Is health-related-quality of life of stroke patients influenced by neurological impairments at one year after stroke?

TLDR

The study aimed to determine which neurological impairments at rehabilitation discharge predict poorer health‑related quality of life one year after stroke. The multicenter observational study assessed 528 first‑time stroke patients, using discharge neurological impairment, demographic, clinical, and process variables to predict HRQoL outcomes measured by EuroQoL‑5D, Eq‑Index, and a visual analogue score. Lower limb motor deficits mainly reduced mobility‑related HRQoL, while upper limb deficits affected all other domains; neglect further lowered self‑care, pain‑discomfort, and anxiety‑depression scores, whereas gender and catheter use had minimal impact, underscoring upper‑limb motor impairment as a key determinant of one‑year HRQoL after stroke.

Abstract

The aim of this study was to evaluate which neurological impairments on discharge from rehabilitation services are associated with a worse outcome in terms of health related-quality of life (HRQoL) one year after stroke.We enrolled 528 first-time stroke patients in a multicenter observational study involving 18 Italian inpatients rehabilitation centers. Neurological impairment-related factors, socio-demographic and general clinical variables and process indicators were considered independent variables at discharge. Outcome was represented by the following dependent variables of HRQoL: EuroQoL-5D questionnaire (5D-EQoL) and its derived index (Eq-Index) and a Visual Analogue Score (QoL-VAS).The strongest predictors of lower HRQoL were an incomplete limbs motor recovery. An incomplete lower limb motor recovery was associated with a lower HRQoL only in the "mobility" domains, whereas a incomplete upper limb motor recovery could predict a lower HRQoL in all domains except "mobility". Regarding cognitive impairments, the presence of neglect at discharge was associated with a lower HRQoL in "self-care", "pain-discomfort" and "anxiety-depression". Female gender, presence of urinary catheter seemed to exert a much lesser role in predicting HRQoL.The results of this study suggest that upper limb motor impairments may have a detrimental impact on the patient's perceived HRQoL one year after stroke.