Disentangling the Association Between Neurologic Deficits, Patient-Reported Impairments, and Quality of Life After Ischemic Stroke

Nadinda A M van der Ende; Sanne J den Hartog; Joseph P Broderick; Pooja Khatri; Johanna M A Visser-Meily; Nikki van Leeuwen; Hester F Lingsma; Bob Roozenbeek; Diederik W J Dippel; IMS III Investigators

doi:10.1212/WNL.0000000000206747

Disentangling the Association Between Neurologic Deficits, Patient-Reported Impairments, and Quality of Life After Ischemic Stroke

Neurology. 2023 Mar 28;100(13):e1321-e1328. doi: 10.1212/WNL.0000000000206747. Epub 2023 Jan 4.

Authors

Nadinda A M van der Ende¹, Sanne J den Hartog², Joseph P Broderick², Pooja Khatri², Johanna M A Visser-Meily², Nikki van Leeuwen², Hester F Lingsma², Bob Roozenbeek², Diederik W J Dippel²; IMS III Investigators

Affiliations

¹ From the Departments of Neurology (N.A.M.v.d.E., S.J.d.H., B.R., D.W.J.D.), Radiology and Nuclear Medicine (N.A.M.v.d.E., S.J.d.H., B.R.) and Public Health (S.J.d.H., N.v.L., H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Departments of Neurology and Rehabilitation Medicine (J.P.B., P.K.) and Emergency Medicine (J.P.B., P.K.), University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati Academic Health Center, OH; and Center of Excellence for Rehabilitation Medicine (J.M.A.V.-M.) and Department of Rehabilitation, Physical Therapy Science & Sports (J.M.A.V.-M.), University Medical Center Utrecht, the Netherlands. n.vanderende@erasmusmc.nl.
² From the Departments of Neurology (N.A.M.v.d.E., S.J.d.H., B.R., D.W.J.D.), Radiology and Nuclear Medicine (N.A.M.v.d.E., S.J.d.H., B.R.) and Public Health (S.J.d.H., N.v.L., H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Departments of Neurology and Rehabilitation Medicine (J.P.B., P.K.) and Emergency Medicine (J.P.B., P.K.), University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati Academic Health Center, OH; and Center of Excellence for Rehabilitation Medicine (J.M.A.V.-M.) and Department of Rehabilitation, Physical Therapy Science & Sports (J.M.A.V.-M.), University Medical Center Utrecht, the Netherlands.

Abstract

Background and objectives: The EuroQol Group 5-Dimension Self-Reported Questionnaire (EQ-5D) is a well-established instrument to assess quality of life and generates generic utility values for health states reported by patients, derived from assessments by the general public. We hypothesized that language problems and other nonmotor deficits are not captured as well as motor deficits by this system. We aimed to quantify the association between disabling neurologic deficits and the EQ-5D dimension scores and the utility score in patients with ischemic stroke.

Methods: We used data of the Interventional Management of Stroke III trial. Missing data were imputed by multiple imputation. The association between neurologic deficits (individual NIH Stroke Scale [NIHSS] item scores) and the EQ-5D-3L (5 three-level dimension scores and utility score) at 90 days was assessed with ordinal logistic regression and Tobit regression, respectively. The explained variance of each model was estimated with Nagelkerke pseudo-R² or R².

Results: In total, 525 surviving patients were included. Complete data on both the NIHSS and EQ-5D were available for 481/525 (91.6%) patients. At 90 days, 161/491 (32.8%) patients had aphasia and 226/491 (46.0%) patients had paresis of at least 1 limb. Limb paresis, facial palsy, sensory loss, and dysarthria explained most of the variance in all EQ-5D dimension scores and the utility score. In the utility score, 8.9% of the variance was explained by neglect, 10.0% by aphasia, 10.8% by hemianopia, and 17.5%-24.1% by limb paresis.

Discussion: The impact of neurologic deficits on the EQ-5D in patients with ischemic stroke is mostly due to limb paresis, while the EQ-5D is less sensitive to other nonmotor deficits such as hemianopia, aphasia, and neglect. This may lead to overestimation of quality of life and, consequently, underestimation of the (cost-)effectiveness of treatments and interventions.

Trial registration information: ClinicalTrials.gov. Unique identifier: NCT00359424.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Hemianopsia
Humans
Ischemic Stroke* / complications
Ischemic Stroke* / therapy
Patient Reported Outcome Measures
Quality of Life*
Surveys and Questionnaires

Associated data

ClinicalTrials.gov/NCT00359424

Abstract

Publication types

MeSH terms

Associated data

Grants and funding