A quality-of-life instrument for young hemorrhagic stroke patients.
OBJECTIVE
Hemorrhagic stroke has a high initial mortality rate. While survivors often recover motor function, many experience significant changes in their quality of life (QOL). Available outcome measures assess neurological impairment, disability, or handicap, yet often inadequately characterize the full impact of a stroke on patients' lives. In this study, we develop and validate a QOL instrument specific for young patients with hemorrhagic strokes.


METHODS
Methodological guidelines for instrument development were initially established. Based on the content of 40 open-ended patient interviews, a 54-item instrument (HSQuale) was developed. The reliability (test-retest and internal consistency) and validity (content and construct) of HSQuale were assessed in another 71 patients (18 to 49 years of age, 63% women, 77% white), at 1 year after their hemorrhagic stroke. Comparisons were made between HSQuale and other commonly used outcome measures.


RESULTS
HSQuale demonstrated reproducibility (test-retest kappa, 0.40 to 0.96) and internal consistency (Cronbach alpha >/=0.80 for 5 of 7 domains). HSQuale scores had broad frequency distributions (</=33% of subjects scored in any single score decile), avoided ceiling effects found for other outcome measures (Barthel Index and Short Form-36), and discriminated among clinically distinct subject groups (eg, intracerebral versus subarachnoid hemorrhage patients).


CONCLUSIONS
HSQuale is a reliable and valid QOL instrument. Compared with other outcome measures, it assesses a broader range of deficits and is better able to discriminate among subgroups of hemorrhagic stroke survivors.
Hamedani
A G
AG
Yale University School of Medicine, New Haven, CT, USA.
Wells
C K
CK
Brass
L M
LM
Kernan
W N
WN
Viscoli
C M
CM
Maraire
J N
JN
Awad
I A
IA
Horwitz
R I
RI
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011795:Surveys and Questionnaires / Q000592:standards*