Can acute clinical outcomes predict health-related quality of life after stroke: a one-year prospective study of stroke survivors

Yen Shing Yeoh,Reshma Aziz Merchant,Kim En Lee,Hui Meng Chang,David B Matchar ,Tian Ming Tu,Rajinder Singh,Helen Hoenig,Deidre Anne De Silva ,Yee Sien Ng,Philip Yap,Effie Chew,Tseng Tsai Yeo,Gerald Choon‐Huat Koh ,Yan Hoon Ang,Sherry Young ,Ning Chou,Narayanaswamy Venketasubramanian ,Chuen Seng Tan,Nan Luo

doi:10.1186/s12955-018-1043-3

Abstract

BackgroundHealth-related quality of life (HRQoL) is a key metric to understand the impact of stroke from patients’ perspective. Yet HRQoL is not readily measured in clinical practice. This study aims to investigate the extent to which clinical outcomes during admission predict HRQoL at 3 months and 1 year post-stroke.MethodsStroke patients admitted to five tertiary hospitals in Singapore were assessed with Shah-modified Barthel Index (Shah-mBI), National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Mini-Mental State Examination (MMSE), and Frontal Assessment Battery (FAB) before discharge, and the EQ-5D questionnaire at 3 months and 12 months post-stroke. Association of clinical measures with the EQ index at both time points was examined using multiple linear regression models. Forward stepwise selection was applied and consistently significant clinical measures were analyzed for their association with individual dimensions of EQ-5D in multiple logistic regressions.ResultsAll five clinical measures at baseline were significant predictors of the EQ index at 3 months and 12 months, except that MMSE was not significantly associated with the EQ index at 12 months. NIHSS (3-month standardized β = − 0.111; 12-month standardized β = − 0.109) and mRS (3-month standardized β = − 0.122; 12-month standardized β = − 0.080) were shown to have a larger effect size than other measures. The contribution of NIHSS and mRS as significant predictors of HRQoL was mostly explained by their association with the mobility, self-care, and usual activities dimensions of EQ-5D.ConclusionsHRQoL at 3 months and 12 months post-stroke can be predicted by clinical outcomes in the acute phase. NIHSS and mRS are better predictors than BI, MMSE, and FAB.

Highlights

Health-related quality of life (HRQoL) is a key metric to understand the impact of stroke from patients’ perspective
The study sample mainly consisted of patients with ischemic stroke (89%) and about 81% of patients were having their first episode of stroke
There was no significant difference in the baseline characteristics between those who were followed-up and loss to follow-up (LTFU), except marital status

Summary

Introduction

Health-related quality of life (HRQoL) is a key metric to understand the impact of stroke from patients’ perspective. This study aims to investigate the extent to which clinical outcomes during admission predict HRQoL at 3 months and 1 year post-stroke. In line with patient-centered healthcare, there is growing consensus that health-related quality of life (HRQoL) is a key metric with which to understand the impact of disease from patients’ perspective [4, 5]. Many studies have investigated predictors or determinants of quality of life after stroke, and some clinical predictors were identified [5,6,7,8,9]. Many prior studies have been cross-sectional which assessed the association between factors and HRQoL at the same time point [6]. The use of different HRQoL instruments and different timing at which HRQoL was measured have contributed to the inconclusive findings [9, 10]

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