Healthcare, Clinical Factors and Rehabilitation Predicting Quality of Life in First-time Stroke Patients: A 12-month Longitudinal Study

• Published in: Journal of stroke and cerebrovascular diseases 2022-04, Vol.31 (4), p.1-10, Article 106300
• Main Authors: Barbosa, Pedro Maciel, Ferreira, Lara Noronha, Cruz, Vitor Tedim, Silva, Augusta, Szrek, Helena
• Format: Article
• Language: English
• Subjects: Delivery of Health Care; EQ-5D-3L; Health-Care; Health-related Quality of Life; Humans; Longitudinal Studies; Predictors; Prospective Studies; Quality of Life; Rehabilitation; SF-6D; Stroke; Stroke - diagnosis; Stroke - therapy; Stroke Rehabilitation
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2021.106300

One of the long-term rehabilitation goals in stroke survivors is to achieve the best health-related quality of life (HRQoL). This study analyzes the evolution of HRQoL one-year post-stroke to establish the main pre-stroke, clinical, health care and rehabilitation predictors. This study uses patient-level data from a one-year single-center prospective cohort study of first stroke patients, assessed at baseline, 3, 6 and 12 months. A generalized linear model with a linear response determined independent predictors of HRQol with EQ-5D-3L and SF-6D. The model included age, gender, scholarity, monthly income, residence, occupation, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Barthel Index (BI), Mini-Mental State Examination (MMSE), length of stay, door-to-neurological examination time, access, frequency, and satisfaction with rehabilitation care. A total of 391 acute stroke patients, with a mean disability of 3.7 and severity of 11.7 participated. A decline of HRQoL was observed from baseline to the first three months in both indexes, with an increase in HRQoL at 3 months until 12 months. Scores were significantly lower compared to corresponding population norms throughout follow-up, mostly affected by stroke severity, disability, rehabilitation access and frequency. Higher HRQoL was associated with lower mRS, NIHSS, age, length of stay, and with higher BI, MMSE, scholarity, occupation, and rehabilitation care. Clinical measures and rehabilitation care were the strongest HRQoL predictors of stroke survivors regardless of severity levels. These findings may contribute to the development of future health policies that focus on post-stroke recovery.