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Determinants of Change in Quality of Life from 1 to 6 Months following Acute Stroke – A Comment

Rønning and Stavem [1] examined a sample of patients with mild disability (Barthel Index: 83 8 22.2) and only 29% of their cases underwent inpatient rehabilitation after discharge from the stroke unit or general medical ward. We think that disability can influence the evolution of both physical and mental aspects of QoL in the acute and subacute periods of the stroke. If we evaluate the evolution of QoL in patients from a general neurological ward, some of whom may not need rehabilitation, we will find a study population with a lesser degree of disability than will be seen in a sample taken from an intensive rehabilitation ward. In order to verify our hypothesis, we compared stroke survivors admitted to our center for an inpatient rehabilitation program with Rønning and Stavem’s [1] sample ( table 1 ). The evaluation, performed for both cohorts, about 1 month after stroke, showed: (1) no significant differences in age between the samples; (2) a greater percentage of female patients in our investigation than in Rønning and Stavem’s; (3) significant differences in Barthel Index (worse in our sample), and (4) worse QoL in our patients (the comparison of some subscores is probably not significant for our small sample). Only vitality is greater in our study We read with great interest the study by Rønning and Stavem [1] evaluating change in quality of life (QoL) from 1 to 6 months following acute stroke. This prospective investigation involved patients who had been hospitalized within 24 h of stroke onset and were still alive 30 days after admission for acute stroke. From 1 to 6 months after stroke, all health dimensions of the Short Form 36 Questionnaire significantly improved. The authors maintain that their results are in contrast with some previously reported data about the time course of QoL in stroke patients. Although many studies on QoL in stroke patients are available (as Rønning and Stavem point out in their report) few of these examine the evolution of QoL in the months following stroke [2, 3] , and a comparison of these trials (as Rønning and Stavem [1] undertake to do) could be misleading, since the evaluated samples are not homogeneous. Suenkeler et al. [2] investigated QoL in patients with transient ischemic attacks, or ischemic or hemorrhagic stroke at 3, 6 and 12 months after stroke. Their data showed that at 3 months 79% of patients are mobile and able to dress themselves without help, and 87% are successful in using the toilet without help. In this cohort of patients the frequency and degree of independence did not change significantly between 3, 6 and 12 months after stroke. Unfortunately, no data about the Barthel Index at admission are reported, nor is there any information regarding rehabilitation treatment performed after discharge from neurological wards. Despite stable and mild disability, Suenkeler et al. [2] showed that global as well as domain-specific measures of QoL deteriorated over a 12-month period. Hopman and Verner [3] , in their prospective study, assessed changes in QoL in stroke survivors during inpatient rehabilitation and at 6 months after discharge. They showed that the improvement in QoL achieved during inpatient stroke rehabilitation was followed by an equally substantial decline in the 6 months after discharge. In this study the authors included only stroke survivors who required rehabilitation treatment, namely patients with severe disability. Unfortunately, this report also lacks data regarding the Barthel Index. Published online: September 26, 2008