HEALTH-RELATED QUALITY OF LIFE IN SINGAPOREAN STROKE PATIENTS AND ITS ASSOCIATION WITH CLINICAL OUTCOMES

Abstract

Objectives: Although health-related quality-of life (HRQoL) of stroke survivors has been examined in many studies, no study has investigated HRQoL deficits due to stroke and prospective studies investigating the association between clinical and patient-reported outcomes of stroke patients are scarce. The objectives of this project were to quantify the HRQoL deficits and investigate its association with clinical outcome measures among stroke survivors. Methods: This project used the data collected in the Singapore Stroke Study, a prospective study of stroke patients admitted to five tertiary hospitals in Singapore during the period from 2011 to 2014. HRQoL of patients at pre-stroke, 3 months and 12 months was assessed with the EQ-5D questionnaire, and their clinical outcomes were assessed with Shah modified Barthel Index (BI), National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (MRS), Mini-Mental State Examination (MMSE), and Frontal Assessment Battery (FAB) before discharge. Pre- and post-stroke EQ-5D index scores were compared to adjusted general population norms using one-sample t tests and their association with clinical outcomes was examined using regression models. Results: The patients’ EQ-5D index scores were significantly lower than age-, gender-, and ethnicity-adjusted population norms at pre-stroke (0.86 vs. 0.93), 3-months (0.61 vs. 0.94) and 12-months (0.76 vs. 0.94) post-stroke (p<0.001 for all). Compared to the pre-stroke level, HRQoL was reduced by 28.7% and 10.3% at 3-months and 12-months post-stroke, respectively. All clinical measures at baseline were significant predictors of post-stroke EQ-5D index scores, with NIHSS and MRS showing larger effect size than others. Conclusion: Stroke has substantial impact on HRQoL and the impact remains significant one year after stroke in Singaporean stroke survivors. HRQoL up to 1 year post-stroke can be predicted by clinical measures in the acute phase, although the predictability of different clinical outcome measures varies.