Peter Hannon, MD

Myzoon Ali, Rachael Fulton, Terry Quinn, and Marian. Brady. How Well Do Standard Stroke Outcome Measures Reflect Quality of Life?:A Retrospective Analysis of Clinical Trial Data. Stroke. 2013

After a stroke patient leaves your care in the acute setting, how do you measure their level of improvement? Primary outcomes are often measured via scales of disability and dependence, but how does this correlate to a patient’s quality of life (QoL)? Ali and colleagues have utilized the Virtual International Stroke Trials Archive (VISTA) to examine whether commonly employed outcome measures capture aspects of a patient’s perceived QoL. 

4,946 patients who were enrolled into acute stroke trials within 6 hours of onset were included in the dataset. Data was extracted on patient age and initial stroke severity (NIHSS), and outcomes at 3 months were measured via European Quality of Life Scale (EQ-5D), two forms of the Stroke Impact Scale (SIS v3.0 and SIS-16), modified Rankin Scale (mRS), NIHSS and Barthel Index (BI). Associations were assessed using partial correlations, adjusting for age and initial stroke severity. Data subsets included assessments by the patient versus a proxy, and mismatches between primary outcome and QoL (for example, good primary outcome with a bad QoL) were specifically investigated. Overall, authors found that patient-assessed QoL had a stronger association with mRS, however proxy-assessed QoL correlated better with BI scores. This disparity may reflect caretaker-bias and/or subtle differences in the emphasis of the various measurement tools, and authors point out that the BI is based on activities that can be observed and assessed easily, such as basic ADLs.

This study reaffirms the importance of outcomes measures that reflect how patients (or proxies) interpret their quality of life, especially as we continue to utilize these scores to grade the success or failure of treatments and interventions. At the end of the day, how do our patients assess the success of their treatment after stroke? For many, it would be safe to say that quality of life tops the list.