title: Trajectories of health-related quality of life after stroke: results from a one-year prospective cohort study.
abstract: To identify trajectories of physical and psychosocial health-related quality of life (HRQoL) from two months to one-year post stroke and to determine the factors that are associated with trajectory membership.
  
  
  
  Multicenter prospective cohort study in which 351 stroke patients were followed up at 2, 6, and 12 months post stroke. Latent class growth mixture modeling was used to determine trajectories of physical and psychosocial HRQoL. Multinomial regression analyses were performed to predict trajectory membership. Potential predictors were demographic, stroke-related, and psychological factors.
  
  
  
  Four trajectories were identified for both physical and psychosocial HRQoL: high, low, recovery, and decline. Comparing the low and recovery trajectories, the groups with low HRQoL were more likely to have higher scores for neuroticism. Comparison of the decline and high trajectories yielded the following predictors of physical HRQoL: discharged to a rehabilitation setting, less acceptance and more neuroticism, pessimism, helplessness, and passive coping. Predictors of psychosocial HRQoL were: discharged to a rehabilitation setting, less self-efficacy, and proactive coping, and more helplessness and passive coping.
  
  
  
  The present study identified four distinct trajectories of physical and psychosocial HRQoL. The findings indicate that psychological factors are the most important factors in identifying stroke patients at risk of unfavorable HRQoL trajectories. Using these factors will help to identify vulnerable patients and guide rehabilitation in the early stages post stroke. Implications for rehabilitation Clinicians should be aware that health-related quality of life follows distinct trajectories stable high, stable low, recovery, or decline, after onset of stroke. Determining relevant psychological factors, in particular helplessness and passive coping, in stroke patients early after stroke is important because these are predictors of unfavorable health-related quality of life trajectories.
authors.affiliation: a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: van Mierlo
authors.affiliation: b Department of Psychiatry and Neuropsychology. School for Mental Health and Neuroscience , Maastricht University , Maastricht , The Netherlands.|c Department of Neuropsychology and Psychopharmacology , Maastricht University , Maastricht , The Netherlands.
authors.forename: Caroline
authors.initials: C
authors.lastname: van Heugten
authors.affiliation: a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.|d Center for Rehabilitation and Department of Rehabilitation Medicine , University of Groningen, and University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Marcel W M
authors.identifier: 0000-0002-2205-9404
authors.initials: MWM
authors.lastname: Post
authors.affiliation: e Faculty of Earth and Life Sciences, Department of Health Sciences, and the EMGO Institute for Health and Care Research , VU University , Amsterdam , The Netherlands.|f Department of Epidemiology and Biostatistics , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Trynke
authors.initials: T
authors.lastname: Hoekstra
authors.affiliation: a Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Visser-Meily
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000067250:Psychiatric Rehabilitation / Q000379:methods*; D011788:Quality of Life; D020377:Self Efficacy; D020521:Stroke / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome
keywords: Health-related quality of life; longitudinal studies; rehabilitation; stroke