Health-related quality of life loss associated with first-time stroke.
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2019-01-28
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OBJECTIVES:This study aimed to quantify health-related quality of life (HRQoL) loss associated with first episode of stroke by comparing patient-reported HRQoL before and after stroke onset. The impact of stroke in local population was also evaluated by comparing the pre- and post-stroke HRQoL with that of the general population. METHODS:The HRQoL of stroke survivors was assessed with the EQ-5D-3L index score at recruitment, for recalled pre-stroke HRQoL, and at 3 and 12 month post-stroke. Change in HRQoL from pre-stroke to 3 and 12 month was self-reported by 285 and 238 patients, respectively. Mean EQ index score at each time point (baseline: 464 patients; 3 month post-stroke: 306 patients; 12 month post-stroke: 258 patients) was compared with published population norms for EQ-5D-3L. RESULTS:There was a significant decrease in HRQoL at 3 (0.25) and 12 month (0.09) post-stroke when compared to the retrospectively recalled patients' mean pre-stroke HRQoL level (0.87). The reduction at 3 month was associated with the reduction in all EQ-5D-3L health dimensions; reductions remaining at 12 month were limited to dimensions of mobility, self-care, usual activities, and anxiety/depression. Stroke patients had a lower mean EQ index than the general population by 0.07 points pre-stroke (0.87 vs. 0.94), 0.33 points at 3 month (0.61 vs. 0.94) and 0.18 points at 12 month (0.76 vs. 0.94) post-stroke. CONCLUSIONS:Stroke has a substantial impact on HRQoL in Singapore, especially in the first three months post-stroke. Compared to the general population, stroke survivors have lower HRQoL even before stroke onset. This pre-stroke deficit in HRQoL should be taken into account when quantifying health burden of stroke or setting goals for stroke rehabilitation.
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Yeoh, Yen Shing, Gerald Choon-Huat Koh, Chuen Seng Tan, Tian Ming Tu, Rajinder Singh, Hui Meng Chang, Deidre A De Silva, Yee Sien Ng, et al. (2019). Health-related quality of life loss associated with first-time stroke. PloS one, 14(1). p. e0211493. 10.1371/journal.pone.0211493 Retrieved from https://hdl.handle.net/10161/22788.
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Helen Marie Hoenig
- General Focus and Goals of Research: Dr. Hoenig's research career centered on geriatric rehabilitation, and included use of technology to ameliorate disability, improving access to care via telerehabilitation, and developing key conceptual models to guide rehabilitation practices. She led work diverse novel approaches to care across the Veterans Health System, including the development and implementation of the VA Spinal Cord Injury & Disorders Registry and the Asynchronous Telehealth My VA Images mobile app. Dr. Hoenig has been involved in global health research on telerehabilitation, community mobility and global rehabilitation needs. Currently, Dr. Hoenig is enrolled in the Hybrid mDiv Program at Duke Divinity School to explore the interface of science, art and theology.
- Specific Approaches or Techniques: Randomized controlled trials, large database analyses and survey research. Her clinical research included studies on rehabilitation intervention studies (e.g., provision of mobility aids) and novel ways to improve access to rehabilitation (e.g., group physical therapy, telerehabilitation). Epidemiological studies and survey research have examined factors exacerbating or ameliorating disability, including medical complications such as fractures, environmental factors, use of assistive technology, and daily activity participation. Her research has ranged from single and multisite studies, to nationwide epidemiological studies, and global health research.
- Special areas of expertise/national recognition: Rehabilitation health services research, geriatric rehabilitation, assistive technology outcomes, telerehabilitation.
KEY WORDS/PHRASES: Rehabilitation, Telehealth, Geriatrics, Disability. Art, Theology
David Bruce Matchar
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention.
Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analysis and cost-effectiveness analysis; (2) a balancing of methodological rigor the needs of medical professionals; and (3) dependence on interdisciplinary groups of experts.
This approach is best illustrated by the Stroke Prevention Patient Outcome Research Team (PORT), for which I served as principal investigator. Funded by the AHCPR, the PORT involved 35 investigators at 13 institutions. The Stroke PORT has been highly productive and has led to a stroke prevention project funded as a public/private partnership by the AHCPR and DuPont Pharma, the Managing Anticoagulation Services Trial (MAST). MAST is a practice improvement trial in 6 managed care organizations, focussing on optimizing anticoagulation for individuals with atrial fibrillation.
I serve as consultant in the general area of analytic strategies for clinical policy development, as well as for specific projects related to stroke (e.g., acute stroke treatment, management of atrial fibrillation, and use of carotid endarterectomy.) I have worked with AHCPR (now AHRQ), ACP, AHA, AAN, Robert Wood Johnson Foundation, NSA, WHO, and several pharmaceutical companies.
Key Words: clinical policy, disease management, stroke, decision analysis, clinical guidelines
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