a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.
b Department of Psychiatry and Neuropsychology. School for Mental Health and Neuroscience , Maastricht University , Maastricht , The Netherlands.
Disabil Rehabil. 2018 May;40(9):997-1006. doi: 10.1080/09638288.2017.1292320. Epub 2017 Mar 13.
To identify trajectories of physical and psychosocial health-related quality of life (HRQoL) from two months to one-year post stroke and to determine the factors that are associated with trajectory membership.
Multicenter prospective cohort study in which 351 stroke patients were followed up at 2, 6, and 12 months post stroke. Latent class growth mixture modeling was used to determine trajectories of physical and psychosocial HRQoL. Multinomial regression analyses were performed to predict trajectory membership. Potential predictors were demographic, stroke-related, and psychological factors.
Four trajectories were identified for both physical and psychosocial HRQoL: high, low, recovery, and decline. Comparing the low and recovery trajectories, the groups with low HRQoL were more likely to have higher scores for neuroticism. Comparison of the decline and high trajectories yielded the following predictors of physical HRQoL: discharged to a rehabilitation setting, less acceptance and more neuroticism, pessimism, helplessness, and passive coping. Predictors of psychosocial HRQoL were: discharged to a rehabilitation setting, less self-efficacy, and proactive coping, and more helplessness and passive coping.
The present study identified four distinct trajectories of physical and psychosocial HRQoL. The findings indicate that psychological factors are the most important factors in identifying stroke patients at risk of unfavorable HRQoL trajectories. Using these factors will help to identify vulnerable patients and guide rehabilitation in the early stages post stroke. Implications for rehabilitation Clinicians should be aware that health-related quality of life follows distinct trajectories stable high, stable low, recovery, or decline, after onset of stroke. Determining relevant psychological factors, in particular helplessness and passive coping, in stroke patients early after stroke is important because these are predictors of unfavorable health-related quality of life trajectories.
确定从脑卒中后两个月到一年的身体和心理社会健康相关生活质量（HRQoL）轨迹，并确定与轨迹成员相关的因素。
多中心前瞻性队列研究，其中 351 例脑卒中患者在脑卒中后 2、6 和 12 个月进行随访。使用潜在类别增长混合模型确定身体和心理社会 HRQoL 的轨迹。进行多项回归分析以预测轨迹成员。潜在的预测因素是人口统计学、与中风相关的和心理因素。
确定了身体和心理社会 HRQoL 的四个轨迹：高、低、恢复和下降。与低和恢复轨迹相比，HRQoL 较低的组神经质得分更高。将下降和高轨迹进行比较，身体 HRQoL 的预测因素为：康复机构出院、接受程度较低、神经质、悲观、无助和被动应对。心理社会 HRQoL 的预测因素为：康复机构出院、自我效能感较低、积极应对、无助和被动应对。
本研究确定了身体和心理社会 HRQoL 的四个不同轨迹。研究结果表明，心理因素是识别 HRQoL 轨迹不良风险的脑卒中患者的最重要因素。使用这些因素将有助于识别易受影响的患者，并指导脑卒中后早期的康复。
临床医生应该意识到，健康相关生活质量在脑卒中发作后会出现稳定的高、稳定的低、恢复或下降等不同轨迹。早期确定脑卒中患者的相关心理因素，特别是无助和被动应对，非常重要，因为这些因素是不利的健康相关生活质量轨迹的预测因素。
