Comparing health-related quality of life in modified Rankin Scale grades: 15D results from 323 patients with brain arteriovenous malformation and population controls

Abstract

Background: We wanted to understand how patients with different modified Rankin Scale (mRS) grades differ regarding their health-related quality of life (HRQoL) and how this affects the interpretation and dichotomization of the grade.

Methods: In 2016, all adult patients in our brain arteriovenous malformation (AVM) database (n = 432) were asked to fill in mailed letters including a questionnaire about self-sufficiency and lifestyle and the 15D HRQoL questionnaire. The follow-up mRS was defined in 2016 using the electronic patient registry and the questionnaire data. The 15D profiles of each mRS grade were compared to those of the general population and to each other, using ANCOVA with age and sex standardization.

Results: Patients in mRS 0 (mean 15D score = 0.954 ± 0.060) had significantly better HRQoL than the general population (mean = 0.927 ± 0.028), p < 0.0001, whereas patients in mRS 1-4 had worse HRQoL than the general population, p < 0.0001. Patients in mRS 1 (mean = 0.844 ± 0.100) and mRS 2 (mean = 0.838 ± 0.107) had a similar HRQoL. In the recently published AVM research, the most commonly used cut points for mRS dichotomization were between mRS 1 and 2 and between mRS 2 and 3.

Conclusions: Using 15D, we were able to find significant differences in the HRQoL between mRS 0 and mRS 1 AVM patients, against the recent findings on stroke patients using EQ-5D in their analyses. Although the dichotomization cut point is commonly set between mRS 1 and 2, patients in these grades had a similar HRQoL and a decreased ability to continue their premorbid lifestyle, in contrast to patients in mRS 0.

Keywords: Arteriovenous malformation; Cerebrovascular malformations; Modified Rankin Scale; Quality of life.

Fig. 1

Search protocol for the literature review. The figure illustrates the exclusion and inclusion criteria for the review

Fig. 2

HRQoL comparison of AVM patients in mRS 0 to the general population. The figure illustrates the HRQoL profiles for AVM patients in mRS 0 (green line) at last follow-up (mean = 18.9 years, SD =  ± 13 years) compared to age- and sex-standardized general population (blue line)

Fig. 3

HRQoL comparison of AVM patients in mRS 1 to the general population. The figure illustrates the HRQoL profiles for AVM patients in mRS 1 (green line) at last follow-up (mean = 22.0 years, SD =  ± 15.6 years) compared to age- and sex-standardized general population (blue line)

Fig. 4

HRQoL comparison between mRS grades, age and sex standardized. The figure includes all the mRS grades and their HRQoL profiles. Profiles are drawn with age- and sex-standardized values. The estimated mean 15D values for this dimension were 0.968 (95% CI = 0.946–0.991) for mRS 0 patients; 0.885 (95% CI = 0.853–0.916) for mRS 1; 0.783 (95% CI = 0.738–0.827) for mRS 2; 0.662 (95% CI = 0.613–0.711) for mRS 3, and 0.311 (95% CI = 0.246–0.376) for mRS 4. In the dimension of usual activities, all the grades, except mRS 1 and 2, differed statistically significantly from one another: the estimated means for this dimension were 0.959 (95% CI = 0.932–0.986) for mRS 0 patients; 0.790 (95% CI = 0.753–0.828) for mRS 1; 0.730 (95% CI = 0.676–0.783) for mRS 2; 0.561 (95% CI = 0.503–0.620) for mRS 3 and 0.283 (95% CI = 0.206–0.360) for mRS 4

Fig. 5

HRQoL comparison between patients in mRS 0 and mRS 1, age and sex standardized. The figure illustrates the 15D profiles for mRS 0 and mRS 1 patients with 95% CIs. The only dimensions with an insignificant difference were eating and breathing. The index score for mRS 0 was 0.954 (95% CI 0.942–0.966) and for mRS1 0.844 (95% CI 0.826–0.859)