Quality of Life during the First Two Years Post Stroke: The Restore4Stroke Cohort Study
Quality of Life during the First Two Years Post Stroke: The Restore4Stroke Cohort Study
复制标题
中风后头两年的生活质量：Restore4Stroke 队列研究
作者：
M. V. van Mierlo;C. V. van Heugten;M. Post;Tibor R.S. Haj�s;L. Kappelle;J. Visser
背景资料：关于卒中后生活质量（QoL）的进程以及对日常生活活动（ADL）的依赖性如何影响这一进程的信息很少。因此，本研究的目的是描述卒中后2个月至2年的生活质量，并研究卒中后第一周ADL依赖性的影响。研究方法：这是一项多中心前瞻性纵向队列研究，纳入了368例卒中患者，并在卒中后1周、2个月、6个月、12个月和24个月收集数据。QoL评估包括健康相关生活质量（HRQoL）（短卒中特异性生活质量量表）、情绪功能（医院焦虑和抑郁量表）、参与（乌得勒支康复参与评估量表）和生活满意度（2LS）。ADL依赖定义为卒中后4天Barthel指数评分≤17。进行广义估计方程分析以检查QoL的4个领域的过程。此外，还检查了年龄、性别、婚姻状况、教育水平和出院目的地的可能混杂效应。结果如下：结果表明，HRQoL，参与和生活满意度在卒中后的第一年有所改善，大多数变化发生在前6个月。此外，与ADL独立患者相比，ADL依赖患者在所有4个QoL领域和测试场合的评分始终较低。在两组患者中，情绪功能没有随时间发生变化。ADL非依赖性患者的HRQoL（p = 0.002）、参与（p < 0.001）和生活满意度（p = 0.020）在2 - 6个月之间改善，生活满意度（p = 0.003）在6 - 12个月之间也改善。ADL依赖型患者在2 - 6个月之间的HRQoL（p = 0.009）以及在2 - 6个月之间（p = 0.001）和6 - 12个月之间（p = 0.031）的参与率有所改善。此外，他们的生活满意度没有变化。在加入年龄、性别、婚姻状况、教育程度和出院目的地后，未发现混杂效应。结论：大多数生活质量的改善发生在卒中后6个月，并在卒中后第一周表现出不同的生活质量特定领域和ADL依赖性和非依赖性患者的模式。因此，重要的是要区分这些不同领域的生活质量时，考虑的长期前景。此外，依赖ADL的患者在所有QoL领域的评分均较低，并且未达到独立于QoL的患者的QoL水平。
Background: Little information is available about the course of quality of life (QoL) post stroke and how dependency on activities of daily living (ADL) influences this course. The aim of this study was therefore to describe the course of QoL from 2 months up to 2 years post stroke and to study the influence of ADL dependency in the first week post stroke. Methods: This is a multicenter prospective longitudinal cohort study in which 368 stroke patients were included and data were collected at 1 week, 2 months, 6 months, 12 months and 24 months post stroke. QoL assessment included measures of health-related quality of life (HRQoL) (short stroke-specific Quality of Life Scale), emotional functioning (Hospital Anxiety and Depression Scale), participation (Utrecht Scale for Evaluation of Rehabilitation-Participation), and life satisfaction (2LS). Dependency on ADL was defined as having a Barthel Index score ≤17 four days post stroke. Generalized Estimating Equations analyses were performed to examine the course of the 4 domains of QoL. Furthermore, the possible confounding effect of age, gender, marital status, level of education and discharge destination was examined. Results: Results showed that HRQoL, participation and life satisfaction improved during the first year post stroke, with most changes occurring in the first 6 months. Furthermore, patients dependent in ADL scored consistently lower on all 4 QoL domains and test occasions compared to ADL-independent patients. In both patient groups separately, no changes over time were found in emotional functioning. ADL-independent patients improved in HRQoL (p = 0.002), participation (p < 0.001) and life satisfaction (p = 0.020) between 2 and 6 months and in life satisfaction (p = 0.003) between 6 and 12 months also. ADL-dependent patients improved in HRQoL (p = 0.009) between 2 and 6 months and in participation between 2 and 6 months (p = 0.001) and between 6 and 12 months (p = 0.031). Furthermore, they experienced no changes in life satisfaction. No confounding effect was found after adding age, gender, marital status, level of education and discharge destination. Conclusions: Most improvement in QoL occurred up to 6 months post stroke and showed different patterns for specific domains of QoL and for patients with and without dependency in ADL in the first week post stroke. It is therefore important to differentiate between these different domains of QoL when the long-term perspective is considered. Furthermore, patients dependent in ADL consistently scored lower on all QoL domains and did not reach the level of QoL of patients independent of QoL.