The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: the Bergen Stroke Study.
BACKGROUND
Many patients with cerebral infarction suffer from symptoms such as pain, fatigue, and depression. The aim of this study was to evaluate these symptoms in relation to health-related quality of life (HRQoL) on long-term follow-up.


METHODS
All surviving stroke patients admitted to the Stroke Unit, Haukeland University Hospital, Norway between February 2006 and November 2008 were sent a questionnaire, including a visual analog pain scale, Fatigue Severity Scale, Depression Subscale of Hospital Anxiety and Depression Scale, Barthel Index, and three measures of HRQoL--15D, EuroQol, and EuroQol Visual Analogue Scale--at least 6 months after stroke onset. Cox regression survival analysis, including EQ-5D, was performed by November 2009.


RESULTS
The questionnaire was returned by 328 patients. All three symptoms were reported by 10.1% of the patients, and 26% reported two symptoms. There was a significant association between worse HRQoL scores and an increasing number of cooccurring symptoms for all three HRQoL scores. Fatigue, depression, pain, functional state, and sleeping disorder on follow-up accounted for 58%-83% of the variability in HRQoL, depending on which HRQoL scale was used. Cox regression analysis showed that mortality was associated with a low EuroQol score (P = 0.016).


CONCLUSIONS
Pain, fatigue, and depression were common symptoms among these stroke patients and, to a large extent, they determined the patients' HRQoL. Low HRQoL was associated with increased mortality.
Department of Neurology, Haukeland University Hospital, Bergen, Norway. haln@haukeland.no
Halvor
H
Naess
Lene
L
Lunde
Jan
J
Brogger
D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D016009:Chi-Square Distribution; D003863:Depression / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D005221:Fatigue / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D009664:Norway / Q000453:epidemiology; D010146:Pain / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D010147:Pain Measurement; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors