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was 1 exception: married participants who had had a
stroke reported “Life as a whole” at the 6-year follow-
up to be more satisfying than the general population
(78% and 70%, respectively). Hence, for this group
the influence of time since stroke seemed to favour a
more positive view on “Life as a whole”. This pattern,
of spouses being less satisfied, has previously been
found in a study of couples (20). A much lower level
of life satisfaction, similar to the level among single
participants in the present study has been found at 4–6
years after a severe stroke (21). Altogether, a somewhat
higher prevalence of satisfied participants was found in
the present 1-year follow-up in comparison with other
follow-up studies within the same time-frame (1, 6).
The present results that reveal low satisfaction with
“Life as a whole” in spouses, both at 1 and 6 years,
concur with results from previous studies (10, 11, 22).
Large differences in prevalence of problematic or
distressing family life after stroke have been reported
in a review by Daniel et al. (2). These variations may
be explained by, for example, methodological varia-
tion, such as the time from stroke to follow-up. In the
present study the same methodology was used for
1-year and 6-year follow-ups. Both single and married
participants who had had a stroke reported high levels
of satisfaction with “Family life” 1 year after stroke;
comparable with a nationally representative sample (9).
However, after 6 years markedly fewer were satisfied.
This dissatisfaction was particularly evident in singles,
although they had a small increase in satisfaction with
“Partner relationship” at the late follow-up. At the
1-year follow-up married participants had high and
comparable levels with the general population with
respect to satisfaction with “Partner relationship”, but
this satisfaction deteriorated markedly at the 6-year
follow-up. Achten et al. (20) have, in agreement with
others (23), found significantly lower satisfaction
with partner relationship in spouses than in those af-
fected. One explanation for this difference might be
that the stroke participants idealize the spouse or the
relationship; referred to as marital aggrandizement
by O’Rourke & Cappeliez (24). Feelings of gratitude
towards the spouse could be another explanation for
the gap between the couples’ satisfaction.
Negative changes in family roles and partner roles
are commonly reported both among those who have
had a stroke and their spouses (12, 15, 25–30) and
can be an important explanation for the low levels
of satisfaction with “Family life” and “Partner rela-
tionship” 6 years after stroke. Unwanted role changes
within a partner relationship, e.g. going from being a
partner to being a care-giver (3, 12, 15, 25, 29) may
create ambivalence, or avoidance of a mutual sexual
life. Thus, not surprisingly “Sexual life” was reported
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as the least satisfying in all 3 groups of participants.
This finding agrees with results from 3-year follow-up
studies post-stroke (8, 20).
It is well-known that sexual dysfunctions and sexual
problems are very common after stroke (25, 31, 32)
due to complex bio-psycho-social factors. Notably,
decreased sexual desire and sexual dysfunctions often
concur within partnerships (33). Furthermore, changes
in sexual repertoires and role identity in intimate rela-
tionships and fear of having a new stroke during sexual
activities have been reported (25, 32). Nevertheless,
in a previous qualitative study we found that changes
in sexual life could be a positive experience as long
as 6 years after stroke (34). The participants attributed
the positive change to feelings of increased intimacy,
different active strategies and an open communication
between spouses. Experiencing a deeper relationship
and caring for each other in new ways were mentioned
by a few spouses at the 1-year follow-up in the present
study, and we interpret this as a positive partner rela-
tionship, which could support a fulfilling sexual life
and vice versa: a rewarding sexual life can support an
intimate partner relationship. Albeit in this population
none of the spouses had any positive statement at the
6-year follow-up and this, together with the very low
proportion of satisfied spouses, once again points to
the importance of including the needs of spouses in
stroke rehabilitation.
Being dissatisfied with “Life as a whole” and the
domain of “Closeness” were further shown when all
3 groups of participants commented on factors leading
to changes in life after stroke and the most pertinent
characteristic was interpreted as feelings of loneliness.
Similarly Boosman et al. (8) found socially active post-
stroke participants to be more satisfied with life than
inactive participants. In a qualitative study Martinsen et
al. (26) have shown the vulnerable situation for persons
with stroke, in particular singles. In light of the present
results, and in accordance with McGrath et al. (15), it
seems important to include spouses when addressing
post-stroke recovery, as the spouses are at risk of a life
in an unsatisfying partner relationship.
Low levels of satisfaction are interpreted here as as-
piration/achievement gaps (5) regarding activities and
roles within the domain “Closeness”. These gaps can
lead to problems and/or distress; resulting in low levels
of satisfaction for the majority of both persons who
have had a stroke as well as their spouses. In addition
to the medical examination and treatment an adequate
case-history, through inter-professional collaboration,
is necessary for identification of problems as well as
resources (individual, familial and social network) that
could be added to the rehabilitation plan. We propose
that, by exploring new ways to reach previous goals,