Association between in hospital frailty and health related quality of life after stroke: the Nor COAST study
Background Stroke survivors are known to have poorer health related quality of life (HRQoL) than the general population, but less is known about characteristics associated with HRQoL decreasing through time following a stroke. This study aims to examine how in hospital frailty is related to HRQoL from 3 to 18 months post stroke. Method Six hundred twenty five participants hospitalised with stroke were included and followed up at 3 and/or 18 months post stroke. Stroke severity was assessed the day after admission with the National Institutes of Health Stroke Scale (NIHSS) A modified Fried phenotype was used to assess in hospital frailty; measures of exhaustion, physical activity, and weight loss were based on pre stroke status, while gait speed and grip strength were measured during hospital stay. HRQoL at 3 and 18 months follow up were assessed using the five level version of the EuroQol five dimensional descriptive system (EQ 5D 5L) and the EuroQol visual analogue scale (EQ 5D VAS) We conducted linear mixed effect regression analyses unadjusted and adjusted for sex, age, and stroke severity to investigate the association between in hospital frailty and post stroke HRQoL. Results Mean (SD) age was 71.7 years (11.6) mean NIHSS score was 2.8 (4.0) and 263 (42.1% were female. Frailty prevalence was 10.4% while 58.6% were pre frail. The robust group had EQ 5D 5L index and EQ 5D VAS scores at 3 and 18 months comparable to the general population. Also at 3 and 18 months, the pre frail and frail groups had significantly lower EQ 5D 5L indices than the robust group p 0.001) and the frail group showed a larger decrease from 3 to 18 months in the EQ 5D 5L index score compared to the robust group 0.056; 95% CI 0.104 to 0.009; p 0.021) There were no significant differences in change in EQ 5D VAS scores between the groups. Conclusion This study on participants mainly diagnosed with mild strokes suggests that robust stroke patients have fairly good and stable post stroke HRQoL, while post stroke HRQoL is impaired and continues to deteriorate among patients with in hospital frailty. This emphasises the importance of a greater focus on frailty in stroke units. Trial registration ClinicalTrials.gov NCT02650531
BMC Neurology