Introduction: Ischemic stroke (IS) may have impact on long-term health-related quality of life (HRQoL) even in the patients with good clinical outcome, and tools mostly used for the assessment of outcome may underestimate or not reflect all relevant sequels after IS. We aimed to analyze HRQoL in the patients with excellent outcome after IS. Methods: We analyzed consecutive IS patients enrolled in the prospective FRAILTY study (ClinicalTrials.gov: NCT04839887) with excellent 3-month clinical outcome (score 0–1 in modified Rankin Scale [mRS]). Stroke Impact Scale (SIS) version 3.0 and Hospital Anxiety and Depression Scale (HADS) were used for the HRQoL, anxiety, and depression assessments, and subgroup comparisons were performed according to NIHSS score (0, ≥1), age (50<, ≥50 years), and sex. Results: In total, 158 patients (55.7% men, mean age 60.3 ± 13.4 years) were analyzed, and 72.2% of them had score 0 in mRS. The overall lowest median scores were found in the SIS domain “emotion,” “strength,” and “participation.” Patients with NIHSS ≥1 had lower scores in all SIS domains except “emotions” and “mobility.” Patients ≥50 years had lower score in “mobility” (p = 0.004) and females in domain of “social participation” (p = 0.044). No differences were found among all subgroups in HADS anxiety and depression. Age, NIHSS score, and depression were found negative predictors for the physical domains of HRQoL. Discussion/Conclusions: Despite excellent 3-month clinical outcome after IS, patients had affected substantially their HRQoL, especially those with NIHSS ≥1. Patients ≥50 years had more affected “mobility” and females “social participation.”

1.
van Mierlo
ML
,
Schröder
C
,
van Heugten
CM
,
Post
MWM
,
de Kort
PLM
,
Visser-Meily
JMA
.
The influence of psychological factors on health-related quality of life after stroke: a systematic review
.
Int J Stroke
.
2014
;
9
(
3
):
341
8
. .
2.
Deb-Chatterji
M
,
Konnopka
A
,
Flottmann
F
,
Leischner
H
,
Fiehler
J
,
Gerloff
C
, et al
.
Patient-reported, health-related, quality of life after stroke thrombectomy in clinical practice
.
Neurology
.
2020
;
95
(
12
):
e1724
32
. .
3.
Rimmele
DL
,
Lebherz
L
,
Frese
M
,
Appelbohm
H
,
Bartz
HJ
,
Kriston
L
, et al
.
Health-related quality of life 90 days after stroke assessed by the international consortium for health outcome measurement standard set
.
Eur J Neurol
.
2020
;
27
(
12
):
2508
16
. .
4.
Rethnam
V
,
Bernhardt
J
,
Johns
H
,
Hayward
KS
,
Collier
JM
,
Ellery
F
, et al
.
Look closer: the multidimensional patterns of post-stroke burden behind the modified Rankin scale
.
Int J Stroke
.
2021
;
16
(
4
):
420
8
. .
5.
Quinn
TJ
,
Paolucci
S
,
Sunnerhagen
KS
,
Sivenius
J
,
Walker
MF
,
Toni
D
, et al
.
Evidence-based stroke rehabilitation: an expanded guidance document from the European Stroke Organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008
.
J Rehabil Med
.
2009
;
41
(
2
):
99
111
. .
6.
Reeves
M
,
Lisabeth
L
,
Williams
L
,
Katzan
I
,
Kapral
M
,
Deutsch
A
, et al
.
Patient-reported outcome measures (PROMs) for acute stroke: rationale, methods and future directions
.
Stroke
.
2018
;
49
(
6
):
1549
56
. .
7.
Carod-Artal
FJ
,
Trizotto
DS
,
Coral
LF
,
Moreira
,
CM
.
Determinants of quality of life in Brazilian stroke survivors
.
J Neurol Sci
.
2009
;
284
(
1–2
):
63
8
. .
8.
van der Ende
N
,
den Hartog
SJ
,
Broderick
JP
,
Khatri
P
,
Visser-Meily
JMA
,
van Leeuwen
N
, et al
.
Disentangling the association between neurologic deficits, patient-reported impairments, and quality of life after ischemic stroke
.
Neurology
.
2023
;
100
(
13
):
e1321
8
. .
9.
Vellone
E
,
Savini
S
,
Fida
R
,
Dickson
VV
,
Melkus
GD
,
Carod-Artal
FJ
, et al
.
Psychometric evaluation of the stroke impact scale 3.0
.
J Cardiovasc Nurs
.
2015
;
30
(
3
):
229
41
. .
10.
Ramírez-Moreno
JM
,
Munoz-Vega
P
,
Alberca
SB
,
Peral-Pacheco
D
.
Health-related quality of life and fatigue after transient ischemic attack and minor stroke
.
J Stroke Cerebrovasc Dis
.
2019
;
28
(
2
):
276
84
. .
11.
Pinter
D
,
Fandler-Höfler
S
,
Fruhwirth
V
,
Berger
L
,
Bachmaier
G
,
Horner
S
, et al
.
Relevance of cognition and emotion for patient-reported quality of life after stroke in working age: an observational cohort study
.
Front Neurol
.
2022
;
13
:
869550
. .
12.
Lam
K-H
,
Blom
E
,
Kwa
VIH
.
Predictors of quality of life 1 year after minor stroke or TIA: a prospective single-centre cohort study
.
BMJ Open
.
2019
;
9
(
11
):
e029697
. .
13.
Duncan
PW
,
Bode
RK
,
Min Lai
S
,
Perera
S
;
Glycine Antagonist in Neuroprotection Americans Investigators
.
Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale
.
Arch Phys Med Rehabil
.
2003
;
84
(
7
):
950
63
. .
14.
Gurkova
E
,
Sanak
D
,
Satekova
L
,
Šaňáková
Š
,
Zapletalová
J
.
Validation of questionnaire for evaluation of ischemic stroke sequels: the Czech version of Stroke Impact Scale 3.0
.
Cesk Slov Neurol N
.
2022
;
85/118
(
4
):
287
95
. .
15.
Samuelsson
H
,
Viken
J
,
Redfors
P
,
Holmegaard
L
,
Blomstrand
C
,
Jern
C
, et al
.
Cognitive function is an important determinant of employment amongst young ischaemic stroke survivors with good physical recovery
.
Eur J Neurol
.
2021
;
28
(
11
):
3692
701
. .
16.
Ali
M
,
Fulton
R
,
Quinn
T
,
Brady
M
;
VISTA Collaboration
.
How well do standard stroke outcome measures reflect quality of life? A retrospective analysis of clinical trial data
.
Stroke
.
2013
;
44
(
11
):
3161
5
. .
17.
Lin
KC
,
Fu
T
,
Wu
CY
,
Hsieh
YW
,
Chen
CL
,
Lee
PC
.
Psychometric comparisons of the stroke impact scale 3.0 and stroke-specific quality of life scale
.
Qual Life Res
.
2010
;
19
(
3
):
435
43
. .
18.
Schneider
S
,
Taba
N
,
Saapar
M
,
Vibo
R
,
Kõrv
J
.
Determinants of long-term health-related quality of life in young ischemic stroke patients
.
J Stroke Cerebrovasc Dis
.
2021
;
30
(
2
):
105499
. .
19.
Kim
JS
,
Choi-Kwon
S
,
Kwon
SU
,
Lee
HJ
,
Park
KA
,
Seo
YS
.
Factors affecting the quality of life after ischemic stroke: young versus old patients
.
J Clin Neurol
.
2005
;
1
:
59
68
. .
20.
Lisabeth
LD
,
Baek
J
,
Morgenstern
LB
,
Zahuranec
DB
,
Case
E
,
Skolarus
LE
.
Prognosis of midlife stroke
.
J Stroke Cerebrovasc Dis
.
2018
;
27
(
5
):
1153
9
. .
21.
Yoon
S
,
Kim
HY
,
Kim
SR
.
A prediction model of health-related quality of life in young adult patients with stroke
.
J Clin Nurs
.
2021
;
30
(
13–14
):
2023
35
. .
22.
Boudokhane
S
,
Migaou
H
,
Kalai
A
,
Jellad
A
,
Borgi
O
,
Bouden
A
, et al
.
Predictors of quality of life in stroke survivors: a 1-year follow-up study of a Tunisian sample
.
J Stroke Cerebrovasc Dis
.
2021
;
30
(
4
):
105600
. .
23.
Adamit
T
,
Maeir
A
,
Ben Assayag
E
,
Bornstein
NM
,
Korczyn
AD
,
Katz
N
.
Impact of first-ever mild stroke on participation at 3- and 6-month post-event: the TABASCO study
.
Disabil Rehabil
.
2015
;
37
(
8
):
667
73
. .
24.
Katzan
IL
,
Thompson
NR
,
Uchino
K
,
Lapin
B
.
The most affected health domains after ischemic stroke
.
Neurology
.
2018
;
90
(
16
):
e1364
71
. .
25.
Kapoor
A
,
Lanctôt
KL
,
Bayley
M
,
Kiss
A
,
Herrmann
N
,
Murray
BJ
, et al
.
‘‘Good outcome’’ isn’t good enough: cognitive impairment, depressive symptoms, and social restrictions in physically recovered stroke patients
.
Stroke
.
2017
;
48
(
6
):
1688
90
. .
26.
Edwards
DF
,
Hahn
M
,
Baum
C
,
Dromerick
AW
.
The impact of mild stroke on meaningful activity and life satisfaction
.
J Stroke Cerebrovas Dis
.
2006
;
15
(
4
):
151
7
. .
27.
Verbraak
ME
,
Hoeksma
AF
,
Lindeboom
R
,
Kwa
VIH
.
Subtle problems in activities of daily living after a transient ischemic attack or an apparently fully recovered non-disabling stroke
.
J Stroke Cerebrovas Dis
.
2012
;
21
(
2
):
124
30
. .
28.
Lopez-Espuela
F
,
Zamorano
JDP
,
Ramírez-Moreno
JM
,
Jiménez-Caballero
PE
,
Portilla-Cuenca
JC
,
Lavado-García
JM
, et al
.
Determinants of quality of life in stroke survivors after 6 months, from a comprehensive stroke unit: a longitudinal study
.
Biol Res Nurs
.
2015
;
17
(
5
):
461
8
. .
29.
Gall
SL
,
Tran
PL
,
Martin
K
,
Blizzard
L
,
Srikanth
V
.
Sex differences in long-term outcomes after stroke: functional outcomes, handicap, and quality of life
.
Stroke
.
2012
;
43
(
7
):
1982
7
. .
30.
Cherepanov
D
,
Palta
M
,
Fryback
DG
,
Robert
SA
.
Gender differences in health-related quality-of-life are partly explained by sociodemographic and socioeconomic variation between adult men and women in the US: evidence from four us nationally representative data sets
.
Qual Life Res
.
2010
;
19
(
8
):
1115
24
. .
31.
Phan
HT
,
Blizzard
CL
,
Reeves
MJ
,
Thrift
AG
,
Cadilhac
DA
,
Sturm
J
, et al
.
Sex differences in long-term quality of life among survivors after stroke in the instruct
.
Stroke
.
2019
;
50
(
9
):
2299
306
. .
32.
Shi
Y
,
Yang
D
,
Zeng
Y
,
Wu
W
.
Risk factors for post-stroke depression: a meta-analysis
.
Front Aging Neurosci
.
2017
;
9
:
218
. .
33.
Naess
H
,
Waje-Andreassen
U
,
Thomassen
L
,
Nyland
H
,
Myhr
KM
.
Health-related quality of life among young adults with ischemic stroke on long-term follow-up
.
Stroke
.
2006
;
37
(
5
):
1232
6
. .
34.
de Bruijn
MA
,
Synhaeve
NE
,
van Rijsbergen
MWA
,
de Leeuw
FE
,
Mark
RE
,
Jansen
BP
, et al
.
Quality of life after young ischemic stroke of mild severity is mainly influenced by psychological factors
.
J Stroke Cerebrovasc Dis
.
2015
;
24
:
2183
8
.
35.
Numminen
S
,
Korpijaakko-Huuhka
AM
,
Parkkila
AK
,
Kulkas
T
,
Numminen
H
,
Dastidar
P
, et al
.
Factors influencing quality of life 6 months after a first-ever ischemic stroke: Focus on thrombolyzed patients
.
Folia Phoniatr Logop
.
2016
;
68
(
2
):
86
91
. .
36.
Szőcs
I
,
Dobi
B
,
Lám
J
,
Orbán-Kis
K
,
Häkkinen
U
,
Belicza
É
, et al
.
Health related quality of life and satisfaction with care of stroke patients in Budapest: a substudy of the EuroHOPE project
.
PLoS One
.
2020
;
15
(
10
):
e0241059
. .
37.
Kono
Y
,
Terasawa
Y
,
Sakai
K
,
Iguchi
Y
,
Nishiyama
Y
,
Nito
C
, et al
.
Association between living conditions and the risk factors, etiology, and outcome of ischemic stroke in young adults
.
Intern Med
.
2023
;
62
(
19
):
2813
20
. .
38.
Liu
Q
,
Wang
X
,
Wang
Y
,
Wang
C
,
Zhao
X
,
Liu
L
, et al
.
Association between marriage and outcomes in patients with acute ischemic stroke
.
J Neurol
.
2018
;
265
(
4
):
942
8
. .
39.
Lisabeth
LD
,
Reeves
MJ
,
Baek
J
,
Skolarus
LE
,
Brown
DL
,
Zahuranec
DB
, et al
.
Factors influencing sex differences in poststroke functional outcome
.
Stroke
.
2015
;
46
(
3
):
860
3
. .
40.
Jacob
L
,
Haro
JM
,
Koyanagi
A
.
Relationship between living alone and common mental disorders in the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys
.
PLoS One
.
2019
;
14
(
5
):
e0215182
. .
41.
Scheurer
D
,
Choudhry
N
,
Swanton
KA
,
Matlin
O
,
Shrank
W
.
Association between different types of social support and medication adherence
.
Am J Manag Care
.
2012
;
18
(
12
):
e461
7
.
42.
Tse
T
,
Binte Yusoff
SZ
,
Churilov
L
,
Ma
H
,
Davis
S
,
Donnan
GA
, et al
.
Increased work and social engagement is associated with increased stroke specific quality of life in stroke survivors at 3 months and 12 months post-stroke: a longitudinal study of an Australian stroke cohort
.
Top Stroke Rehabil
.
2017
;
24
(
6
):
405
14
. .
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