Patel M D, McKevitt C, Lawrence E, Rudd A G, Wolfe C D A
Division of Health and Social Care, King's College, London, UK.
Age Ageing. 2007 May;36(3):316-22. doi: 10.1093/ageing/afm014. Epub 2007 Mar 19.
To determine factors that independently predict health-related quality of life (HRQOL) 1 and 3 years after stroke.
Subjects numbering 397, from a population-based register of first-ever strokes were assessed for HRQOL using the Short Form 36 (SF36) 1 year after stroke. Physical (PHSS) and mental health (MHSS) summary scores were derived from the eight domains of HRQOL in the SF36. Multivariate stepwise regression analyses were conducted to determine independent predictors of these scores; beta coefficients with 95% CI were obtained.beta coefficient is the difference between average value of the variable (e.g. male) and average value under consideration (e.g. female). Demographic and stroke risk factors, neurological impairments and cognitive impairment (MMSE <24) were included in the models. Similar analyses were undertaken on 150 subjects 3 years post-stroke.
A year after stroke, independent predictors of the worst PHSS were of females (beta coefficient -3.3: 95% CI -5.7 to -0.8), manual workers (-3.2: -5.9 to -0.4), diabetes (-4.2: -7.7 to -0.8), right hemispheric lesions (-4.9: -8.7 to -1.2), urinary incontinence (-7.8: -11.6 to -4.1) and cognitive impairment (-2.7: -5.5 to -0.1); the worst MHSS were associated with being Asian (-11.8: -20.6 to -3.0), ischaemic heart disease (-2.7: -5.4 to -0.03), cognitive impairment (-3.04: -5.8 to -0.3). Subjects aged 65-75 years (5.4: 2.5 to -8.4) had better MHSS than those <65 years. Three years post-stroke, independent predictors of worse PHSS were hypertension (-8.7: -13.5 to -3.9), urinary incontinence (-8.1: -15 to -1.1) and cognitive impairment (-8.3: -13.2 to -3.5).
Determinants of HRQOL vary both over time after stroke and whether physical or psychosocial aspects of HRQOL are being considered. This study provides valuable information on factors predicting long-term HRQOL, which can be taken into consideration in audits of clinical practice or in future interventional studies aiming to improve HRQOL after stroke.
确定中风后1年和3年独立预测健康相关生活质量（HRQOL）的因素。
从基于人群的首次中风登记册中选取397名受试者，在中风后1年使用简短健康调查问卷（SF-36）对其HRQOL进行评估。身体（PHSS）和心理健康（MHSS）总结分数源自SF-36中HRQOL的八个领域。进行多变量逐步回归分析以确定这些分数的独立预测因素；获得了带有95%置信区间的β系数。β系数是变量（如男性）的平均值与所考虑的平均值（如女性）之间的差异。模型中纳入了人口统计学和中风风险因素、神经功能缺损和认知障碍（MMSE<24）。对中风后3年的150名受试者进行了类似分析。
中风后1年，PHSS最差的独立预测因素为女性（β系数-3.3：95%置信区间-5.7至-0.8）、体力劳动者（-3.2：-5.9至-0.4）、糖尿病（-4.2：-7.7至-0.8）、右半球病变（-4.9：-8.7至-1.2）、尿失禁（-7.8：-11.6至-4.1）和认知障碍（-2.7：-5.5至-0.1）；MHSS最差与亚洲人（-11.8：-20.6至-3.0）、缺血性心脏病（-2.7：-5.4至-0.03）、认知障碍（-3.04：-5.8至-0.3）有关。65-75岁的受试者（5.4：2.5至-8.4）的MHSS比<65岁的受试者更好。中风后3年，PHSS较差的独立预测因素为高血压（-8.7：-13.5至-3.9）、尿失禁（-8.1：-15至-1.1）和认知障碍（-8.3：-13.2至-3.5）。
HRQOL的决定因素在中风后的不同时间以及HRQOL的身体或心理社会方面有所不同。本研究提供了关于预测长期HRQOL的因素的有价值信息，可在临床实践审计或未来旨在改善中风后HRQOL的干预研究中加以考虑。
