Predictors of health-related quality of life of community-dwelling stroke survivors: a prospective longitudinal study
DOI:
https://doi.org/10.17267/2238-2704rpf.2022.e4911Keywords:
Stroke, Health-related quality of life, CommunityAbstract
INTRODUCTION: Knowing the factors that contribute to health-related quality of life (HRQoL) and its changes over time is essential to understanding the extent of stroke impact. Our objective was to identify predictors of HRQoL in community-dwelling individuals after stroke. METHODS: Cohort of individuals with stroke followed up in an outpatient clinic. Sociodemographic and clinical data were collected at baseline evaluation and the following scales: National Institutes of Health Stroke Scale (NIHSS), Timed Up and Go Test (TUGT), Modified Barthel Index (MBI), Frenchay Activity Index (FAI). The HRQoL was assessed using the EuroQol-5 dimensions (EQ-5D). After univariate analysis, the variables were included in two logistic regression models. RESULTS: There were 100 subjects, and at baseline evaluation 55% were female, mean age of 54 ± 13.9 years old, 57% with marital life, and 91% with a support network. The median time stroke was 36 (16-48) months, median of the NIHSS of 3 (1-5.5), MBI with a median of 49 points (48-50). The median of TUGT time was 13.8 (11, 3-19) seconds and the performance in instrumental activities (FAI) was 20 (12-25). After one year of follow-up, 60% of the assessed individuals had favorable HRQoL, and the identified predictors were the level of functionality in daily life activities (OR = 1.21 per 1point increase in MBI; 95% CI = 1.03-1.42; P = 0.016), the vascular territory of the lesion (OR = 4.98 for posterior vs anterior circulation; 95% CI = 1.53-16.22; P = 0.008), and time since stroke onset (OR = 0.98 per month since stroke onset; 95% CI = 0.96-0.99; P = 0.016. CONCLUSION: A higher level of functionality in activities of daily living, posterior circulation vascular territory, and a shorter time since stroke onset at baseline evaluation were the predictors of a favorable HRQoL.
Downloads
References
(1) Yeoh YS, Koh GCH, Tan CS, Tu TM, Singh R, Chang HM, et al. Health-related quality of life loss associated with first-time stroke. PLoS One. 2019;14(1):e0211493. https://doi.org/10.1371/journal.pone.0211493
(2) Andrenelli E, Ippoliti E, Coccia M, Millevolte M, Cicconi B, Latini L, et al. Features and predictors of activity limitations and participation restriction 2 years after intensive rehabilitation following first-ever stroke. Eur J Phys Rehabil Med. 2015;51(5):575-85. Cited: PMID: 25616152.
(3) Murakami K, Tsubota-Utsugi M, Satoh M, Asayama K, Inoue R, Ishiguro A, et al. Impaired Higher-Level Functional Capacity as a Predictor of Stroke in Community-Dwelling Older Adults: The Ohama Study. Stroke. 2016;47(2):323-8. https://doi.org/10.1161/STROKEAHA.115.011131
(4) Blomgren C, Jood K, Jern C, Holmegaard L, Redfors P, Blomstrand C, et al. Long-term performance of instrumental activities of daily living (IADL) in young and middle-aged stroke survivors: Results from SAHLSIS outcome. Scand J Occup Ther. 2018;25(2):119-26 https://doi./org/10.1080/11038128.2017.1329343
(5) Van Exel NJ, Reimer WJMS, Koopmanschap MA. Assessment of post-stroke quality of life in cost-effectiveness studies: the usefulness of the Barthel Index and the EuroQol-5D. Qual Life Res. 2004;13(2):427-33. https://doi.org/10.1023/B:QURE.0000018496.02968.50
(6) Fischer U, Anca D, Arnold M, Nedeltchev K, Kappeler L, Ballinari P, et al. Quality of life in stroke survivors after local intra-arterial thrombolysis. Cerebrovac Dis. 2008;25(5):438-44. https://doi.org/10.1159/000126917
(7) The WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med. 1995;41(10):1403-9. https://doi.org/10.1016/0277-9536(95)00112-k
(8) Chen CM, Tsai CC, Chung CY, Chen CL, Wu KP, Chen HC. Potential predictors for health-related quality of life in stroke patients undergoing inpatient rehabilitation. Health Qual Life Outcomes. 2015;13:118. https://doi.org/10.1186/s12955-015-0314-5
(9) White J, Magin P, Attia J, Sturm J, McElduff P, Carter G. Predictors of health-related quality of life in community-dwelling stroke survivors: a cohort study. Fam Pract. 2016;33(4):382-7. https://doi.org/10.1093/fampra/cmw011
(10) Ayis S, Wellwood I, Rudd AG, McKevitt C, Parkin D, Wolfe CDA. Changes in health-related quality of life (HRQoL) and 1-year survival after stroke: five European population-based registries. BMJ Open. 2015;5(6):e007101. https://doi.org/10.1136/bmjopen-2014-007101
(11) Hamza AM, Al-Sadat N, Loh SY, Jahan NK. Predictors of post-stroke health-related quality of life in Nigeria stroke survivors: a 1-year follow-up study. Biomed Res Int. 2014;2014:350281. https://doi.org/10.1155/2014/350281
(12) Pinto EB, Maso I, Pereira JLB, Fukuda TG, Seixas JC, Menezes DF, et al. Differential aspects of stroke and congestive heart failure in quality of life reduction: a case series with three comparison groups. Health Qual Life Outcomes. 2011;9:65. https://doi.org/10.1186/1477-7525-9-65
(13) Carod-Artal FJ, Trizotto DS, Coral LF, Moreira CM. Determinants of quality of life in Brazilian stroke survivors. J Neurol Sci 2009;284(1-2):63-8. https://doi.org/10.1016/j.jns.2009.04.008
(14) Fróes KSSO, Valdés MTM, Lopes DPLO, Silva CEP. Factors associated with health-related quality of life for adults with stroke sequelae. Arq Neuropsiquiatr. 2011;69(2-B):371-6. https://doi.org/10.1590/S0004-282X2011000300020
(15) Dewilde S, Annemans L, Lloyd A, Peeters A, Hemelsoet D, Vandermeeren Y, et al. The combined impact of dependency on caregivers, disability, and coping strategy on quality of life after ischemic stroke. Health Qual Life Outcomes. 2019;17:31. https://doi.org/10.1186/s12955-018-1069-6
(16) Cincura C, Pontes-Neto OM, Neville IS, Mendes HF, Menezes DF, Mariano DC, et al. Validation of the National Institutes of Health Stroke Scale, modified Rankin Scale and the Barthel Index in Brazil: the role of cultural adaptation and structured interview. Cerebrovasc Dis. 2009;27(2):119-22. https://doi.org/10.1159/000177918
(17) Monteiro M, Maso I, Sasaki AC, Barreto Neto N, Oliveira Filho J, Pinto EB. Validation of the Frenchay activity index in stroke victims. Arq Neuropsiquiatr. 2017;75(3):167-71. https://doi.org/10.1590/0004-282X20170014
(18) Pinto EB, Maso I, Vilela RNR, Santos LC, Oliveira-Filho J. Validation of the EuroQol quality of life questionnaire on stroke victims. Arq Neuropsiquiatr. 2011;69(2B):320-3. https://doi.org/10.1590/S0004-282X2011000300010
(19) Anderson CS, Jamrozik KD, Broadhurst RJ, Stewart-Wynne EG. Predicting survival for 1 year among different subtypes of stroke. Results from the Perth Community Stroke Study. Stroke. 1994;25(10):1935-44. https://doi.org/10.1161/01.str.25.10.1935
(20) Cohen JW, Ivanova TD, Brouwer B, Miller KJ, Bryant D, Garland SJ. Do performance measures of strength, balance, and mobility predict quality of life and community reintegration after stroke? Arch Phys Med Rehabil. 2018;99(4):713-9. https://doi.org/10.1016/j.apmr.2017.12.007
(21) Almborg AH, Ulander K, Thulin A, Berg S. Discharge after stroke - important factors for health-related quality of life. J Clin Nurses. 2010;19(15-16):2196-206. https://doi.org/10.1111/j.1365-2702.2010.03251.x
(22) Haacke C, Althaus A, Spottke A, Siebert U, Back T, Dodel R. Long-term outcome after stroke: Assessing health-related quality of life using utility measurements. Stroke. 2006;37(1):193-8. https://doi.org/10.1161/01.STR.0000196990.69412.fb
(23) Chang WH, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, et al. Predictors of functional level and quality of life at 6 months after a first-ever stroke: the KOSCO study. J Neurol. 2016;263(6):1166-77. https://doi.org/10.1007/s00415-016-8119-y
(24) Mayo NE, Wood-Dauphinee S, Côté R, Durcan L, Carlton J. Activity, participation and quality of life 6 months poststroke. Arch Phys Med Rehabil. 2002;83(8):1035-42. https://doi.org/10.1053/apmr.2002.33984
(25) Gbiri CA, Akinpelu AO. Relationship between post-stroke functional recovery and quality of life among Nigeria stroke survivors. Niger Postgrad Med J. 2013;20(1):29-33. Cited: PMID: 23661207.
(26) Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165(6):710-8. https://doi.org/10.1093/aje/kwk052
(27) De Wit L, Theuns P, Dejaeger E, Devos S, Gantenbein AR, Kerckhofs E, et al. Long-term impact of stroke on patients' health-related quality of life. Disabil Rehabil. 2017;39(14):1435-40. https://doi.org/10.1080/09638288.2016.1200676
(28) Mierlo M, Heugten C, Post MWM, Hoekstra T, Visser-Meily A. Trajectories of health-related quality of life after stroke: results from a one-year prospective cohort study. Disablil Rehabil. 2018;40(9):997-1006. https://doi.org/10.1080/09638288.2017.1292320
(29) Owolabi MO. What are the consistent predictors of generic and specific post-stroke health-related quality of life?. Cerebrovasc Dis. 2010;29(2):105-10. https://doi.org/10.1159/000262305
(30) Ali M, Fulton R, Quinn T, Brady M. How well do standard stroke outcome measures reflect quality of life? A retrospective analysis of clinical trial data. Stroke. 2013;44(11):3161-5. https://doi.org/10.1161/STROKEAHA.113.001126
(31) Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL, et al. Global stroke statistics. Int J Stroke. 2017;12(1):13-32. https://doi.org/10.1177/1747493016676285
(32) Rønning OM, Stavem K. Determinants of change in quality of life 1 to 6 months after following acute stroke. Cerebrovasc Dis. 2008;25(1-2):67-73. https://doi.org/10.1159/000111524
(33) Hopman WM, Verner J. Quality of life during and after inpatient rehabilitation. Stroke. 2003;34(3):801-5. https://doi.org/10.1161/01.STR.0000057978.15397.6F
(34) Inoa V, Aron AW, Staff I, Fortunato G, Sansing LH. Lower NIH stroke scale scores are required to accurately predict a good prognosis in posterior circulation stroke. Cerebrovasc Dis. 2014;37(4):251-5. https://doi.org/10.1159/000358869
(35) Libman RB, Kwiatkowski TG, Hansen MD, Clarke WR, Woolson RF, Adams HP. Differences between anterior and posterior circulation stroke in TOAST. Cerebrovasc Dis. 2001;11(4):311-6. https://doi.org/10.1159/000047659
(36) Förster A, Gass A, Kern R, Griebe M, Hennerici MG, Szabo K. Thrombolysis in posterior circulation stroke: stroke subtypes and patterns, complications and outcome. Cerebrovasc Dis. 2011;32(4):349-53. https://doi.org/10.1159/000330346
(37) Breuer L, Blinzler C, Huttner HB, Kiphuth IC, Schwab S, Köhrmann M. Off-label thrombolysis for acute ischemic stroke: rate, clinical outcome, and safety are influenced by the definition of "minor stroke". Cerebrovasc Dis. 2011;32(2):177-85. https://doi.org/10.1159/000328811
(38) Jönsson AC, Lindgren I, Hallström B, Norrving B, Lindgren A. Prevalence and intensity of pain after stroke: a population based study focusing on patients’ perspectives. J Neurol Neurosurg Psychiatry. 2006;77(5):590-5. https://doi.org/10.1136/jnnp.2005.079145
(39) Paolucci S, Iosa M, Toni D, Barbanti P, Bovi P, Cavallini A, et al. Prevalence and Time Course of Post-Stroke Pain: A Multicenter Prospective Hospital-Based Study. Pain Med. 2016;17(5):924-30. https://doi.org/10.1093/pm/pnv019
(40) Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis. 2015;39(3-4):190-201. https://doi.org/10.1159/000375397
(41) Klit H, Finnerup NB, Overvad K, Andersen G, Jensen TS. Pain after stroke: a population-based follow-up study. PLoS One. 2011;6(11):e27607. https://doi.org/10.1371/journal.pone.0027607
(42) Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Insomnia and health-related quality of life in stroke. Top Stroke Rehabil. 2015;22(3):201-7. https://doi.org/10.1179/1074935714Z.0000000026
(43) Morris JH, Wijck F, Joice S, Donaghy M. Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction. Disabil Rehabil. 2013;35(4):291-9. https://doi.org/10.3109/09638288.2012.691942
(44) Santos EB, Rodrigues RAP, Pontes-Neto OM. Prevalence and predictors of post stroke depression among elderly stroke survivors. Arq Neuropsiquiatr. 2016;74(8):621-5. https://doi.org/10.1590/0004-282X20160088
(45) Blozik E, Scherer M, Lacruz ME, Ladwig KH. Diagnostic utility of a one-item question to screen depressive disorders: results from the KORA F3 study. BMC Fam Pract. 2013;14:198. https://doi.org/10.1186/1471-2296-14-198
(46) Lopez-Espuela F, Zamorano JDP, Ramírez-Moreno JM, Jiménez-Caballero PE, Portilla-Cuenca JC, Lavado-García JM, et al. Determinants of quality of life in stroke survivors after 6 months from a comprehensive stroke unit: a longitudinal study. Biol Res Nurs. 2015;17(5):461-8. https://doi.org/10.1177/1099800414553658
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Luciana Oliveira Rangel Pinheiro, Moema Pires Guimarães, Maria Baía, Maria Eduarda de Carvalho, Jamary Oliveira-Filho, Elen Beatriz Pinto
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
