Quality of Life Among Stroke Survivors Evaluated
1 Year After Stroke
Experience of a Stroke Unit
Javier Carod-Artal, MD, PhD; José Antonio Egido, MD;
José Luis González, MD; E. Varela de Seijas, MD, PhD
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Background and Purpose—We sought to study overall and domain-specific quality of life in stroke survivors 1 year after
stroke and to identify variables that could predict quality of life after stroke.
Methods—We followed up for 1 year a cohort of 118 patients consecutively admitted to our stroke unit at San Carlos
University Hospital in Madrid, Spain. The final series at 1-year follow-up consisted of 90 survivors (41 women and 49
men; mean age, 68 years; range, 32 to 90 years). A cross-sectional, descriptive design was developed. Patients
completed a questionnaire that included socioeconomic variables, Hamilton Rating Scale for Depression, Sickness
Impact Profile (SIP), Short Form 36, Frenchay Index, Barthel Index, Rankin Scale, and Scandinavian Stroke Scale.
Independent variables were sex, age, functional status, motor impairment, and depression. We developed an ANOVA
model for statistical analysis.
Results—We interviewed 79 patients with ischemic and 11 with hemorrhagic stroke. Thirty-eight percent of patients scored
in the depressed range. Variables related to depression were status as a housewife, female sex, inability to work because
of disability, and diminished social activity (P⬍0.0001). Mean total SIP (24.3), SIP psychosocial dimension (27.5), and
SIP physical dimension (21.2) were correlated with disability, female sex, motor impairment, and depression
(P⬍0.0001).
Conclusions—Functional status and depression were identified as predictors of quality of life. Patients independent in their
activities of daily living suffered from a deterioration of the psychosocial dimension of the SIP. (Stroke.
2000;31:2995-3000.)
Key Words: disability evaluation 䡲 quality of life 䡲 stroke assessment 䡲 stroke outcome
S
physical, functional, psychological, and social health.10 The
physical health dimension refers to disease-related symptoms.
Functional health comprises self-care, mobility, and the
capacity to perform various family and work roles. Psychological dimension includes cognitive and emotional functions
(eg, vascular dementia and poststroke depression) and subjective perceptions of health and life satisfaction. Social
dimension includes social and familial contacts.
The multidimensional approach of perceived health status
in stroke patients has received attention only in the last few
years.11–12 Consequences of stroke and health status affect
even mild strokes.13 However, evaluation of QOL data in
stroke is complicated by several factors. These include the
use of nonstandardized measures, comparison of samples
taken from patients with wide variability in their condition
since symptom onset, and variability of treatment regimens
from centers of contrasting orientation such as rehabilitation
centers and general wards versus stroke units.
There are few studies of QOL in stroke units.14 Most
published works focused on rehabilitation centers or gen-
troke is a major public health issue. The long-term
consequences of stroke have been recognized in recent
years. Traditionally, epidemiological stroke studies focused
on mortality and recurrence1,2 but not on quality of life (QOL)
issues. The prevalence of stroke survivors with incomplete
recovery has been estimated at 460/100 000.3 First-year
mortality has been estimated between 15% and 25%, recurrence between 5% and 14%, and partial or complete disability
between 24% and 54%.4
QOL related to stroke and life satisfaction after stroke are
important healthcare outcomes that have not received sufficient
attention in the literature. The Barthel Index (BI) and the Rankin
Scale have been the most frequent outcome measures used in
stroke research, focusing on stroke-related disability and recovery of motor function after stroke.5–9 However, stroke patients
have a broad range of impairments and a wide spectrum of
symptom severity and sequelae. Some aspects of QOL considered important by the patients have been studied infrequently.
A multidimensional approach is necessary to measure
QOL. QOL assessment includes at least 4 dimensions:
Received April 28, 2000; final revision received July 12, 2000; accepted August 7, 2000.
From the Stroke Unit, Department of Neurology, San Carlos University Hospital, Madrid, Spain.
Correspondence to Dr Javier Carod-Artal, Servicio de Neurologı́a, Hospital Universitario San Carlos, Calle Profesor Martı́n Lagos s/n, CP 28040,
Madrid, Spain. E-mail [email protected]
© 2000 American Heart Association, Inc.
Stroke is available at http://www.strokeaha.org
2995
2996
Stroke
December 2000
eral neurology wards. European QOL studies have been
centered for some time in Scandinavian12,15–17 but not in
Mediterranean countries. These studies reported diminished global, leisure, sexual, and work-related satisfaction.11–17 The purposes of this study were to examine
global and domain-specific QOL in individuals treated
with a standardized approach to treatment and outcome
measurement in a stroke unit located in Madrid, Spain.
TABLE 1.
Demographics of Study Population
Mean age (SD), y
68.19 (10.82)
Male
65.16 (11.40)
Female
71.80 (8.88)
Sex, %
Male
55.44
Female
45.56
Education, %
Subjects and Methods
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We followed up for 1 year (1996 to 1997) a cohort of 118 patients
consecutively admitted to our stroke unit at San Carlos University
Hospital in Madrid, Spain. The stroke unit takes care of all stroke
patients admitted to our Neurology Department. We studied all
patients admitted to the stroke unit between July 1 and December 31,
1996. Patients with advanced age or coma at stroke onset were
admitted to the stroke unit; patients with severe comorbidity were
not. Patients affected by a subarachnoid hemorrhage or transient
ischemic attack and those who died during the acute stage were
excluded from the study. Diagnosis of stroke was confirmed by
clinical and/or radiological findings.18 The Oxfordshire classification19 was used to define stroke subtype. A cross-sectional, descriptive analysis design was developed. All interviews were conducted 1
year after stroke and were administered by the main author (J.C-A.).
When cognition and language function were not adequate, QOL
questionnaires were administered as a proxy and recognized as such
during statistical analysis. Three patients were rated by proxy (main
caregiver) for the Sickness Impact Profile (SIP) because of aphasia.
We did not include proxy ratings in the Short Form 36 (SF-36)
subscales vitality and mental health.
Data were collected on age, sex, marital status, education, location
of brain lesion, diagnostic stroke subtype, and stroke laterality.
Independent variables included age, sex, comorbid conditions, functional status, motor impairment, and depression. Neurological impairment was measured with the Scandinavian Stroke Scale (SSS)20
and handicap with the Rankin Scale.21 Information about falls was
recorded from interviews with patients and main caregivers 1 year
after stroke. Activities of daily living (ADL) were measured with the
BI.22 We defined severe disability as BI score ⱕ60; moderate
disability, 65 to 90; mild disability, 95; and independent in ADL,
100. Instrumental ADL were measured with the Frenchay Activities
Index (FAI).23 The FAI measures lifestyle in terms of more complex
physical activities and social functioning. The FAI rates the frequency with which respondents perform 15 activities (eg, gardening,
washing dishes) that have been content-validated for application to
the stroke population.23 It can be measured as a total score (total FAI)
or divided into 3 subscales (domestic activities, work/pleasure, and
social activities).
QOL was measured by the SIP24 and the SF-36.25 The SIP is a
well-evaluated 136-item measure organized into 12 subscales and 2
main dimensions, psychosocial and physical. The physical dimension contains items measuring a broad range of ADL, mobility, and
complex physical activities. Because of its breadth, the SIP is chiefly
used for cross-sectional studies. Its reliability is enhanced by using
aggregated category scores for description and analysis10 rather than
analyzing specific item responses. Health status measures included
the SF-36, the 8 subscales of which assess general health, mental
health, emotional role, physical role, social function, vitality, bodily
pain, and physical function. Depression was evaluated with the
Hamilton Rating Scale for Depression.26
QOL scales were validated in Spanish by other authors.27–29
Informed consent was obtained from all participants in the study at
the time of data collection and interview. All but 2 interviews were
conducted in our stroke unit; the remaining 2 patients were interviewed in a nursing home. A multifactorial ANOVA was performed
to examine relations among qualitative variables and a quantitative
variable. A Bonferroni correction was applied for multiple significance tests. A 2-tailed probability value ⬍0.05 was considered
Read and write
28.89
Primary school
41.11
Secondary school
7.78
Bachelor’s degree
22.22
Living arrangement, %
Alone
7.78
Spouse, relatives
87.78
Nursing home
4.44
Employment, %
Retired
45.56
Housewife
34.44
Disability
12.22
Employed
7.78
statistically significant. A regression model was used to correlate
quantitative variables.
Results
One hundred eighteen patients met the inclusion criteria of
the study. Seventeen patients could not be located for final
follow-up at 12 months, 10 died, and 1 refused to participate.
Marital status, age, and sex were not significantly different
among participants and nonparticipants. Ninety survivors
were available at 1-year follow-up, consisting of 41 women
and 49 men with a mean age of 68 years, ranging from 32 to
90 years. They included 79 patients affected by ischemic
stroke and 11 with hemorrhagic stroke.
Table 1 describes the sociodemographic characteristics of
the patients 12 months after stroke. In this group 64.44% of
patients were older than 65 years. All individuals were white,
and slightly more than one half were male. Family support
seemed to be strong since, on average, 1.6 family members
were living with the stroke patient.
Table 2 describes stroke characteristics and the distribution
of other comorbid diseases. Fifty-one percent of patients had
ⱖ3 vascular risk factors. Hypertension was the most frequent
vascular risk factor; 52.2 patients had osteoarthritis. Mean
comorbid conditions in patients numbered 2.93; when we
included vascular risk factors, the mean comorbid index
increased to 5.6.
Seventeen patients (18.89%) had moved temporarily or
permanently to a relative’s house or nursing home, for a mean
time of 7.29 months; 13.3% of patients had to make modifications in the bathroom or lounge; and 31% of patients
needed walking assistance, cane, or wheelchair to move 12
months after stroke. Thirty-six patients (40%) had falls after
stroke at home, in the bathroom, or in the street. We measured
70 falls during the first year after stroke, with a mean fall
Carod-Artal et al
TABLE 2. Stroke Characteristics and Comorbid Diseases in
Study Population
Variable
No.
Quality of Life Among Stroke Survivors
TABLE 3. ADL Assessed by BI at Stroke Onset and BI 1 Year
After Stroke
%
BI at
Onset
BI 1 Year
After
Stroke
Total dependence (BI 0 –20)
15 (16.6)
1 (1.1)
Severe dependence (BI 25–60)
21 (23.3)
9 (10)
Moderate dependence (BI 65–90)
25 (27.7)
20 (22.2)
Mild dependence (BI 95)
10 (11.1)
13 (8.4)
Independence (BI 100)
19 (21.1)
47 (52.2)
Side of brain lesion
Right
45
50
Left
45
50
Stroke syndrome
TACI
12
13.33
PACI
25
27.78
LACI
33
36.67
POCI
Hemorrhage
9
10
11
12.22
73
81.11
Communication impairment
None
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Motor/sensitive aphasia
9
10
Transcortical aphasia
8
8.89
Hypertension
59
65.56
Hyperlipidemia
36
40
Cardiopathy
35
38.89
Diabetes
27
30
Smoking
26
28.89
Previous stroke/TIA
15
16.67
Osteoarthritis
47
52.22
Cataracts/retinopathy
26
28.89
Cardiac dysrhythmia (AF)
24
26.67
Ischemic heart disease
10
11.10
Valvular heart disease
8
8.89
11
12.22
COPD
8
8.89
Hepatic disease
4
4.44
Peripheral vascular disease
3
3.33
Vacular risk factors
Comorbid conditions
Heart failure
TACI indicates total anterior circulation infarct; PACI, partial anterior
circulation infarct; LACI, lacunar infarct; POCI, posterior circulation infarct; TIA,
transient ischemic attack; AF, atrial fibrillation; and COPD, chronic obstructive
pulmonary disease.
index of 0.78 per patient year. No significant correlations
were observed between falls and dimensions of SIP. After
stroke, 28.89% of patients modified their habits and ceased
tobacco or alcohol consumption.
Barthel Index
Mean BI score at onset was 65.8 and 1 year later was 88.5
(scoring moderate to mild disability; P⬍0.0001). At 1-year
follow-up, 52% of patients were independent in their ADL,
while only 32.2% of patients were independent at stroke
onset. Forty percent of patients presented total or severe
disability (defined by BI score ⱕ60) at discharge and only
11.1% at 1-year follow-up. Twenty percent of patients were
incontinent or had problems with vesical control, 32% were
dependent when bathing, and 7% were completely dependent
for personal hygiene 1 year after stroke. BI scores in women
were significantly lower than those in men (mean BI score, 80
2997
Values are number (percent).
versus 95.7; P⫽0.0001) at 1 year follow-up and also at onset
(mean BI score, 55.6 versus 74.3). BI scores were not
significantly modified by age. Patients with lacunar infarction
had a higher BI score 1 year after stroke than those with
cortical infarctions (P⫽0.0044). Table 3 shows the comparison between BI score at stroke onset and BI score 1 year after
stroke.
Scandinavian Stroke Scale
The SSS total score at 1 year was 50.9. Patients with lacunar
and atherothrombotic stroke subtypes had significantly lower
SSS scores. Women had lower total SSS scores than men
(mean SSS score, 47.9 versus 53.4; P⫽0.0014). The mean
Rankin Scale score was 1 point lower at 1 year of follow-up
than at hospital discharge. According to the modified Rankin
Scale, 55 patients (62.33%) had either no symptoms or
symptoms that did not interfere with their capacity to look
after themselves (scores of 0 to 2).
Frenchay Activities Index
We used the original scoring system for FAI, with scores
between 0 and 60. Mean FAI score 12 months after stroke
was 36 (SD, 11); 74.5% of patients scored ⬎30. We found no
statistically significant differences by sex or age in the global
FAI score. Men scored better in the subscales hobby/work
and social activities (P⬍0.001); there were no differences by
sex in the domestic work category. The 3 FAI subscales were
diminished 50% in patients with severe disability (BI score
⬍60); social activities were significantly decreased in patients with severe disability (P⬍0.0001). Patients independent in ADL scored 42.2, patients with BI ⱕ60 scored 20, and
patients with BI between 65 and 100 scored 38.3 in total FAI.
Domains on FAI according to level of disability and FAI
overall scores are shown in Tables 4 and 5.
Hamilton Rating Scale for Depression
Depression was estimated by use of the Hamilton Rating
Scale for Depression. The mean score 12 months after stroke
was 13.1. A third of patients showed depressive symptoms at
TABLE 4.
Domains on FAI According to Level of Disability
BI ⱕ60
BI ⬎60
P
6.36
12.80
⬍0.0007
Pleasure/work
7
12
⬍0.0001
Social activities
6.70
13.64
⬍0.0001
FAI Domains
Domestic activities
2998
Stroke
December 2000
TABLE 5. Instrumental ADL 12 Months After Stroke Measured
by FAI (nⴝ90 Subjects)
Overall
Score
Men
Women
Total FAI
36.0
38.4
33.7
Domestic activities
12.00
11.24
12.95
Pleasure/work
11.46
12.83
9.82
P⬍0.001
Social activities
12.80
14.34
10.95
P⬍0.001
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discharge; 67% of patients scored in the range of depression
at the end of the year of follow-up, with 37.7% in the range
of major depression. Twelve months after stroke, 13.3% of
patients were receiving antidepressive treatment, and 24.4%
were receiving sedatives. Prevalence of depression was significantly higher in women than in men (78% versus 57%;
P⫽0.014), as was the severity and mean time of illness.
Neither stroke laterality, stroke subtype diagnosis, marital
status, nor educational level was correlated with depression.
Two social variables, status as a housewife and inability to
work because of a poststroke handicap, were significantly
correlated with depression (P⫽0.0356). Thus, poststroke
depression was highly prevalent 1 year after stroke (37.7%)
and was chiefly associated with female sex, status as a
housewife, handicap that affected ability to work, and diminished social activity (P⬍0.0001).
Short Form 36
Mean scores in the 8 SF-36 subscales were decreased 40%
from theoretical values of reference (100). Figure 1 expresses
values corrected by sex. QOL perceived by SF-36 was
significantly much lower in women (P⫽0.0001); the main
differences were observed in the subscales physical functioning, mental health, emotional role, and vitality. Bodily pain
was the only subscale that significantly decreased with age.
Neither educational level nor marital status influenced scoring. Low QOL measured by SF-36 was significantly correlated with presence of depression and severe disability. SF-36
subscale values according to level of ADL are shown in Table
6. SF-36 social function was affected more in disabled than in
depressed patients (22.7 versus 40), while SF-36 vitality
Figure 1. Mean scores on SF-36 in men and women.
decreased slightly more in patients with poststroke depression
(35.2 versus 41). Women perceived a lower QOL according
to SF-36 score in all dimensions of this questionnaire
(P⫽0.0001). SF-36 social function was correlated with the
FAI social activities category (r2⫽0.62).
Sickness Impact Profile
The mean total SIP score 1 year after stroke was 24.3; mean
physical dimension score was 21.2 and psychosocial dimension 27.5. The categories of home management (42.6),
emotional activity (31.2), and recreation (32.1) were the most
altered (Figure 2). Variables related to deterioration of QOL
evaluated with SIP were female sex (P⫽0.0001), cerebral
anterior circulation infarction, cardioembolic or atherothrombotic stroke subtype, depression, disability, and sociodemographic variables such as work-related disability and status as
a housewife. Physical and psychosocial dimension and total
score of SIP showed significantly greater deterioration in
women and in subjects with severe disability and depression
(Table 6). Patients independent in ADL 12 months after
stroke also were affected on the psychosocial dimension of
SIP (score of 21.24) even though they were clinically recovered in terms of ADL. The most sensitive measure of
depression by SIP was the category of emotional role, with a
mean value of 31. Stroke patients who were not depressed (as
measured by the Hamilton scale) scored 14 in this category,
while depressed patients scored 50.1 (P⬍0.0001).
We have shown that SIP and SF-36 are 2 valid instruments to
study QOL. A strong correlation was observed between SF-36
physical functioning and SIP body movement (r2⫽0.79), SIP
transfers (r2⫽0.73), SIP home management (r2⫽0.63), SIP
physical dimension (r2⫽0.83), and total SIP (r2⫽0.67) and also
between SF-36 mental health and SIP emotional role (r2⫽0.63),
psychosocial dimension (r2⫽0.51), and total SIP (r2⫽0.49).
Discussion
The aim of our study was to provide information regarding
the variables that had the greatest impact on the QOL of
patients treated in a stroke unit 1 year after stroke. Additionally, we wished to determine the utility of the various
outcome measures developed in other cultural environments
as applied to our Spanish population.
The mortality rate of 8.47% during follow-up and the 15% of
patients lost to follow-up are within the expected range, and thus
we believe that they do not invalidate our results. Almost 50% of
patients recovered as measured by BI, which is similar to the
findings of Wade and Langton-Hewer.30 This good recovery
was confirmed in ADL, social activities, and return to work.
However, significant deleterious effects persisted in the QOL of
patients independent in ADL but not achieving the level of
function they enjoyed before the stroke. This latter effect is
shown in the results of the psychosocial dimension of SIP and all
subscales of the SF-36. These results agree with previous
descriptions in the literature.12,13,31 This apparent divergence
may be due to 2 factors. The first is the presence of a ceiling
effect in the BI. The BI is insensitive to subjective dysfunction
in patients with high performance in ADL. The second is the
presence of anomalous perceptions and dissatisfaction in patients with minor disability levels that were incompletely re-
Carod-Artal et al
TABLE 6.
Quality of Life Among Stroke Survivors
2999
Health Status of Individuals According to ADL and Depression Rating
BI
Subscales
ⱕ60
ⱕ95
Hamilton Rating Scale for Depression
100
P
0 –7
8 –15
⬎16
P
SF-36
Physical functioning
2.72
38.85
77.23
⬍0.0001
37.79
60.60
60.85
0.0001
Physical role
38.65
55.35
71.80
0.0462
49.26
67
78.33
0.0093
Bodily pain
52.27
53
59
0.27
46
55.64
68.20
0.0023
General health
38.34
44
57.78
37.12
54.76
63.78
⬍0.0001
Vitality
41
47.19
63.17
⬍0.0002
38.51
58.75
72
⬍0.0001
Social functioning
22.72
47.10
79.52
⬍0.0001
40
72.20
85
⬍0.0001
Emotional role
33.33
53.10
77.75
0.0035
35.29
76
92.41
0.0001
Mental health
36.80
47.10
71.08
⬍0.0001
41.33
65.16
76.60
⬍0.0001
Physical dimension
56.54
34.80
8.70
⬍0.0001
30.89
17.58
13.54
0.0003
Psychosocial dimension
46.34
34.45
21.24
⬍0.0001
40.13
23.04
17.16
⬍0.0001
Total SIP
47.43
33.70
13.64
⬍0.0001
34.84
20.67
15.46
⬍0.0001
⬍0.0023
SIP
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stored after the stroke. Thus, the consequences of mild to
moderate stroke can affect all dimensions of QOL despite the
patient achieving full independence in ADL.13
Isolated measures of the physical domains of health such as
the BI are not adequate to study the full impact of the long-term
disability that stroke produces. QOL measurement, when added
to measures of the person’s state of health, assesses the patient
more completely. The additional subjective component shows
the effect of survivor attitudes, health beliefs, and their interaction on activity levels. The focus of the SF-36 is on this
subjective perception of health. The SIP emphasizes behavior as
a valid and reliable generic instrument of QOL. Unfortunately,
the SIP takes a long time to administer, thus limiting its use in
the older patient population.
Another objective was to identify selected variables with
major effects on QOL. Depression and disability were the
strongest predictors of overall, psychosocial, and physical QOL
Figure 2. Mean scores on SIP by categories 1 year after stroke.
measured with SF-36 and SIP. Poststroke disability was a
stronger predictor of low QOL than poststroke depression 1 year
after stroke. Patients with severe/moderate disability had lower
QOL than depressed patients. Isolation and diminished social
activities were the result of physical disability more than
poststroke depression.
Poststroke depression is a treatable condition; early diagnosis
is of paramount importance to prevent progression to a chronic
depressive disorder. Depression slows down the process of
rehabilitation, exerting a negative influence on all aspects of the
process of recovery. All variables related to depression 1 year
after stroke were of sociodemographic origin but not related to
stroke subtype or stroke etiology. The depression prevalence rate
in the present study, measured by Hamilton Rating Scale for
Depression, SF-36 vitality and mental health subscales, and
psychosocial dimension of SIP, showed a high prevalence of
mood disturbances, slightly higher than other studies.32,33
Older age or lower educational level was not correlated with
low QOL. Increasing educational level showed only a weak
relationship with better QOL. Comorbid conditions, diabetes,
hypertension, or other vascular risk factors did not decrease
global QOL. Social support was an important predictor of
depression. Social activities measured by SF-36 were lower in
women.
Women had a lower BI score both on admission and at
1-year follow-up. Similarly, women had a lower SSS score at
1 year than men and a lower QOL assessed by SIP and SF-36.
Several hypotheses may explain these results. The mean age
of women at stroke onset was 71 years, which is 6 years later
than men. Mean Rankin Scale score at discharge was 2.3 in
men and 3 in women. Thus, advanced age at stroke onset and
more severe impairment at discharge could affect recovery,
functional status, and QOL 1 year after stroke in women.
Failure to recover the ability to work is a major source of
low QOL for the subsample of people aged ⬍65 years.11
Women in general and housewives in particular are affected
with low scores in all instruments of QOL and in the
Hamilton Rating Scale for Depression as well. In our study
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December 2000
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73.8% of women were housewives before stroke. Wyller et
al,34 however, found better subjective well-being in women
according to measurements in their cultural area. This may be
a sociocultural effect specific to Spain, since in Spain elderly
women are valued and routinely take responsibility for
household management until they reach an advanced age.
This social factor may also influence the low QOL in women
surviving a stroke.
The absence of patients with dementia or aphasia is a bias
in most of studies of QOL and stroke, including ours.
Methodology for measuring QOL in those patients is difficult
and may be better analyzed by caregivers or proxy. Another
limitation was the lack of a comparison group of healthy
adults. However, it is possible to compare findings with the
same QOL instruments in a normal population in whom
scales were validated.27,28 The mean SIP score found (24.3) is
coincident with results by Nydevik and Hulter-Åsberg16 9
months after stroke. These authors used a score of 10 as a
cutoff because 70% of patients had a SIP mean score ⬎10,
and the mean SIP score in the aged control group was 12.5.
De Haan et al,35 in a case-control study 6 months after stroke,
found the following scores: psychosocial SIP, 19.5 (controls,
3.4); physical SIP, 24.6 (controls, 5); and total SIP, 23.14
(controls, 5).
An important difficulty in the analysis of QOL results in
stroke patients is that few studies use the same measurement
tools and there is poor agreement about which QOL measures— generic or specific—are adequate to use in stroke
patients. Most of the stroke trials and reports have used
generic QOL stroke scales that have the advantage of allowing comparisons among patients with different diseases, but
they are less sensitive for exploring the effects of particular
impairments on QOL in stroke patients. Recently, SS-QOL,36
a new stroke-specific QOL measure, has been developed and
has been used to predict poststroke QOL in patients with mild
and moderate stroke. Thus, we believe that it is necessary to
study QOL and patient-centered outcomes in longitudinal
studies in patients after stroke with normal and standardized
instruments that are accepted as standard in all stroke units.
Only in this way will it be possible to accurately quantify the
impact and effects of stroke management on the patients.
Acknowledgment
The authors express gratitude to Dr Thomas A. Horan for helpful
suggestions and review of English usage in the manuscript.
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Quality of Life Among Stroke Survivors Evaluated 1 Year After Stroke: Experience of a
Stroke Unit
Javier Carod-Artal, José Antonio Egido, José Luis González and E. Varela de Seijas
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Stroke. 2000;31:2995-3000
doi: 10.1161/01.STR.31.12.2995
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