Publication
Title
The combined impact of dependency on caregivers, disability, and coping strategy on quality of life after ischemic stroke
Author
Abstract
BackgroundTo estimate the additional impact of coping and of being dependent on caregivers, over and above the large effects of disability on utility after ischemic stroke.MethodsA total of 539 patients were recruited into an observational, retrospective study when returning for a check-up between 3 and 36months after an ischemic stroke. Patients' modified Rankin Scale (mRS), dependency on caregivers, the Brandtstadter and Renner Coping questionnaire (with summary scores: Tenacity of Goal Pursuit (TGP) and Flexible Goal Adjustment (FGA) coping styles), EQ-5D-3L and co-morbidities were evaluated.ResultsIn multivariable regression, greater disability (mRS) resulted in large utility losses, between 0.06 for mRS 1 to 0.65 for mRS 5 (p<0.0001). Dependency on caregivers caused an additional dis-utility of 0.104 (p=0.0006) which varied by mRS (0.044, 0.060, 0.083, 0.115, 0.150 and 0.173 for mRS 0-5). The effect of coping on utility varied by coping style, by the disability level of the patient and by his or her dependency on caregivers. FGA coping was associated with additional increases in utility (p<0.0001) over and above the effect of disability and dependency, whereas TGA had no significant impact. FGA coping was associated with larger utility changes among more disabled patients (0.018 to 0.105 additional utility, for mRS 0 to mRS 5 respectively). Dependent patients had more to gain from FGA coping than patients who function independently of caregivers: utility gains were between 0.049 and 0.072 for moderate to high levels of FGA coping. In contrast, the same positive evolution in FGA coping resulted in 0.039 and 0.057 utility gain among independent patients. Finally, we found that important stroke risk factors and co-morbidities, such as diabetes and atrial fibrillation, were not predictors of EQ-5D utility in a multivariable setting.ConclusionsThis study suggests that treatment strategies targeting flexible coping styles and decreasing dependency on caregivers may lead to significant gains in quality of life above and beyond treatment strategies that solely target disability.
Language
English
Source (journal)
Health and quality of life outcomes. - London
Publication
London : 2019
ISSN
1477-7525
DOI
10.1186/S12955-018-1069-6
Volume/pages
17 (2019) , 11 p.
Article Reference
31
ISI
000458183000003
Pubmed ID
30732619
Medium
E-only publicatie
Full text (Publisher's DOI)
Full text (open access)
UAntwerpen
Faculty/Department
Research group
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
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Creation 01.03.2019
Last edited 01.01.2025
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