Quality of Life Trajectories among Stroke Survivors and the Related Changes in Caregiver Outcomes: A Growth Mixture Study

Publication date: Available online 18 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Gianluca Pucciarelli, Christopher S. Lee, Karen S. Lyons, Silvio Simeone, Rosaria Alvaro, Ercole Vellone

Abstract

Objectives

To identify the distinct quality of life (QoL) trajectories among stroke survivors, and to evaluate the associations with their caregivers' burden, anxiety, and depression.

Design

This was a longitudinal dyadic study.

Settings

Stroke survivors and their informal caregivers were enrolled upon discharge from several rehabilitation hospitals, and they were followed during this multisite longitudinal study.

Participants

The stroke survivors (n=405, mean age=70.7 years old) included older adult males (52.0%), most of whom (80.9%) had had ischemic strokes. The caregivers (n=244, mean age=52.7 years old) included mostly females (65.2%), most of whom were the survivors' children (50.0%) or spouses (36.1%).

Interventions

Not applicable

Main Outcome Measures

Latent growth mixture modeling was used to identify the distinct QoL trajectories among the stroke survivors over the course of 12 months of recovery. The longitudinal associations between the stroke survivor QoL trajectories and the caregivers' burden, anxiety, and depression were evaluated. A multinomial regression was then used to identify the predictors of the various survivor QoL trajectories.

Results

Three distinct survivor QoL trajectories were identified: "high and slightly improving QoL," "moderate and slightly worsening QoL," and "markedly improving QoL." The caregivers' burden, anxiety, and depression mirrored the survivors' QoL trajectories. In the multinomial models, an older survivor age, hemorrhagic stroke, lower education, and coexisting chronic obstructive pulmonary disease or thyroid disease were significantly associated with a "moderate and slightly worsening QoL" trajectory. Female gender and blindness were associated with a "markedly improving QoL" survivor trajectory.

Conclusions

A survivor's QoL trajectory after a stroke was associated with their caregiver's burden, anxiety, and depression. Those survivors belonging to the "moderate and slightly worsening QoL" trajectory and their caregivers, in particular, need special care, because they are at risk for the worst outcomes.

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