QUALITY OF LIFE OF POST-STROKE PATIENTS
Sylva BÁRTLOVÁ1*, Lenka ŠEDOVÁ1, Lucie HAVIERNIKOVÁ1, Andrea HUDÁČKOVÁ1,  
František DOLÁK1, Petr SADÍLEK2
1University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences, Institute of Nursing, 
Midwifery and Emergency Care, U Výstaviště 26, 370 05 České Budějovice, Czech Republic
2Medical Information Center, Sokolská 31, 120 21 Praha, Czech Republic
Received: Nov 27, 2021
Accepted: Feb 11, 2022
Original scientific article
*Corresponding author: Tel. + 420 606 050 592; E-mail: sbartlova@zsf.jcu.cz
10.2478/sjph-2022-0014 Zdr Varst. 2022;61(2):101-108
101
KAKOVOST ŽIVLJENJA BOLNIKOV PO MOŽGANSKI KAPI
© National Institute of Public Health, Slovenia. 
Bártlová S, Šedová L, Havierniková L, Hudáčková A, Dolák F, Sadílek P. Quality of life of post-stroke patients. 
Zdr Varst. 2022; 61(2): 101-108.  doi: 10.2478/sjph-2022-0014.
ABSTRACT
Keywords: 
quality of life, stroke, 
psychological problems, 
patient, nurses
IZVLEČEK
Ključne besede: 
kakovost življenja, 
možganska kap,  
psihološke 
težave, bolniki, 
medicinske sestre
Introduction: Stroke is a disease whose consequences have a considerable impact on the quality of the patient’s 
life. It is a widespread disease that has a disabling impact on life and, in addition to physical changes, brings 
about a number of psychological and cognitive processes. 
Goal: The goal of the study was to identify and describe the quality of life of post-stroke patients.
Methodology: The study design was quantitative. A questionnaire of the authors’ own design and the SF-36 
questionnaire were used to obtain the data.
Results: Significant differences in patient quality of life were identified in relation to patient gender. Moreover, 
the quality of life in all individual SF-36 dimensions, except for mental health, deteriorated with age. With 
regard to occupational placement, employed respondents gave the highest evaluation of quality of life according 
to SF-36 and old-age pensioners the lowest. The analysis shows that quality of life in individual dimensions is 
positively influenced by respondents’ higher education. The evaluation in individual dimensions improves with 
the time that has passed since the stroke.
Conclusion: The quality of life of post-stroke patients deteriorates with age. The deteriorating level of patient 
quality of life in older age requires programmes that include assessments and interventions that lead to the 
treatment of these patients.
Uvod: Možganska kap je bolezen, katere posledice pomembno vplivajo na kakovost življenja bolnikov. Gre za 
eno najbolj razširjenih bolezni, ki lahko vodi v stanje invalidnosti. Pri tem ne gre le za telesne, ampak tudi za 
številne spremembe v psiholoških in kognitivnih procesih.
Cilj: Namen raziskave je bil ugotoviti in opisati kakovost življenja bolnikov po možganski kapi.
Metodologija: Za pridobivanje podatkov sta bila uporabljena vprašalnik, ki smo ga sestavili sami, in vprašalnik 
SF-36.
Rezultati: Višja ko je starost bolnika po možganski kapi, slabša je raven kakovosti življenja v vseh dimenzijah 
lestvice SF-36 z izjemo duševnega zdravja. Glede na poklicni status zaposleni najbolje ocenjujejo kakovost 
življenja v dimenzijah SF-36, najslabše pa upokojenci. Analiza je pokazala, da je kakovost življenja v vsaki 
dimenziji tem boljša, čim višja je izobrazba bolnikov z možgansko kapjo. Daljši ko je čas, ki je pretekel od kapi, 
boljši so rezultati v vsaki dimenziji.
Zaključek: Poslabšanje kakovosti življenja starejših bolnikov po možganski kapi potrjuje potrebo po programih, 
ki vključujejo oceno in intervencije za njihovo zdravljenje.
1 INTRODUCTION
In recent times, there has been greater promotion of quality 
of life (more precisely: health-related quality of life). It 
has become an essential criterion for the seriousness of 
patient health. There are many definitions of quality of 
life. However, they have one thing in common: it is mainly 
subjective wellness that includes physical, psychological, 
social and mental dimensions (1). Nursing care puts the 
spotlight on subjectively perceived quality of life.  Nurses 
play an important role as care providers and as mediators 
of personal recovery and multidisciplinary care, and can 
support stroke patients’ return to an independent life (2). 
Chronic diseases, such as stroke, are associated with QoL 
(Quality of life) impairment. In clinical practice, stronger 
emphasis should be placed on monitoring the quality of 
life of post-stroke patients.
Stroke is a undoubtedly a disease whose consequences have 
a considerable impact on the quality of the patient’s life. 
Every year, in a population of one million, approximately 
2,400 people will suffer a stroke.  Of these, fewer than 
50% return to an independent life (Leys et al., 2005). Even 
those patients who regained their functional independence 
continue to suffer considerable deficits, limitations and 
changes in cognitive functions and behaviour. Stroke is a 
widespread disease that has a disabling impact on life and, 
in addition to physical changes, brings about a number of 
psychological and cognitive processes. Stroke is one of the 
main causes of disability, and doubles the risk of dementia 
(3). The variables closely associated with a lower QoL 
or satisfaction with life of post-stroke patients include 
depression (4, 5), lower functional status (6, 7) and more 
serious paralysis (8). Post-stroke psychological problems 
can include depression, anxiety, emotionalism and post-
traumatic stress disorder. About one third of surviving 
patients experience depression at a certain period. 
However, this tends not to be diagnosed in time or else is 
insufficiently treated (9). Emotional problems relating to 
stroke can include fear, anxiety, frustration, loss of trust, 
feeling of loss, uncertainty and disappointment at not 
regaining health. Patients who survived a stroke regard 
information, problem-solving strategies and involvement 
in activities as highly useful for their recovery and their 
ability to cope (10). Early psychological interventions 
are necessary in individuals at risk of QoL impairment, 
particularly in elderly and lonely patients. Chronic 
diseases, such as stroke, require long-term treatment. A 
low quality of life and a poor psychological state can result 
in a decrease in the patient’s compliance with treatment, 
which can consequently result in stroke recurrence (11). 
The study shows that effective psychological intervention 
can significantly decrease stress in post-stroke patients 
and increase their commitment to treatment (12, 13). 
Therefore, psychological interventions are essential for 
these high-risk groups in clinical practice. 
10.2478/sjph-2022-0014 Zdr Varst. 2022;61(2):101-108
102
Although significant progress has been achieved in the 
medical treatment of stroke patients (decreases in 
mortality), post-stroke patients need a qualified nursing 
approach in the rehabilitation phase (14). According to 
these authors, the rule of thirds applies: approximately 
one third die within a few hours, one third completely 
recover, and one third dies hours, days or weeks after 
the attack. The remaining third, sometimes called the 
middle third, can regain independence by using various 
rehabilitation programmes (14).  
The goal of the study was to identify and describe the 
quality of life of post-stroke patients.  
2 METHODOLOGY
The study design was quantitative. The study itself was 
conducted in the Czech Republic between 20 September 
and 20 October 2020. The data was collected by 96 
professional survey workers from the Institute for Health 
and Lifestyle across the Czech Republic. 
2.1 Tools 
Two instruments were used for obtaining the data: (1) a 
questionnaire of the authors’ own design and (2) the SF-36 
questionnaire.   
2.1.1 Questionnaire designed by the authors
A non-standardised questionnaire of the authors’ own 
design was used to identify the socio-demographic 
profiles of stroke patients. It contained 16 items. The 
factors studied included age, education, occupational 
placement, the time that had passed since the stroke, 
persisting symptoms, the patient’s ability to deal with 
the symptoms, the degree of the patient’s ability to work 
and how the patient’s ability to work had changed since 
the stroke, the patient’s ability to take care of their loved 
ones and how this ability had changed since the stroke, 
the ability to perform common household tasks and how 
this ability had changed since the stroke, the ability to 
continue one’s hobbies and how this ability had changed 
since the stroke, the ability to perform the everyday living 
activities relating to self-care and how this ability had 
changed since the stroke.  
2.1.2 SF-36 questionnaire
Short Form 36 (SF-36) Health Survey Questionnaire, i.e. 
an abbreviated version containing 36 questions. The 
actual questionnaire was published by Ware, Sherbourne 
in 1992 (15). The questionnaire is often used in many 
medical and nursing disciplines. The Short Form 36 (SF-
36) Health Survey Questionnaire is a tool administered 
by the RAND Corporation, a non-profit organisation deals 
with the subjective assessment of health and/or quality of 
10.2478/sjph-2022-0014 Zdr Varst. 2022;61(2):101-108
103
life of patients. The translated questionnaire version was 
validated for the survey of quality of life of the 40+ Czech 
population in 2016 (16).
This standardised questionnaire can be used to identify all 
health problems of a physical character, as well as general 
mental health, in order to make a general evaluation 
of quality of life.  The questionnaire contains 36 items 
divided into 8 dimensions. The individual dimensions are 
as follows: PF – physical functioning; RP – restrictions 
due to physical problems; BP – body pain; GH – general 
health; VT – vitality/tiredness; SF – social functioning; 
RE – restrictions due to emotional problems; MH – mental 
health. Patient physical and psychological spheres were 
also generally assessed. Each item (question) contains 
several suggested answers according to the scale 
principle. The evaluation used the concept https://www.
rand.org/health-care/surveys_tools/mos/36-item-short-
form/scoring.html.
2.2 Data collection 
The field study used face-to-face interviews.  The final 
form of the interview sheet was established using the pilot 
study results. The study was anonymous and participation 
was voluntary. It did not include any controversial ethical 
questions.
In the field study, 488 respondents were asked to take 
part in an interview on the topic of post-stroke quality 
of life. A total of 72 patients (i.e. 14.8% of all persons 
addressed) refused to take part in an interview, while 
416 respondents (i.e. 85.2%) did agree to take part. The 
proportion of refusals to participate in the study was low. 
These were patients with minor stroke (according to NIHSS 
1-4 – minor stroke). 
The main reasons for the refusals included a lack of interest 
in the study and a general unwillingness to take part in a 
study (36.5%), and the fact that patients found it difficult 
to speak about the consequences of stroke (24.3%). Other 
reasons for refusals included the lack of time (14.8%), 
distrust of the study and fear of losing privacy (9.5%), 
fear of infection in the COVID-19 pandemic (9.5%), and 
the impossibility of communication with the patient or a 
complete misunderstanding of the questions (5.4%). 
2.3 Data processing 
The data was processed using the SASD 1.5.8 (Statistical 
Analysis of Social Data) and SPSS software.  The analysis 
used the first and second degrees of classification. In 
classification degree 1, frequency tables were constructed 
for individual indicators, and absolute and relative 
frequencies and expected values were calculated (modus, 
median, mean, dispersion, standard deviation, range, 
estimations of the dispersion and standard deviation, and 
interval estimation of the expected value and dispersion 
at the level of 0.05). In classification degree 2, contingency 
tables with absolute and relative frequencies (column, 
row, total and expected frequencies) and the sign scheme 
were calculated. 
Tests of the distribution of variables (Tests of Normality) 
were performed using the Kolmogorov-Smirnov and 
Shapiro-Wilk tests. According to the character of this 
distribution and character of the signs, parametric and 
non-parametric tests (Chi-Square Tests, Mann-Whitney 
Test, Kruskal-Wallis Tests) were used for the significance 
calculations. In justified cases, the value for Phi/Cramer V, 
which also represents an actual significance (r coefficient) 
of testing statistic significance and/or Cohen’s d). Based 
on this analysis, data was interpreted and relevant tables 
were processed. 
2.4 Sample 
The sample consisted of stroke patients. Since there is 
no data about the inner structure of this group, quota 
sampling was used, where GPs’ offices and healthcare 
facilities treating stroke patients were chosen at random, 
and stroke patients were randomly chosen with the help of 
the above-mentioned institutions. As quotas, regions and 
gender were chosen. The respondents’ numbers according 
to these quotas were derived from the basic sample of 
the CR population 15+ according to the data of the Czech 
Statistical Office, valid on 31 December 2019.   
3 RESULTS
The sample consisted of 416 stroke patients: 207 (49.8%) 
men and 209 (50.2%) women. In comparison with the basic 
sample of the Czech population, the deviation is 0.8%. 
The sample structure corresponds with the structure of 
the basic sample of the CR population 15+ with regard to 
gender. 
With regard to age, the 70–79 age group was the most 
numerous and the 49-and-under age group was the least 
numerous. The most numerous group contained stroke 
patients with vocational education. The largest group 
included old-age pensioners.  Respondents for whom one 
to two years had passed since their last stroke were the 
most numerous (Table 1). 
The composition of the sample of stroke patients with 
regard to regions has the greatest deviation (0.3%) in 
comparison with the basic sample of the CZ population 
15+. The sample structure corresponds with the structure 
of the basic sample of the CZ population 15+ with regard 
to regions.   
The variables SF-36 (dependent variables) were examined 
using the normality test (Kolmogorov-Smirnov). In all 
features, abnormal distribution was identified. Therefore, 
non-parametric testing was used to identify differences 
with regard to independent variables (Mann-Whitney U 
test and Kruskal-Wallis test, both tests at the significance 
level of p<0.05).
The QoL results and their description (score SF-36) for the 
whole group studied are given in Table 2.
No significant differences were discovered with regard 
to gender in the testing of quality of life in post-stroke 
patients. The tests did not identify any significant 
differences in the quality of life between male and female 
post-stroke patients (Table 3). 
The tests the quality of life with regard to age revealed 
significant differences between individual age groups.
The testing of individual SF-36 dimensions with regard to 
age categories shows significant differences, except for MH 
– mental health. The results were as follows: low defect 
for RE – restrictions due to emotional problems, mean 
effect for RP – restrictions due to physical problems, BP 
–  body pain, VT – vitality/tiredness, SF – social functioning 
and in the mental sphere in general (MENTSPH), and high 
effects for PF – physical functioning, GH – general health 
and in the physical sphere in general. Generally, the 
quality of life of stroke patients in individual dimensions, 
with the exception of mental health, deteriorates with 
age (Table 4). 
Gender
Men
Women
Age
Up to 49 years
50–59 years 
60–69 years 
70–79 years
80 years and over 
Education
Basic 
Vocational (no school-leaving exam) 
Secondary with school-leaving exam 
Higher professional 
Academic 
Occupational placement 
Self-employed, businessperson 
Employed 
Disability pensioner 
Old-age pensioner 
Unemployed 
Others 
Time that had passed 
since the last stroke 
up to 1 year 
1–2 years 
3–4 years 
5–6  years 
More than 6 years 
PF
RP
BP
GH
VT
SF
RE
MH
FYZOBL
DUSOBL
N
Mean Std. DeviationMedian Minimum Maximum
Absolute 
frequency
Valid Missing
%
207
209
39
59
105
132
81
70
137
127
22
60
15
78
68
237
16
2
 
99
138
54
44
81
416
416
416
416
416
416
416
416
416
416
41.83
35.40
62.67
38.92
42.80
56.28
57.21
62.06
44.70
54.59
31.701
38.123
28.037
19.710
19.423
28.011
41.022
17.678
24.207
21.790
40.00
25.00
65.00
40.00
40.00
62.50
66.67
64.00
40.63
56.23
0
0
0
0
0
0
0
16
0
7
100
100
100
100
100
100
100
100
100
100
0
0
0
0
0
0
0
0
0
0
49.8
50.2
9.4
14.2
25.2
31.7
19.5
16.8
32.9
30.6
5.3
14.4
3.6
18.8
16.3
57.0
3.8
0.5
 
23.8
33.2
13.0
10.6
19.5
Table 1.
Table 2.
Socio-demographic characteristics of the sample.
QoL results and their description (score SF-36) for the whole group studied.
104
10.2478/sjph-2022-0014 Zdr Varst. 2022;61(2):101-108
PF – PHYSICAL FUNCTIONING
RP – RESTRICTIONS DUE TO PHYSICAL PROBLEMS 
BP – BODY PAIN 
GH – GENERAL HEALTH 
VT – VITALITY/TIREDNESS 
SF – SOCIAL FUNCTIONING 
RE – RESTRICTIONS DUE TO EMOTIONAL PROBLEMS 
MH – MENTAL HEALTH
PHYSICAL SPHERE
MENTAL SPHERE
PF – PHYSICAL FUNCTIONING
RP – RESTRICTIONS DUE TO PHYSICAL PROBLEMS 
BP – BODY PAIN 
GH – GENERAL HEALTH 
VT – VITALITY/TIREDNESS 
SF – SOCIAL FUNCTIONING 
RE – RESTRICTIONS DUE TO EMOTIONAL PROBLEMS 
MH – MENTAL HEALTH
PHYSICAL SPHERE
MENTAL SPHERE
Domain
Domain
SD
Chi-Square Asymp. Sig. Fisher’s eta2 (η2) Evaluation of the effect df
Asymp. Sig. (2-tailed)Mann-Whitney U test
-1.851
-.686
-1.002
-1.259
-.149
-1.463
-1.131
-.740
-1.448
-1.171
77.354
34.206
41.551
68.911
28.584
31.519
19.850
6.491
72.132
29.660
.000
.000
.000
.000
.000
.000
.001
.165
.000
.000
.191
.077
.099
.170
.069
.083
.050
 
.180
.075
high effect
mean effect
mean effect
high effect
mean effect
mean effect
low effect
high effect
mean effect
4
4
4
4
4
4
4
4
4
4
.064
.492
.316
.208
.882
.143
.258
.459
.148
.242
19,368.50
20,826.50
20,412.00
20,092.00
21,450.00
19,853.50
20,308.50
20,726.50
19,856.00
20,196.00
Table 3.
Table 4.
Quality of life in relation to gender (Mann-Whitney U test).
Quality of life in relation to age (Kruskal-Wallis test).
105
10.2478/sjph-2022-0014 Zdr Varst. 2022;61(2):101-108
The effect evaluation:
η2≥ 0.14   →    high effect 
η2∈0.06–0.14)    →    mean effect,
η2∈0.01–0.06)     →     low effect (17).
The analyses of the second degree of classification dealt 
with the testing of the respondents’ quality of life with 
regard to their occupational placement. In this case, 
significant differences were also identified. The testing of 
individual SF-36 dimensions with regard to occupational 
placement shows that, as in the case of age, significant 
differences were identified in all dimensions except for 
MH – mental health. The results were as follows: low 
effects for VT – vitality/tiredness, RE – restrictions due 
to emotional problems and the mental sphere in general; 
mean effect for RP – restrictions due to physical problems, 
BP – body pain, GH – general health, SF – social functioning, 
and a high effect for PF – physical functioning and the 
physical sphere in general. Generally speaking, quality of 
life in the SF-36 dimensions is scored highest by employed 
respondents and lowest by old-age pensioners (Table 5).
106
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PF – PHYSICAL FUNCTIONING
RP – RESTRICTIONS DUE TO PHYSICAL PROBLEMS
BP – BODY PAIN
GH – GENERAL HEALTH
VT – VITALITY/TIREDNESS
SF – SOCIAL FUNCTIONING
RE – RESTRICTIONS DUE TO EMOTIONAL PROBLEMS
MH – MENTAL HEALTH
PHYSICAL SPHERE
MENTAL SPHERE
PF – PHYSICAL FUNCTIONING
RP – RESTRICTIONS DUE TO PHYSICAL PROBLEMS 
BP – BODY PAIN 
GH – GENERAL HEALTH 
VT – VITALITY/TIREDNESS 
SF – SOCIAL FUNCTIONING 
RE – RESTRICTIONS DUE TO EMOTIONAL PROBLEMS 
MH – MENTAL HEALTH
PHYSICAL SPHERE
MENTAL SPHERE
PF – PHYSICAL FUNCTIONING
RP – RESTRICTIONS DUE TO PHYSICAL PROBLEMS 
BP – BODY PAIN 
GH – GENERAL HEALTH 
VT – VITALITY/TIREDNESS 
SF – SOCIAL FUNCTIONING 
RE – RESTRICTIONS DUE TO EMOTIONAL PROBLEMS 
MH – MENTAL HEALTH
PHYSICAL SPHERE
MENTAL SPHERE
Domain
Domain
Domain
Chi-Square
Chi-Square
Chi-Square
Asymp. Sig.
Asymp. Sig.
Asymp. Sig.
Fisher’s eta2 (η2)
Fisher’s eta2 (η2)
Fisher’s eta2 (η2)
Evaluation of the effect 
Evaluation of the effect 
Evaluation of the effect 
df
df
df
63.966
31.437
36.423
50.763
19.004
29.987
9.980
7.003
56.304
20.378
15.468
10.958
23.680
18.420
16.753
4.907
6.364
4.997
18.736
6.759
1.278
8.436
1.577
2.753
9.069
.767
13.352
13.442
1.447
9.026
.000
.000
.000
.000
.001
.000
.041
.136
.000
.000
.004
.027
.000
.001
.002
.297
.174
.288
.001
.149
.865
.077
.813
.600
.059
.943
.010
.009
.836
.060
.165
.082
.083
.134
.044
.073
.024
 
.156
.048
.037
.023
.055
.044
.040
.048
 
 
 
 
 
 
.031
.029
 
 
high effect
mean effect
mean effect
mean effect
low effect
mean effect
low effect
 
high effect
low effect
low effect
low effect
low effect
low effect
low effect
low effect
 
low effect
low effect
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
Table 5.
Table 6.
Table 7.
Quality of life relating to occupational placement (Kruskal-Wallis test).
Quality of life relating to education (Kruskal-Wallis test).
Quality of life relating to the time that has passed since the last stroke attack (Kruskal-Wallis test).
The analyses also compared quality of life with regard 
to respondents’ education. Significant differences were 
also identified. In the SF-36 dimensions of quality of 
life, differences were found (though with a low effect) 
with regard to education in the following dimensions: PF 
– physical functioning, RP – restrictions due to physical 
problems, BP –  body pain, GH – general health, VT – 
vitality/tiredness, and in the sphere of physical health in 
general. The analysis shows that quality of life is better in 
respondents with higher education (Table 6).
The time that has passed since the last stroke can also play 
an important role in quality of life. These correlations were 
also tested. The comparison of quality of life according to 
SF-36 with regard to the time that has passed since the 
last stroke attack revealed differences of low practical 
significance only in the dimensions of RE – restrictions due 
to emotional problems and MH – mental health. Quality of 
life was the worst among patients with the shortest time 
since their last stroke. The evaluation in these dimensions 
improves with the time that has passed since the stroke 
(Table 7).
4 DISCUSSION
No significant differences in quality of life were found in 
stroke patients in relation to their gender.  The comparison 
of quality of life with regard to age identified significant 
differences between the individual age groups, except for 
MH – mental health. The results were as follows: low defect 
for RE – restrictions due to emotional problems, mean 
effect for RP – restrictions due to physical problems, BP 
–  body pain, VT – vitality/tiredness, SF – social functioning 
and the mental sphere in general (MENTSPH), and high 
effects for PF – physical functioning, GH – general health 
and physical sphere (PHYSPH) in general. The quality of life 
of stroke patients in individual dimensions according to SF-
36, with the exception of mental health, deteriorates with 
age. The deterioration of quality of life with age can be 
also influenced by the increasing prevalence of diabetes, 
hypertension and other coronary diseases (18). 
Studies dealing with correlations between age and stroke 
patients have produced controversial results. This can be 
caused by the fact that various scales for quality of life 
were used in individual studies, and there were differences 
in the severity of respondents’ stroke symptoms (19). 
In most cross-sectional, short-term and long-term studies 
dealing with QoL of stroke patients, it was found out that 
the main QoL determinant was the degree of functional 
impairment.  The study examining elderly Korean post-
stroke patients identified physical functioning as the main 
factor influencing quality of life (20).
The testing of individual SF-36 dimensions with regard to 
occupational placement shows that, as in the case of age, 
significant differences were identified in all dimensions 
except for MH – mental health. The remaining results were 
as follows: low effects for VT – vitality/tiredness, RE – 
restrictions due to emotional problems and the mental 
sphere in general; mean effect for RP – restrictions due 
to physical problems, BP – body pain, GH – general health, 
SF – social functioning, and a high effect for PF – physical 
functioning and the physical sphere in general.  In SF-36, 
quality of life was scored highest by employed respondents 
and lowest by old-age pensioners. 
In the SF-36 dimensions of quality of life, differences were 
found (though with a low effect) with regard to education 
in the following dimensions: PF – physical functioning, RP – 
restrictions due to physical problems, BP – body pain, GH – 
general health, VT – vitality/tiredness, and in the sphere of 
physical health in general. The analysis shows that quality 
of life is better in respondents with higher education. 
The time that has passed since the last stroke can also 
play an important role in the quality of a patient’s life. 
The comparison of quality of life according to SF-36 with 
regard to the time that has passed since the last stroke 
attack revealed differences of low actual significance only 
in the dimensions of RE – restrictions due to emotional 
problems and MH – mental health. Quality of life was the 
worst among patients with the shortest time since their 
last stroke. The evaluation in these dimensions improves 
with the time that has passed since the stroke. 
The study by Chen, et al. (21) found that no important 
improvement of quality of life at mental level had 
occurred in patients after four weeks of post-stroke 
treatment. Another multi-variation analysis (22) found 
that marital status and age were factors associated with 
QoL improvement. The above-mentioned findings suggest 
that age closely relates to QoL improvement. 
As mentioned in the study by Bays (23), the general 
quality of life of post-stroke patients differed depending 
on the country in which the study was conducted. The 
variables that were positively associated with the quality 
of life of post-stroke patients included independence 
in everyday activities, improved functional abilities, 
social support and sources of healthcare. The variables 
that were negatively associated with the quality of life 
of post-stroke patients included psychological affection, 
seriousness of the affection, seriousness of aphasia, 
inadequate reactions to the illness and pessimism, and 
incapability of returning to one’s occupation. Specifically, 
between 22% to 73% of QoL dispersion in post-stroke 
patients was mainly explained by the presence of 
depression, functional disabilities, particularly of the 
upper extremities, and socialisation, particularly leisure 
time activities (23). Professional nursing aiming at the 
QoL improvement of post-stroke patients includes support 
of independence, depression management, and the 
promotion of interpersonal relationships. Rehabilitation 
should include the promotion of adaptation for patients 
to help them cope with complicated and uncertain post-
stroke lives, and find meaningful and realistic individual 
goals for their recovery. 
The positive features of the study include the fact that 
a high number of respondents participated, with only a 
few patients refusing to take part. The non-existence 
of any data on the internal structure of this sample of 
respondents represents a limitation. 
5 CONCLUSION
Life expectancy is increasing worldwide. However, quality 
of life deteriorates as the post-stroke patient gets older. 
Quality of life in the SF-36 dimensions is scored highest by 
employed respondents and lowest by old-age pensioners. 
The analysis shows that quality of life improves with better 
education. The patients with the shortest time since 
stroke have the lowest quality of life in the dimensions in 
question. In individual SF-36 dimensions, the quality of life 
of post-stroke patients improves with time. In combination 
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10.2478/sjph-2022-0014 Zdr Varst. 2022;61(2):101-108
with the increased number of persons who have survived 
stroke, the Czech Republic faces a challenge.
It is assumed that, in future, research in the Czech 
Republic will have to be focused on the quality of life of 
patients post-stroke.  The assessment and evaluation of 
quality of life are elements that can significantly help to 
develop effective individualised curative and preventive 
treatment in elderly patients. Intervention plans can 
start at in-patient facilities and continue in outpatient or 
primary care. Elderly post-stroke patients should therefore 
be provided with the necessary health and social support. 
CONFLICT OF INTERESTS 
The authors declare that no conflicts of interest exist.
FUNDING
The study was supported by the Ministry of Health of the 
Czech Republic, grant no NV19-09-00199. 
ETHICAL APPROVAL
Research was conducted in accordance with ethical 
principles and approved by the Ethics Committee on 4 
June 2018.
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