Melbourne School of Population Health, University of Melbourne, Carlton, Australia.
J Neurol Neurosurg Psychiatry. 2011 Dec;82(12):1365-71. doi: 10.1136/jnnp.2010.234765. Epub 2011 May 7.
Little is known about health-related quality of life (HRQoL) in the long term after stroke.
The aim of this study was to assess the level of, and factors associated with, HRQoL at 7 years post-stroke.
All stroke cases from a prospective community-based stroke incidence study (excluding subarachnoid haemorrhage) were assessed 7 years after stroke. HRQoL was measured with the Assessment of Quality of Life instrument. Proportional odds ordinal logistic regression was used to determine factors associated with HRQoL at 7 years post-stroke.
Overall, 1321 stroke cases were recruited. Seven years after stroke, 413 (31.2%) were alive and 328 (79.4%) were assessed. Those assessed were less often current smokers pre-stroke than those not assessed (p<0.01). Seventy-six survivors (23%) had very poor HRQoL (range: -0.038 to 0.100). Factors present at 7 years that were associated with better 7-year HRQoL were independence in instrumental activities of daily living (IADL) (estimated OR=11.2, 95% CI 4.87 to 25.6, p<0.001), independence in basic activities of daily living (BADL) (OR=4.53, 95% CI 2.03 to 10.1, p<0.001), independence in IADL and BADL (OR=9.90, 95% CI 4.51 to 21.7, p<0.001), male gender (OR=1.89, 95% CI 1.21 to 2.96, p=0.005) and lesser handicap (trend: OR=3.47, 95% CI 2.51 to 4.79, p<0.001). Participants' HRQoL scores tended to be lower when HRQoL assessments were completed by proxy (OR=0.13, 95% CI 0.06 to 0.31, p<0.001).
At 7 years post-stroke, 68.8% had died and a substantial proportion of survivors had poor HRQoL. Factors such as handicap, BADL and IADL could be targeted to improve HRQoL in long-term survivors of stroke.
关于卒中后长期健康相关生活质量（HRQoL）的了解甚少。
本研究旨在评估卒中后 7 年时的 HRQoL 水平及其相关因素。
从一项前瞻性社区为基础的卒中发病率研究（不包括蛛网膜下腔出血）中评估所有卒中病例，在卒中后 7 年进行 HRQoL 评估。采用生活质量评估工具进行评估。采用比例优势有序逻辑回归来确定与卒中后 7 年 HRQoL 相关的因素。
共纳入 1321 例卒中病例。卒中后 7 年，413 例（31.2%）存活，328 例（79.4%）接受评估。与未接受评估者相比，评估时卒中前的当前吸烟者比例较低（p<0.01）。76 例幸存者（23%）的 HRQoL 非常差（范围：-0.038 至 0.100）。7 年内存在的与更好的 7 年 HRQoL 相关的因素包括：工具性日常生活活动（IADL）独立（估计 OR=11.2，95%CI 4.87 至 25.6，p<0.001）、基本日常生活活动（BADL）独立（OR=4.53，95%CI 2.03 至 10.1，p<0.001）、IADL 和 BADL 独立（OR=9.90，95%CI 4.51 至 21.7，p<0.001）、男性（OR=1.89，95%CI 1.21 至 2.96，p=0.005）和残疾程度较轻（趋势：OR=3.47，95%CI 2.51 至 4.79，p<0.001）。当由代理人完成 HRQoL 评估时，参与者的 HRQoL 评分往往较低（OR=0.13，95%CI 0.06 至 0.31，p<0.001）。
卒中后 7 年，68.8%的患者死亡，相当一部分幸存者的 HRQoL 较差。残疾程度、BADL 和 IADL 等因素可以作为改善卒中长期幸存者 HRQoL 的目标。
