Health-related Quality of Life After Stroke

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dc.contributor.advisorSmith, Eric E
dc.contributor.authorJoundi, Raed A
dc.contributor.committeememberHill, Michael D
dc.contributor.committeememberPatten, Scott B
dc.dateFall Convocation
dc.date.accessioned2023-05-11T05:27:08Z
dc.date.embargolift2023-06-21
dc.date.issued2021-06-21
dc.description.abstractBackground: Health-related quality of life (HRQoL) is increasingly being used to measure outcomes in patients with stroke. Differences in HRQoL with age, impairments in specific domains, and effects of treatments on HRQoL are not very well understood.Objectives: To determine the overall HRQoL in patients post stroke, how HRQoL differs by age, sex, other baseline characteristics, and effects of acute stroke treatment on HRQoL.Methods: A systematic review and meta-analysis was done to pool HRQoL values over the past 25 years of overall stroke survivors and stratify by age, sex, and time since stroke. A population- based study of Canadian respondents with and without stroke was completed to assess the impact of stroke on HRQoL and specific domains, and differences with age. Lastly, data from the ESCAPE randomized trial was used to determine the impact of endovascular thrombectomy on HRQoL and specific domains at 90 days post-stroke with exploration of differences by age.Results: In the meta-analysis of 107 studies, stroke survivors had substantially lower HRQoL compared to population norms as measured by health utility scores, and utility was lower in older individuals, females, and closer to stroke onset. In the population-based study, HRQoL in respondents with prior stroke was significantly lower than controls, overall and in domains of mobility, cognition, pain, and emotion. Those aged 60-74 had the greatest reduction in HRQoL compared to controls. In the ESCAPE trial, endovascular thrombectomy substantially improved HRQoL in patients with acute ischemic stroke, particularly in domains of self-care, usual activities, and mobility, and partially driven by a mortality benefit in the elderly. Among survivors, those aged 60-79 had the greatest benefit to HRQoL.Conclusions: HRQoL is highly impaired in stroke survivors, with particular impact on mobility, self-care, usual activities, cognition, pain, and emotional health. Those at older age and women have lower HRQoL. Endovascular thrombectomy is an effective treatment for improving HRQoL post stroke, with a large effect size when accounting for mortality. HRQoL is an important metric to evaluate stroke outcomes and is complementary to conventional disability scales. These findings may be useful for future analyses of stroke interventions, and clinical or economic studies of HRQoL after stroke.
dc.identifier.citationJoundi, R. A. (2021). Health-related Quality of Life After Stroke (Master thesis). University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca .
dc.identifier.urihttp://hdl.handle.net/1880/116418
dc.identifier.urihttps://dx.doi.org/10.11575/PRISM/dspace/41262
dc.language.isoEnglish
dc.publisher.facultyScience
dc.subjectStroke
dc.subjectQuality of life
dc.subject.classificationHealth Sciences--Epidemiology
dc.titleHealth-related Quality of Life After Stroke
dc.typemaster thesis
thesis.degree.disciplineMedicine – Community Health Sciences
thesis.degree.grantorUniversity of Calgary
thesis.degree.nameMaster of Science (MSc)
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