Post-stroke well-being: Correlation between activity limitations and other predictors
AravindGanesh, Neurology Resident, Stroke Fellow, Dept Clinical Neurosciences, U of Calgary; Centre for Stroke and Dementia Prevention, U of Oxfordaravind.ganesh@ndcn.ox.ac.uk
Submitted August 01, 2017
I enjoyed reading the cross-sectional study of post-stroke subjective well-being by Zahuranec et al. and thank them for their insightful work. [1] Although the authors concluded that "activity limitations were not predictive of subjective well-being after adjustment for other factors," [1] these factors included "restricted participation in valued activities" and "chewing/swallowing difficulties." One would expect the former to strongly correlate with activity limitations, and the latter to correlate with eating/feeding limitations, a key component of activity-based scales, like the Barthel Index, [2] and of the study's listed activity limitations. While it makes sense that some activities would be more important for patient well-being than others, this may not discount the association of activity limitations with post-stroke well-being. It would be of value to know how the models change upon adding terms for interaction of activity limitations with restriction of valued activities, chewing/swallowing issues, and pain.
Although post-stroke functional outcome measures (eg, modified Rankin Scale, mRS) are activity-focused, a 1-month mRS predicted 5-year quality-of-life in a recent prospective population-based study. [3] Quality-of-life was measured using the EQ-5D, [4] which, in addition to activity-related domains, includes pain/discomfort and anxiety/depression. Importantly, Zahuranec et al. found that pain and depressive symptoms were strongly associated with reduced well-being. [1]
1. Zahuranec DB, Skolarus LE, Feng C, Freedman VA, Burke JF. Activity limitations and subjective well-being after stroke. Neurology Epub 2017 Jul 21.
2. Quinn TJ, Langhorne P, Stott DJ. Barthel index for stroke trials: development, properties, and application. Stroke 2011;42:1146-1151.
3. Ganesh A, Luengo-Fernandez R, Wharton RM, et al. Abstract 166: One-month Modified Rankin Scale (mRS) Score Predicts Five-year Disability, Death, Quality-of-Life, and Healthcare Costs in Ischaemic Stroke: A Prospective Cohort Study. Stroke 2017;48:A166.
4. Dorman PJ, Waddell F, Slattery J, Dennis M, Sandercock P. Is the EuroQol a valid measure of health-related quality of life after stroke? Stroke 1997;28:1876-1882.
For disclosures, please contact the editorial office at journal@neurology.org.
I enjoyed reading the cross-sectional study of post-stroke subjective well-being by Zahuranec et al. and thank them for their insightful work. [1] Although the authors concluded that "activity limitations were not predictive of subjective well-being after adjustment for other factors," [1] these factors included "restricted participation in valued activities" and "chewing/swallowing difficulties." One would expect the former to strongly correlate with activity limitations, and the latter to correlate with eating/feeding limitations, a key component of activity-based scales, like the Barthel Index, [2] and of the study's listed activity limitations. While it makes sense that some activities would be more important for patient well-being than others, this may not discount the association of activity limitations with post-stroke well-being. It would be of value to know how the models change upon adding terms for interaction of activity limitations with restriction of valued activities, chewing/swallowing issues, and pain.
Although post-stroke functional outcome measures (eg, modified Rankin Scale, mRS) are activity-focused, a 1-month mRS predicted 5-year quality-of-life in a recent prospective population-based study. [3] Quality-of-life was measured using the EQ-5D, [4] which, in addition to activity-related domains, includes pain/discomfort and anxiety/depression. Importantly, Zahuranec et al. found that pain and depressive symptoms were strongly associated with reduced well-being. [1]
1. Zahuranec DB, Skolarus LE, Feng C, Freedman VA, Burke JF. Activity limitations and subjective well-being after stroke. Neurology Epub 2017 Jul 21.
2. Quinn TJ, Langhorne P, Stott DJ. Barthel index for stroke trials: development, properties, and application. Stroke 2011;42:1146-1151.
3. Ganesh A, Luengo-Fernandez R, Wharton RM, et al. Abstract 166: One-month Modified Rankin Scale (mRS) Score Predicts Five-year Disability, Death, Quality-of-Life, and Healthcare Costs in Ischaemic Stroke: A Prospective Cohort Study. Stroke 2017;48:A166.
4. Dorman PJ, Waddell F, Slattery J, Dennis M, Sandercock P. Is the EuroQol a valid measure of health-related quality of life after stroke? Stroke 1997;28:1876-1882.
For disclosures, please contact the editorial office at journal@neurology.org.