Trajectories of health-related quality of life among people with a physical disability and/or chronic disease during and after rehabilitation: a longitudinal cohort study

B. L. Seves,F. J. Hettinga,T. Hoekstra,R. Dekker,L. H. V. van der Woude,F. Hoekstra

doi:10.1007/s11136-020-02647-7

Abstract

PurposeTo identify Health-related Quality of Life (HR-QoL) trajectories in a large heterogeneous cohort of people with a physical disability and/or chronic disease during and after rehabilitation and to determine which factors before discharge are associated with longitudinal trajectory membership.MethodsA total of 1100 people with a physical disability and/or chronic disease were included from the longitudinal cohort study Rehabilitation, Sports and Active lifestyle. All participants participated in a physical activity promotion programme in Dutch rehabilitation care. HR-QoL was assessed using the RAND-12 Health Status Inventory questionnaire at baseline (T0: 3–6 weeks before discharge) and at 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. A data-driven approach using Latent Class Growth Mixture modelling was used to determine HR-QoL trajectories. Multiple binomial multivariable logistic regression analyses were used to determine person-, disease- and lifestyle-related factors associated with trajectory membership.ResultsThree HR-QoL trajectories were identified: moderate (N = 635), high (N = 429) and recovery (N = 36). Trajectory membership was associated with person-related factors (age and body mass index), disease-related factors (perceived fatigue, perceived pain and acceptance of the disease) and one lifestyle-related factor (alcohol consumption) before discharge from rehabilitation.ConclusionsMost of the people who participated in a physical activity promotion programme obtained a relatively stable but moderate HR-QoL. The identified HR-QoL trajectories among our heterogeneous cohort are disease-overarching. Our findings suggest that people in rehabilitation may benefit from person-centred advice on management of fatigue and pain (e.g. activity pacing) and the acceptance of the disability.

Highlights

Improving health-related quality of life (HR-QoL) is one of the key objectives in today’s rehabilitation practice
The two large and stable trajectories of HR-QoL among our sample are similar to the large HR-QoL trajectories identified in specific disease populations, which might indicate that HR-QoL trajectories are not necessarily disease specific
This study identified three trajectories of HR-QoL after rehabilitation among a large heterogeneous cohort of people with a physical disability and/or chronic disease, of which there were two large stable trajectories, and one small intermediate trajectory

Summary

Introduction

Improving health-related quality of life (HR-QoL) is one of the key objectives in today’s rehabilitation practice. In people with a physical disability and/or chronic disease, HR-QoL during rehabilitation is lower than in the nondisabled population [3]. After rehabilitation, low levels of HR-QoL are commonly reported in people with a physical disability and/or chronic disease [4,5,6], and HR-QoL is poorer compared to a healthy reference population [7]. Previous literature found that physical activity is positively associated with all components of HR-QoL, except for mental health in people after rehabilitation [7]. Physical activity promotion programmes in rehabilitation care could have positive impact on improving HR-QoL by reducing secondary health conditions during and after treatment has finished [4, 11, 12]

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Discussion

Conclusion