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Clinical Trial
. 2023 Mar 28;100(13):e1321-e1328.
doi: 10.1212/WNL.0000000000206747. Epub 2023 Jan 4.

Disentangling the Association Between Neurologic Deficits, Patient-Reported Impairments, and Quality of Life After Ischemic Stroke

Nadinda A M van der Ende  1 , Sanne J den Hartog  2 , Joseph P Broderick  2 , Pooja Khatri  2 , Johanna M A Visser-Meily  2 , Nikki van Leeuwen  2 , Hester F Lingsma  2 , Bob Roozenbeek  2 , Diederik W J Dippel  2 ; IMS III Investigators
Affiliations
Clinical Trial

Disentangling the Association Between Neurologic Deficits, Patient-Reported Impairments, and Quality of Life After Ischemic Stroke

Nadinda A M van der Ende et al. Neurology. .

Abstract

Background and objectives: The EuroQol Group 5-Dimension Self-Reported Questionnaire (EQ-5D) is a well-established instrument to assess quality of life and generates generic utility values for health states reported by patients, derived from assessments by the general public. We hypothesized that language problems and other nonmotor deficits are not captured as well as motor deficits by this system. We aimed to quantify the association between disabling neurologic deficits and the EQ-5D dimension scores and the utility score in patients with ischemic stroke.

Methods: We used data of the Interventional Management of Stroke III trial. Missing data were imputed by multiple imputation. The association between neurologic deficits (individual NIH Stroke Scale [NIHSS] item scores) and the EQ-5D-3L (5 three-level dimension scores and utility score) at 90 days was assessed with ordinal logistic regression and Tobit regression, respectively. The explained variance of each model was estimated with Nagelkerke pseudo-R2 or R2.

Results: In total, 525 surviving patients were included. Complete data on both the NIHSS and EQ-5D were available for 481/525 (91.6%) patients. At 90 days, 161/491 (32.8%) patients had aphasia and 226/491 (46.0%) patients had paresis of at least 1 limb. Limb paresis, facial palsy, sensory loss, and dysarthria explained most of the variance in all EQ-5D dimension scores and the utility score. In the utility score, 8.9% of the variance was explained by neglect, 10.0% by aphasia, 10.8% by hemianopia, and 17.5%-24.1% by limb paresis.

Discussion: The impact of neurologic deficits on the EQ-5D in patients with ischemic stroke is mostly due to limb paresis, while the EQ-5D is less sensitive to other nonmotor deficits such as hemianopia, aphasia, and neglect. This may lead to overestimation of quality of life and, consequently, underestimation of the (cost-)effectiveness of treatments and interventions.

Trial registration information: ClinicalTrials.gov. Unique identifier: NCT00359424.

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Conflict of interest statement

D. Dippel reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Medtronic, Thrombolytic Science, LLC, and Cerenovus for research, all paid to institution. P. Khatri reports grant funding from the NIH and Cerenovus and consulting fees from Lumosa, Bayer, Diamedica, and Basking Biosciences. The other authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Figures

Figure 1
Figure 1. Flowchart of IMS III Patients Selected for Analysis
EQ-5D = EuroQol Group 5-Dimension Self-Report Questionnaire; IMS = Interventional Management of Stroke; NIHSS = NIH Stroke Scale.
Figure 2
Figure 2. Explained Variance of the NIHSS Sum Score on the EQ-5D Dimension Scores and on the Utility Score
EQ-5D = EuroQol Group 5-Dimension Self-Report Questionnaire; NIHSS = NIH Stroke Scale.
Figure 3
Figure 3. Explained Variance of NIHSS Items on the EQ-5D Dimension Scores and on the Utility Score
EQ-5D = EuroQol Group 5-Dimension Self-Report Questionnaire; NIHSS = NIH Stroke Scale; 1a, level of consciousness (LOC); 1b, LOC questions; 1c, LOC commands; 2, best gaze; 3, visual; 4, facial palsy; 5, motor arm left (a) and right (b); 6, motor leg left (a) and right (b); 7, limb ataxia; 8, sensory; 9, best language; 10, dysarthria; and 11, extinction and inattention.
See this image and copyright information in PMC

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