Exploring the Association Between Measures of Disability and Quality of Life Outcomes in Acute Stroke: A Secondary Analysis of the ACTION-2 Trial

Stroke is a leading cause of long-term disability worldwide and affects millions of people each year. After a stroke, doctors often use a simple scale called the Modified Rankin Scale (mRS) to describe how independent a person is in daily life. The mRS ranges from no symptoms to severe disability or death. While this scale is useful, it does not fully describe how people feel about their health, happiness, or ability to enjoy life. Many people with similar levels of physical disability can report very different experiences of quality of life.

In this study, we will explore how physical disability after stroke relates to quality of life (QoL), which reflects a person’s overall well-being, including physical comfort, emotional health, and ability to think clearly. Understanding this relationship is important because recovery after stroke is not only about survival or movement, but also about how people experience their lives.

We will use existing data from the ACTION-2 trial, a large clinical study that enrolled patients with acute ischemic stroke, which is a stroke caused by a blockage that reduces blood flow to the brain. In this trial, participants were randomly assigned to receive either natalizumab or a placebo (an inactive treatment). Natalizumab is a medication that works by limiting the movement of certain immune cells into the brain. After a stroke, inflammation caused by the immune system can worsen brain injury. Natalizumab was studied to see whether reducing this immune response could improve recovery, although it is not currently a standard treatment for stroke.

We will focus on information collected 90 days after the stroke, a commonly used time point to assess recovery. We will examine how mRS scores relate to quality of life measures, including the EQ-5D (EuroQol five-dimension questionnaire), which asks about mobility, self-care, usual activities, pain, and anxiety or depression, and the Visual Analogue Scale (VAS), which allows patients to rate their overall health from worst to best imaginable health.

We will study whether small changes in disability are linked to large changes in quality of life, especially at lower levels of disability. We will also examine wheter receiving natalizumab or placebo changes the relationship between disability and quality of life. In addition, we will identify groups of patients whose disability level and quality of life do not align, such as people with little physical disability but poor quality of life, or people with more severe disability who still report good quality of life.

By doing this research, we aim to improve how stroke outcomes are measured and to support more patient-centered care, where both physical ability and lived experience are considered.