Factors associated with quality of life in 7-year survivors of stroke
Leach, MJ and Gall, SL and Dewey, HM and Macdonell, RAL and Thrift, AG, Factors associated with quality of life in 7-year survivors of stroke, Journal of Neurology, Neurosurgery and Psychiatry, 82, (12) pp. 1365-1371. ISSN 0022-3050 (2011) [Refereed Article]
Background Little is known about health-related quality
of life (HRQoL) in the long term after stroke.
Aim The aim of this study was to assess the level of,
and factors associated with, HRQoL at 7 years
Methods All stroke cases from a prospective
community-based stroke incidence study (excluding
subarachnoid haemorrhage) were assessed 7 years after
stroke. HRQoL was measured with the Assessment of
Quality of Life instrument. Proportional odds ordinal
logistic regression was used to determine factors
associated with HRQoL at 7 years post-stroke.
Results Overall, 1321 stroke cases were recruited.
Seven years after stroke, 413 (31.2%) were alive and
328 (79.4%) were assessed. Those assessed were less
often current smokers pre-stroke than those not
assessed (p<0.01). Seventy-six survivors (23%) had
very poor HRQoL (range: 0.038 to 0.100). Factors
present at 7 years that were associated with better
7-year HRQoL were independence in instrumental
activities of daily living (IADL) (estimated OR¼11.2, 95%
CI 4.87 to 25.6, p<0.001), independence in basic
activities of daily living (BADL) (OR¼4.53, 95% CI 2.03 to
10.1, p<0.001), independence in IADL and BADL
(OR¼9.90, 95% CI 4.51 to 21.7, p<0.001), male gender
(OR¼1.89, 95% CI 1.21 to 2.96, p¼0.005) and lesser
handicap (trend: OR¼3.47, 95% CI 2.51 to 4.79,
p<0.001). Participants’ HRQoL scores tended to be
lower when HRQoL assessments were completed by
proxy (OR¼0.13, 95% CI 0.06 to 0.31, p<0.001).
Conclusion At 7 years post-stroke, 68.8% had died and
a substantial proportion of survivors had poor HRQoL.
Factors such as handicap, BADL and IADL could be
targeted to improve HRQoL in long-term survivors of