Factors associated with quality of life in 7-year survivors of stroke
- Michael J Leach1,2,
- Seana L Gall3,
- Helen M Dewey4,5,6,
- Richard A L Macdonell4,6,
- Amanda G Thrift2,5,7
- 1Melbourne School of Population Health, University of Melbourne, Carlton, Australia
- 2Stroke Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- 3Menzies Research Institute, University of Tasmania, Hobart, Australia
- 4Neurology Department, Austin Health, Heidelberg, Australia
- 5National Stroke Research Institute, Austin Health—Repatriation Campus, Heidelberg Heights, Australia
- 6Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
- 7Department of Medicine, Southern Clinical School, Monash Medical Centre, Monash University. Melbourne, Victoria, Australia
- Correspondence to Professor Amanda Thrift, Epidemiology and Prevention Unit, Stroke and Ageing Research Centre (STARC), Department of Medicine, Monash Medical Centre, Southern Clinical School, Monash University, Level 1/43-51 Kanooka Grove, Clayton, Victoria 3168, Australia;
Contributors All authors have made a substantial contribution to (1) conception and design, acquisition of data or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content and (3) final approval of the version published.
- Received 16 November 2010
- Revised 25 March 2011
- Accepted 28 March 2011
- Published Online First 7 May 2011
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 post-stroke.
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 OR=11.2, 95% CI 4.87 to 25.6, p<0.001), independence in basic activities of daily living (BADL) (OR=4.53, 95% CI 2.03 to 10.1, p<0.001), independence in IADL and BADL (OR=9.90, 95% CI 4.51 to 21.7, p<0.001), male gender (OR=1.89, 95% CI 1.21 to 2.96, p=0.005) and lesser handicap (trend: OR=3.47, 95% CI 2.51 to 4.79, p<0.001). Participants' HRQoL scores tended to be lower when HRQoL assessments were completed by proxy (OR=0.13, 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 stroke.
Funding National Health & Medical Research Council (NHMRC), Australia Victorian Health Promotion Foundation and Australia Foundation for High Blood Pressure Research, Department of Physiology, University of Melbourne.
Competing interests None declared.
Ethics approval This study was conducted with the approval of each of the participating institutions including Austin Health.
Provenance and peer review Not commissioned; externally peer reviewed.