Relationships between long-term stroke disability, handicap and health-related quality of life
1 Department of Public Health Sciences, Guy’s, King’s & St. Thomas’ School of Medicine, King’s College London, UK
2 Department of Elderly Medicine, University Hospital Lewisham, London, UK
Address for correspondence: M. D. Patel. Tel: (+44) 20 8333 3000. Fax: (+44) 20 8333 3381. Email: mehool.patel{at}uhl.nhs.uk
Objectives: to estimate levels of disability, handicap and health-related quality of life (HRQOL) up to 3 years after stroke and examine the relationships between these domains.
Design: a longitudinal, observational study
Setting: population-based register of first-ever strokes
Methods: subjects, registered between 1 January 1995 and 31 December 1997, were assessed at 1 year (n = 490) and 3 years (n = 342) post-stroke for disability [Barthel index (BI)], handicap [Frenchay activity index (FAI)] and HRQOL (SF-36). BI was categorised as severe, moderate, mild and independent (0–9, 10–14, 15–19 and 20); FAI was categorised as inactive, moderately active and very active (0–15, 16–30 and 31–45). SF-36 domains include: Physical Functioning (PF), Role Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role Emotional (RE) and Mental Health (MH). Physical (PHSS) and Mental Health (MHSS) Summary Scores were computed.
Results: at 1 and 3 years, 26.1 and 26.3%, respectively, were disabled (BI <15); 55 and 51%, respectively, were handicapped (FAI = 0–15); and survivors had low mean PHSS (37.1 and 37.9), but satisfactory mean MHSS (46.6 and 47.7). There was a graded positive relationship between all SF-36 domains and the categories of BI and FAI. Spearman rank correlations were significant between BI and all SF-36 domains at both time points: strong (r>0.70) with PF, moderate (r = 0.31–0.70) with RP, SF and PHSS, but weak (r <0.30) with other domains. Correlations between FAI and SF-36 domains were strong with PF, weak with BP, RE and MHSS, and moderate with other domains.
Conclusions: disability and handicap remain highly prevalent up to 3 years after stroke. Patients’ perception of physical health is persistently low, but mental health perception is satisfactory up to 3 years. Due to variable correlations between different HRQOL domains with disability and handicap, it is suggested that disability, handicap and HRQOL should all be assessed to acquire a broader measure of stroke outcome.
Keywords: stroke, long-term outcomes, disability, handicap, quality of life, elderly
Received November 10, 2005; accepted in revised form February 6, 2006.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M A Busch, C Coshall, P U Heuschmann, C McKevitt, and C D A Wolfe Sociodemographic differences in return to work after stroke: the South London Stroke Register (SLSR) J. Neurol. Neurosurg. Psychiatry, August 1, 2009; 80(8): 888 - 893. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Saver, J. Gornbein, J. Grotta, D. Liebeskind, H. Lutsep, L. Schwamm, P. Scott, and S. Starkman Number Needed to Treat to Benefit and to Harm for Intravenous Tissue Plasminogen Activator Therapy in the 3- to 4.5-Hour Window: Joint Outcome Table Analysis of the ECASS 3 Trial Stroke, July 1, 2009; 40(7): 2433 - 2437. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Cumberland Consensus Working Group, B. Cheeran, L. Cohen, B. Dobkin, G. Ford, R. Greenwood, D. Howard, M. Husain, M. Macleod, R. Nudo, et al. The Future of Restorative Neurosciences in Stroke: Driving the Translational Research Pipeline From Basic Science to Rehabilitation of People After Stroke Neurorehabil Neural Repair, February 1, 2009; 23(2): 97 - 107. [Abstract] [PDF]
|
|
|
|
|
|
J. H. Pan, X. Y. Song, S. Y. Lee, and T. Kwok Longitudinal Analysis of Quality of Life for Stroke Survivors Using Latent Curve Models Stroke, October 1, 2008; 39(10): 2795 - 2802. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S.K. Lo, J. O.Y. Cheng, E. M.C. Wong, W. K. Tang, L. K.S. Wong, J. Woo, and T. Kwok Handicap and Its Determinants of Change in Stroke Survivors: One-Year Follow-Up Study Stroke, January 1, 2008; 39(1): 148 - 153. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Gray, N. Sprigg, P. M.W. Bath, G. Boysen, P. P. De Deyn, D. Leys, D. O'Neill, E. B. Ringelstein, and for the TAIST Investigators Sex Differences in Quality of Life in Stroke Survivors: Data From the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST) Stroke, November 1, 2007; 38(11): 2960 - 2964. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. K. Lo, T. C. Y. Kwok, J. O. Y. Cheng, H. Yang, H. J. Yuan, R. Harwood, and J. Woo Cross-cultural validation of the London Handicap Scale and comparison of handicap perception between Chinese and UK populations Age Ageing, September 1, 2007; 36(5): 544 - 548. [Abstract] [Full Text] [PDF]
|
|