Domains and determinants of quality of life after stroke caused by brain infarction

Objective: To evaluate the domain-specific quality of life (QOL), including physical, social and role functioning, mental health, vitality, bodily pai n, and general health domains, and to assess QOL's clinical and sociodemogr aphic correlates in patients who were disabled by ischemic stroke. Design: One-year prospective study of an inception cohort of patients with first-ever brain infarction. Setting: Stroke unit of a neurologic department of a university hospital. Patients: Eighty-five consecutive patients (36 women, 49 men; mean age +/- SD, 65 +/- 12.5yr) with first-ever stroke of a mild to moderate nature caus ed by brain infarction. Main Outcome Measures: Patients were examined at 3 and 12 months poststroke . QOL was measured using the RAND 36-Item Health Survey. The variables stud ied were lateralization of cerebral lesion, neurologic and functional statu s, depression, age, gender, marital status, and living conditions. Depressi on was evaluated according to the criteria of Diagnostic and Statistical Ma nual of Mental Disorders, Revised Third Edition. Neurologic impairment was assessed by Scandinavian Stroke Scale, performance in activities of daily l iving by the Barthel index, and the intellectual deterioration by the Mini- Mental State Examination. Results: QOL was poorer for the patients with mild to moderate stroke impai rments at 3 months poststroke. The test domains most prone to being affecte d were physical functioning, physical role limitations, vitality, and gener al health. Only the domains of physical functioning and physical role limit ations improved during the follow-up at 1 year. Depression, although mostly minor, was the most important reason for impaired QOL. Depression, being m arried, and age emerged as significant independent contributors to the low score value of vitality. Depression and being married were related to the l ow score value of physical role limitations. Conclusions: Stroke affects QOL, impairing its physical and psychosocial do mains. The most important determinants of low QOL seem to be depression and being married. These findings provide new challenges for stroke rehabilita tion, calling for identification of patients and spouses in need of support ive services.