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Paper text:
stroke can result in survival with the permanent sequelae impairing in physical , 
 psychological , and social functions .
dependence in activities of daily life living , 
 alteration of emotional and psychological status , and deterioration in social communication 
 can influence the qol of patients with stroke1 .
various studies have shown a reduced qol among patients with stroke 
 compared with healthy individuals .
physical limitations have been stated as a determinant of 
 the qol . about 75% of patients with stroke experience difficulties with daily living activities2 .
if stroke occurs after the age of 65  years , 
 about 80% of individuals will experience chronic disability3 .
the number of deaths caused by stroke has decreased due to 
 advancements in medical science . however , as a result , the number of survivors with chronic 
 stroke has increased .
in addition to improving survival , the treatment of stroke is 
 important for the patients quality of life ( qol ) . as noted by de hann et al .
, the ultimate 
 aim of rehabilitation of stroke patients is to improve their qol4 .
most patients with stroke experience role changes due to impaired autonomy caused by 
 difficulty with performing daily living activities , as well as problems with interpersonal 
 relationships .
they also face psychosocial maladjustment due to long - term stress and strain , 
 which reduces their subjective evaluation ability of their qol5 .
much effort is required to integrate patients with chronic stroke into the local community 
 through the improvement of functional independence and qol . to help establish rehabilitation 
 objectives for patients with stroke in the future ,
this study investigated the correlation 
 between the activities of daily living and the qol of patients with chronic stroke .
this study was conducted from june 20 , 2012 , to july 19 , 2012 , and the subjects were 68 
 persons who attended a program at a health care center or a disabilities welfare center 
 after being diagnosed with stroke .
patients were excluded if they had severe aphasia or 
 cognition problems ( mini - mental state examination [ mmse ] score < 20 ) , which can adversely 
 influence the assessment of qol and daily living activities three survey questionnaires were administered to identify the level of participation of the 
 patients in the local community , and the subjects answers were analyzed .
the survey 
 consisted of three categories : general information about the subjects , stroke - specific qol 
 ( ss - qol ) questions , and the functional independence measure ( fim ) .
a physiotherapist from 
 the welfare center , a nurse from the health care center , and two physiotherapists conducted 
 in the surveys using the face - to - face method .
all the patients included understood the 
 purpose of this study and provided their written informed consent prior to their 
 participation in the study in accordance with the ethical principles of the declaration of 
 helsinki .
the ss - qol , which is a disease - specific qol measure , consists of 49 items encompassing 12 
 domains ( social role , mobility , energy , language , self - care , mood , personality , thinking , 
 upper - extremity function , family role , vision , and work / productivity ) .
the summary score of this scale is the weighted average of the 12 
 domains .
the total score ranges from 49 to 245 , with higher scores indicating better 
 qol6 . to measure the independence level of activities of daily living , the fim developed by keith 
 et al .
the fim is an 
 18-item measurement tool , which evaluates the following parameters : self - care , sphincter 
 control , mobility ( transfers ) , locomotion , communication , and social cognition .
the items on 
 the fim are scored on a 7-point ordinal scale ranging from 1 to 7 .
the minimum score on the 
 fim is 18 , which indicates a low level of functioning , and the maximum score is 126 , which 
 indicates a very high level of functioning8 .
the correlation coefficient of the inter - rater reliability ranges 
 between 0.83 and 0.99 , and the test - retest reliability ranges between 0.84 and 0.939 .
data were collected by direct observation 
 of the patient and , when necessary , by interviews with relatives .
pearson s correlation coefficient was used to assess the correlation among the items of the 
 fim , the total score , and the ss - qol total score .
multiple regression analysis using the 
 backward selection method was employed to find the most influential parameter on the qol 
 total score from among the six items of the fim .
the results were processed using the spss 
 18.0 statistical processing program , and a significance level of p=0.01 .
the subjects consisted of 47 males and 21 females , all of whom had experienced a stroke . 

their average age was 64.689.7  years , and their average period from stroke was 
 8.465.1  years .
fim_sc : self - care in fim , fim_sp : sphincter control in fim , fim_mo : 
 mobility in fim , fim_lo : locomotion in fim , fim_co : communication in fim , fim_so : 
 social cognition in fim shows the correlations among the six categories of the fim , the fim total 
 score , and the qol total score .
all the items and the total score of the fim showed a high 
 correlation with the qol total score .
the relationship between daily life activities and qol 
 ( total ) showed a significant positive correlation ( p<0.01 ) .
that is , the more independent 
 the patient s daily living was , the higher the qol was ( total ) . *
fim_sc : self - care in fim , fim_sp : sphincter control in fim , fim_mo : 
 mobility in fim ,
fim_lo : locomotion in fim , fim_co : communication in fim , fim_so : 
 social cognition in fim analysis of the importance of the items in the fim with regard to qol showed that mobility 
 and social cognition had the most significant effects ( p<0.01 ) .
the modified 
 r value was 0.67 , mobility and social cognition explained approximately 67% of 
 the change in the qol .
the present study aimed to assess the functional independence level and the qol of patients 
 with stroke , and to determine the correlation between the fim items and their qol .
the goal 
 was to provide basic data for treatment planning and the development of interventions for 
 the rehabilitation of patients with chronic stroke in a local community .
many patients with stroke experience difficulties due to impairment of the central nervous 
 system10 .
the main purpose of the 
 treatment of stroke is to improve a patient s level of disability to facilitate functional 
 independence , thereby helping to integrate the patient into the local community and improve 
 their qol11 .
the main criterion for assessing the qol of patients with stroke is their ability to 
 perform daily living activities independently .
various tools have been used to assess the 
 daily living activities in the rehabilitation sector . among them
, the fim has been utilized 
 in a variety of ways , not only to assess the status of the patient , but also to determine 
 the patient s prognosis and to establish treatment objectives12 . in this study
, there was a significant correlation among the fim items and the ss - qol 
 ( p<0.01 ) .
in most previous studies related to the qol of stroke patients , some of which were 
 cross - sectional and others that included long - term follow - up , the main determinant of qol 
 was the functional disability level . in a study performed with older korean stroke patients , 

aprile et al . observed that the qol assessed by the sf-36 was 
 related to the disability level evaluated by the fim and the modified rankin scale in 
 patients with stroke14 .
furthermore , in a 
 study performed with elderly stroke patients , the most important determinant was their 
 functional status15 .
in the current study , the results of the regression analysis using the backward selection 
 method showed that mobility and social cognition were the most influential of the fim items 
 affecting qol .
the mobility item of the fim refers to transfers to bed , chairs , wheelchair , 
 toilet , and bathtub or shower .
if patients lack this ability , they are more dependent on 
 carers , and they have a lower qol . as noted in previous studies , among older adults , 
 impaired mobility is associated with a loss of independence , reduced qol , 
 institutionalization , and a higher risk of mortality16 .
the social cognition item on the fim refers to social interaction , problem solving , and 
 memory .
these items are essential for forming interpersonal relationships , and patients with 
 higher social cognition abilities have better interpersonal relationships .
accordingly , rehabilitation 
 programs should concentrate on increasing the attention , concentration , information 
 processing capabilities , memory , and judgment ability of patients to improve social 
 cognition .
reported that it is important for self - help programs and rehabilitation 
 institutions to ensure that stroke patients have encouragement , psychological support , 
 adaptation training , and sufficient neuropsychological information17 .
such social support would enable patients who are 
 discouraged by stroke to assess themselves more realistically and to live healthier and 
 fuller lives17 .
the ability to perform independent activities of daily living is closely related to a quick 
 return to social life .
therefore , functional rehabilitation interventions aimed at chronic 
 stroke patients who have a limited ability of mobility and social cognition should focus on 
 improving their abilities to perform independent activities of daily living , thereby 
 improving their qol and helping overcome physical , psychological and social problems .
this research focused on only activities of daily living , although there are many other 
 factors that affect the qol of stroke patients .
[ purpose ] the present study aimed to determine the correlation between the activities of 
 daily living and the quality of life ( qol ) of patients with chronic stroke . 
 [ subjects and 
 methods ] the study subjects were 68 patients with stroke . 
 three questionnaires were 
 distributed by visiting the subjects . [ results ] 
 all the items and total scores of the 
 functional independence measure ( fim ) showed a high correlation with the qol total score . 
 
 the relationship between the activities of daily living and the total qol score showed a 
 significant positive correlation . among the fim items , mobility and social cognition 
 showed the most significant effects . 
 the modified r2 value was 0.67 , mobility 
 and social cognition explained approximately 67% of the change in the qol . 
 [ conclusion ] 
 the activities of daily living of the patients with chronic stroke and their qol showed a 
 high correlation . among the fim items , mobility ( transfers ) and social cognition had the 
 largest effects on the total qol score .