Abstract
Background and Purpose: Patient beliefs/values over illness/wellbeing are important considerations in health care delivery. We aimed to map function with health-related quality of life (HRQoL) to derive utility-weighted outcomes to test the efficacy of acute stroke trial interventions. Methods: Physical function and HRQoL were defined by modified Rankin scale (mRS) and EuroQol 5-dimensional questionnaire (EQ-5D) scores, respectively, for calculating utility-weighted mRS (UW-mRS) scores in pooled data from 5 international trials and externally validated in another trial database. UW-mRS was derived using ordinary least squares regression with mRS as a discrete ordinal explanatory dummy variable and EQ-5D as a continuous response variable. Linear regression was used to assess mean UW-mRS scores between intervention groups. Results: UW-mRS scores derived from 19338 acute stroke patients were 0.96, 0.92, 0.75, 0.58, 0.32, -0.093 for mRS scores 0, 1, 2, 3, 4 and 5, respectively. Both UW-mRS and ordinal mRS were statistically significant in INTERACT (P=0.04 and P=0.02 for UW-mRS and ordinal mRS, respectively) and ENCHANTED (0.04, P<0.0001). For HeadPoST (0.84, 0.41), SCAST (0.12, 0.22), ATTEND (0.42, 0.29) and COSSACS (0.77, 0.95), both UW-mRS and ordinal mRS scores captured divergent treatment effects in showing neutral results. Conclusions: UW-mRS as an outcome measure provides comparable statistical efficiency to ordinal analysis of mRS, but may better reflect patient and societal views on recovery. Greater HRQoL occurs where there is a large favourable shift away from high disability (mRS scores 3-5); interventions that achieve this provide the greatest benefit to patients.
Published Version
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