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Pohjola A, Oulasvirta E, Roine RP, Sintonen HP, Hafez A, Koroknay-Pál P, Lehto H, Niemelä M, Laakso A. Comparing health-related quality of life in modified Rankin Scale grades: 15D results from 323 patients with brain arteriovenous malformation and population controls. Acta Neurochir (Wien) 2021; 163:2037-2046. [PMID: 33860377 PMCID: PMC8195799 DOI: 10.1007/s00701-021-04847-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
Background We wanted to understand how patients with different modified Rankin Scale (mRS) grades differ regarding their health-related quality of life (HRQoL) and how this affects the interpretation and dichotomization of the grade. Methods In 2016, all adult patients in our brain arteriovenous malformation (AVM) database (n = 432) were asked to fill in mailed letters including a questionnaire about self-sufficiency and lifestyle and the 15D HRQoL questionnaire. The follow-up mRS was defined in 2016 using the electronic patient registry and the questionnaire data. The 15D profiles of each mRS grade were compared to those of the general population and to each other, using ANCOVA with age and sex standardization. Results Patients in mRS 0 (mean 15D score = 0.954 ± 0.060) had significantly better HRQoL than the general population (mean = 0.927 ± 0.028), p < 0.0001, whereas patients in mRS 1–4 had worse HRQoL than the general population, p < 0.0001. Patients in mRS 1 (mean = 0.844 ± 0.100) and mRS 2 (mean = 0.838 ± 0.107) had a similar HRQoL. In the recently published AVM research, the most commonly used cut points for mRS dichotomization were between mRS 1 and 2 and between mRS 2 and 3. Conclusions Using 15D, we were able to find significant differences in the HRQoL between mRS 0 and mRS 1 AVM patients, against the recent findings on stroke patients using EQ-5D in their analyses. Although the dichotomization cut point is commonly set between mRS 1 and 2, patients in these grades had a similar HRQoL and a decreased ability to continue their premorbid lifestyle, in contrast to patients in mRS 0.
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Affiliation(s)
- Anni Pohjola
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland.
| | - Elias Oulasvirta
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
| | - Risto P Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Harri P Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
| | - Päivi Koroknay-Pál
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
| | - Hanna Lehto
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
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Pohjola A, Oulasvirta E, Roine RP, Sintonen HP, Hafez A, Koroknay-Pál P, Lehto H, Niemelä M, Laakso A. Long-term health-related quality of life in 262 patients with brain arteriovenous malformation. Neurology 2019; 93:e1374-e1384. [PMID: 31511351 DOI: 10.1212/wnl.0000000000008196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/05/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To discover the health-related quality of life (HRQOL) of patients with treated arteriovenous malformation (AVM), we used the self-applicable HRQOL instrument, the 15D, and analyzed the scores in both in the whole study population and specified cohorts. METHODS The 15D questionnaires were mailed to adult patients with AVM alive in 2016 (n = 432) in our database. Patients with completely eradicated AVM (n = 262) were included in a subsequent analysis. The results were compared with those of the general population standardized for age and sex. Subgroup analyses were conducted for epilepsy, number of bleeding episodes, location of the lesion, modified Rankin Scale score, and Spetzler-Ponce classification (SPC) using independent-samples t test or analysis of covariance. Tobit regression was used to explain the variance in the 15D score. RESULTS Patients had impaired HRQOL compared to the reference population (p < 0.0001). Deep location, multiple bleeding episodes, and refractory epilepsy were associated with impaired HRQOL. Patients in SPC A and B had similar posttreatment 15D scores, whereas those in class C had an impaired HRQOL. Significant explanatory variables in the regression model were age, sex, number of bleeding episodes, refractory epilepsy, and SPC. CONCLUSIONS With careful patient selection, patients in SPC B can reach as favorable HRQOL as those in SPC A provided the operation is successful. Multiple bleeding episodes should be prevented with effective treatment aiming at complete AVM obliteration. The postoperative treatment of patients with AVM should focus on preventing depressive symptoms, anxiety, and epileptic seizures. We encourage other research groups to use HRQOL instruments to fully understand the consequences of neurologic and neurosurgical diseases on patients' HRQOL.
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Affiliation(s)
- Anni Pohjola
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Elias Oulasvirta
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Risto P Roine
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Harri P Sintonen
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Ahmad Hafez
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Päivi Koroknay-Pál
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Hanna Lehto
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Mika Niemelä
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Aki Laakso
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland.
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