No measure has proven superiority above others. Future research should focus on comparisons between existing instruments and on their reliability and responsiveness.

Background: To investigate the prevalence of cognitive complaints after subarachnoid hemorrhage (SAH) and the relationships between cognitive complaints and cognitive impairments, disability and emotional problems. Methods: Cognitive complaints were assessed with the Checklist for Cognitive and Emotional Consequences following stroke (CLCE-24) in 111 persons who visited our outpatient clinic 3 months after SAH. Associations between cognitive complaints and cognitive functioning, demographic characteristics, disability and emotional problems were examined using Spearman correlations and linear regression analysis. Results: In this study group, 105 patients (94.6%) reported at least one cognitive or emotional complaint that hampered everyday functioning. The most frequently reported cognitive complaints were mental slowness, short-term memory problems and attention deficits. All cognitive domains, disability, depressive symptoms and feelings of anxiety were significantly associated with the CLCE-24 cognition score. In the final regression model, memory functioning (β value –0.21), disability (–0.28) and depressive symptoms (0.40) were significant determinants of cognitive complaints, together explaining 35.4% of the variance. Conclusion: Cognitive complaints are common after SAH and associated with memory deficits, disability and depressive symptoms. Rehabilitation programs should focus on these symptoms and deficits.

Background and Purpose-Many patients who survive an aneurysmal subarachnoid hemorrhage experience decreased health-related quality of life (HRQoL). Physical factors have been identified as determinants of HRQoL. We describe long-term HRQoL and assessed whether psychological symptoms and personality characteristics determine HRQoL after subarachnoid hemorrhage. Methods-In a cross-sectional study in 141 patients living independently in the community 2 to 4 years after subarachnoid hemorrhage, we assessed whether HRQoL, evaluated by the Stroke Specific Quality of Life scale, was related to psychological symptoms (mood disorders, fatigue, and cognitive complaints), personality characteristics (neuroticism and passive coping style), demographic characteristics, and subarachnoid hemorrhage disease characteristics. Results-Best Stroke Specific Quality of Life scale scores were found in the physical domain and worst in the emotional and social domains. Thirty-two percent reported anxiety, 23% depression, and 67% fatigue. Mood (beta between Ϫ0.42 and Ϫ0.18), fatigue (beta between Ϫ0.40 and Ϫ0.24), and cognitive complaints (beta between Ϫ0.46 and Ϫ0.16) were strongly associated with Stroke Specific Quality of Life scale scores in multivariate regression analyses. Conclusion-Depression, anxiety, and fatigue were present in a substantial proportion of patients and were strongly related to decreased HRQoL. These symptoms identified are helpful to tailor rehabilitation to the needs of patients in the chronic phase after subarachnoid hemorrhage.

ObjectivesTo assess and explore over 1 year poststroke (1) the societal costs, (2) changes in costs and quality of life (QoL) and (3) the relation between costs and QoL.DesignThe current study is a burden of disease study focusing on the cost-of-illness (in Euros) and QoL (in utilities) after stroke.SettingAdult patients with stroke were recruited from stroke units in hospitals and followed for 1 year.ParticipantsData were collected from 395 patients with stroke.Main outcome measuresCosts and QoL expressed in utilities.MethodsCost categories were identified through a bottom-up method. The Dutch 3-level 5-dimensional EuroQol (EQ-5D-3L) was used to calculate utilities. Non-parametric bootstrapping was applied to test for statistical differences in costs. Subgroup analyses were performed to identify predictors for costs and QoL. Robustness of results was tested via sensitivity analyses.ResultsThe total societal costs for 1 year poststroke were €29 484 (n=352) of which 74% were in the first 6 months. QoL remained stable over time. The discharge location was a significant predictor for cost and QoL; men had a significantly higher QoL than women and younger patients (<65) had significantly more costs than older patients (>65). Ceiling effects appear on all dimension of the EQ-5D-3L. Costs and QoL show a weak correlation (r=−0.29). Sensitivity analyses showed robustness of results.ConclusionsWe found lower patient costs and higher QoL than expected. This may be explained by the good state of health of our study population and by change in the Dutch healthcare system, which has led to considerable shorter hospitalisation poststroke. Future research must question the use of the EQ-5D-3L in a similar population due to ceiling effects.Trial registration numberNTR3051.

The frequency of participation decreased after a stroke, and this decrease was associated with participation restrictions experienced and satisfaction with participation. Resuming vocational activities and screening and, if applicable, treatment of depressive symptoms should be priorities in stroke rehabilitation.

There is very low- to moderate-quality evidence that CME may be a valuable intervention to augment the pallet of therapeutic options for stroke rehabilitation. Included studies were small, heterogeneous, and some trials had an unclear or high risk of bias. Future high-quality research should determine whether CME interventions are (cost-)effective.

No abstract

Three years post stroke, many patients report ongoing dissatisfaction with various life domains. Social activity was related to life satisfaction.