Participation in daily life activities at two months after stroke predicts long-term health-related quality of life

ABSTRACT

Background

After stroke, many patients experience problems with participation in daily activities. Improving participation is the main goal in stroke rehabilitation. However, the longitudinal relationship between participation and health-related quality of life (HRQoL) remains unclear.

Objectives

This study aimed to examine (1) the predictive value of participation at two months on long-term HRQoL and (2) the longitudinal relationship between participation and HRQoL.

Methods

In this multicenter, prospective cohort study, patients were assessed at two and 12 months after stroke. Participation was measured with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation – Participation. HRQoL was assessed with the three-level version of the EuroQoL five dimensions questionnaire index score.

Results

This study included 291 patients. Mean age was 66.6 ± 12.4 years, 64.3% were male and mean National Institutes of Health Stroke Scale (NIHSS) was 2.5 ± 2.9. Multivariable linear regression, adjusted for demographic characteristics, stroke characteristics, physical and cognitive impairment, showed that a higher level of participation at two months correlated with a higher HRQoL at one year (B = .004; 95% CI =.002–.005). Patients whose participation improved had a greater increase in HRQoL, compared to patients without improvement (0.080 ± .21 versus −.054 ± .21; p < .001).

Conclusions

The level of participation at two months post-stroke predicts HRQoL at one year. Improvement in participation during the first year after stroke is associated with improvement in HRQoL. We recommend including the assessment of participation in daily activities at follow-up visits.

KEYWORDS:

• Stroke
• social participation
• quality of life
• rehabilitation

Acknowledgments

We would like to thank all participants for their contributions to this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Authors’ contributions

- Conception and design of the study: JdG, JS, JV, MP

- Data acquisition and analysis: CH, JdG, JS, JV, MP

- Interpretation of data: CH, JdG, JS, JV, MP, RvdB, VK

- Drafting the article: JdG, JS, JV, MP

- Revising the article for valuable intellectual content: CH, JdG, JS, JV, MP, RvdB, VK

- Approval of final version: CH, JdG, JS, JV, MP, RvdB, VK

Consent to participate

All participants provided informed consent.

Consent for publication: all authors have read and approved the submitted manuscript, the manuscript has not been submitted elsewhere nor published elsewhere in whole or in part.

Ethical approval

The study complies with the Declaration of Helsinki and was approved by the Committee on Research involving Human Subjects of the St. Antonius Hospital in Nieuwegein in the Netherlands (R10.41A, February 2011) and by the medical ethics committees of all participating hospitals.

Non-standard abbreviations and acronyms

BI Barthel Index

EQ-5D-3 L EuroQoL five dimensions questionnaire

HRQoL health-related quality of life

MoCA Montreal Cognitive Assessment

NIHSS National Institutes of Health Stroke Scale

USER-P Restriction Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation – Participation

Additional information

Funding

This paper was supported by ZonMw, Efficiency Studies programme; project number 843004122. The Restore4stroke Cohort Study was funded by the VSBfonds (grant number 89000004), and coordinated by ZonMw (Dutch Organization for Health Research and Development).