Published Online
on December 8, 2005

A more recent version of this article appeared on January 1, 2006

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Submitted on July 25, 2005
Accepted on October 17, 2005

Long-Term Outcome After Stroke. Evaluating Health-Related Quality of Life Using Utility Measurements

Caroline Haacke MD; Astrid Althaus MA; Annika Spottke MD; Uwe Siebert MD, MPH; Tobias Back MD; and Richard Dodel MD^*

From the Department of Neurology (C.H., T.B.), Philipps-University Marburg, Germany; the Department of Neurology (A.A., A.S., R.D.), University of Bonn, Germany; MGH Institute for Technology Assessment and the Department of Radiology (U.S.), Harvard Medical School, Boston, Mass; the Department of Public Health, Medical Decision Making and Health Technology Assessment (U.S.), University for Health Sciences, Medical Informatics and Technology, Hall, Austria; and Department of Neurology (T.B.), University of Mannheim, Germany.

^* To whom correspondence should be addressed. E-mail: richard.dodel{at}ukb.uni-bonn.de.

Background and Purpose--As stroke mortality rates decline, individuals are increasingly likely to live with their residual impairments and disabilities. Therefore, the quality of poststroke life is 1 of the pivotal topics that have to be considered beneath the functional outcome. However, data on health-related quality of life (HRQoL) have been infrequently used in stroke trials. The purpose of this study was to examine the long-term outcome (4 years after stroke) of HRQoL and to identify the determinants of HRQoL in stroke survivors.

Methods--Seventy-seven patients were included who were admitted to the Department of Neurology, Philipps-University Marburg, after experiencing an ischemic stroke, a transient ischemic attack, or a hemorrhagic stroke. All patients were examined by a physician, and assessment was performed using a standardized questionnaire. HRQoL was assessed using the German version of the EuroQoL Index (EQ-5D) and the Health Utility Index 2 and 3 (HUI2/3).

Results--Four years after stroke, besides physical functioning, neuropsychological sequelae such as depression and cognitive impairment contributed to a reduced HRQoL. In addition, the incidence of incontinence proved to be an important factor for HRQoL. Explained variances in regression analysis models were high (R²=0.802 for HUI and 0.633 for EQ-5D--visual analogue scale) and were based on a few important determinants, including physical state, depression, cognitive impairment, and incontinence.

Conclusion--Our results underscore the importance of nonmotor symptoms on HRQoL in patients with stroke.

Key words: multivariate • quality of life • stroke • stroke outcome

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