Life satisfaction 6 years after stroke
or to reorient oneself in the domain of “Closeness”,
the burden of stroke might be reduced. However, this
demands acknowledgement of the process of adapta-
tion, a process that most often necessitates support,
adequate treatment and long follow-ups. We agree with
Kitzmüller et al. (35), who underline the importance of
professional family support to increase communication
skills and handle changes in relationship roles; inclu-
ding provision of support for sexual health after stroke.
An overall strength of this study is its long follow-up
period and the use of the same methodology on both oc-
casions. In addition, strengths include using data from
both single and married stroke participants, as well as
spouses, and data collection performed during home
visits (i.e. a place where participants can relax and feel
safe). A limitation is the small sample and the few male
spouses, which might affect the external validity of
the findings. Furthermore, due to the small sample no
inferential statistics were performed. Thus, leading to
caution regarding interpretation and generalization of
the results. However, since studies on experiences on
overall life satisfaction and aspects of “Closeness” after
stroke are scarce, in particular in the long-term, our
results contribute important new knowledge. In addi-
tion, it should be acknowledged that most participants
with stroke were homogeneous regarding the severity
of stroke (i.e. these were mild strokes) and the mean
age at stroke onset was 65 years, whereas the mean
age for stroke in the general Swedish population is 75
years (36). No qualitative analysis of the answers to the
open-ended questions was conducted. Instead, answers
that illustrated the results on LiSat were selected.
Clinical relevance
The negative long-term changes in life satisfaction in
the domain “Closeness” both for persons who have had
a stroke and their spouses emphasize the importance of
interventions that support “Family life”, “Partner rela-
tionship” and “Sexual life”. Moreover, the relatively
large differences in perception of satisfaction between
married stroke participants and spouses should be no-
ted. In clinical practice, this is an important finding,
as the impact on everyday life can affect intrapersonal
and interpersonal areas of life including social circum-
stances; the discrepancies in satisfaction can create and
maintain unnecessary difficulties. Thus, it seems im-
portant to open up discussions and to raise the issue of
satisfaction within the domain “Closeness” both early
on and in the long-term after a stroke (32, 35, 37–39).
In spite of the relatively small sample the results sup-
port the need for inter-professional rehabilitation teams
and interventions, ranging from peer-group supportive
programmes to individual, couple or family psychoth-
497
erapy. Furthermore, development of educational pro-
grammes for healthcare professionals covering aspects
of “Closeness” seems important (37–39).
The long-term deterioration in experienced life
satisfaction, overall and domain-specific, after stroke
also has implications in research on life satisfaction/
quality of life. As pointed out by Daniel et al. (2) there
is a need for improved study methodology that makes
comparable conclusions possible. New interventions
will require gaining knowledge, not only on risk factors,
but also salutogenic factors; knowledge that can be
gained through long follow-ups. In addition, we propose
that extra attention to be paid to both single people who
had had a stroke and to the interplay within a partner
relationship where one person had had a stroke.
ACKNOWLEDGEMENT
This study was funded by the Swedish Research Council
(2013–2806), the Stockholm County Council (20060700), the
Swedish Stroke Association and Promobilia Foundation.
The authors have no conflicts of interest to declare.
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