{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:25:31Z","timestamp":1787117131736,"version":"build-2736575974"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to model and compare the network architecture of HRQoL between stroke survivors with mild-to-moderate versus severe functional dependence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\u2013Moderate group (Barthel Index, BI &amp;gt; 40;\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f259) and a Severe group (BI \u2264 40;\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f192). Polychoric correlations were used to account for the ordinal nature of the SS-QOL items. Strength centrality and bridge expected influence (based on\n                      <jats:italic>a priori<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Although network structure did not differ significantly between groups (\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.928), the severe dependence group showed significantly higher global strength (\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.021), suggesting a more densely connected HRQoL network. In the Mild\u2013Moderate 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\u2013moderate 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).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1808859","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T04:41:38Z","timestamp":1787114498000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The architecture of quality of life after stroke: a network comparison of mild-to-moderate versus severe functional impairment"],"prefix":"10.3389","volume":"17","author":[{"given":"Jingjing","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Nursing, Ningbo Medical Center Lihuili Hospital","place":["Ningbo, Zhejiang, China"]},{"name":"Rehabilitation Ward, Ningci Rehabilitation Hospital","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Ningbo Medical Center Lihuili Hospital","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Nursing, Ningbo Medical Center Lihuili Hospital","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulu","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Zhejiang Provincial People\u2019s Hospital","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Ningbo Medical Center Lihuili Hospital","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/s1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: a systematic analysis for the global burden of disease study 2019","volume":"20","author":"Feigin","year":"2021","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e231455","DOI":"10.1001\/jamanetworkopen.2023.1455","article-title":"Estimated burden of stroke in China in 2020","volume":"6","author":"Tu","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1454220","DOI":"10.3389\/fneur.2024.1454220","article-title":"Effects of repetitive transcranial magnetic stimulation at different targets on brain function in stroke patients: a randomized controlled 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