scholarly journals Ethnicity and Other Determinants of Quality of Functional Outcome in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 588-593
Author(s):  
Xiaoying Chen ◽  
Xia Wang ◽  
Candice Delcourt ◽  
Jingwei Li ◽  
Hisatomi Arima ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Poor Hrqol ◽  
Stroke Patients ◽  
Quality Of Life Scale ◽  
Life Scale

Background and Purpose— Patient-centered outcomes are important. We aimed to determine predictors of health-related quality of life (HRQoL) and develop utility-weighted modified Rankin Scale (mRS) scores in thrombolyzed acute ischemic stroke patients from both arms of ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Methods— ENCHANTED was an international quasi-factorial clinical trial of different doses of intravenous alteplase and intensities of blood pressure control in acute ischemic stroke patients, with outcomes on the 5-Dimensional European Quality of Life Scale and mRS assessed at 90 days post-randomization. Logistic regression models were used to identify baseline predictors of poor HRQoL (≤mean 5-Dimensional European Quality of Life Scale utility scores). Ordinary least squares regression derived utility-weighted mRS scores. Results— In 4016 acute ischemic stroke patients with complete 5-Dimensional European Quality of Life Scale and mRS data, independent predictors of poor HRQoL were older age (odds ratio, 1.19 [95% CI, 1.12–1.27], per 10-year increase), non-Asian ethnicity (1.91 [1.61–2.27]), greater stroke severity on the National Institutes of Health Stroke Scale (1.11 [1.09–1.12]), diabetes mellitus (1.41 [1.18–1.69]), premorbid disability (mRS score 1 versus 0; 1.62 [1.33–1.97]), large vessel atheromatous pathogenesis (1.32 [1.12–1.54]), and proxy respondent (2.35 [2.01–2.74]). Sensitivity analyses indicate the ethnicity influence on HRQoL was driven by the high proportion of Chinese (62.9% of Asian) participants with better HRQoL compared with non-Chinese or other Asian groups. Derived utility values across mRS scores 0 to 5 were 0.977, 0.885, 0.748, 0.576, 0.194, and −0.174, respectively. Correlations between mRS and 5-Dimensional European Quality of Life Scale scores were stronger in Asians. Conclusions— HRQoL is worse after thrombolyzed acute ischemic stroke in the elderly, non-Asians, with greater initial severity, diabetes mellitus, premorbid disability, due to large vessel atheroma, and proxy assessment. The broader significance of better HRQoL in Asians is tempered by Chinese participants dominating analyses. From utility-weighted mRS scores indicating the greatest steps in mRS scores are between 5 and 3, treatments to avoid major disability provide the greatest benefits for patients. Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT01422616.

Abstract 2435: Validation of the 12-Item Stroke-Specific Quality of Life Scale in a Bi-ethnic Stroke Population

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Kevin A Kerber ◽  
Devin L Brown ◽  
Lesli E Skolarus ◽  
Lewis B Morgenstern ◽  
Melinda A Smith ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Stroke Patients ◽  
Stroke Population ◽  
Quality Of Life Scale ◽  
Life Scale ◽  
The Mean ◽  
Item Scores ◽  
Item Scale

Background and Purpose: The 12-item Stroke-Specific Quality of Life Scale (SSQOL), a shortened version of the original SSQOL, was recently developed in a mixed cerebrovascular disorders population from the Netherlands. Lacking, however, are validation studies of the shortened version specifically in ischemic stroke patients alone and in those from other race-ethnic backgrounds. We aimed to assess the validity of this scale in a bi-ethnic ischemic stroke population. Methods: From an on-going population-based study, the Brain Attack Surveillance in Corpus Christi (BASIC) Project, validated ischemic stroke patients who completed the 49-item SSQOL at 90 days post-stroke were identified. Cronbach’s alpha was used to assess internal consistency of the 49- and 12-item scales. An intraclass correlation coefficient (ICC) and linear regression model were used to assess agreement between the two scales and the variance of the 49-item SSQOL explained by the 12-item SSQOL subscale. The Bland-Altman “differences against the mean” plot was used to assess for bias in the 12-item scale across the range of scores. Results: Of the 46 ischemic stroke patients, the mean age was 66.3 years (SD, 11.4). Fifty-four percent were female and 52% were Mexican American. The mean score of the 49-tem scale was 3.35 (SD, 0.85) compared with 3.34 (SD, 0.96) from the 12-item scale. Internal consistency was very high for both the 49-item scale (α = 0.96) and the 12-item scale (α = 0.88). More than 96% of the variance in the 49-item scale was explained by the 12-item scale (ICC, 0.98; R 2 , 0.97). The Bland Altman plot revealed that the 12-item scale scores were slightly higher than 49-item scores at high mean scores and slightly lower at low mean scores ( Figure ). Conclusions: This study in ischemic stroke patients from diverse race-ethnic backgrounds found that the more efficient 12-item SSQOL is a valid alternative to the full scale for the assessment of health-related quality of life. Figure. Bland-Altman plot of the differences between the 49-item Stroke Specific Quality of Life (SSQOL) scale and the 12-item SSQOL. Each circle represents an individual patient. The x-axis is computed as the average of the 49-item and 12-item scores, and the y-axis is the difference between the 49-item and 12-item scores. The dashed horizontal line represents the mean difference and the shaded region represents the mean difference ± 2 standard deviations.

scholarly journals Brain Imaging Signs and Health-Related Quality of Life after Acute Ischemic Stroke: Analysis of ENCHANTED Alteplase Dose Arm

2020 ◽  
Vol 49 (4) ◽  
pp. 427-436 ◽  
Author(s):  
Xiaoying Chen ◽  
Candice Delcourt ◽  
Lingli Sun ◽  
Zien Zhou ◽  
Sohei Yoshimura ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Brain Imaging ◽  
Performance Model ◽  
Health Related Quality ◽  
Quality Of Life Scale ◽  
Related Quality ◽  
Health Related

Background and Purpose: The influence of specific brain lesions on health-related quality of life (HRQoL) after acute ischemic stroke (AIS) is uncertain. We aimed to identify imaging predictors of poor HRQoL in alteplase-treated participants of the alteplase dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Methods: ENCHANTED was an international trial of low- versus standard-dose intravenous alteplase in AIS patients, with functional outcome (modified Rankin scale [mRS]) and HRQoL on the 5-dimension European Quality of Life Scale (EQ-5D) assessed at 90 days post-randomization. Brain images were analyzed centrally by trained assessors. Multivariable logistic regression was undertaken in the study population randomly divided (2:1) into training (development) and validation (performance) groups, with age (per 10-year increase), ethnicity, baseline National Institutes of Health Stroke Scale (NIHSS) score, diabetes mellitus, premorbid function (mRS score 0 or 1), and proxy respondent, forced into all models. Data are presented with odds ratios (ORs) and 95% confidence intervals (CIs). Results: Eight prediction models were developed and validated in 2,526 AIS patients (median age 67.5 years; 38.4% female; 61.7% Asian) with complete brain imaging and 90-day EQ-5D utility score data. The best performance model included acute ischemic changes in the right (OR 1.69, 95% CI: 1.24–2.29) and deep (OR 1.50, 95% CI: 1.03–2.19) middle cerebral artery (MCA) regions. Several background features of brain frailty – atrophy, white matter change, and old infarcts – were significantly associated with adverse physical but not emotional HRQoL domains. Conclusions: In thrombolysed AIS patients, right-sided and deep ischemia within the MCA territory predict poor overall HRQoL, whilst features of old cerebral ischemia are associated with reduced physical HRQoL.

Abstract 210: Is Endovascular Treatment Beneficial in Acute Ischemic Stroke Patients With M2 Segment Middle Cerebral Artery Occlusion?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Muhammad A Saleem
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Functional Independence ◽  
Neurological Deterioration ◽  
Stroke Patients

Background: The benefit of endovascular treatment in acute ischemic stroke patients with occlusion of distal middle cerebral artery (M2 segment) is unclear. Methods: We analyzed data from subjects with occlusion of M2 segment of middle cerebral artery confirmed with computed tomographic (CT) angiogram who were randomized to either intravenous (IV) recombinant tissue plasminogen activator (rt-PA) alone or in combination with endovascular treatment. We compared the rates of neurological deterioration within 24 hours; symptomatic intracranial hemorrhage (ICH) within 30 hours; good quality of life (defined by EQ-5D index score of ≥0.6) and functional independence (defined by modified Rankin scale of 0-2) at 3 months among subjects who underwent endovascular treatment with subjects who received IV rt-PA alone. Results: Of these 51 subjects (mean age ±SD; 68.3±11.8 years) with M2 segment occlusion, 34 and 17 subjects received IV rt-PA followed by endovascular treatment and IV rt-PA alone, respectively. There was a non-significantly lower rate of neurological deterioration (14.7% versus 25.0%) and symptomatic intracranial hemorrhages (5.9% versus 17.6%) among subjects who received IV rt-PA followed by endovascular treatment. At 3 months, the rates of independent functional outcome (52.9% versus 41.2%, odds ratio [OR] 1.6; 95 % confidence interval [CI] 0.5-5.2; P = 0.46) and good quality of life (50.0% vs 35.3% OR 1.9; 95% CI 0.5-7.2; p=0.37) were non-significantly higher among subjects with M2 segment occlusion who received IV rt-PA followed by endovascular treatment. The rate of death within 3 months was significantly lower among those who received IV rt-PA followed by endovascular treatment (5.9% vs 35.3%; OR 0.2; 95% CI 0.1-0.9; p=0.048). Conclusions: A randomized clinical trial should be considered based on the significant reduction in mortality and non-significant increase in functional independence and good quality of life following endovascular treatment in among acute ischemic stroke patients with M2 segment occlusion.

Abstract WMP7: Cost Effectiveness of Stent-retriever Thrombectomy Compared With Intravenous Thrombolytic Therapy Alone in Acute Ischemic Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Muhammad F Ishfaq ◽  
Kamesh Sivagnanam ◽  
Adnan I Qureshi
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Acute Ischemic Stroke ◽  
Stent Retriever ◽  
Stroke Patients ◽  
The Cost ◽  
Iv Tpa

Introduction: Despite recent clinical trials demonstrating greater benefit with mechanical thrombectomy,thehigher cost associated with thrombectomy may limit its broad applicability. Objective: To determine the cost-effectiveness of stent-retriever thrombectomy plus IV-tPA versus IV-tPA alone in acute ischemic stroke patients. Method: The probability of individual primaryendpoints was obtained from the results of the SWIFT PRIME trial that compared98 acute ischemic stroke patients who received intravenous rt-PA alone with 98 patients who had mechanical thrombectomy with IV rt-PA (combination therapy). Total cost associated with each therapeutic intervention was derived from hospitalization cost and cost associated with primary and secondary endpoints of dependence, independence and death in each group. All probabilities, quality-of-life factors, and costs were estimated from the published literature. Costs were adjusted for inflation. A Monte Carlo simulation model was built to compare the health benefits and costs associated with combination therapy compared with IV-tPA alone. Overall costs and QALY’s were varied around probability values from the SWIFT PRIME trial to generate the simulation. Standard errors were used for generating variability.Incremental cost effectiveness ratio and cost effectiveness acceptability curves were also derived. Results: The cost effectiveness acceptability plane was completely situated in the south-east quadrant. This denotes that thrombectomy along with t-PA was both cheaper as well as improved Quality of life when compared to t-PA alone. Overall, QALYs for the thrombectomy and Iv-tPA and IV-tPA groups were 0.60(0.005) and 0.51(0.004), respectively (ranging from 0.0 [death] to 0.77 [independent]. Overall cost of combination therapy was $754,790 (12,303) and for IV-tPA alone was $933,190($7,495). The incremental cost effectiveness ratio was -$21,450 ($1,857)per QALY. The major costs in the tPA arm were a result of greater dependence at 90 days. Conclusion: In acute ischemic stroke patients and major arterial occlusion, stent-retriever thrombectomy in addition to intravenous t-PA,is both cost effective and improves quality of life.

scholarly journals Coping Strategies, Quality of Life, and Neurological Outcome in Patients Treated with Mechanical Thrombectomy after an Acute Ischemic Stroke

2020 ◽  
Vol 17 (17) ◽  
pp. 6014
Author(s):  
Silvia Reverté-Villarroya ◽  
Antoni Dávalos ◽  
Sílvia Font-Mayolas ◽  
Marta Berenguer-Poblet ◽  
Esther Sauras-Colón ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Coping Strategies ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Stroke Patients ◽  
Brief Cope ◽  
Best Medical Treatment ◽  
Prospective Longitudinal

New reperfusion therapies have improved the clinical recovery rates of acute ischemic stroke patients (AISP), but it is not known whether other factors, such as the ability to cope, might also have an effect. The aim of this study was to evaluate the effect of endovascular treatment (EVT) on coping strategies, quality of life, and neurological and functional outcomes in AISP at 3 months and 1 year post-stroke. A multicenter, prospective, longitudinal, and comparative study of a sub-study of the participants in the Endovascular Revascularization with Solitaire Device versus Best Medical Therapy in Anterior Circulation Stroke within 8 Hours (REVASCAT) clinical trial was conducted after recruiting from two stroke centers in Catalonia, Spain. The cohort consisted of 82 ischemic stroke patients (n = 42 undergoing EVT and n = 40 undergoing standard best medical treatment (BMT) as a control group), enrolled between 2013–2015. We assessed the coping strategies using the Brief Coping Questionnaire (Brief-COPE-28), the health-related quality of life (HRQoL) with the EQ-5D questionnaire, and the neurological and functional status using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), modified Rankin Scale (mRS), and Stroke Impact Scale-16 (SIS-16). Bivariate analyses and multivariate linear regression models were used. EVT patients were the ones that showed better neurological and functional outcomes, and more patients presented reporting no pain/discomfort at 3 months; paradoxically, problem-focused coping strategies were found to be significantly higher in patients treated with BMT at 1 year.

scholarly journals The correlation between location and size of infarction toward the quality of life in acute ischemic stroke patients at Sanglah General Hospital, Bali, Indonesia

2020 ◽  
Vol 11 (2) ◽  
pp. 717
Author(s):  
Mirani Ulfa Yusrika ◽  
Anak Agung Bagus Ngurah Nuartha ◽  
Ida Ayu Sri Wijayanti ◽  
Made Widhi Asih ◽  
Skolastika Savitri Sujatmiko
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
General Hospital ◽  
Stroke Patients

scholarly journals Quality of life in aphasia: differences between fluent and non-fluent aphasic Augmentative and Alternative Communication users

2014 ◽  
Vol 19 (4) ◽  
pp. 352-359 ◽  
Author(s):  
Mariana Mendes Bahia ◽  
Regina Yu Shon Chun
Keyword(s):  
Quality Of Life ◽  
Augmentative And Alternative Communication ◽  
Social Roles ◽  
Structure Interview ◽  
Alternative Communication ◽  
Stroke Patients ◽  
Quality Of Life Scale ◽  
Life Scale ◽  
Transversal Study

Purpose To investigate and to compare quality of life (QOL) in fluent and non-fluent aphasics. Methods This is a prospective, quantitative, and transversal study. We included 11 stroke patients with aphasia (five non-fluent aphasics augmentative and alternative communication users and six fluent aphasics). Data was gathered from the Stroke Specific Quality of Life Scale (SS-QOL), a structure interview, and The Modified Rankin Scale. Results The non-fluent aphasics presented poorer Rankin and quality of life than the fluent aphasics. The major difference occurred in the fields of language and upper extremity function. The three most affected domains in non-fluent aphasics were language, social roles, and thinking, whereas in the fluent aphasics were personality, social roles, and thinking. All the subjects referred a worse quality of life after stroke. The domains of language and self-care were identified as the most affected after stroke. Conclusion This study demonstrated that, in general, non-fluent aphasics have lower quality of life than fluent aphasics. However, this difference is not homogeneous among the several quality of life domains. Additionally, this research evidences a relationship between aphasia severity and individual functionality, implying impairment in quality of life, especially for non-fluent aphasics.

scholarly journals Assess the Quality of Life amongst Antenatal Mothers with Gestational Diabetes Mellitus in a Selected Districts, Tamil Nadu, India

2021 ◽  
pp. 116-121
Author(s):  
D. Joanie Priya ◽  
A. Agusta ◽  
M. Jasmine ◽  
M. Rakesh ◽  
Praveen Nirmala
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Tamil Nadu ◽  
Well Being ◽  
Demographic Variables ◽  
Quality Of Life Scale ◽  
Life Scale

Background: Gestational diabetes Mellitus is defined as the diabetes diagnosed within the second or third trimester of pregnancy. Gestational Diabete Mellitus is one of the most frequent metabolic diseases during pregnancy. It approximately affects 7% (range:2-18%) of all pregnancies. This clinical condition potentially affects not only negative medical outcomes but also the mental state status with additional adverse consequences on psychological well-being and Quality of Life. Objectives: Were to assess the quality of life amongest antenatal mothers with Gestational Diabetes Mellitus and to associate the quality of life amongest antenatal mothers with the selected demographic variable. Methods: The descriptive research design was used in this study. The convenient Sample (N=30) was used to assess the Quality of Life Scale among antenatal mothers with the Gestational Mothers. The data regarding demographic variables like Age, Income, Occupation, Education and Obstetric Variables like past obstetrical complications, Gravid, Week of Gestation. The result showed that 30 Antenatal Mothers with Gestational Diabetes was participated in this study and they were assessed by Modified Quality of Life Scale (WHOQOL – BREF) which includes physical, psychological and social relationships domains are rated on 5points Likert Scale to determine Score. Conclusion: The result shows that the level of Quality of Life Scale of Antenatal Mothers with Gestational Diabetes Mellitus (N=30) 12 of them have Moderate Quality of Life, 11 of them have Adequate Quality of Life and 07 of them have Inadequate Quality of Life. And there is Significant Association of demographic variables of age, except age other demographic and Obstetrical variables are Not Significant and (X2 – 56.16, P = >0.05).

scholarly journals Quality of Life in Recent Stroke Patients and Burden on Caregivers in Gujarat state of Western India

2021 ◽  
pp. 45-53
Author(s):  
Palani Kumar ◽  
Preksha Nagar ◽  
Lata Parmar
Keyword(s):  
Quality Of Life ◽  
Western India ◽  
Social Dimensions ◽  
Stroke Patients ◽  
Gujarat State ◽  
Quality Of Life Scale ◽  
Sex Type ◽  
Life Scale ◽  
Spss Software

Background: Stroke is a global health problem. Patients with stroke may be damaged in many aspects of life, which affects the physical, psychological and social dimensions of quality of life. These factors lead to burden on the caregivers. This burden on the caregivers negatively affects the rehabilitation of the stroke patients. Objective: To study the quality of life of stroke patients and burden on caregivers. Methods: Stroke patients fulfilling the inclusion criteria were assessed for the quality of life by the Stroke Specific Quality Of Life Scale and the burden on caregivers was measured using the Zarit Burden Interview on one to one interview basis. The data were analysed using the SPSS software. Results: The quality of life and burden scores were weakly correlated (r= -0.558 and p= 0.001). The quality of life and burden scores were also weakly correlated to the MMSE scores. Conclusion: There is a negative correlation of the burden on caregivers with the quality of life of the stroke patients. There is also a positive correlation of MMSE score with the quality of life. Whereas, there is no correlation of the quality of life and burden scores with the patient’s age and sex, type of stroke, duration post stroke and whether any treatment has been taken.

scholarly journals Quality of Life Assessment in Post-Stroke Patients

2018 ◽  
Vol 17 (2) ◽  
pp. 12-22 ◽  
Author(s):  
Anna Pacian ◽  
Teresa B. Kulik ◽  
Joanna Bednarz ◽  
Monika Kaczoruk ◽  
Ewa Kawiak-Jawor
Keyword(s):  
Quality Of Life ◽  
Nonparametric Tests ◽  
Life Assessment ◽  
Survey Method ◽  
Stroke Patients ◽  
Significance Level ◽  
Post Stroke ◽  
Quality Of Life Scale ◽  
Life Scale

Abstract Aim. Presentation of quality of life of post-stroke patients treated in the Neurology Ward of the District Specialist Hospital. Material and methods. The research covered 80 patients after stroke, treated in the Neurology Ward of the District Specialist Hospital. The study used the diagnostic survey method, the questionnaire technique and the standardized research tool: the Polish version of the Stroke-Specific Quality of Life Scale (SS-QOL), authored by Williams et al. The scale comprised 12 subscales and an overall result, all of which ranged between 1 and 5 points. Higher scores corresponded to higher quality of life. Differences between the variables were verified with nonparametric tests. The significance level was established at p<0.05. Results. Quality of life of post-stroke patients treated in the Neurology Ward of the District Specialist Hospital was at the level of 2.64, that is below the average established in the middle of the 1-5 scale. The overall quality of life was higher among women (3.02) than among men (2.39). Patients after ischemic stroke had significantly higher quality of life (at the level of 2.83) than patients after hemorrhagic stroke (at 2.23). Conclusions. The problem of patients after stroke is not only limitation of mobility due to paresis. Identification of bio-psycho-social disorders and help in overcoming them can radically change the patient’s situation. The assessment of quality of life is an indispensable task because it enables evaluation of the patient’s condition, not only in terms of effectiveness of therapy, but above all, in terms of a possibility for improvement of the patient’s quality of functioning, in the mental and social aspects.

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