Health-related quality of life loss associated with first-time stroke.

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

doi:10.1371/journal.pone.0211493

Abstract

ObjectivesThis study aimed to quantify health-related quality of life (HRQoL) loss associated with first episode of stroke by comparing patient-reported HRQoL before and after stroke onset. The impact of stroke in local population was also evaluated by comparing the pre- and post-stroke HRQoL with that of the general population.MethodsThe HRQoL of stroke survivors was assessed with the EQ-5D-3L index score at recruitment, for recalled pre-stroke HRQoL, and at 3 and 12 month post-stroke. Change in HRQoL from pre-stroke to 3 and 12 month was self-reported by 285 and 238 patients, respectively. Mean EQ index score at each time point (baseline: 464 patients; 3 month post-stroke: 306 patients; 12 month post-stroke: 258 patients) was compared with published population norms for EQ-5D-3L.ResultsThere was a significant decrease in HRQoL at 3 (0.25) and 12 month (0.09) post-stroke when compared to the retrospectively recalled patients’ mean pre-stroke HRQoL level (0.87). The reduction at 3 month was associated with the reduction in all EQ-5D-3L health dimensions; reductions remaining at 12 month were limited to dimensions of mobility, self-care, usual activities, and anxiety/depression. Stroke patients had a lower mean EQ index than the general population by 0.07 points pre-stroke (0.87 vs. 0.94), 0.33 points at 3 month (0.61 vs. 0.94) and 0.18 points at 12 month (0.76 vs. 0.94) post-stroke.ConclusionsStroke has a substantial impact on HRQoL in Singapore, especially in the first three months post-stroke. Compared to the general population, stroke survivors have lower HRQoL even before stroke onset. This pre-stroke deficit in HRQoL should be taken into account when quantifying health burden of stroke or setting goals for stroke rehabilitation.

Highlights

Prior to the seventies, the health outcomes of disease were primarily measured with the rather limited “hard” end-points, for example, survival and treatment toxicity
Stroke has a substantial impact on health-related quality of life (HRQoL) in Singapore, especially in the first three months post-stroke
Compared to the general population, stroke survivors have lower HRQoL even before stroke onset. This pre-stroke deficit in HRQoL should be taken into account when quantifying health burden of stroke or setting goals for stroke rehabilitation

Summary

Introduction

The health outcomes of disease were primarily measured with the rather limited “hard” end-points, for example, survival and treatment toxicity. Stroke is one of the most devastating neurological conditions that contributes significantly to the increasing disease burden and death worldwide. 15 million people worldwide suffer from a stroke, in which 5 million are left permanently disabled, placing a huge burden on family and society. In 2012, stroke was the third leading cause of disability-adjusted life years (DALYs) lost worldwide, which accounted for 1998 DALYs per 100,000 populations. From 1990 to 2010, DALYs had increased by 19% in the Global Burden in Disease Study [2]. Recovery from a stroke is an arduous journey which takes months or years. It was estimated that the prevalence of stroke survivors with incomplete recovery was 460 per 100,000 and about 30% of these survivors required assistance in at least one activity of daily living [3]

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