Measuring Health-Related Quality Of Life (HRQOL) During Inpatient Stroke Rehabilitation (S21.002)

Abstract

OBJECTIVE: We examine whether it is feasible to ask stroke survivors to estimate their own health-related quality of life (HRQOL), and change in HRQOL during acute inpatient rehabilitation. We compared self-assessment with clinician, third-party assessment. We also examined whether HRQOL changes were associated with changes in functional status. BACKGROUND: Functional status may not represent the impact of stroke on a patient's life. Studies have shown that stroke patients can appear functionally independent while still reporting major problems with return to work, engaging in leisure activities or with emotional adjustment. Determinants of HRQOL have been studied on stroke patients across the health-care continuum. DESIGN/METHODS: Independent HRQOL assessments with the Euro-Quol (EQ-5) were made by moderate stroke survivors and clinicians, and functional status scores were assigned by clinicians with the functional independence measure (FIM), at admission and discharge. RESULTS: 175 moderate stroke survivors were tested, with only 10.2% unable to complete the EQ-5 due to cognitive/ language impairments (e.g., delirium, aphasia). Patients and clinicians reported significant improvements on each EQ-5 domain during inpatient rehabilitation (p < .05). Moreover, patient and clinician ratings positively and significantly correlated in all EQ-5 domains: mobility (r = .31, p <.001), self-care (r = .21, p < .01), activities (r = .31, p <.001), pain/discomfort (r =.52, p < .001), and anxiety/depression (r = .57, p <.001). Significant cognitive and motor FIM improvements during rehabilitation did not correlate with any improvements on EQ-5 therapist ratings of patients' HRQOL. CONCLUSIONS: EQ-5 ratings converged between stroke survivors and clinicians, suggesting it is valid and reliable to measure moderate stroke survivor HRQOL in inpatient rehabilitation. EQ-5 and FIM improvement were poorly associated; HRQOL may independently complement functional outcome assessment in inpatient rehabilitation. Future studies could explore different areas of function to clarify the factor structure of improvement on these measures relative to HRQL. Study Supported by: NIH, Kessler Foundation