title: Temporal trends in health-related quality of life after stroke: analysis from the South London Stroke Register 1995-2011.
abstract: BACKGROUND
  Survival after stroke has dramatically increased in the last two decades as the treatment of stroke has improved. However, time-trend analyses of health-related quality of life in stroke patients covering this time period are still not well investigated.
  
  
  OBJECTIVE
  The study aims to examine temporal trends in mental and physical health-related quality of life of stroke survivors between the period of 1995 and 2011.
  
  
  METHODS
  First in a lifetime strokes were registered in the South London Stroke Register between 1995 and 2011. Using the Short Form-12 Health Survey, trends in self-reported health-related quality of life at one-year after stroke were assessed over a 17-year period using linear regression, adjusting for socio-demographics, risk factors, and case-mix variables. Analyses stratifying by age, gender, race-ethnicity, and functional impairment were also performed.
  
  
  RESULTS
  The overall trends of mental and physical health-related quality of life scores at one-year after stroke remained relatively unchanged over the period 1995-2011. However, mental health-related quality of life scores significantly improved between the period of 1995-2007 [β = 0·94 (95% CI; 0·15 to 1·74), P = 0·02], after which scores deteriorated [β = -2·02 (-3·82 to -0·22), P = 0·03]. Physical health-related quality of life scores remained stable until 2007, after which scores declined [β = -1·63 (-3·25 to -0·01), P = 0·05].
  
  
  CONCLUSIONS
  Despite declining health-related quality of life trends within the general population, stroke survivors' overall health-related quality of life remained unchanged, possibly due to lower expectations of health among stroke survivors. However, in recent years there has been a significant unexplained decline in both physical and mental health-related quality of life, suggesting that despite stroke policy aims to improve health-related quality of life, more needs to be done to target this decline.
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Sheldenkar
authors.forename: Siobhan
authors.initials: S
authors.lastname: Crichton
authors.forename: Abdel
authors.initials: A
authors.lastname: Douiri
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Rudd
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
authors.forename: Ruoling
authors.initials: R
authors.lastname: Chen
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D016014:Linear Models; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D057566:Self Report; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology* / Q000523:psychology; D013997:Time Factors
keywords: health-related quality of life (HRQOL); stroke; trends