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Hughes AK, Woodward AT, Fritz MC, Swierenga SJ, Freddolino PP, Reeves MJ. Unmet Needs of US Acute Stroke Survivors Enrolled in a Transitional Care Intervention Trial. J Stroke Cerebrovasc Dis 2019; 29:104462. [PMID: 31761737 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Needs of patients that go unmet after a stroke can compromise the speed and extent of recovery. While unmet needs in long-term survivors has been studied, less is known about the unmet needs of acute stroke survivors. We examine unmet needs in the immediate postdischarge period among 160 participants in the (blinded for review) a transitional care intervention conducted in (blinded for review [1 US state]) during 2016 and 2017. METHODS Bivariate and multivariate analyses using Poisson models were used to examine the relationship between total number of unmet needs and demographics, stroke type and severity, stroke effects, and stroke risk factors. RESULTS The mean number of unmet needs was 4.55; number of unmet needs ranged from 2 to9; all participants had some unmet need. The most common unmet needs were stroke education (73.8%), financial (33.8%), and health-related (29.4%). In the final multivariate model income and education were inversely associated with number of unmet needs. As total number of stroke effects increased, so did number of unmet needs. Demographic variables (age, gender, and race), stroke risk factors, stroke type, and stroke severity were not statistically significantly associated with the number of unmet needs. CONCLUSIONS These results identify that in the acute post discharge period stroke survivors have many unmet needs that range from physical to psychosocial. Targeting interventions to those with the potential for greater numbers of unmet needs might be a salient clinical approach to improving stroke recovery and rehabilitation.
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Affiliation(s)
- Anne K Hughes
- Michigan State University, School of Social Work, East Lansing, MI.
| | | | - Michele C Fritz
- Michigan State University, Department of Epidemiology and Biostatistics, East Lansing, MI
| | - Sarah J Swierenga
- Michigan State University, University Outreach and Engagement, East Lansing, MI
| | | | - Mathew J Reeves
- Michigan State University, Department of Epidemiology and Biostatistics, East Lansing, MI
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Johnson B, Handler D, Urrutia V, Alexandrov AW. Retention of Stroke Education Provided during Hospitalization: Does Provision of Required Education Increase Stroke Knowledge? INTERVENTIONAL NEUROLOGY 2018; 7:471-478. [PMID: 30410527 DOI: 10.1159/000488884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/16/2018] [Indexed: 12/24/2022]
Abstract
Background Provision of stroke education to patients is a Centers for Medicare/Medicaid (CMS) requirement. However, little is known about retention of the educational content. Methods Two pilot studies were conducted: Pilot A delivered CMS-required stroke education during hospitalization in a standardized manner and tested knowledge retention in patients returning to the Stroke Clinic for 1-month follow-up; Pilot B randomized patients to either a control group with standardized education or a test-enhanced learning group (target), with measurement of stroke knowledge retention at hospital discharge. Results A total of 198 patients/caregivers participated in Pilot A, with only 25% scoring 100% correct on required stroke education items. The question most commonly answered incorrectly (n = 117; 59%) was "personal risk factors for stroke," and 74 (37%) could not correctly identify stroke signs and symptoms. Pilot B found that significantly more target group patients could identify their personal stroke risk factors (100 vs. 67%; p = 0.04) and the purpose of their secondary prevention medications (87 vs. 40%; p = 0.02) compared to controls. Discussion While stroke education is required during hospitalization, its ability to produce retention may be poor. We propose study of test-enhanced learning methods through the Targeted Education in Stroke Trial (TEST) to examine the effect of novel teaching methods on patient/caregiver knowledge retention.
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Affiliation(s)
- Brenda Johnson
- Department of Neurology, College of Medicine, John Hopkins Medical Center, Baltimore, Maryland, USA
| | - Diane Handler
- Stroke Team, Unity Point Health - St. Luke's Hospital, Cedar Rapids, Iowa, USA
| | - Victor Urrutia
- Department of Neurology, College of Medicine, John Hopkins Medical Center, Baltimore, Maryland, USA
| | - Anne W Alexandrov
- Department of Neurology and Mobile Stroke Unit, College of Medicine, College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,NET SMART Program, Health Outcomes Institute, Fountain Hills, Arizona, USA
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Mendyk AM, Duhamel A, Bejot Y, Leys D, Derex L, Dereeper O, Detante O, Garcia PY, Godefroy O, Montoro FM, Neau JP, Richard S, Rosolacci T, Sibon I, Sablot D, Timsit S, Zuber M, Cordonnier C, Bordet R. Controlled Education of patients after Stroke (CEOPS)- nurse-led multimodal and long-term interventional program involving a patient's caregiver to optimize secondary prevention of stroke: study protocol for a randomized controlled trial. Trials 2018; 19:137. [PMID: 29471839 PMCID: PMC5824577 DOI: 10.1186/s13063-018-2483-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Setting up a follow-up secondary prevention program after stroke is difficult due to motor and cognitive impairment, but necessary to prevent recurrence and improve patients' quality of life. To involve a referent nurse and a caregiver from the patient's social circle in nurse-led multimodal and long-term management of risk factors after stroke could be an advantage due to their easier access to the patient and family. The aim of this study is to compare the benefit of optimized follow up by nursing personnel from the vascular neurology department including therapeutic follow up, and an interventional program directed to the patient and a caregiving member of their social circle, as compared with typical follow up in order to develop a specific follow-up program of secondary prevention of stroke. METHODS/DESIGN The design is a randomized, controlled, clinical trial conducted in the French Stroke Unit of the Strokavenir network. In total, 410 patients will be recruited and randomized in optimized follow up or usual follow up for 2 years. In both group, patients will be seen by a neurologist at 6, 12 and 24 months. The optimized follow up will include follow up by a nurse from the vascular neurology department, including therapeutic follow up, and a training program on secondary prevention directed to the patient and a caregiving member of their social circle. After discharge, a monthly telephone interview, in the first year and every 3 months in the second year, will be performed by the nurse. At 6, 12 and 24 month, the nurse will give the patient and caregiver another training session. Usual follow up is only done by the patient's general practitioner, after classical information on secondary prevention of risk factors during hospitalization. The primary outcome measure is blood pressure measured after the first year of follow up. Blood pressure will be measured by nursing personnel who do not know the group into which the patient has been randomized. Secondary endpoints are associated mortality, morbidity, recurrence, drug side-effects and medico-economic analysis. DISCUSSION The result of this trial is expected to provide the benefit of a nurse-led optimized multimodal and long-term interventional program for management of risk factors after stroke, personalizing the role of the nurse and including the patient's caregiver. TRIAL REGISTRATION ClinicalTrials.gov, NCT 02132364. Registered on 7 May 2014. EUDRACT, A 00473-40.
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Affiliation(s)
- Anne-Marie Mendyk
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France
| | - Alain Duhamel
- University Lille, CHU, EA2694, F-59000, Lille, France
| | - Yannick Bejot
- University Hospital and Medical School of Dijon, University of Burgundy, Digon, France
| | - Didier Leys
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France
| | - Laurent Derex
- Department of Stroke Medicine, Université Lyon 1, Lyon, France
| | - Olivier Dereeper
- Stroke Unit, Neurology Department, Calais Hospital, Calais, France
| | - Olivier Detante
- Université Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France
| | - Pierre-Yves Garcia
- Stroke Unit, Neurology Department, Compiègne Hospital, Compiègne, France
| | - Olivier Godefroy
- Department of Neurology and Functional Neuroscience Laboratory EA 4559, Amiens University Medical Center, Amiens, France
| | | | - Jean-Philippe Neau
- Department of Neurology, CHU of Poitiers, University of Poitiers, Poitiers, France
| | - Sébastien Richard
- Stroke unit, Department of Neurology, CHU of Nancy, Lorraine University, Nancy, France
| | - Thierry Rosolacci
- Stroke Unit, Neurology Department, Maubeuge Hospital, Maubeuge, France
| | - Igor Sibon
- Department of Neurology, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Denis Sablot
- Stroke Unit, Neurology Department, Perpignan Hospital, Perpignan, France
| | - Serge Timsit
- CHRU Brest, Department of Neurology and Stroke Unit, Université de Bretagne Occidentale, Brest, France
| | - Mathieu Zuber
- Department of Neurology, Saint-Joseph Hospital Center, AP - HP, Université Paris-Descartes, INSERM UMR S 919, Paris, France
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France
| | - Régis Bordet
- University Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', F-59000, Lille, France.
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Abstract
This review of literature explores various interventions that promote stroke awareness and knowledge of stroke warning signs in individuals. The review looks at the differences and similarities in several identified interventions, including mass media, printed materials, presentations, children's programs, and stroke screenings. An assessment of these 5 interventions provides information on cost, personnel involved, number of persons reached, and knowledge retention from each program. Programs reviewed using the identified types of interventions demonstrate the benefits and challenges of each and enable program developers to coordinate programs based on these evaluations.
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Nursing Best Practices to Prevent Stroke in Women. Stroke 2015; 46:e75-7. [DOI: 10.1161/strokeaha.114.006320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gill L, Sullivan KA. Boosting Exercise Beliefs and Motivation Through a Psychological Intervention Designed for Poststroke Populations. Top Stroke Rehabil 2015; 18:470-80. [DOI: 10.1310/tsr1805-470] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bauler S, Jacquin-Courtois S, Haesebaert J, Luaute J, Coudeyre E, Feutrier C, Allenet B, Decullier E, Rode G, Janoly-Dumenil A. Barriers and facilitators for medication adherence in stroke patients: a qualitative study conducted in French neurological rehabilitation units. Eur Neurol 2014; 72:262-70. [PMID: 25277833 DOI: 10.1159/000362718] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 04/06/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the perceptions of French patients, caregivers and healthcare professionals on stroke and secondary preventive medications. METHOD A qualitative study was conducted, based on four predetermined topics: stroke, secondary prevention medications, patient's experience, relationship between patient/caregiver and healthcare team. RESULTS Twenty-six interviews were conducted. Difficulties in taking medications, lack of knowledge on stroke and medication benefits, fear of over medication were identified as barriers for adherence in patients. Doubts about generic drugs were expressed by caregivers. Healthcare professionals reported lack of knowledge and absence of clinical symptoms as barriers. On the other hand, support from caregivers and healthcare professional support is essential for compliance in all participants. Patients and caregivers expressed that fear of recurrence was a facilitator for treatment compliance. CONCLUSION This study highlights the barriers and facilitators for stroke treatment adherence and underlines the similarities and differences between the perceptions of patients, caregivers and healthcare professionals. These results must be integrated into the future French educational programs to improve medication adherence.
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Affiliation(s)
- Stephanie Bauler
- Pôle de Rééducation et de Réadaptation Fonctionnelles, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint Genis Laval, France
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Nickles A, Fiedler J, Roberts S, Lyon-Callo S, Hurst R, Reeves M. Compliance With the Stroke Education Performance Measure in the Michigan Paul Coverdell National Acute Stroke Registry. Stroke 2013; 44:1459-62. [DOI: 10.1161/strokeaha.111.000763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke education, 1 of 8 endorsed stroke performance measures, consists of 5 specific subcomponents: risk factors, stroke warning signs, emergency medical service activation, physician follow-up, and discharge medications. We identified predictors of stroke education performance measure compliance in the Michigan Paul Coverdell National Acute Stroke Registry.
Methods—
Data were collected on 9609 acute stroke admissions to 20 registry hospitals during 2008 and 2009. Predictors of measure compliance (delivery of all 5 subcomponents) were determined using multivariable logistic regression.
Results—
Overall compliance with the stroke education measure was 61.8% (hospital-level compliance ranged between 16% and 93%). Compliance with individual subcomponents were risk factors (65.5%), stroke warning signs (68.9%), emergency medical service activation (66.8%), physician follow-up (92.9%), and discharge medications (91.5%). Age, gender, stroke subtype, prestroke ambulation, discharge destination, and hospital size were all significant independent predictors of compliance. Stroke education was delivered less often to patients who were ≥70 years of age, nonambulatory prestroke, not discharged to home, had transient ischemic attack, or hemorrhagic stroke.
Conclusions—
Only 60% of patients received stroke education consistent with the endorsed performance measures. Strategies to increase stroke education, including the impact of incorporating stroke-specific education measures into hospital care protocols, should be explored.
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Affiliation(s)
- Adrienne Nickles
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
| | - Jay Fiedler
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
| | - Stacey Roberts
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
| | - Sarah Lyon-Callo
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
| | - Rochelle Hurst
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
| | - Mathew Reeves
- From the Michigan Department of Community Health, Lansing, MI (A.N., J.F., S.R., S.L.-C., R.H.); and Department of Epidemiology, Michigan State University, East Lansing, MI (M.R.)
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Byers AM, Lamanna L, Rosenberg A. The effect of motivational interviewing after ischemic stroke on patient knowledge and patient satisfaction with care: a pilot study. J Neurosci Nurs 2011; 42:312-22. [PMID: 21207769 DOI: 10.1097/jnn.0b013e3181f8a5e7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Knowledge of the warning signs of stroke may reduce the incidence of having a second stroke by receiving medical intervention in a timely manner. The need for stroke education is paramount to empower stroke patients to recognize the signs and symptoms of an impending stroke. The purpose of this pilot study was to develop and to evaluate the effectiveness of an educational method of providing stroke education in an acute care setting. Twenty patients were recruited and randomized to two groups. Group 1 received the standard of care: verbal and written education at the time of discharge by the discharge nurse. Group 2 received individualized protocol-driven verbal and written education with their caregiver present within the context of the Therapeutic Alliance Model using motivational interviewing techniques. Each group was sent a Stroke Knowledge Test and a patient satisfaction survey at 1 month. Results indicate that the enhanced education group received improved scores on the Stroke Knowledge Test and had better patient satisfaction scores regarding stroke education. An enhanced educational method using motivational interviewing and an individualized protocol-driven education intervention given to both the patient and a caregiver enhance stroke knowledge and patient satisfaction after discharge from the acute care setting.
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Affiliation(s)
- Ann Marie Byers
- Department of Neurology, Stony Brook University Medical Center Stony Brook, NY, USA.
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