Supplementary Material for: Association Between Marital/Partner Status and Patient-reported Outcomes in Stroke Patients: A Systematic Review

Background: The extent to which marital/partner status affects patient-reported outcome measures (PROMs) in stroke patients varies among reported studies. We conducted a systematic review and meta-analysis to clarify this relationship.
Methods: Five databases (Medline, Web of Science, Scopus, EMBASE, and PsycINFO) were searched from inception to April 15, 2024. Peer-reviewed studies that reported the independent association of marital/partner status with defined PROMs for patients who had a stroke were eligible for inclusion. Results for eligible studies were classified into four pre-defined outcome domains (health-related quality of life [HRQoL], functional status, symptoms, and personal recovery outcomes). Study quality was appraised using the Newcastle-Ottawa Scale, and data were synthesized by outcome domains.
Results: We identified 51 studies (n=552,943 participants), of which 10 were included in meta-analyses. Being married/partnered was associated with a lower likelihood of post-stroke depression (pooled OR, 0.62 [95%CI, 0.43 to 0.89], I2=0%) and anxiety (pooled OR, 0.32 [95%CI, 0.21 to 0.49], I2=0%) but was not associated with HRQoL (mixed and insignificant association in physical and mental domains). Qualitative synthesis further suggested that most studies supported better functional and personal recovery outcomes for stroke patients who were married/partnered compared with those who were unpartnered. Data were insufficient to determine whether the association of partner status varied by the sex of the stroke patient.
Conclusions: Our findings highlight the importance of the influence of marital/partner status on PROMs among stroke patients for mental health, but not for HRQoL. Future research should aim to harmonize assessments and standardize reporting to enhance further investigation of these associations, determine whether there are differences by sex, and further explore the association between marital/partner status and poststroke functional outcomes.

背景：现有研究表明，婚姻/伴侣状况对脑卒中患者的患者报告结局指标（Patient-Reported Outcome Measures，PROMs）的影响程度存在差异。本研究开展系统综述与荟萃分析，以明确二者间的关联。
方法：本研究检索了Medline、Web of Science、Scopus、EMBASE及PsycINFO五个数据库，检索时限自建库至2024年4月15日。纳入标准为同行评议发表的、报告了婚姻/伴侣状况与脑卒中患者特定PROMs独立关联的研究。纳入研究的结果被划分为四个预先设定的结局领域：健康相关生活质量（Health-Related Quality of Life，HRQoL）、功能状态、症状及个人转归结局。研究质量采用纽卡斯尔-渥太华量表进行评价，并按结局领域对数据进行合并分析。
结果：本研究共检索到51项研究（纳入参与者共552943例），其中10项被纳入荟萃分析。已婚/有伴侣的脑卒中患者出现卒中后抑郁（合并比值比OR=0.62，95%置信区间CI：0.43~0.89，I²=0%）及焦虑（合并OR=0.32，95%CI：0.21~0.49，I²=0%）的风险显著更低，但与HRQoL无显著关联（躯体与心理领域的关联结果混杂且无统计学意义）。定性综合分析进一步显示，与无伴侣的脑卒中患者相比，多数研究支持已婚/有伴侣的患者具备更优的功能及个人转归结局。现有数据不足以判断伴侣状况与结局的关联是否因患者性别而异。
结论：本研究结果表明，婚姻/伴侣状况对脑卒中患者PROMs的影响主要体现在心理健康方面，而非健康相关生活质量。未来研究应统一评估方法、规范报告标准，以进一步深化此类关联的研究，明确该关联是否存在性别差异，并深入探讨婚姻/伴侣状况与卒中后功能结局的关联。