Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549, Singapore.
Farrer Park Hospital, 1 Farrer Park Station Road, #10-08 Connexion, Singapore, Singapore.
Health Qual Life Outcomes. 2018 Nov 21;16(1):221. doi: 10.1186/s12955-018-1043-3.
Health-related quality of life (HRQoL) is a key metric to understand the impact of stroke from patients' perspective. Yet HRQoL is not readily measured in clinical practice. This study aims to investigate the extent to which clinical outcomes during admission predict HRQoL at 3 months and 1 year post-stroke.
Stroke patients admitted to five tertiary hospitals in Singapore were assessed with Shah-modified Barthel Index (Shah-mBI), National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Mini-Mental State Examination (MMSE), and Frontal Assessment Battery (FAB) before discharge, and the EQ-5D questionnaire at 3 months and 12 months post-stroke. Association of clinical measures with the EQ index at both time points was examined using multiple linear regression models. Forward stepwise selection was applied and consistently significant clinical measures were analyzed for their association with individual dimensions of EQ-5D in multiple logistic regressions.
All five clinical measures at baseline were significant predictors of the EQ index at 3 months and 12 months, except that MMSE was not significantly associated with the EQ index at 12 months. NIHSS (3-month standardized β = - 0.111; 12-month standardized β = - 0.109) and mRS (3-month standardized β = - 0.122; 12-month standardized β = - 0.080) were shown to have a larger effect size than other measures. The contribution of NIHSS and mRS as significant predictors of HRQoL was mostly explained by their association with the mobility, self-care, and usual activities dimensions of EQ-5D.
HRQoL at 3 months and 12 months post-stroke can be predicted by clinical outcomes in the acute phase. NIHSS and mRS are better predictors than BI, MMSE, and FAB.
健康相关生活质量（HRQoL）是从患者角度了解中风影响的关键指标。然而，HRQoL 在临床实践中不易测量。本研究旨在调查入院期间的临床结果在多大程度上预测中风后 3 个月和 1 年的 HRQoL。
新加坡五所三级医院收治的中风患者在出院前接受 Shah 改良巴氏指数（Shah-mBI）、美国国立卫生研究院中风量表（NIHSS）、改良 Rankin 量表（mRS）、简易精神状态检查（MMSE）和额叶评估量表（FAB）评估，中风后 3 个月和 12 个月进行 EQ-5D 问卷调查。使用多元线性回归模型检查基线时的临床测量与 EQ 指数之间的关联。采用逐步向前选择法，对与 EQ-5D 各维度有显著关联的临床指标进行多元逻辑回归分析。
除 MMSE 与 12 个月时的 EQ 指数无显著相关性外，基线时的所有 5 项临床指标均为 3 个月和 12 个月时 EQ 指数的显著预测因子。NIHSS（3 个月标准化β=-0.111；12 个月标准化β=-0.109）和 mRS（3 个月标准化β=-0.122；12 个月标准化β=-0.080）的效应量大于其他指标。NIHSS 和 mRS 作为 HRQoL 显著预测因子的贡献主要归因于它们与 EQ-5D 的移动性、自理和日常活动维度的关联。
中风后 3 个月和 12 个月的 HRQoL 可以通过急性期的临床结果来预测。NIHSS 和 mRS 是比 BI、MMSE 和 FAB 更好的预测因子。
