Quality of Life Profiles in Brain Stroke Survivors Versus Community Controls: A Case–Control Study from an Under-Resourced District Hospital

Abstract

Background: Brain stroke is a leading cause of disability and mortality globally, profoundly impacting quality of life (QOL), particularly in under-resourced settings like rural Pakistan where rehabilitation access is limited. Few studies provide case-control comparisons of QOL, cognitive function, and functional independence in district-level hospitals, leaving gaps in understanding localized deficits and screening strategies. Objective: To compare QOL, cognitive function, and functional independence between stroke survivors and community controls at a district hospital in Narowal, Pakistan, and identify simple screening thresholds for low QOL. Methods: In a case-control study from September to November 2023 at District Head Quarter Hospital Narowal, 100 stroke survivors and 100 community controls were assessed using the WHOQOL-BREF, Montreal Cognitive Assessment (MoCA), and Barthel Index (BI). Independent t-tests, two-way ANOVA for age-stratified effects, and ROC analyses were conducted to compare groups and derive cut-offs for low QOL (≤25th percentile of control scores). Results: Stroke survivors showed significantly lower scores across all WHOQOL-BREF domains (p<0.01, Cohen’s d=1.57–3.02), MoCA (mean=15.35 vs. 29.15, p<0.001), and BI (mean=44.90 vs. 98.55, p<0.001), with older survivors (age >65) exhibiting steeper QOL declines (p<0.05). MoCA cut-offs (15–18) and BI cut-offs (45–55) achieved AUCs of 0.75–0.87 for detecting low QOL. Conclusion: Stroke survivors in rural Pakistan face substantial QOL, cognitive, and functional deficits, accentuated by age, necessitating accessible screening and targeted rehabilitation to improve outcomes. Keywords: Stroke, Quality of Life, Cognitive Impairment, Functional Independence, Case-Control Study, Pakistan