Longitudinal comparison of health-related quality of life at 3 and 12 months post-stroke using patient-reported outcome measures

Abstract

Background

Health-related quality of life (HRQoL) is a key outcome in stroke survivors, but evidence on distinct physical and mental recovery trajectories is limited. EuroQoL 5-dimension 3-level (EQ-5D-3L) is widely used but prone to ceiling effects and cannot separate physical (PH) and mental health (MH). We administered Patient-Reported Outcomes Measurement Information System 10-item short form (PROMIS-10) at 3 and 12 months post-stroke, identified discharge-related predictors of PROMIS-10 PH and MH to distinguish their recovery trajectories, and compared their discriminatory capacity with that of EQ-5D-3L.

Methods

We analyzed PROMIS-10 and EQ-5D-3L scores in a retrospective cohort of 741 stroke survivors discharged from a tertiary center and followed at 3 and 12 months. Discriminatory capacity across modified Rankin Scale (mRS) groups was assessed using effect sizes. Linear regression identified demographic and clinical predictors of PROMIS-10 PH and MH at 3 and 12 months.

Results

At 3 months, EQ-5D-3L demonstrated greater discriminatory capacity across mRS groups. At 12 months, PH exhibited better discriminatory capacity than EQ-5D-3L for mild disability (mRS 0–1 vs. 2), consistent with ceiling effects reducing EQ-5D-3L sensitivity in the mild impairment group. Discharge ambulation consistently predicted both PH and MH at 3 and 12 months. Comorbidity burden, employment status, respondent type (proxy vs. patient), and discharge destination were associated with PROMIS-10, particularly in 12-month MH.

Conclusion

Predictors and trajectories differed between PH and MH groups, supporting separate assessment. PROMIS-10 exhibited better discriminatory capacity of milder disability at 12 months by distinguishing physical and mental dimensions, supporting tailored care basis.