The participants’ stroke-related characteristics were shown that 319 (83.5%) had experienced stroke attack only once. 332 (86.9%) counted normal to moderate level in mRS. And Hemiplegia (129, 33.8%) and Dysarthria (92, 24.1%) were the most frequent complications overall. The level of self-reported medication adherence in MMS-knowledge was higher than in MMS-motivation. 370 (96.9%) showed high level in the MMS knowledge and 331 (86.6%) in the MMS motivation (Table 2).
Domain-specific levels of WHODAS and associated factors
Among 382 participants, prevalence by WHODAS 2.0 level was 37.4% for no (disability-free), 41.6% for mild, 16.0% for moderate, and 5.0% for severe disability in Global scores. The breakdown by domain also shows that prevalence decreased with severity. People with no disability was relatively common in SCA (63.6%) and GAP (51.6%), whereas the prevalence for severe disability was higher in PSO (16.8%) and GAR (11.8%) than in the other domains of WHODAS 2.0 (Fig. 1).
Table 3 showed associations between different variables and disability in domain-specific WHODAS 2.0 scores. The aORs obtained from ordinal logistic regression models for different variables represent disability in the index group compared with that in the reference group. The results for domain-specific scores were adjusted for the 5 demographic, 9 stroke-related and 2 medication adherence variables.
Table 3
Association between WHODAS 2.0 domains and selected variables
Variable | UAC | | GAR | | SCA | |
aOR | (95% CI) | P | | aOR | (95% CI) | P | | aOR | (95% CI) | P | |
Age (years) | 1.03 | ( | 1.01 | - | 1.05 | ) a | 0.010 | | 1.06 | ( | 1.04 | - | 1.09 | ) | < 0.001 | | 1.07 | ( | 1.04 | - | 1.10 | ) | < 0.001 | |
Sex: female | 1.21 | ( | 0.77 | - | 1.90 | ) | 0.404 | | 1.25 | ( | 0.79 | - | 1.97 | ) | 0.339 | | 0.86 | ( | 0.50 | - | 1.48 | ) | 0.582 | |
Living without spouse | 0.97 | ( | 0.61 | - | 1.56 | ) | 0.915 | | 1.05 | ( | 0.66 | - | 1.69 | ) | 0.826 | | 1.44 | ( | 0.84 | - | 2.47 | ) | 0.181 | |
Highest academic qualification | | | | | | | | | | | | | | | | | | | | | | | | |
Elementary school | 1.44 | ( | 0.68 | - | 3.06 | ) | 0.344 | | 0.80 | ( | 0.38 | - | 1.70 | ) | 0.565 | | 1.30 | ( | 0.50 | - | 3.34 | ) | 0.590 | |
Middle school | 2.07 | ( | 0.96 | - | 4.45 | ) | 0.063 | | 0.91 | ( | 0.42 | - | 1.94 | ) | 0.799 | | 2.66 | ( | 1.02 | - | 6.92 | ) | 0.045 | |
High school | 1.32 | ( | 0.66 | - | 2.63 | ) | 0.434 | | 0.84 | ( | 0.43 | - | 1.66 | ) | 0.617 | | 2.92 | ( | 1.20 | - | 7.12 | ) | 0.018 | |
College and above | | | | 1 | | | | | | | | 1 | | | | | | | | 1 | | | | |
Monthly family income (10,000won) | | | | | | | | | | | | | | | | | | | | | | | | |
100 and less | 0.73 | ( | 0.43 | - | 1.24 | ) | 0.243 | | 1.10 | ( | 0.63 | - | 1.87 | ) | 0.733 | | 1.58 | ( | 0.86 | - | 2.93 | ) | 0.143 | |
100 to 200 | 1.30 | ( | 0.77 | - | 2.18 | ) | 0.039 | | 1.10 | ( | 0.65 | - | 1.86 | ) | 0.996 | | 1.25 | ( | 0.69 | - | 2.30 | ) | 0.479 | |
More than 200 | | | | 1 | | | | | | | | 1 | | | | | | | | 1 | | | | |
Recurrent stroke | 1.22 | ( | 0.71 | - | 2.11 | ) | 0.465 | | 1.88 | ( | 1.08 | - | 3.26 | ) | 0.024 | | 1.42 | ( | 0.78 | - | 2.59 | ) | 0.253 | |
mRSb | | | | | | | | | | | | | | | | | | | | | | | | |
Normal to mild | | | | 1 | | | | | | | | 1 | | | | | | | | 1 | | | | |
Moderate to severe | 4.04 | ( | 2.06 | - | 7.93 | ) | < 0.001 | | 8.27 | ( | 4.03 | - | 16.96 | ) | < 0.001 | | 11.60 | ( | 5.50 | - | 24.46 | ) | < 0.001 | |
Complication after stroke | | | | | | | | | | | | | | | | | | | | | | | | |
Hemiplegia | 1.41 | ( | 0.87 | - | 2.28 | ) | 0.159 | | 3.86 | ( | 2.37 | - | 6.27 | ) | < 0.001 | | 5.32 | ( | 3.06 | - | 9.28 | ) | < 0.001 | |
Dysarthria | 1.88 | ( | 1.17 | - | 3.03 | ) | 0.010 | | 1.32 | ( | 0.81 | - | 2.15 | ) | 0.263 | | 1.16 | ( | 0.67 | - | 1.98 | ) | 0.599 | |
Facial palsy | 2.76 | ( | 0.95 | - | 8.02 | ) | 0.063 | | 4.85 | ( | 1.55 | - | 15.21 | ) | 0.007 | | 1.70 | ( | 0.53 | - | 5.42 | ) | 0.372 | |
Trouble seeing | 2.86 | ( | 1.11 | - | 7.38 | ) | 0.030 | | 1.44 | ( | 0.52 | - | 4.00 | ) | 0.480 | | 1.97 | ( | 0.66 | - | 5.84 | ) | 0.222 | |
Paresthesia | 0.86 | ( | 0.26 | - | 2.79 | ) | 0.800 | | 2.31 | ( | 0.76 | - | 7.02 | ) | 0.140 | | 2.00 | ( | 0.48 | - | 8.23 | ) | 0.339 | |
Cognition problem | 5.59 | ( | 1.61 | - | 19.38 | ) | 0.007 | | 0.65 | ( | 0.18 | - | 2.32 | ) | 0.506 | | 1.30 | ( | 0.33 | - | 5.15 | ) | 0.706 | |
General weakness | 2.46 | ( | 0.88 | - | 6.88 | ) | 0.085 | | 3.19 | ( | 1.14 | - | 8.93 | ) | 0.027 | | 0.98 | ( | 0.24 | - | 3.93 | ) | 0.972 | |
MMS knowledgec | | | | | | | | | | | | | | | | | | | | | | | | |
Low | 2.15 | ( | 0.68 | - | 6.75 | ) | 0.191 | | 2.24 | ( | 0.72 | - | 7.00 | ) | 0.164 | | 2.93 | ( | 0.87 | - | 9.86 | ) | 0.082 | |
High | | | | 1 | | | | | | | | 1 | | | | | | | | 1 | | | | |
MMS motivationc | | | | | | | | | | | | | | | | | | | | | | | | |
Low | 3.12 | ( | 1.75 | - | 5.55 | ) | < 0.001 | | 3.22 | ( | 1.78 | - | 5.80 | ) | < 0.001 | | 2.88 | ( | 1.52 | - | 5.46 | ) | 0.001 | |
High | | | | 1 | | | | | | | | 1 | | | . | | | | | 1 | | | | . |
UAC = Understanding and communicating; GAR = Getting around; SCA = Self-care; GAP = Getting along with people; LAC = Life activities; PSO = Participation in society; MMS = Modified Morisky Scale. a Adjusted odds ratios (95% confidence interval) from ordinal logistic regression models were estimated using age, sex, living without spouse, education level, family income level, recurrent stroke, mRS, hemiplegia, dysarthria, facial palsy, trouble seeing, paresthesia, cognition problem, general weakness, MMS knowledge and MMS motivation. b Normal to mild mRS < 3; moderate to severe mRS ≥ 3. c Low MMS knowledge (or motivation) < 2; high MMS knowledge (or motivation) ≥ 2. |
Table 3
Association between WHODAS 2.0 domains and selected variables (continued)
Variable | GAP | | LAC | | PSO | |
aOR | (95% CI) | P | | aOR | (95% CI) | P | | aOR | (95% CI) | P | |
Age (years) | 1.02 | ( | 1.00 | - | 1.04 | ) | 0.051 | | 1.05 | ( | 1.03 | - | 1.07 | ) | < 0.001 | | 1.00 | ( | 0.98 | - | 1.02 | ) | 0.979 | |
Sex: female | 1.34 | ( | 0.85 | - | 2.11 | ) | 0.208 | | 1.42 | ( | 0.89 | - | 2.29 | ) | 0.146 | | 1.13 | ( | 0.73 | - | 1.76 | ) | 0.589 | |
Living without spouse | 0.70 | ( | 0.43 | - | 1.13 | ) | 0.141 | | 1.04 | ( | 0.64 | - | 1.70 | ) | 0.871 | | 1.76 | ( | 1.11 | - | 2.80 | ) | 0.017 | |
Highest academic qualification | | | | | | | | | | | | | | | | | | | | | | | | |
Elementary school | 1.59 | ( | 0.74 | - | 3.40 | ) | 0.235 | | 1.28 | ( | 0.57 | - | 2.86 | ) | 0.543 | | 1.07 | ( | 0.52 | - | 2.21 | ) | 0.846 | |
Middle school | 2.17 | ( | 1.01 | - | 4.67 | ) | 0.048 | | 2.23 | ( | 1.00 | - | 5.01 | ) | 0.051 | | 1.24 | ( | 0.60 | - | 2.58 | ) | 0.565 | |
High school | 1.58 | ( | 0.80 | - | 3.14 | ) | 0.188 | | 1.70 | ( | 0.82 | - | 3.54 | ) | 0.155 | | 1.22 | ( | 0.65 | - | 2.30 | ) | 0.538 | |
College and above | | | | 1 | | | | | | | | 1 | | | | | | | | 1 | | | | |
Monthly family income (10,000won) | | | | | | | | | | | | | | | | | | | | | | | | |
100 and less | 1.34 | ( | 0.78 | - | 2.29 | ) | 0.292 | | 1.77 | ( | 1.01 | - | 3.11 | ) | 0.048 | | 1.16 | ( | 0.69 | - | 1.97 | ) | 0.574 | |
100 to 200 | 1.20 | ( | 0.70 | - | 2.04 | ) | 0.694 | | 1.70 | ( | 0.98 | - | 2.96 | ) | 0.899 | | 1.08 | ( | 0.64 | - | 1.83 | ) | 0.799 | |
More than 200 | | | | 1 | | | | | | | | 1 | | | | | | | | 1 | | | | |
Recurrent stroke | 1.72 | ( | 1.00 | - | 2.94 | ) | 0.049 | | 1.30 | ( | 0.74 | - | 2.28 | ) | 0.367 | | 1.73 | ( | 1.00 | - | 3.01 | ) | 0.050 | |
mRSb | | | | | | | | | | | | | | | | | | | | | | | | |
Normal to mild | | | | 1 | | | | | | | | 1 | | | | | | | | 1 | | | | |
Moderate to severe | 1.03 | ( | 0.53 | - | 2.00 | ) | 0.924 | | 10.17 | ( | 4.84 | - | 21.35 | ) | < 0.001 | | 12.48 | ( | 5.77 | - | 27.00 | ) | < 0.001 | |
Complication after stroke | | | | | | | | | | | | | | | | | | | | | | | | |
Hemiplegia | 2.72 | ( | 1.68 | - | 4.42 | ) | < 0.001 | | 6.23 | ( | 3.74 | - | 10.38 | ) | < 0.001 | | 3.87 | ( | 2.38 | - | 6.28 | ) | < 0.001 | |
Dysarthria | 1.82 | ( | 1.13 | - | 2.94 | ) | 0.015 | | 1.87 | ( | 1.14 | - | 3.06 | ) | 0.013 | | 1.94 | ( | 1.19 | - | 3.18 | ) | 0.008 | |
Facial palsy | 1.56 | ( | 0.53 | - | 4.62 | ) | 0.418 | | 2.36 | ( | 0.77 | - | 7.20 | ) | 0.131 | | 1.94 | ( | 0.62 | - | 6.04 | ) | 0.253 | |
Trouble seeing | 1.61 | ( | 0.61 | - | 4.26 | ) | 0.334 | | 2.67 | ( | 0.97 | - | 7.39 | ) | 0.058 | | 5.45 | ( | 1.93 | - | 15.41 | ) | 0.001 | |
Paresthesia | 1.51 | ( | 0.48 | - | 4.78 | ) | 0.485 | | 1.17 | ( | 0.32 | - | 4.25 | ) | 0.810 | | 1.53 | ( | 0.51 | - | 4.58 | ) | 0.447 | |
Cognition problem | 1.93 | ( | 0.56 | - | 6.63 | ) | 0.298 | | 2.68 | ( | 0.77 | - | 9.31 | ) | 0.122 | | 6.06 | ( | 1.62 | - | 22.58 | ) | 0.007 | |
General weakness | 2.28 | ( | 0.81 | - | 6.43 | ) | 0.120 | | 1.19 | ( | 0.37 | - | 3.84 | ) | 0.777 | | 3.88 | ( | 1.38 | - | 10.92 | ) | 0.010 | |
MMS knowledge | | | | | | | | | | | | | | | | | | | | | | | | |
Low | 2.23 | ( | 0.72 | - | 6.93 | ) | 0.164 | | 4.35 | ( | 1.31 | - | 14.44 | ) | 0.016 | | 2.19 | ( | 0.65 | - | 7.37 | ) | 0.207 | |
High | | | | 1 | | | | | | | | 1 | | | | | | | | 1 | | | | |
MMS motivation | | | | | | | | | | | | | | | | | | | | | | | | |
Low | 3.83 | ( | 2.16 | - | 6.82 | ) | < 0.001 | | 3.21 | ( | 1.76 | - | 5.82 | ) | < 0.001 | | 2.59 | ( | 1.42 | - | 4.70 | ) | 0.002 | |
High | | | | 1 | | | . | | | | | 1 | | | . | | | | | 1 | | | | |
UAC = Understanding and communicating; GAR = Getting around; SCA = Self-care; GAP = Getting along with people; LAC = Life activities; PSO = Participation in society; MMS = Modified Morisky Scale. a Adjusted odds ratios (95% confidence interval) from ordinal logistic regression models were estimated using age, sex, living without spouse, education level, family income level, recurrent stroke, mRS, hemiplegia, dysarthria, facial palsy, trouble seeing, paresthesia, cognition problem, general weakness, MMS knowledge and MMS motivation. b Normal to mild mRS < 3; moderate to severe mRS ≥ 3. c Low MMS knowledge (or motivation) < 2; high MMS knowledge (or motivation) ≥ 2. |
Age, mRS, dysarthria, trouble seeing, cognition problem and MMS-motivation were significant positive predictors of the disability of UAC in the model. For every one-year increase on age, the odds of being in more severe category on UAC was 1.03 times higher (p = 0.01). This indicated that a participant aged older was more likely to indicate greater disability of UAC. The odds of being in more severe level on UAC was 4.04 times higher for those who had the level of moderate to severe as compared to those who had the level of normal to mild in mRS (p < 0.001). And the odds of being in more severe level on UAC were 1.88, 2.86 and 5.59 times higher when a participant had the complication in dysarthria, trouble seeing and cognition problem, respectively (p = 0.01; 0.03; 0.007). In addition, the odds of being in more severe level on UAC was 3.12 times higher for those who showed low level of adherence to medication as compared to those who showed high in MMS-motivation (p < 0.001).
Age, recurrent stroke, mRS, hemiplegia, facial palsy, general weakness and MMS-motivation were significant positive predictors of the disability of GAR in the model. For every one-year increase on age, the odds of being in more severe category on GAR was 1.06 times higher (p < 0.001). This indicated that a participant aged older was more likely to indicate greater disability of GAR. The odds of being in more severe level on GAR was 1.88 times higher for those who experienced recurrent stroke as compared to those who had experienced stroke attack only once (p = 0.024). The odds of being in more severe level on GAR was 8.27 times higher for those who had the level of moderate to severe as compared to those who had the level of normal to mild in mRS (p < 0.001). And the odds of being in a higher level on GAR were 3.86, 4.85 and 3.19 times higher when a participant had the complication in hemiplegia, facial palsy, and general weakness, respectively (p < 0.001; 0.007; 0.027). In addition, the odds of being in more severe level on GAR was 3.22 times higher for those who showed low level of adherence to medication as compared to those who showed high in MMS-motivation (p < 0.001).
Age, highest academic qualification, mRS, hemiplegia and MMS-motivation were significant positive predictors of the disability of SCA in the model. For every one-year increase on age, the odds of being in more severe category on SCA was 1.07 times higher (p < 0.001). This indicated that a participant aged older was more likely to indicate greater disability of SCA. The odds of being in more severe level on SCA were 2.92 and 2.66 times higher for those who had their highest academic qualification as high and middle school, respectively as compared to those who had college and above (p = 0.018; 0.045). The odds of being in more severe level on SCA was 11.6 times higher for those who had the level of moderate to severe as compared to those who had the level of normal to mild in mRS (p < 0.001). And the odds of being in more severe level on SCA was 5.32 times higher when a participant had the complication in hemiplegia (p < 0.001). In addition, the odds of being in more severe level on SCA was 2.88 times higher for those who showed low level of adherence to medication as compared to those who showed high in MMS-motivation (p = 0.001).
Highest academic qualification, recurrent stroke, hemiplegia, dysarthria and MMS-motivation were significant positive predictors of the disability of GAP in the model. The odds of being in more severe level on GAP was 2.17 times higher for those who had their highest academic qualification as middle school as compared to those who had college and above (p = 0.048). The odds of being in more severe level on GAP was 1.72 times higher for those who experienced recurrent stroke as compared to those who had experienced stroke attack only once (p = 0.049). And the odds of being in more severe level on GAP were 2.72 and 1.82 times higher when a participant had the complication in hemiplegia, and dysarthria, respectively (p < 0.001; 0.015). In addition, the odds of being in more severe level on GAP was 3.83 times higher for those who showed low level of adherence to medication as compared to those who showed high in MMS-motivation (p < 0.001).
Age, highest academic qualification, monthly family income, mRS, hemiplegia, dysarthria, MMS-knowledge and MMS-motivation were significant positive predictors of the disability of LAC in the model. For every one-year increase on age, the odds of being in more severe category on LAC was 1.05 times higher (p < 0.001). This indicated that a participant aged older was more likely to indicate greater disability of LAC. The odds of being in more severe level on LAC was 2.23 times higher for those who had their highest academic qualification as middle school as compared to those who had college and above (p = 0.051). The odds of being in more severe level on LAC was 1.77 times higher for those who had their monthly family income as one million and less Korean won as compared to those who had more than two million and less Korean won (p = 0.048). The odds of being in more severe level on LAC was 10.17 times higher for those who had the level of moderate to severe as compared to those who had the level of normal to mild in mRS (p < 0.001). And the odds of being in more severe level on LAC were 6.23 and 1.87 times higher when a participant had the complication in hemiplegia, and dysarthria, respectively (p < 0.001; 0.013). In addition, the odds of being in more severe level on LAC was 4.35 and 3.21 times higher for those who showed low level of adherence to medication as compared to those who showed high in MMS-knowledge and MMS-motivation, respectively (p = 0.016; <0.001).
Living without spouse, mRS, hemiplegia, dysarthria, trouble seeing, cognition problem, general weakness and MMS-motivation were significant positive predictors of the disability of PSO in the model. For living without spouse, the odds of being in more severe category on PSO was 1.76 times higher (p = 0.017). The odds of being in more severe level on PSO was 12.48 times higher for those who had the level of moderate to severe as compared to those who had the level of normal to mild in mRS (p < 0.001). And the odds of being in more severe level on PSO were 3.87, 1.94, 5.45, 6.06 and 3.88 times higher when a participant had the complication in hemiplegia, dysarthria, trouble seeing, cognition problem and general weakness, respectively (p < 0.001; 0.008; 0.001; 0.007; 0.010). In addition, the odds of being in more severe level on PSO was 2.59 times higher for those who showed low level of adherence to medication as compared to those who showed high in MMS-motivation (p = 0.002).