Dichotomous "Good Outcome" Indicates Mobility More Than Cognitive or Social Quality of Life.
Dichotomous "Good Outcome" Indicates Mobility More Than Cognitive or Social Quality of Life.
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DOI：
10.1097/ccm.0000000000001082
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发表时间：
2015-08
影响因子：
8.8
通讯作者：
Cella D
中科院分区：
文献类型：
--
作者：
Naidech AM;Beaumont JL;Berman M;Francis B;Liotta E;Maas MB;Prabhakaran S;Holl J;Cella D
脑出血（ICH）或蛛网膜下腔出血（SAH）的干预措施是否有价值通常取决于它们是否能提高“良好结局”的几率。虽然良好的结果与活动性相关，但与健康相关生活质量（HRQoL）的其他领域（如认知功能（CF）和社会功能）的相关性尚未得到很好的描述。我们测试了这一假设，即良好的结果是更密切相关的流动性比其他领域。我们将“良好结局”定义为1个月、3个月和12个月时改良兰金量表（mRS）0 - 3分（独立或更好）与4 - 5分（依赖）。我们同时评估了mRS和HRQoL使用基于网络的计算机自适应测试领域的流动性，CF（执行功能和一般问题），并与社会角色和活动（SRA）的满意度。我们比较了不同HRQoL域之间的曲线下面积（AUC）。神经科重症监护病房与网络随访我们纵向随访了114名幸存者的数据在一个月，62名患者在三个月，58名患者在12个月。在一个月时，活动性的AUC最高（0.957，95% CI 0.904 - 0.98），高于CF -一般问题（0.819，95%CI 0.715-0.888，与活动性相比P=0.003），对SRA的满意度（0.85，95%CI 0.753-0.911，与活动性相比P=0.01）和CF -执行功能（0.879，95%CI 0.782-0.935，与活动性相比P=0.058）。ROC分析的最佳特异性和灵敏度约为低于美国人群平均值1.5 SD。HRQoL评估可靠地区分了由mRS确定的良好和不良结局。“良好结局”表明HRQoL比美国人群平均值低约1.5 SD。协会弱CF和社会功能比流动性。
Worthwhile interventions for intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) generally hinge on whether they improve the odds of “good outcome.” While good outcome is correlated with mobility, correlations with other domains of health-related quality of life (HRQoL), such as cognitive function (CF) and social functioning, are not well described. We tested the hypothesis that good outcome is more closely associated with mobility than other domains. We defined “good outcome” as 0 through 3 (independent ambulation or better) vs. 4 through 5 (dependent) on the modified Rankin Scale (mRS) at one, three and 12 months. We simultaneously assessed the mRS and HRQoL using web-based computer adaptive testing in the domains of mobility, CF (executive function and general concerns), and satisfaction with social roles and activities (SRA). We compared the area under the curve (AUC) between different HRQoL domains. Neurological intensive care unit with web-based follow-up We longitudinally followed 114 survivors with data at one month, 62 patients at three months, and 58 patients at 12 months. At one month, AUC was highest for mobility (0.957, 95% CI 0.904 – 0.98), higher than CF - general concerns (0.819, 95%CI 0.715-0.888, P=0.003 compared to mobility), satisfaction with SRA (0.85, 95%CI 0.753-0.911, P=0.01 compared to mobility) and CF - executive function (0.879, 95%CI 0.782-0.935, P=0.058 compared to mobility). Optimal specificity and sensitivity for ROC analysis were approximately 1.5 SD below the US population mean. HRQoL assessments reliably distinguished between good and poor outcome as determined by the mRS. “Good outcome” indicated HRQoL about 1.5 SD below the US population mean. Associations were weaker for CF and social function than mobility.