February 29, 2016

A Good Quality of Life is Complicated

Rehab for stroke survivors focuses on physical recovery and functional skills like dressing.
Yet physical and functional abilities only partially predict a person's quality of life (1).  Clarke discovered factors that explain why some clients experience a sense of well-being after a
stroke and others do not (2).  Physical and cognitive disabilities are less disruptive when they:
(a) permit participation in self-defining activities that contribute to a positive self-identity and
(b) are counterbalanced by adaptive strategies and social resources.

Self-defining activities.  Three of Clarke's subjects defined themselves as very physically active before their stroke (e.g. skiing, gardening, etc.).  One subject who used to be physically active said "What quality is there left?"  Five of Clarke's subjects did not define themselves by their physical activities so their sense of well-being was higher.  For example, they appreciated things like modifications that allowed them to drive again.  Teaching and helping others used to define me and they still do.  I present to stroke support groups, OT students. and OT conferences.  Participation in these activities has been an important way to reclaim a feeling of self-worth.

Adaptive strategies.  Six of Clarke's subjects successfully adapted to their stroke.  Prior education helped them get the most out of their rehab.  A school principal felt being an educator helped him listen closely and "tap into" instructions he was given.  A systems analyst used her logical reasoning skills to create memory aids.  Being an OT made me aware of a cornucopia of adaptive strategies, like energy conservation, so I can defeat deficits like exhaustion.   

Social resources.  Some of Clarke's subjects got support from family and friends.  One spouse helped his wife both physically and emotionally.  He was described as "being very gentle and humorous."  Other subjects felt a lack of social support.  One woman talked about being "dropped" by her neighborhood friends and feeling stigmatized because she could not drive.  No one walks in her neighborhood except cleaning ladies.  A second woman felt rejected because her husband would not walk down the street with her because she "cannot walk well enough."  A third woman's husband was critical of the memory aids she created and wanted them removed from the house.  My family lives far away so I am blessed to have many supportive friends.

1.  Wilson, I Cleary, P Linking clinical variables with health-related quality of life: a conceptual
      model of patient outcomes.  Journal of the American Medical Association. 1995;273:59-65.
2.  Clarke, P. Towards a greater understanding of the stroke experience: integrating quantitative
      and qualitative methods. Journal of Aging Studies. 2003;17:171-187.


  1. A lot of the changes met while in the forever recovery cycle has to do with adaptability to the situation. Women tend to adapt faster than men. Home life is also a factor. A glass half full type of person is more adaptable than a glass half empty.
    The PT and OT that understands this is priceless.

  2. Rebecca, thanks for this post. Fortunately, I am blessed with a wonderful support system of family and friends that helps balance the loss of activity that has been forced on me and contributes to my sense of well-being.

    Yes, it's complicated.

    Jo, don't forget the type that says, "the glass is twice as big as it needs to be."