# IMPACT OF MULTIDISCIPLINARY REHABILITATION ON FUNCTIONING AND QUALITY OF LIFE IN STROKE SURVIVORS: A LONGITUDINAL RETROSPECTIVE ANALYSIS

## TL;DR

Multidisciplinary rehabilitation improves stroke recovery and quality of life more than primary care or no rehab, with depression being a key factor in outcomes.

## Contribution

Demonstrates the superior effectiveness of multidisciplinary rehabilitation in stroke recovery and identifies depression as a critical predictor of quality of life improvements.

## Key findings

- Multidisciplinary rehabilitation leads to greater functional recovery and higher HRQoL compared to primary care or no rehabilitation.
- Depression is the strongest predictor of HRQoL improvements after stroke.
- Correlations between mRS, EQ-5D, and WHODAS 2.0 scores increase over time, indicating consistent measurement of recovery.

## Abstract

This study investigates the impact of different rehabilitation approaches on functional recovery and health-related quality of life (HRQoL) in stroke patients.

A longitudinal retrospective observational study.

The study included all 538 consecutive stroke patients treated in Satakunta County, Finland, between January 2021 and January 2022.

Functional recovery was assessed using the modified Rankin Scale (mRS), WHODAS 2.0, and HRQoL using the EQ-5D. Outcomes were evaluated at 1, 3, 6, and 12 months. Patients were categorized into 3 groups: no rehabilitation, primary care (PC) rehabilitation, and multidisciplinary (MD) rehabilitation. Longitudinal changes in mRS, WHODAS, and EQ-5D were further assessed at a 3-year follow-up.

MD rehabilitation resulted in significantly greater improvements in HRQoL and functional recovery compared with PC rehabilitation and no rehabilitation. Female patients reported lower HRQoL and poorer functioning than males; however, rates of improvement were similar between the sexes. Dependency (mRS > 2) was associated with lower HRQoL, although changes over the 1-year follow-up were comparable between dependent and independent patients. Depression emerged as the strongest predictor of HRQoL improvements. Substantial correlations were observed among mRS, EQ-5D, and WHODAS 2.0 scores, with the strength of these correlations increasing over time. At the 3-year follow-up, stroke survivors continued to exhibit decreasing HRQoL and functional status.

Multidisciplinary rehabilitation substantially enhances functional recovery and HRQoL during the first year after stroke compared with primary care or no rehabilitation. Although women and patients with greater dependency report lower HRQoL, their rates of improvement are similar to those of other groups. Depression is a key determinant of HRQoL gains, underscoring the importance of integrating mental health support into rehabilitation pathways. The persistently low HRQoL observed 3 years post-stroke highlights the long-term burden of stroke and the need for sustained, comprehensive follow-up and rehabilitation strategies to address ongoing functional limitations.

Functioning and Health-Related Quality of Life (HRQoL) improved significantly more in a multidisciplinary rehabilitation setting compared with primary care rehabilitation and no rehabilitation. Improvements were measured using the modified Rankin Scale (mRS), EQ-5D, and WHODAS 2.0.The mRS, WHODAS 2.0, and EQ-5D showed substantial correlation with one another. Correlations were weakest at the 3-month follow-up but improved significantly over time.Depression was the strongest predictor of changes in HRQoL. Addressing and managing depression is critical to improving quality of life after a stroke.Subacute and first-year stroke follow-up should be centred on multidisciplinary rehabilitation units, which prioritize addressing health-related quality of life and life satisfaction in their care models.

Functioning and Health-Related Quality of Life (HRQoL) improved significantly more in a multidisciplinary rehabilitation setting compared with primary care rehabilitation and no rehabilitation. Improvements were measured using the modified Rankin Scale (mRS), EQ-5D, and WHODAS 2.0.

The mRS, WHODAS 2.0, and EQ-5D showed substantial correlation with one another. Correlations were weakest at the 3-month follow-up but improved significantly over time.

Depression was the strongest predictor of changes in HRQoL. Addressing and managing depression is critical to improving quality of life after a stroke.

Subacute and first-year stroke follow-up should be centred on multidisciplinary rehabilitation units, which prioritize addressing health-related quality of life and life satisfaction in their care models.