PMID- 24352907 OWN - NLM STAT- MEDLINE DCOM- 20150721 LR - 20211021 IS - 1573-2649 (Electronic) IS - 0962-9343 (Linking) VI - 24 IP - 1 DP - 2015 Jan TI - Modeling health-related quality of life in people recovering from stroke. PG - 41-53 LID - 10.1007/s11136-013-0605-4 [doi] AB - BACKGROUND: The Wilson-Cleary (W-C) model of health-related quality of life (HRQL) has not been tested in stroke, and a better understanding of the components of HRQL during recovery would lead to a more integrated and person-centered approach to health management and outcome optimization for this vulnerable population. OBJECTIVE: To enhance our understanding for how QOL emerges from the sequelae of stroke during the recovery period, the aim was to empirically test a biopsychosocial conceptual model of HRQL for people recovering from stroke. METHODS: We present a multi-site longitudinal study of an inception cohort of 678 persons recruited at stroke onset and studied at key intervals over the first post-stroke year. As the most pronounced recovery after stroke occurs in the first 3 months, this time frame was chosen as the focus of this analysis. The measures for this study were chosen for their relevance to key constructs of stroke impact and for their optimal psychometric properties. Multiple measures for each of the W-C rubrics were available from instruments such as the Stroke Impact Scale, RAND-36, HUI, and EQ-5D, among others. A structural equation model (SEM) was fit using MPlus. To minimize potential bias arising from the missing data, multiple imputation was performed on the longitudinal data using SAS proc MI. RESULTS: Of the 678 subjects who entered the cohort, 618 were interviewed at 1 month post-stroke and 533 at 3 months (486 and 454 had data at 6 and 12 months, respectively). A 3-month model with paths from biological factors to symptoms and symptoms to function fits well (CFI:0.966, RMSEA:0.044), though one model with paths from function to health perception did not (CFI:0.934, RMSEA:0.058). Allowing additional paths across non-adjacent rubrics improved fit considerably (CFI:0.962, RMSEA:0.044). A final model included emotional well-being under the symptom rubric (CFI:0.955, RMSEA:0.047). Including social support as an environmental factor had little impact on the model. Total variance in health perception explained was 76.3 %. CONCLUSION: These results emphasize that to optimize overall HRQL during the crucial first 3 months of recovery, interventions need to continue to focus on comorbid health conditions and on reducing stroke impairments. A function-only focus too soon in the recovery process may not produce the desired impact to optimize HRQL. FAU - Mayo, Nancy E AU - Mayo NE AD - Division of Clinical Epidemiology, Royal Victoria Hospital Site, McGill University Health Center, Ross Pavilion R4.29, Montreal, QC, Canada, nancy.mayo@mcgill.ca. FAU - Scott, Susan C AU - Scott SC FAU - Bayley, Mark AU - Bayley M FAU - Cheung, Angela AU - Cheung A FAU - Garland, Jayne AU - Garland J FAU - Jutai, Jeffrey AU - Jutai J FAU - Wood-Dauphinee, Sharon AU - Wood-Dauphinee S LA - eng PT - Journal Article DEP - 20131219 PL - Netherlands TA - Qual Life Res JT - Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation JID - 9210257 SB - IM MH - Aged MH - Cross-Sectional Studies MH - Female MH - *Health Status MH - Humans MH - Longitudinal Studies MH - Male MH - Mental Health/*statistics & numerical data MH - Psychometrics MH - Quality of Life/*psychology MH - Risk Factors MH - Social Support MH - Stroke/*psychology MH - *Stroke Rehabilitation EDAT- 2013/12/20 06:00 MHDA- 2015/07/22 06:00 CRDT- 2013/12/20 06:00 PHST- 2013/12/11 00:00 [accepted] PHST- 2013/12/20 06:00 [entrez] PHST- 2013/12/20 06:00 [pubmed] PHST- 2015/07/22 06:00 [medline] AID - 10.1007/s11136-013-0605-4 [doi] PST - ppublish SO - Qual Life Res. 2015 Jan;24(1):41-53. doi: 10.1007/s11136-013-0605-4. Epub 2013 Dec 19.