The negative impact of spasticity on the health-related quality of life of stroke survivors: a longitudinal cohort study

Abstract

Background: Spasticity often leads to symptomatic and functional problems that can cause disability for stroke survivors. We studied whether spasticity has a negative impact on health-related quality of life (HRQoL).

Methods: As part of the Greater Cincinnati/Northern Kentucky Stroke Study (NCT00642213), 460 ischemic stroke patients were interviewed during hospitalization and then followed over time. HRQoL was measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Short Form-12 (SF-12), EuroQol-5 dimension (EQ-5D), and Stroke-Specific Quality of Life (SSQOL) instruments, with lower scores indicating worse health. HRQoL differences between stroke survivors with and without spasticity were compared, adjusting for age, race, stroke severity, pre-stroke function, and comorbidities.

Results: Of the 460 ischemic stroke patients, 328 had spasticity data available 3 months after their stroke (mean age of 66 years, 49% were female, and 26% were black). Of these patients, 54 (16%) reported having spasticity. Three months following their stroke, patients who reported spasticity had lower mean scores on the PCS (29.6 ± 1.4 vs 37.3 ± 0.6; P < .001), EQ-5D (0.59 ± 0.03 vs 0.71 ± 0.01; P < .001), and SSQOL (3.57 ± 0.08 versus 3.78 ± 0.03; P = .03) compared with patients who did not report spasticity. Lower HRQoL scores were also observed at the 1-year (PCS, EQ-5D, and SSQOL) and 2-year (EQ-5D and SSQOL) interviews in those with spasticity compared with those without spasticity.

Conclusions: Statistically and clinically meaningful differences in HRQoL exist between stroke survivors with and without spasticity.

Fig. 1

Adjusted mean Short Form-12 (SF-12) scores, by patient-reported spasticity presence. Significantly lower mean Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were reported by survivors with spasticity than those without spasticity at 3 months (mean PCS difference, −7.7; 95 % confidence interval [CI] –10.7 to −4.6; P < .001 and mean MCS difference 0.8; 95 % CI, −2.2 to 3.8; P = .59) and at 1 year (mean PCS difference −6.9; 95 % CI −10.3 to −3.6; P < .001 and mean MCS difference 0.1; 95 % CI −3.3 to 3.5; P = .96) poststroke. The SF-12 was not administered at the 2-year interview. Scores were adjusted for age, race, stroke severity using the retrospective National Institute of Health Stroke Scale, prestroke function using the modified Rankin Scale, and comorbidities

Fig. 2

Adjusted mean EuroQol-5 dimension (EQ-5D) scores by patient-reported spasticity presence. Significantly lower EQ-5D scores were reported by survivors with spasticity than those without spasticity at 3 months (mean difference −0.12; 95 % confidence interval [CI] –0.18 to −0.06; P < .001), at 1 year (mean difference −0.12; 95 % CI −0.19 to −0.06; P < .001), and at 2 years (mean difference −0.08; 95 % CI −0.16 to −0.0004; P = .049) poststroke. Scores were adjusted for age, race, stroke severity using the retrospective National Institute of Health Stroke Scale, prestroke function using the modified Rankin Scale, and comorbidities

Fig. 3

Adjusted mean Stroke-Specific Quality of Life (SSQOL) scores by patient-reported spasticity presence. Significantly lower SSQOL scores were reported by survivors with spasticity than those without spasticity at 3 months (mean difference −0.20; 95 % CI −0.38 to −0.02; P = .03), at 1 year (mean difference −0.51; 95 % CI −0.70 to −0.32; P < .001), and at 2 years (mean difference −0.30; 95 % CI −0.52 to −0.09; P = .01) poststroke. Scores were adjusted for age, race, stroke severity using the retrospective National Institute of Health Stroke Scale, prestroke function using the modified Rankin Scale, and comorbidities