In this study we examined quality of life of ischaemic stroke patients one year after thrombolytic therapy compared to patients who had not undergone thrombolytic therapy.
Unfortunately, the two groups are not fully comparable. The severity of the stroke experienced by the patient group that underwent thrombolytic therapy was significantly greater than in the group without treatment. A possible explanation is that more severe stoke patients reach the hospital earlier and are eligible for thrombolysis [25, 26]. The WTG was older and there were more women in this group, possibly because women may be less likely to reach hospital for thrombolysis treatment in time [27, 28]. However, we corrected for the differences between the two groups. Risk factors present before stroke were approximately the same in both groups.
The primary outcome was health-related quality of life one year post-stroke. HRQOL in both groups was as high as in the Dutch elderly population  and is nearly identical in both groups, although patients in the thrombolysis group have a significantly better HRQOL for the ‘Mental health’ and ‘Vitality’ scales. Other studies report lower HRQOL after one year [29–31]. However, these studies included all patients with ischemic strokes, so they possibly studied more severely impaired stroke patients. It is known that higher ADL independence correlates to a worse HRQOL [29–32]. One possible explanation for the high scores on the RAND-36 is that a stroke has such an impact on life that patients one year post-stroke see quality of life in greater perspective. During their interviews, patients made comments such as: ‘it could have been worse’.
We examined whether there was a difference between the two groups in stopping or diminishing different activities. There was only a significant difference with respect to hobbies. This is possibly due to the fact that patients in the TG are younger and had more hobbies that they could practise before their strokes. Patients who stopped or reduced various activities have a significantly worse HRQOL. To increase HRQOL further, brief psychosocial intervention and antidepressant treatment could reduce post-stroke depression and improve functional outcomes [6, 33]. Starting community-based rehabilitation programmes could also help by increasing the patients’ activity levels and give them greater satisfaction [34, 35].
One year after stroke, more patients in the TG are ADL dependent. It is remarkable that one year after stroke, the average score on the BI in the TG has become higher than at discharge from hospital and lower in the WTG. This effect could be due to thrombolysis treatment [1, 36]. Another explanation is that there are significantly more men in the TG. Some studies show that men are more likely than women to achieve functional independence [27, 37].
Being more dependent is related to diminishing daily occupations in both groups [6, 38]. It is important to pay attention to this in rehabilitation [6, 39].
There were two significant interaction effects with respect to BI between the TG and WTG, namely for visiting family and friends and going on holiday. In the TG the level of dependence was of less influence on visiting family and friends and going on holiday. This could be because patients in the TG are younger. In the WTG there is a significant relationship between ADL independence and loss of social contacts. This has also been observed in other studies [6, 40]. It is important to consider this in the rehabilitation of stroke patients because life satisfaction is significantly related to social activity and ADL independence [41, 42].
After one year there is no significant difference in the prevalence of depression between the TG and the WTG. There is an indication of depression in about 12-15% for both groups. This is less than other studies indicate, namely 18-60% [43–45]. There also is no significant difference between the two groups with respect to anxiety disorder. About 9-18% have an anxiety disorder. This percentage is also less than was found in other studies, namely 25-50% . It therefore seems that thrombolysis has no apparent effect on the prevalence of depression or anxiety disorder. It is nonetheless important to screen patients for depression or anxiety disorder because this significantly influences their quality of life [6, 46]. By treating these diseases, HRQOL can be influenced positively.
In this study we used the HADS to measure depression and anxiety disorder, meaning that the percentages reported are only an indication. To diagnose these diseases, more extensive tests should be performed.
This study has several limitations. First, the study groups were relatively small because of the selection criteria. As a consequence, only large differences in the outcome variables resulted in statistically significant results. Another study also reported good health-related QOL for patients after thrombolysis . Therefore, we expected minor differences in QOL after thrombolysis compared to those who did not receive this treatment. We may need to study a larger group of patients to detect a significant improvement in QOL after thrombolysis. Moreover, we only interviewed patients in the TG who went home immediately after discharge from hospital. They were probably good responders to thrombolytic therapy. We did not include those patients in the TG who were not discharged home and who were probably non-responders to thrombolytic therapy.
Secondly, the participants were distributed to two groups depending on which hospital they were admitted to, because the UMCG acts as a comprehensive stroke centre to which patients from the region eligible for thrombolytic treatment are transported. The Martini Hospital acts as a community hospital where stroke patients ineligible for thrombolytic treatment are admitted. Although the aftercare available to the two groups was the same, we could not completely rule out the confounding factor ‘hospital’. For stronger generalizations, the study group should be larger and patients from multiple hospitals with and without thrombolytic treatment should be studied.
One of this study’s strengths is the method of data acquisition. We visited patients at home to complete the questionnaires together. A lot of information was obtained through conversation, not only through the actual talking but also by being able to demonstrate.
Another strength is the fact that a single researcher visited all the patients and that we used standardized questionnaires. This avoided different interpretations of the results.