Clinical and health-related quality of life evaluation of acute strokeunit care versus conventional medical care for minor stroke patients

Abstract

The efficacy of stroke units has been extensively investigated in clinical trials. However, little information is available to the health care providers and policy makers on the benefits of stroke unit care in Hong Kong. The quality of life of our local stroke patients is largely unknown.

The objective of this study was to compare the 2-month outcomes after stroke admitted to either a stroke unit or a non-stroke unit. Outcomes included mortality, dependency, institutional care and quality of life. This was a prospective observational study conducted in a regional, tertiary hospital in Hong Kong. Baseline demographic and clinical data were collected from the subjects. The 36-Item Short-Form health survey (SF-36) questionnaire was administered to them. Follow up assessment at two months were made for mortality, dependency, institutionalisation, length of hospital stay and SF-36.

Eligible subjects were Cantonese-speaking Chinese aged 18 years or over. They should provide written informed consent, and verbally and cognitively competent in completing the SF-36 questionnaire

162 patients with acute stroke were included in the analysis. 106 patients were solely managed in the stroke unit. 41 patients were managed in other wards (as the control group). There were no statistically significant differences found between the two groups for death alone, death or dependency, and death or institutionalisation. Multivariate logistic regression analyses showed similar findings. Mean lengths of acute and total hospital stay were similar between the two groups. Quality of life was impaired during the acute phase of stroke as reflected by low Physical Functioning (PF) and Social Functioning (SF) dimensions of the SF-36. At two months, significant improvement was observed in five out of eight dimensions of the SF-36 as well as its two summary scores, Physical Component Summary (PCS) and Mental Component Summary (MCS). There were several limitations in our study, namely small number of patients, minor stroke severity and tertiary hospital setting.

In conclusion, no significant differences in the clinical outcomes were found between the stroke unit group and the control group. These findings were inconclusive in view of limitations in this study. Stroke affected quality of life. Future researches with larger sample size are warranted.