Minimal clinically important differences in health-related quality of life after ischemic stroke

Abstract

Introduction: Health-related quality of life (HR-QoL) is an essential index of outcome after acute ischemic stroke (AIS). The minimal clinically important differences (MCIDs) represent the smallest change detected by a specific HR-QoL measuring tool beyond the standard measurement error. Aim: We aimed to establish the MCID in the HR-QoL after AIS during the first three months post-stroke. Materials and Methods: A total of 143 participants were assessed using the Stroke Impact Scale 3.0 (SIS 3.0) to measure HR-QoL at discharge, the first and the third month after AIS. Aggregated scores between 0-100 for all domains were used. MCID was defined as positive changes (PCs)(+15 points), negative changes (NCs)(–15 points), and no significant difference (NSDs)(–14 to +14). General linear modeling was used to determine time changes, and the differences were considered significant at a p-value < 0.05. Results: The most affected SIS 3.0 domains on the third month were Mobility - 56.74, Hand function - 58.92, and Strength - 59.62. The majority of the patients had NSDs. The proportion of those with NCs was significantly lower than those of PCs. The domains with most PCs were Stroke recovery - 34.97%, Strength - 33.57%, and Mobility - 31.47%, while Memory and thinking had the least - 13.29%. The most NCs were found in the domains Participation - 4.90%, Emotion - 4.20%, and Hand function -3.50%. The emotion domain manifested with the greatest variety ranging from 25.87% PCs and 4.20% NCs. Conclusion: The most affected HR-QoL aspects were from the physical dimension, with an additionally high level of engagement of the emotional sphere. Stroke survivors require a holistic approach during the recovery period, including physical and speech rehabilitation and timely social and mental support.