Quality of Life Decrements after Stroke

Authors: Dewilde S, Peeters A, Thijs V, Annemans L, Belgian SC
Published in: Value in Health. 2014 Nov;17(7):A331

Abstract

Objectives: To quantify which factors affect the quality of life valuations (QoL) of patients after stroke.

Methods: 569 ischemic stroke patients were recruited into a retrospective, observational study in 10 teaching and regional hospitals across Belgium. Patients were stratified according to their modified Rankin Score (mRS) ranging from 0 (full health) to 5 (severely dependent). QoL as measured by the EQ5D and the VAS were collected for their health status before and after the index stroke. Utility decrements were calculated and using a general linear model the relationship between a set of variables and quality of life evaluation and its decrement associated with the stroke experience was investigated. Different distributions and link functions were tested against each other using the AICC and BIC criterion.

Results: Stroke had a significant effect on patient’s QoL: a positive relationship with the degree of disability was found: EQ5D decrements were 0.08, 0.17, 0.25, 0.40, 0.64 and 0.75 for mRS categories 0 to 5; and equivalent decrements on the VAS scale were 7, 11, 20, 27, 33 and 39. The EQ5D and VAS decrements were significantly related to each other (r=0.49, p<0.001) and the decrements were also correlated with their baseline values (r=-0.74 for EQ5D baseline measurement and its decrement; r=-0.55 for VAS baseline value and decrement, p<0.001). The decrements were of higher magnitude when measured by the EQ5D compared to the VAS. Furthermore the utility decrements were significantly associated with being female, being diabetic, having atrial fibrillation, being in a wheelchair, experiencing a change in one’s living situation and the number of days spent in an inpatient care facility during the first 3 months after stroke.

Conclusions: Stroke results in a significant decrease in patient’s QoL, the magnitude of which is related to patient characteristics, disease severity measures, clinical risk factors and living circumstances.