Background: Stroke has a huge impact on the patient, including activity limitations, psychosocial consequences such as affective disorders and poor quality of life (QoL). Post-stroke affective disorders, mainly post-stroke depression (PSD) and/or post-stroke anxiety (PSA), are common and compromise the outcomes of rehabilitation and stroke survivors’ reintegration to normal life. The resulting social consequences are considerable, ranging from a loss of vital impetus to an inability to communicate with others. After a stroke, QoL is reported to decrease compared with pre-stroke QoL. This reduction is more pronounced when physical impairment and activity limitations are present. However, to our knowledge, data on affective disorders, activity limitations and quality of life of stroke survivors in Benin are scarce.

Purpose: To evaluate impact of PSD, PSA and activity limitations on QoL of Beninese stroke survivors.

Methods: 176 stroke survivors (113 males; mean age±SD: 56.47±10.46 years old) were recruited in Benin with a mean time since stroke±SD = 47.47±48.96 months. We used the Barthel Index (BI) to assess post-stroke activity limitations. It’s a scale that measures disability or dependence in activities of daily living in stroke patients. All patients were screened for depression and anxiety symptoms using the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HAM-A).  Euroqol-5 Dimensions (EQ-5D) was used to assess their QoL in five dimensions namely: mobility, personal care, usual activities, pain/discomfort and anxiety/depression. EQ-5D also includes a visual analog scale (VAS), allowing respondents to report their perceived health status. Sociodemographic data were recorded and presented as means and standard deviations (SD) or in percentage. Univariate linear regressions were performed with BI, HDRS, HAM-A scores (independent variables) and EQ-5D summary index, EQ-VAS scores (dependent variables) to determine impact of affective disorders and activity limitations on QoL of stroke survivors.

Results: Statistical analyses showed that BI (β = 0.50; p < 0.0001; model R²= 0.25), HDRS (β = -0.40; p < 0.0001; model R²=0.16), HAM-A (β = -0.42; p < 0.0001; model R²=0.18) were associated with EQ-5D summary index. Also, BI (β = 0.81; p < 0.0001; model R²= 0.66), HDRS (β = -0.66; p < 0.0001; model R²=0.44), HAM-A (β = -0.59; p < 0.0001; model R²=0.35) were associated with EQ-VAS. The variances of the EQ-VAS scores were best explained by BI (66%), by HDRS (44%), and by HAM-A (35%). The variances of the EQ-5D scores were also explained by the same factors, namely BI (25%), HDRS (16%), and HAM-A (18%).

Conclusion: Activity limitations, depression and anxiety are linked to a poor QoL in Beninese stroke survivors. These post-stroke consequences better define their perception of overall life than scores of the QoL’ dimensions.

Clinical Implications: This study allows health professionals involved in rehabilitation to take into account the importance of affective disorders and activity limitations in planning care for stroke survivors.

Ethics approval: The study received approval from Health Sciences Faculty, University of Abomey-Calavi, Benin. Subjects signified their agreement to participate by signing a consent form.

Keywords: Activity limitations, Post-Stroke Depression, Post-Stroke Anxiety, Quality of Life, stroke survivors.