title: Predictors of health-related quality of life in community-dwelling stroke survivors: a cohort study.
abstract: Impaired health-related quality of life (HRQoL) post stroke is common, though prevalence estimates vary considerably. Few longitudinal studies explore post-stroke patterns of HRQoL and factors contributing to their change over time. Accurately identifying HRQoL after stroke is essential to understanding the extent of stroke effects.
  
  
  
  This study aimed to assess change in levels of, and identify independent predictors of, HRQoL over the first 12-months post-stroke.
  
  
  
  Design. A prospective cohort study.
  
  
  
  Community-dwelling stroke survivors in metropolitan Newcastle, New South Wales (NSW), Australia. Consecutively recruited stroke patients (n = 134) participated in face-to-face interviews at baseline, 3, 6, 9 and 12 months.
  
  
  
  HRQoL (measured using the Assessment Quality-of-life).Independent measures. Physical and psycho-social functioning, including depression and anxiety (measured via Hospital Anxiety and Depression Scale), disability (Modified Rankin Scale), social support (Multi-dimensional Scale Perceived Social Support) and community participation (Adelaide Activities Profile).
  
  
  
  A linear mixed model was used to establish the predictors of, change in HRQoL over time.
  
  
  
  On multivariable analysis, HRQOL did not change significantly with time post-stroke. Higher HRQoL scores were independently associated with higher baseline HRQoL (P = 0.03), younger age (P = 0.006), lower disability (P = 0.003), greater community participation (P ≤ 0.001) and no history of depression (P = 0.03).
  
  
  
  These results contribute to an understanding of HRQoL in the first year post-stroke. Community participation and stroke-related disability are potentially modifiable risk factors affecting post-stroke HRQoL. Interventions aimed at addressing participation and disability post-stroke should be developed and tested.
authors.affiliation: Hunter Medical Research Institute, Newcastle, University of Newcastle, Newcastle and jennifer.white@hnehealth.nsw.gov.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: White
authors.affiliation: University of Newcastle, Newcastle and General Practice Training Valley to Coast, Mayfield, New South Wales, Australia.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
authors.affiliation: Hunter Medical Research Institute, Newcastle, University of Newcastle, Newcastle and.
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.affiliation: University of Newcastle, Newcastle and.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sturm
authors.affiliation: Hunter Medical Research Institute, Newcastle, University of Newcastle, Newcastle and.
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: University of Newcastle, Newcastle and.
authors.forename: Gregory
authors.initials: G
authors.lastname: Carter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009517:New South Wales; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012944:Social Support; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation; D017741:Survivors / Q000523:psychology*
keywords: Community care; health-related quality of life; quality of life; rehabilitation; stroke.