Relationship Between Disability and Health-Related Quality of Life and Caregiver Burden in Patients With Upper Limb Poststroke Spasticity

Objective

To evaluate the relationship between disability and both health-related quality of life (HRQoL) and caregiver burden in patients with upper limb poststroke spasticity.

Design

Multicenter open-label study.

Setting

Thirty-five sites in North America.

Participants

Patients (N = 279) with upper limb poststroke spasticity.

Methods

Post hoc analyses of data from an open-label study were performed to estimate HRQoL and caregiver burden at study baseline across levels of disability in 4 problem domains: hygiene, dressing, limb posture, and pain. Disability severity in these areas was determined by using the 4-point Disability Assessment Scale rated by the physicians.

Main Outcome Measurements

HRQoL measured by the patient-reported EuroQol 5 Dimensions questionnaire and the Stroke-Adapted Sickness Impact Profile and caregiver burden.

Results

At study baseline, increasing disability in the hygiene, dressing, and pain domains of the Disability Assessment Scale was associated with diminishing HRQoL scores (P < .002) measured by the EuroQol 5 Dimensions. By using the Stroke-Adapted Sickness Impact Profile, greater disability scores in all problem domains were significantly associated with higher overall dysfunction scores (P ≤ .05). Within the physical dimension of the Stroke-Adapted Sickness Impact Profile, significant associations also were observed in all domains. At baseline, caregiver burden was significantly related to increasing levels of hygiene and dressing domain severity (P ≤ .05). Caregiver assistance requirement increased from approximately 9.0-28.2 hours per week in the hygiene domain and 3.3-32.1 hours per week in the dressing domain as disability increased from “none” to “severe.”

Conclusions

In patients with upper limb poststroke spasticity, increasing disability in the hygiene, dressing, and pain domains of the Disability Assessment Scale were associated with diminishing HRQoL. Furthermore, these patients required caregiver assistance proportionally related to the severity of their disability in the hygiene and dressing domains.

• ⁎ Disclosure: 2B, Allergan
• † Disclosure: 2B, Allergan, Ipsen, Merz; 3A; 7B, research support from Allergan, Ipsen, Merz, and NINDS with funds paid to the academic institution (IU or Wake)
• ‡ Disclosure: 1, employed by Allergan
• § Disclosure: 1B, employed by Allergan, stock options
• ¶ Disclosure: 1B, employed by Allergan
• ∥ Disclosure: 1B, employed by Allergan, stock options
• # Disclosure: 2A, Allergan, Merz, Ipsen; 7A, grant support from Allergan