Post Stroke Outcome: Global Insight into Persisting Sequelae Using the Post Stroke Checklist

The Post-Stroke Checklist: longitudinal use in routine clinical practice during first year after stroke

BACKGROUND

Few studies describe the use of the Post-Stroke Checklist (PSC) as a tool for longitudinal stroke follow-up in clinical practice. We mapped the prevalence of stroke-related health problems and targeted interventions at 3 and 12 months post-stroke by using the PSC.

METHODS

Patients with acute stroke discharged home in 2018-2019 at Skåne University Hospital, Sweden, were invited to participate in a comprehensive nurse-led follow-up based on a 14-item PSC 3 and 12 months post-stroke. We measured time consumption, screened for stroke-related health problems, compared the findings, and recorded targeted healthcare interventions. Problems at 12 months were grouped into new, persistent, or none compared to the 3-month evaluation.

RESULTS

Of 200 consecutively included patients, 146 (77%) completed both the 3- and 12-month follow-ups. At 12-month follow-up, 36% of patients reported no stroke-related health problems, 24% reported persistent problems, and 40% reported new problems since the 3-month evaluation. New problems at 12 months were most common within the domains: secondary prevention (23%) and life after stroke (10%). Stroke recurrence rate was 7.5%, 43% had high blood pressure, and few smokers had quit smoking. At 12 months, 53% received at least one new healthcare intervention, compared to 84% at 3 months.

CONCLUSIONS

Stroke-related health problems decreased beyond 3 months but were still present in two-thirds of patients at 1 year. This emphasizes the relevance of continuous structured follow-up using the PCS. However, the follow-up alone was insufficient to adequately achieve treatment targets for secondary prevention, which require intensified focus.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT04295226, (04/03/2020).

The healthcare experience of young stroke survivors: an interpretative phenomenological study

PURPOSE

While stroke is becoming increasingly prevalent in young people (<65 years), diagnosis, treatment, rehabilitation, and management continue to reflect the needs of older people. This study aimed to characterise and appreciate the healthcare experiences of young stroke survivors, whose needs and trajectories differ from those of older people.

MATERIALS AND METHODS

Qualitative in-depth semi-structured interviews were conducted with 11 stroke survivors aged 18-49 using virtual conferencing software. The data were analysed using interpretative phenomenological analysis.

RESULTS

Four main themes were identified that reflect the experiences and needs of young stroke survivors and are (1) The health system overlooks the experiences and needs of young stroke survivors; (2) Support is fragmented rather than holistic; (3) Feelings of helplessness at a time agency is required; and (4) Positive attitudes despite challenges.

CONCLUSIONS

The experiences of young stroke survivors are distinct. Health services that consider the unique trajectories of young stroke survivors will better facilitate rehabilitation and support for this population.

The cognitive appraisal path of stroke knowledge, coping traits, family functioning and stigma among stroke patients: A moderated parallel mediation model

AIMS

To establish a cognitive appraisal path model that examines the impact of stroke knowledge on stigma with the parallel mediating effects of negative and positive coping traits, as well as the moderating effects of family functioning.

BACKGROUND

Stroke-related stigma, a 'mixture' of negative emotions involving internal criticism and external judgement, has been shown to impair patients' health outcomes. However, the specific factors underlying cognitive appraisals and their pathways remain unknown.

DESIGN

A cross-sectional design.

METHODS

The cross-sectional sample was from two stroke centres in China. Questionnaires were administered to collect sociodemographic data, stroke knowledge, coping traits, family functioning and stigma. Hierarchical regression models and the moderated parallel mediation model were constructed to analyse influencing pathways. The study adhered to the strengthening the reporting of observational studies in epidemiology guideline.

RESULTS

All 144 samples reported stigma symptoms with a moderate-to-high standardising score. The best hierarchical regression model explains 55.5% of the variance in stigma. The parallel mediation model indicated that negative and positive coping traits co-mediating the association of stroke knowledge and stigma. After adding the family functioning as a moderator, the moderated parallel mediation model was confirmed with adequate fit indices.

CONCLUSION

Among the cognitive appraisal factors affecting stroke-related stigma, stroke knowledge reduces stigma by modifying coping traits, while poor family functioning may serve as an opposing moderator. Notably, when family support is insufficient, enhanced stroke knowledge might paradoxically exacerbate the stigma.

RELEVANCE TO CLINICAL PRACTICE

This study contributes knowledge on transforming health education and emphasises the pivotal roles of clinical nursing practitioners. In similar global contexts, the study highlights integrating health education, psychological counselling and family support to advance systematic nursing practices.

PATIENT OR PUBLIC CONTRIBUTION

None.

Interventions within the Scope of Occupational Therapy in the Hospital Discharge Process Post-Stroke: A Systematic Review

Stroke is one of the main causes of disability in adulthood. Its rehabilitation is a complex process that requires a multidisciplinary team of specialised professionals. The main goal of this review was to determine the impact of occupational therapy intervention post-stroke on the home discharge process. A systematic search was carried out of the following databases: Pubmed, Web of Science, PsycINFO, Scopus, Otseeker, and Dialnet. A screening was performed taking into account the type of article, including exclusively RCT, and type of intervention, only including interventions within the scope of occupational therapy that take place during the process of hospital discharge post-stroke. A total of 2285 citations were identified in the search from which 13 articles met the inclusion criteria. Comparisons of the groups indicated that early occupational therapy intervention during the process of hospital discharge can be effective in terms of functional recovery and can lead to the caregiver seeing improvements in self-efficacy and fatigue. In addition, the inclusion of a caregiver in the intervention influences the patient's adherence to treatment, leading to a reduction in the cost of treatment and rehabilitation.

Understanding the priorities in life beyond the first year after stroke: Qualitative findings and non-participant observations of stroke survivors and service providers

ABSTRACTLong-term unmet health needs are associated with a lower quality of life in stroke survivors. Survivors' priorities in living their lives and health professionals' recognition influence survivors' perceptions of their needs. From the perspectives of survivors and service providers, this study investigated survivors' long-term priorities for continuing their lives after stroke. A qualitative study was conducted with a convenience sample of 40 stroke survivors and a purposive sample of 11 providers who had worked with survivors for more than five years and were currently managers of community-based stroke care services or leaders of volunteer groups. Following the survivors' interviews, non-participant observations of a random day's activities were conducted. Data were transcribed verbatim. Survivors' and providers' data were analyzed separately and then together thematically. Five themes emerged: healing the mind in order to move forward, optimizing adaptations and maintaining physical function, living a safe and cost-effective life, returning to work, and giving back to society. Community-based services can be improved to offer more at-home, technology-supported psychological and self-management interventions, barrier-free and one-stop services, and opportunities for employment and volunteering. It would be worthwhile to invest in conducting public education to promote social inclusion and strengthening collaboration between academic and community organizations.

A process evaluation of patient care needs using the Post- Stroke Checklist: a prospective study

Objective

To assess the utility of the modified Post-Stroke Checklist (mPSC) to identify impairments and care needs of patients with stroke (PwS) in an inpatient rehabilitation setting.

Methods

Prospective observational design with consecutive admission of PwS (n = 44) at a tertiary rehabilitation facility. The post-stroke checklist was administered at hospital discharge (T1) and 3 months post-discharge (T2). Furthermore, validated questionnaires assessed function and participation, including the Clinical Functioning Information Tool (ClinFIT) on admission (T0), T1 and T2.

Results

Participants’ mean age was 67.7 years (standard deviation; SD) 14.6), 58% of participants were female, and the mean length of inpatient stay was 32.7 days (SD 22.4). At T1, 80% and at T2 only 60% of participants reported ≥1 strokerelated problem (mean 5.3 (SD 3.3) and 3.6 (SD 2.8), respectively). Half of participants were referred to physiotherapy/occupational therapy, and 36% to specialist clinics following discharge. The most prevalent problems included: life after stroke (62.2%), fatigue (55.6%), activities of daily living, and mobility (51.1% each). Compared with T1, at T2 there was an observed reduction in all mPSC items, except pain and incontinence. Participants showed improved function at T1 and T2 (Extension Index, ClinFIT set), from T0 to T1 and T0 to T2 (p<0.001, with large effect sizes).

Conclusion

The mPSC is feasible to implement in an inpatient rehabilitation setting and community. It can identify relevant stroke-related problems, and hence facilitate targeted intervention.

Results of a four-year multi-channel regional program for monitoring stroke survivors in Franche-Comté, France

INTRODUCTION

Clinical monitoring of stroke survivors after hospital discharge was initiated in France in 2012 and funding for its model began in 2016. A regional program in Franche-Comté relying on various assessment methods including telehealth was initiated. The objective of this study was to describe the implementation and quality of the program.

METHODS

A retrospective observational study was conducted from 1^st January 2016 to 31^st December 2019. Patients were included if they were adults, hospitalized for stroke or transient ischemic attack in one of the six public hospitals in the region and discharged alive. There were five types of monitoring methods: physical consultation, day hospital, nurse-led phone consultation, postal mail or medical record analysis. Characteristics, method of monitoring and discharge delay were described.

RESULTS

In total, 7166 patients were identified; male gender predominated (52.9%); mean age was 72.2years. Monitoring coverage increased from 89.2% to 92% within the period. Most patients had ischemic stroke (68.5%, n=4912) and were at home at the time of monitoring (71.6%, n=5130). The main method was nurse-led phone consultations (40.8%, n=2921) followed by physical consultation (16%, n=1143). Day hospital monitoring increased (1.5% to 14.4%) while the postal mail method decreased (18.7% to 8.1%). The average delay decreased from 240.3 to 148.6days. Monitoring period of less than four months was 46.2% in 2019 and 75.3% for thrombolysis. In 2019, 99.3% of patients were being monitored at one year. Mortality decreased from 10% to 6.3%.

DISCUSSION

The program improved over time with an increase in the number of patients and reduction in delays and mortality rate.