Patel M D, Tilling K, Lawrence E, Rudd A G, Wolfe C D A, McKevitt C
Department of Public Health Sciences, Guy's, King's & St. Thomas' School of Medicine, King's College London, UK.
Age Ageing. 2006 May;35(3):273-9. doi: 10.1093/ageing/afj074.
To estimate levels of disability, handicap and health-related quality of life (HRQOL) up to 3 years after stroke and examine the relationships between these domains.
A longitudinal, observational study
Population-based register of first-ever strokes
Subjects, registered between 1 January 1995 and 31 December 1997, were assessed at 1 year (n = 490) and 3 years (n = 342) post-stroke for disability [Barthel index (BI)], handicap [Frenchay activity index (FAI)] and HRQOL (SF-36). BI was categorised as severe, moderate, mild and independent (0-9, 10-14, 15-19 and 20); FAI was categorised as inactive, moderately active and very active (0-15, 16-30 and 31-45). SF-36 domains include: Physical Functioning (PF), Role Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role Emotional (RE) and Mental Health (MH). Physical (PHSS) and Mental Health (MHSS) Summary Scores were computed.
at 1 and 3 years, 26.1 and 26.3%, respectively, were disabled (BI < 15); 55 and 51%, respectively, were handicapped (FAI = 0-15); and survivors had low mean PHSS (37.1 and 37.9), but satisfactory mean MHSS (46.6 and 47.7). There was a graded positive relationship between all SF-36 domains and the categories of BI and FAI. Spearman rank correlations were significant between BI and all SF-36 domains at both time points: strong (r > 0.70) with PF, moderate (r = 0.31-0.70) with RP, SF and PHSS, but weak (r < 0.30) with other domains. Correlations between FAI and SF-36 domains were strong with PF, weak with BP, RE and MHSS, and moderate with other domains.
Disability and handicap remain highly prevalent up to 3 years after stroke. Patients' perception of physical health is persistently low, but mental health perception is satisfactory up to 3 years. Due to variable correlations between different HRQOL domains with disability and handicap, it is suggested that disability, handicap and HRQOL should all be assessed to acquire a broader measure of stroke outcome.
评估卒中后长达3年的残疾、残障及健康相关生活质量（HRQOL）水平，并研究这些领域之间的关系。
一项纵向观察性研究
基于人群的首次卒中登记
对1995年1月1日至1997年12月31日期间登记的受试者在卒中后1年（n = 490）和3年（n = 342）时进行残疾评估[Barthel指数（BI）]、残障评估[Frenchay活动指数（FAI）]及HRQOL评估（SF - 36）。BI分为重度、中度、轻度和独立（0 - 9、10 - 14、15 - 19和20）；FAI分为不活动、中度活动和非常活动（0 - 15、16 - 30和31 - 45）。SF - 36领域包括：身体功能（PF）、角色身体（RP）、身体疼痛（BP）、总体健康（GH）、活力（VT）、社会功能（SF）、角色情感（RE）和心理健康（MH）。计算了身体（PHSS）和心理健康（MHSS）总结得分。
在1年和3年时，分别有26.1%和26.3%的患者存在残疾（BI < 15）；分别有55%和51%的患者存在残障（FAI = 0 - 15）；幸存者的平均PHSS较低（37.1和37.9），但平均MHSS令人满意（46.6和47.7）。所有SF - 36领域与BI和FAI类别之间存在分级正相关。在两个时间点，BI与所有SF - 36领域之间的Spearman等级相关性均显著：与PF的相关性强（r > 0.70），与RP、SF和PHSS的相关性中等（r = 0.31 - 0.70），与其他领域的相关性弱（r < 0.30）。FAI与SF - 36领域之间的相关性与PF强，与BP、RE和MHSS弱，与其他领域中等。
卒中后长达3年，残疾和残障仍然非常普遍。患者对身体健康的感知持续较低，但心理健康感知在3年内令人满意。由于不同HRQOL领域与残疾和残障之间的相关性各不相同，建议对残疾、残障和HRQOL都进行评估，以更全面地衡量卒中结局。
