Very Low Quality of Life After Acute Stroke

At day 90 you still have no idea what recovery is possible. Don't checkout at this point.
http://stroke.ahajournals.org/content/44/12/3458.abstract?etoc

Data From the Efficacy of Nitric Oxide in Stroke Trial

1. Nikola Sprigg, DM;
2. James Selby, BMBS;
3. Lydia Fox, MSc;
4. Eivind Berge, MD;
5. David Whynes, Mlitt;
6. Philip M.W. Bath, MD
7. for the Efficacy of Nitric Oxide in Stroke Investigators

+ Author Affiliations

1. From the Stroke Trials Unit (N.S., J.S., L.F., P.M.W.B.) and School of Economics (D.W.), University of Nottingham, Nottingham, United Kingdom; and Department of Internal Medicine, Ullevaal University Hospital, Oslo, Norway (E.B.).

1. Correspondence to Nikola Sprigg, DM, Stroke Trials Unit, Division of Clinical Neurosciences, University of Nottingham, Clinical Sciences Bldg, City Hospital Campus, Nottingham NG7 2UH, United Kingdom. E-mail nikola.sprigg@nottingham.ac.uk

Abstract

Background and Purpose—Health-related quality of life, a key outcome after stroke, plays a role in the analysis of treatment cost-effectiveness. Some measures of health-related quality of life allow for a quality of life worse than death; the characteristics of such patients have not been well described.

Methods—Data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial were used to explore health-related quality of life after stroke. The EuroQol questionnaire (EQ-5D) was performed at day 90, and a health utility score (HUS) was calculated. HUS was defined as follows: poor-good HUS >0, death HUS=0, and very poor HUS <0. The characteristics and outcomes of patients with HUS <0 were then explored.

Results—Of the 2569 patients, 303 (11.8%) died, and of the 2238 with quality of life data available, of whom 724 (32.3%) were completed by a proxy, 1959 (87.5%) had an HUS >0 and 279 (12.5%) had an HUS <0. Patients with HUS <0 were more likely to be older, women, have severe stroke, have proxy responders, and be institutionalized. Dominant hemisphere strokes were more likely to have proxy responders but not HUS <0. HUS was strongly correlated with dependency (modified Rankin Scale, r=−0.78) and disability (Barthel index, r=0.84) and moderately correlated with mood (Zung depression score, r=−0.59) and baseline severity (r=0.51). All but 1 patient with modified Rankin Scale of 5 had an HUS <0.

Conclusions—Very low health-related quality of life is relatively common after stroke, particularly in patients with mobility problems or who are dependent on help for usual activities, and is related to poor functional outcome measures.

Clinical Trial Registration—URL: http://www.controlled-trials.com/. Unique identifier: ISRCTN99414122.