Longitudinal changes in health-related quality of life in working-age adults one year after ischaemic stroke: findings from the FRAILTY study

OBJECTIVES: Limited evidence exists on how working-age adults perceive the impact of ischaemic stroke (IS) during the first months post-event, and longitudinal data on health-related quality of life (HRQoL) are scarce. The aim of the study was to examine 12-month changes in HRQoL, functional outcomes, cognitive function, and psychosocial sequelae in working-age adults after IS, and to explore age-related differences (< 50 vs. ≥ 50 years). METHODS: In this prospective cohort study, 220 patients aged 18-65 years with first-ever IS were assessed before hospital discharge, 3-, 6-, and 12-month post-discharge. Measures included the Stroke Impact Scale (SIS 3.0), Neuro-QoL, Fatigue Severity Scale (FSS), Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS), Brief Pain Inventory, and Multidimensional Scale of Perceived Social Support (MSPSS). Longitudinal changes were analysed using the Wilcoxon signed-rank, Bowker's test, and the Mann-Whitney U test with Bonferroni correction. RESULTS: Significant improvements in HRQoL, cognitive function, and psychosocial outcomes occurred mainly within the first three months. FSS scores indicated clinically relevant fatigue. SIS domains - strength, emotion, communication, activities of daily living (ADL), mobility, hand function, and social participation - improved, while memory remained unchanged. Neuro-QoL T-scores increased for satisfaction with social roles, positive affect, and physical function. Changes after three months were generally not statistically significant. Post-stroke pain and perceived social support remained stable. Age subgroup analysis revealed no significant differences. CONCLUSION: Recovery in HRQoL, cognitive function, and psychosocial outcomes typically occurs within the first three months post-IS, with a subsequent plateau. Younger and older working-age adults exhibit similar trajectories, underscoring the importance of early comprehensive rehabilitation interventions adapted to the patient's condition and deficit.