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Observational Study
. 2018 Mar;49(3):761-764.
doi: 10.1161/STROKEAHA.117.019771. Epub 2018 Feb 9.

Quality of Life Is Poorer for Patients With Stroke Who Require an Interpreter: An Observational Australian Registry Study

Monique F Kilkenny  1 , Natasha A Lannin  2 , Craig S Anderson  2 , Helen M Dewey  2 , Joosup Kim  2 , Karen Barclay-Moss  2 , Chris Levi  2 , Steven Faux  2 , Kelvin Hill  2 , Brenda Grabsch  2 , Sandy Middleton  2 , Amanda G Thrift  2 , Rohan Grimley  2 , Geoffrey Donnan  2 , Dominique A Cadilhac  2 ; AuSCR Consortium
Affiliations
Observational Study

Quality of Life Is Poorer for Patients With Stroke Who Require an Interpreter: An Observational Australian Registry Study

Monique F Kilkenny et al. Stroke. 2018 Mar.

Abstract

Background and purpose: In multicultural Australia, some patients with stroke cannot fully understand, or speak, English. Language barriers may reduce quality of care and consequent outcomes after stroke, yet little has been reported empirically.

Methods: An observational study of patients with stroke or transient ischemic attack (2010-2015) captured from 45 hospitals participating in the Australian Stroke Clinical Registry. The use of interpreters in hospitals, which is routinely documented, was used as a proxy for severe language barriers. Health-Related Quality of Life was assessed using the EuroQoL-5 dimension-3 level measured 90 to 180 days after stroke. Logistic regression was undertaken to assess the association between domains of EuroQoL-5 dimension and interpreter status.

Results: Among 34 562 registrants, 1461 (4.2%) required an interpreter. Compared with patients without interpreters, patients requiring an interpreter were more often women (53% versus 46%; P<0.001), aged ≥75 years (68% versus 51%; P<0.001), and had greater access to stroke unit care (85% versus 78%; P<0.001). After accounting for patient characteristics and stroke severity, patients requiring interpreters had comparable discharge outcomes (eg, mortality, discharged to rehabilitation) to patients not needing interpreters. However, these patients reported poorer Health-Related Quality of Life (visual analogue scale coefficient, -9; 95% CI, -12.38, -5.62), including more problems with self-care (odds ratio: 2.22; 95% CI, 1.82, 2.72), pain (odds ratio: 1.84; 95% CI, 1.52, 2.34), anxiety or depression (odds ratio: 1.60; 95% CI, 1.33, 1.93), and usual activities (odds ratio: 1.62; 95% CI, 1.32, 2.00).

Conclusions: Patients requiring interpreters reported poorer Health Related Quality of Life after stroke/transient ischemic attack despite greater access to stroke units. These findings should be interpreted with caution because we are unable to account for prestroke Health Related Quality of Life. Further research is needed.

Keywords: ischemic attack, transient; quality of health care; quality of life; stroke; visual analog scale.

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