The Quality of Life in Citizens with Oropharyngeal Dysphagia-A Cross-Sectional Study. J Clin Med. 2022; 11(14). PMC: 9322035. DOI: 10.3390/jcm11144212. View

Westergren A, Melgaard D . The Minimal Eating Observation Form-II Danish Version: Psychometric and Metrological Aspects. J Nurs Meas. 2020; . DOI: 10.1891/JNM-D-18-00084. View

Perry L, McLaren S . An exploration of nutrition and eating disabilities in relation to quality of life at 6 months post-stroke. Health Soc Care Community. 2004; 12(4):288-97. DOI: 10.1111/j.1365-2524.2004.00494.x. View

Westergren A, Karlsson S, Andersson P, Ohlsson O, Hallberg I . Eating difficulties, need for assisted eating, nutritional status and pressure ulcers in patients admitted for stroke rehabilitation. J Clin Nurs. 2002; 10(2):257-69. DOI: 10.1046/j.1365-2702.2001.00479.x. View

10.

Adeloye D, Ezejimofor M, Auta A, Mpazanje R, Ezeigwe N, Ngige E . Estimating morbidity due to stroke in Nigeria: a systematic review and meta-analysis. J Neurol Sci. 2019; 402:136-144. PMC: 6650746. DOI: 10.1016/j.jns.2019.05.020. View

11.

Kuang J, Yang L, Lv R, Li J, Zhou K, Xu M . The mediating effect of post-stroke depression between social support and quality of life among stroke survivors: A meta-analytic structural equation modeling. Int J Geriatr Psychiatry. 2022; 37(12). DOI: 10.1002/gps.5820. View

12.

Andersson P, Hallberg I, Renvert S . Inter-rater reliability of an oral assessment guide for elderly patients residing in a rehabilitation ward. Spec Care Dentist. 2003; 22(5):181-6. DOI: 10.1111/j.1754-4505.2002.tb00268.x. View

13.

Carlsson E, Paterson B, Scott-Findlay S, Ehnfors M, Ehrenberg A . Methodological issues in interviews involving people with communication impairments after acquired brain damage. Qual Health Res. 2007; 17(10):1361-71. DOI: 10.1177/1049732307306926. View

14.

Purba F, Hunfeld J, Iskandarsyah A, Fitriana T, Sadarjoen S, Passchier J . Quality of life of the Indonesian general population: Test-retest reliability and population norms of the EQ-5D-5L and WHOQOL-BREF. PLoS One. 2018; 13(5):e0197098. PMC: 5947896. DOI: 10.1371/journal.pone.0197098. View

15.

Abma I, Rovers M, van der Wees P . Appraising convergent validity of patient-reported outcome measures in systematic reviews: constructing hypotheses and interpreting outcomes. BMC Res Notes. 2016; 9:226. PMC: 4837507. DOI: 10.1186/s13104-016-2034-2. View

16.

Everaars B, Weening-Verbree L, Jerkovic-Cosic K, Schoonmade L, Bleijenberg N, de Wit N . Measurement properties of oral health assessments for non-dental healthcare professionals in older people: a systematic review. BMC Geriatr. 2020; 20(1):4. PMC: 6942417. DOI: 10.1186/s12877-019-1349-y. View

17.

Faul F, Erdfelder E, Buchner A, Lang A . Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009; 41(4):1149-60. DOI: 10.3758/BRM.41.4.1149. View

18.

. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998; 28(3):551-8. DOI: 10.1017/s0033291798006667. View

19.

Klinke M, Wilson M, Hafsteinsdottir T, Jonsdottir H . Recognizing new perspectives in eating difficulties following stroke: a concept analysis. Disabil Rehabil. 2012; 35(17):1491-500. DOI: 10.3109/09638288.2012.736012. View

20.

Westergren A, Ohlsson O, Hallberg I . Eating difficulties in relation to gender, length of stay, and discharge to institutional care, among patients in stroke rehabilitation. Disabil Rehabil. 2002; 24(10):523-33. DOI: 10.1080/09638280110113430. View