Quality of life measurement and outcome in aphasia

BACKGROUND Quality of life (QL) can be defined as the individual's perception of their own well-being. Aphasia is the most important potential consequence of stroke and has a profound effect on a patient's life, causing emotional distress, depression, and social isolation, due to loss of language functions. AIMS To draw up a QL questionnaire for aphasics (QLQA) focusing particularly on difficulties in interpersonal relationships and on the loss of independence as a result of language disorders. We reported the results of a psychometric evaluation of this measure. Moreover, we experimentally focused on the differences in QLQA between patients affected only by neurological motor impairment and hemiparetic patients with aphasia (PWA) in order to verify the specific role of aphasia on QL. We also explored if the QLQA is sensitive to the severity of aphasia and to the time elapsing from the stroke. METHODS A total of 146 consecutive PWA and 37 control subjects were enrolled to evaluate the reliability (internal consistency and test-retest reliability) and validity of the QLQA, using standard psychometric methods. Patients were divided into acute (within 3 months since stroke) and chronic (beyond 3 months) groups, and into mild and severe according to the severity of aphasia. The experimental group of only acute PWA was compared to control subjects, with right hemispherical lesion and without aphasia in QLQA total and partial scores. RESULTS The QLQA had good internal consistency and test-retest reliability. Acute and chronic PWA and mild and severe ones differed in QLQA total, communication, and autonomy subscales. No differences were found in psychological condition. Between aphasic and control patients, significant differences were found in all QLQA subscales. CONCLUSION The QLQA is a valid measure of QL in PWA, contributing to a better distinction between severe and mild aphasia, and it is sensitive also to the variations in QL depending on the time interval from stroke.