# Health-related quality of life, emotional disturbances, physical functionality, perceived control, and their associations among stroke survivors: A cross-sectional study

**Authors:** Shazli Ezzat Ghazali, Nor Azlin Mohd Nordin, Deepak Thazhakkattu Vasu

PMC · DOI: 10.1371/journal.pone.0333386 · PLOS One · 2025-10-13

## TL;DR

This study explores how emotional and physical factors affect the quality of life for stroke survivors during early recovery.

## Contribution

The study identifies emotional disturbances and perceived control as significant predictors of quality of life in stroke survivors.

## Key findings

- Health-related quality of life was significantly correlated with physical functioning, anxiety, and internal locus of control.
- Emotional disturbances, particularly anxiety, were more prevalent among male stroke survivors.
- QOL outcomes were predicted by scores from HADS, RLOC, and MBI assessments.

## Abstract

The reintegration of stroke survivors into society is significantly and independently influenced by the survivors’ physical disabilities and emotional disturbances. In this study, we examined the relationships between stroke survivors’ emotional disturbances, physical functioning, perceived control, and health-related quality of life (QOL) during the early recovery phase, aiming to determine the predictive value of these variables for QOL outcomes.

This cross-sectional study involved 66 acute stroke patients attending the outpatient rehabilitation unit of a teaching hospital in Kuala Lumpur, Malaysia. The variables of interest we measures using the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression, the Euroqol-5-dimensions-5-levels (EQ-5D-5L) for QOL, the Modified Barthel Index (MBI) for physical functioning, and the Recovery Locus of Control (RLOC) scale for perceived control. Pearson’s correlation and regression analyses were performed to determine the ability of the variables to predict stroke survivors’ QOL.

Most of the patients were between 50 and 59 years old and were in the early stages of poststroke recovery. Although no significant gender differences were found in overall HADS scores (7.69 vs. 7.52), emotional disturbances, particularly anxiety disorders, were more prevalent among males, with 57% reporting symptoms compared to 48% of females. Health-related QOL was significantly correlated with physical functioning (r = −.439, p < .001), anxiety (r = .292, p < .001), and internal locus of control (r = −.224, p < .001). The study also revealed that QOL could be predicted by HADS (F = 4.03, p < .001), RLOC (F = 2.86, p < .001), and MBI (F = 7.46, p < .001) scores.

In addition to physical disabilities, perceived control and emotional disturbances had a substantial influence on stroke survivors’ QOL outcomes. Addressing these psychosocial and behavioural factors within treatment plans is crucial for improving stroke survivors’ poststroke recovery and enhancing their QOL.

## Linked entities

- **Diseases:** stroke (MONDO:0005098)

## Full-text entities

- **Diseases:** acute stroke (MESH:D020521), emotional disturbances (MESH:D014832), anxiety disorders (MESH:D001008), Anxiety and Depression (MESH:D001007)
- **Species:** Homo sapiens (human, species) [taxon 9606]

## Full text

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## References

38 references — full list in the complete paper: https://tomesphere.com/paper/PMC12517510/full.md

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Source: https://tomesphere.com/paper/PMC12517510