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Quality of life after stroke: a longitudinal analysis of a cluster randomized trial

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Abstract

Purpose

Health-related quality of life (QoL) is poor after stroke, but may be improved with comprehensive care plans. We aimed to determine the effects of an individualized management program on QoL in people with stroke or transient ischemic attack (TIA), describe changes in QoL over time, and identify variables associated with QoL.

Methods

This was a multicenter, cluster randomized controlled trial with blinded assessment of outcomes and intention‐to‐treat analysis. Patients with stroke or TIA aged ≥ 18 years were randomized by general practice to receive usual care or an intervention comprising a tailored chronic disease management plan and education. QoL was assessed at baseline and 3, 12, and 24 months after baseline using the Assessment of Quality of Life instrument. Patient responses were converted to utility scores ranging from − 0.04 (worse than death) to 1.00 (good health). Mixed-effects models were used for analyses.

Results

Among 563 participants recruited (mean age 68.4 years, 64.5% male), median utility scores ranged from 0.700 to 0.772 at different time points, with no difference observed between intervention and usual care groups. QoL improved significantly from baseline to 3 months (ß = 0.019; P = 0.015) and 12 months (ß = 0.033; P < 0.001), but not from baseline to 24 months (ß = 0.013; P = 0.140) in both groups combined. Older age, females, lower educational attainment, greater handicap, anxiety and depression were longitudinally associated with poor QoL.

Conclusion

An individualized management program did not improve QoL over 24 months. Those who are older, female, with lower educational attainment, greater anxiety, depression and handicap may require greater support.

Clinical trial registration

https://www.anzctr.org.au. Unique identifier: ACTRN12608000166370.

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Availability of data and material

Anonymized data and all code for data cleaning and analysis may be available by reasonable request from the corresponding author.

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Acknowledgements

The dedication and tireless efforts of the research nurses is much appreciated. The contribution of the participants, participating hospitals and the research team is acknowledged.

Funding

The STANDFIRM trial was supported by a National Health and Medical Research Council (NHMRC) project grant (586605). We further acknowledge fellowship support from the NHMRC (AGT 1042600; DAC 1063761).

Author information

Authors and Affiliations

  1. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia

    Zhomart Orman, Amanda G. Thrift, Muideen T. Olaiya, David Ung, Dominique A. Cadilhac, Thanh Phan, Jason Vuong & Joosup Kim

  2. Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia

    David Ung & Velandai K. Srikanth

  3. Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia

    Dominique A. Cadilhac & Joosup Kim

  4. Department of Neurology, Monash Medical Centre, Clayton, VIC, Australia

    Thanh Phan & Jason Vuong

  5. Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia

    Mark R. Nelson & Velandai K. Srikanth

  6. National Centre for Healthy Ageing, Melbourne, Australia

    Velandai K. Srikanth

  7. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Mark R. Nelson & Sharyn M. Fitzgerald

  8. Eastern Health Clinical School, Box Hill, VIC, Australia

    Christopher F. Bladin

  9. Victorian Stroke Telemedicine, Ambulance Victoria, Melbourne, VIC, Australia

    Christopher F. Bladin

  10. Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia

    Richard P. Gerraty

  11. Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia

    Judith Frayne

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  1. Zhomart Orman
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the STANDFIRM (Shared Team Approach between Nurses and Doctors For Improved Risk factor Management) Investigators

Corresponding author

Correspondence to Zhomart Orman.

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Conflict of interest

AGT reports being a Board Member of the Stroke Foundation (Australia) and funding from NHMRC. DAC reports grants from NHMRC, the Stroke Foundation and the Heart Foundation. MRN reports being a Member of Research Advisory Board of the Stroke Foundation (Australia), grants from NHMRC and the Heart Foundation, and being on a lipids advisory board for Novartis. All other authors report no potential conflicts of interest.

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Details of ethics approval and trial registration can be found on the following link https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=82711.

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Orman, Z., Thrift, A.G., Olaiya, M.T. et al. Quality of life after stroke: a longitudinal analysis of a cluster randomized trial. Qual Life Res 31, 2445–2455 (2022). https://doi.org/10.1007/s11136-021-03066-y

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