Increased work and social engagement is associated with increased stroke specific quality of life in stroke survivors at 3 months and 12 months post-stroke: a longitudinal study of an Australian stroke cohort

Abstract

Background: There is a relative lack of longitudinal studies investigating stroke-specific outcomes and quality of life (QOL). This study aimed to identify which factors (level of disability, cognitive functioning, depressive symptoms, physical activity, and work and social engagement) were independently associated with each stroke-specific domain of QOL, adjusting for age and gender, at 3 months and 12 months post-stroke in an Australian cohort.

Method: Survivors of ischemic stroke were recruited from 18 sites of the STroke imAging pRevention and Treatment (START) longitudinal cohort study. Survivors were assessed at 3 months (n = 185) and 12 months (n = 170) post-stroke using the Stroke Impact Scale (SIS), modified Rankin Scale (mRS), Montreal Cognitive Assessment (MoCA), Montgomery-Asberg Depression Rating Scale, Rapid Assessment of Physical Activity, and Work and Social Adjustment Scale (WSAS).

Results: WSAS was independently associated with the SIS domains of: Physical Composite function; Participation; and Perceived Recovery at 3 months and 12 months and SIS domain of Emotion at 12 months post-stroke. The presence of depressive symptoms was independently associated with the SIS domains of: Memory and Thinking; and Emotion at 3 months. At 12 months post-stroke, mRS was independently associated with SIS domain of Physical Composite function and MoCA with SIS domain of Communication.

Conclusion: Engaging in work and social activities is an important factor associated with stroke-specific domains of QOL over time. It is recommended that services focus on improving work and social engagement given their importance related to QOL in the first year of recovery post-stroke. Identifying and treating those with depressive symptoms may enhance QOL in the early months post-stroke.

Trial registration: START-PrePARE Australian New Zealand Clinical Trials, www.anzctr.org.au, Registry number: ACTRN12610000987066. EXTEND ClinicalTrial.gov identifier: NCT00887328.

Keywords:

• Quality of life
• stroke
• participation
• depression
• social activities
• work

Acknowledgements

The authors wish to acknowledge and thank the participants, lead investigators and study co-ordinators from the START recruiting sites including Royal Melbourne Hospital, Austin Hospital, John Hunter Hospital, Box Hill Hospital, Auckland City Hospital, Royal Brisbane and Women’s Hospital, Flinders Medical Centre, Royal Adelaide Hospital, Epworth Hospital, Monash Medical Centre, St Vincent’s Hospital Sydney, Western Hospital, Lyell McEwin Hospital, Royal North Shore Hospital, Nambour General Hospital, Westmead Hospital, The Queen Elizabeth Hospital, and Gosford Hospital. We also thank the Commonwealth Scientific and Industrial Research Organization (CSIRO) management and research teams involved in this research, in particular Lance Macaulay and the CSIRO data analytics team (Simon McBride, Karen Harrap, Chris Stanbridge). Finally, we acknowledge and thank the management and research team of the START program of research (www.START.csiro.au).