Temporal trends in health-related quality of life after stroke: analysis from the South London Stroke Register 1995–2011
- Conflict of interest: None declared.
- Funding: The research was funded/supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, and a NIHR Program Grant (RP-PG-0407-10184). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.
Survival after stroke has dramatically increased in the last two decades as the treatment of stroke has improved. However, time-trend analyses of health-related quality of life in stroke patients covering this time period are still not well investigated.
The study aims to examine temporal trends in mental and physical health-related quality of life of stroke survivors between the period of 1995 and 2011.
First in a lifetime strokes were registered in the South London Stroke Register between 1995 and 2011. Using the Short Form-12 Health Survey, trends in self-reported health-related quality of life at one-year after stroke were assessed over a 17-year period using linear regression, adjusting for socio-demographics, risk factors, and case-mix variables. Analyses stratifying by age, gender, race-ethnicity, and functional impairment were also performed.
The overall trends of mental and physical health-related quality of life scores at one-year after stroke remained relatively unchanged over the period 1995–2011. However, mental health-related quality of life scores significantly improved between the period of 1995–2007 [β = 0·94 (95% CI; 0·15 to 1·74), P = 0·02], after which scores deteriorated [β = −2·02 (−3·82 to −0·22), P = 0·03]. Physical health-related quality of life scores remained stable until 2007, after which scores declined [β = −1·63 (−3·25 to −0·01), P = 0·05].
Despite declining health-related quality of life trends within the general population, stroke survivors' overall health-related quality of life remained unchanged, possibly due to lower expectations of health among stroke survivors. However, in recent years there has been a significant unexplained decline in both physical and mental health-related quality of life, suggesting that despite stroke policy aims to improve health-related quality of life, more needs to be done to target this decline.