Predictors of Quality of Life in Stroke Survivors: A 1-year Follow-Up Study of a Tunisian Sample.

BACKGROUND: Stroke survivors often have impaired quality of live (QOL). There is very little information about the determining factors of QOL of stroke survivors in developing countries managed in public health structures with limited access to state of the art treatments. OBJECTIVE: To identify the main determinants of QOL in Tunisian stroke survivors. METHODS: QOL was assessed at 3, 6 and 12 months after the stroke using the Tunisian version of the SF-36 questionnaire. Patients were evaluated using the National Institue of Health Stroke Scale, the motor index of Demeurisse, the Functional Independence Measure instrument, the Reintegration to Normal Living Index, the Mini-Mental State Examination and the Hospital Anxiety and Depression Scale. RESULTS: 65 stroke survivors were included (60% males; mean age 62.2±10.3 years). Eighty-sex percent of the patients had an ischemic infarction. Most of the stroke patients had minor or moderate stroke. All the QOL dimensions were altered at 3 months post stroke. Between the 3 and 6-months follow-ups, there were significant changes in the SF-36 scores and individual domains but QOL remained altered. Between 6 and 12 months, there were no significant changes in the majority of the SF-36 domains. Advanced age, neurologic impairment, depression and disability measured 1 month after stroke, the stroke side (left hemisphere), the life style, and higher education, were associated with worse QOL. CONCLUSIONS: Stroke severity, advanced age, post-stroke depression and disability seem to represent consistent determinants of QOL in Tunisian stroke patients.

Translation and validation of the Intermittent Catheterisation Difficulty Questionnaire (ICDQ) in an Arabic population.

Objective: To translate and validate linguistically an Arabic version of the Intermittent Catheterisation Difficulty Questionnaire (ICDQ) adapted to the Tunisian population. Patients and methods: An Arabic translation and cultural adaptation of the ICDQ was obtained via the reverse translation method after two sets of comprehension tests within two groups of 10 patients. Psychometric validation included testing the questionnaire on a group of 30 patients. Intra-rater reliability was evaluated by the calculation of the intraclass correlation coefficient (ICC) for each item of the questionnaire. Cronbach's α was used to assess internal consistency. Results: The study included 30 patients (seven females, 23 males) with a mean (SD) age of 40.6 (15.3) years. The ICC was 0.96, demonstrating excellent intra-rater reliability. Cronbach's α was 0.96 (>0.9) confirming an excellent correlation between the different items. Conclusion: This work provides a translated, validated and Tunisian adapted version of the ICDQ that can be used to evaluate Tunisian patients' difficulties with clean intermittent self-catheterisation in daily practice. We expect that this version will also be helpful for patients in other Arabic and North African countries, although such a hypothesis needs to be confirmed by further studies. Abbreviations: CISC: clean intermittent self-catheterisation; ICDQ: Intermittent Catheterisation Difficulty Questionnaire; ASIA: American Spinal Injury Association; ICC: intraclass correlation coefficient.

Arabic (Tunisian) translation and validation of the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact Questionnaire short form (IIQ-7).

Objective: To translate and validate an Arabic (Tunisian) version of the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact Questionnaire short form (IIQ-7), which can be used reliably in daily practice and clinical research for Tunisian and Arabic populations. Patients and methods: This cross-sectional study was conducted from January to June 2018. The UDI-6 assesses the presence of urinary incontinence (UI) and the degree of impairment that it causes, whilst the IIQ-7 evaluates women's life quality with lower urinary tract symptoms. As UI is a relatively common condition in middle-aged and older women these tools are utilised worldwide. The Arabic (Tunisian) translation and cultural adaptation of the UDI-6 and IIQ-7 was achieved via the forward/backward method and comprehension test within a group of 15 patients. Psychometric validation included testing the questionnaire on a group of 35 patients. Intra-rater reliability was evaluated by calculation of the intraclass correlation coefficient (ICC) for each item of the questionnaires. Cronbach's α was used to assess internal consistency. The International Consultation on Incontinence Modular Questionnaire short form (ICIQ-SF), in its Arabic version, was used as the 'gold standard'. Results: For the UDI-6, the ICC was 0.98 demonstrating excellent intra-rater reliability and Cronbach's α was 0.99 (>0.9), confirming an excellent correlation between the different items. Internal consistency (Cronbach's α 0.99) and test-retest reliability of the IIQ-7 (ICC 0.98) were very good. For both questionnaires, the κ values for each item ranged from 0.77 to 0.96. Conclusions: We found that the UDI-6 and IIQ-7 questionnaires were valid tools that can be used reliably in daily practice and clinical research for Tunisian and Arabic women with UI. Abbreviations: ICC: intraclass correlation coefficient; ICIQ-SF: Incontinence Modular Questionnaire short form; IIQ-7: Incontinence Impact Questionnaire short form; QoL: quality of life; UDI-6: Urogenital Distress Inventory short form; UI: urinary incontinence.