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The architecture of quality of life after stroke: a network comparison of mild-to-moderate versus severe functional
Jingjing Ma1,2, Yiqing Zhang1, Tao Zhou1
1Department of Nursing, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China.
Background:
Health-related quality of life (HRQoL) after stroke is multidimensional, yet conventional analyses often overlook the complex interactions among its domains and how these might differ by functional status.
Objective:
This study aimed to model and compare the network architecture of HRQoL between stroke survivors with mild-to-moderate versus severe functional dependence.
Methods:
In this multi-center cross-sectional study, 451 inpatients were assessed using the Stroke-Specific Quality of Life (SS-QOL) scale across 12 domains. Participants were stratified into a Mild-Moderate group (Barthel Index, BI > 40; n = 259) and a Severe group (BI ≤ 40; n = 192). Polychoric correlations were used to account for the ordinal nature of the SS-QOL items. Strength centrality and bridge expected influence (based on a priori communities: Physical, Psychological, Social, General) were calculated to identify hubs and bridges. Network stability was assessed via bootstrap analysis, and a Network Comparison Test (NCT) was performed to compare global strength and network structure between groups.
Results:
Although network structure did not differ significantly between groups (p = 0.928), the severe dependence group showed significantly higher global strength (p = 0.021), suggesting a more densely connected HRQoL network. In the Mild-Moderate group, strength centrality was highest for Self-Care (S7; 1.209) and Social Roles (S8; 1.014). In the Severe group, strength centrality was highest for Upper Extremity Function (S10; 1.124) and Thinking (S9; 1.031). Bridge expected influence was highest for Thinking (S9; 0.694) in the mild-moderate group and for Language (S3; 0.722) and Thinking (S9; 0.701) in the severe group. Network stability was acceptable in both groups (CS-coefficients: 0.595 and 0.438 for strength centrality).
Conclusion:
The fundamental architecture of post-stroke HRQoL differs across levels of functional dependence. These findings support a precision rehabilitation framework: one targeting the synergy between physical functions in milder cases, and another focused on supporting cognitive integrity and social adaptation in severe disability.
