Abstract WP377: Outcome After Stroke - “Good” Or “Poor”?
Background: The modified Rankin Scale (mRS) is a commonly used instrument to measure outcome in stroke research and is often dichotomized into good and poor outcome. Quality of life (QoL) is likely affected by factors besides level of disability. The goal of this study was to assess the correlation between the mRS and a more patient-centered QOL measure, the European QoL visual analog scale (EQVAS).
Methods: The Medic One Stroke Study reviewed pre-hospital and hospital records from 11 acute care hospitals in the Seattle area from June 2000-January 2003. Subjects with a final hospital diagnosis of stroke were telephoned 3-4 months after stroke onset and both mRS (0-6, with 0 the best) and EQ VAS (0-100 with 100 best) were assessed.
Results: We identified 574 patients with stroke: 420 ischemic stroke (IS), 121 intraparenchymal hemorrhage (IPH) and 33 subarachnoid hemorrhage (SAH). At three months after discharge, the proportion with mRS of ≤ 3 varied significantly with stroke type: 50% IS, 20% IPH, and 27% SAH (p<0.001). Similarly, good quality of life, defined as EuroQoL ≥ 75, occurred in 48% IS, 25% IPH, and 27% SAH (p<0.001). Spearman’s rho showed a strong correlation of 0.89 (p<0.001) between mRS and EuroQoL. Likelihood of good QoL progressively decreased with increasing mRS (82%, 58%, 33%, 31%, 21%, 11% for mRS 0-5, respectively, p<0.001), yet a number of patients with high mRS (4,5) still reported good QoL (16/102 = 16%). Among patients with low mRS (0,1), 32% did not achieve good QoL.
Conclusion: Following stroke, QoL decreases with increasing mRS, but exceptions exist with good QoL despite high mRS scores. In the endeavor to advance patient-centeredness as a core component of quality health care, factors other than disability need further exploration, both by researchers doing clinical trials as well as by physicians making treatment recommendations.
- © 2012 by American Heart Association, Inc.