Tesis Doctorales
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Browsing Tesis Doctorales by Subject "Brain Health"
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Item Novel strategies to assess the clinical outcome of patients affected by long COVID or stroke, considering its impact on quality of life(Universidad del Desarrollo. Facultad de Medicina, 2026) Delfino Garay, Carlos Osvaldo; Muñoz Venturelli, PaulaIntroduction Brain disorders such as stroke and post-COVID-19 condition (PCC) can compromise Brain health through different pathways, yet both produce long-term sequelae that are often incompletely captured by traditional clinician-rated endpoints. The aim of this thesis is to apply novel assessment strategies for people with highly prevalent neurological conditions, incorporating the impact on their daily lives, and compare these results to conventional clinical outcomes using clinical trials databases. Methods This thesis combined a conceptual and an applied programme of work to evaluate PCO assessment across established and emerging conditions affecting brain health. First, in the Chilean prospective stroke cohort, HRQoL was measured using the EQ 5D-3L and integrated with functional status (mRS) to derive UW-mRS. In INTERACT3, an international intracerebral haemorrhage (ICH) trial, UW-mRS was derived from EQ-5D-3L and mRS data and used to assess clinical and socioeconomic determinants of poorer patient-centred outcomes. In TRIDENT, an international double-blind ICH trial with longitudinal follow-up, repeated EQ-5D-3L, cognitive screening (Montreal Cognitive Assessment, MoCA), and disability assessments were analysed using longitudinal modelling to characterise recovery trajectories, evaluate time-dependent differences in UW-mRS, and quantify the association between cognition and HRQoL. Finally, in STRONGER, an international trial in adults with persistent neurological symptoms following COVID-19, a cross sectional baseline analysis quantified EQ-5D-5L utility and examined its associations with symptom burden, mental health, sleep quality, and cognitive performance within a trial-ready framework for long COVID management. Results Preference-based PCO consistently revealed health losses not fully captured by conventional endpoints across conditions affecting brain health. In the Chilean community-based stroke cohort, EQ-5D utilities declined sharply across mRS categories and problems were common across all dimensions, particularly pain/discomfort (67%); notably, participants with mRS 0–1 still reported HRQoL impairment, indicating residual burden despite “favourable” disability. In INTERACT3, 6-month patient-perceived burden was substantial and poorer HRQoL was largely explained by acute severity and baseline vulnerability, while variation by context (country and living situation) showed that similar disability did not equate to comparable lived health across settings. In TRIDENT, PCO improved from baseline and were largely maintained, with no clear treatment-by-time differences; cognition remained a consistent correlate of HRQoL, supporting a model where utilities add patient-valued meaning to traditional assessments. In STRONGER, baseline analyses showed marked HRQoL impairment alongside a heterogeneous cognitive profile, suggesting that lived health in PCC is strongly shaped by multidomain symptom impact—especially fatigue, affective symptoms, and sleep disturbance—beyond what standard cognitive tests capture at a single timepoint Conclusion This thesis advanced patient-centred assessment of brain health by applying preference-based PCO across stroke, intracerebral haemorrhage, and post-COVID 19 condition. It shows that disability scales and cognitive tests remain indispensable, yet they do not fully capture what matters to patients—how health is experienced, valued, and lived in daily life. Preference-based utilities provide a common metric to summarise multidimensional burden across diseases and study designs, but require contextual interpretation because valuation choices, setting, assessment timing, and capacity for self-report can influence what is measured. By making otherwise under recognised burden visible and comparable, PCO strengthen outcome interpretation, help identify high-burden subgroups, and support more targeted prevention, follow up, and rehabilitation strategies that address the domains driving lived morbidit.