Changes in functional outcome and quality of life in patients and caregivers after aneurysmal subarachnoid hemorrhage

Object. Although the case-fatality rate after subarachnoid hemorrhage (SA-H ) does not change considerably after the first 4 weeks, functional outcome and the quality of life (QOL) may. To assess the extent of changes in funct ional outcome and QOL after SAH, the authors conducted a follow-up study at IS months in patients and caregivers who had participated in a previous st udy of QOL 4 months after SAH Methods. In a consecutive series of 98 patients admitted with SAH, 68 had s urvived until 4 months postbleed, at which time an initial outcome assessme nt had been performed in 64 of them. This series of 64 patients was contact ed again at a median of 18 months after SAH. In all patients, functional ou tcome was assessed by means of the modified Rankin Scale (mRS). In 48 patie nts and 35 caregivers QOL was-assessed using the SF-36, the Sickness Impact Profile (SIP), and a visual analog scale. The results were compared with t he scores that had been obtained at 4 months after SAH. Thirty-two patients (50%) had improved at least one point on the mRS, in 23 patients functional outcome had remained unchanged, six patients had deter iorated one point on the mRS, and three had died. No major changes in the Q OL of patients and caregivers could be found on the SIP, but on the SF-36 a n improved QOL was detected in patients with better Rankin grades. On both instruments, the QOL at 18 months was still reduced compared with the, refe rence population in all patients. Conclusions. Functional outcome improves significantly between 4 months and 18 months post-SAH; studies on functional outcome after SAH can be compare d only if outcome is assessed at the same time interval. The improved funct ional outcome seems to be accompanied by an improved QOL.