Delivery of high quality stroke and vision care: experiences of UK services

Abstract

Practical elements for improved stroke and vision care provision are highlighted which can be implemented with relatively little financial inputs. Implications for Rehabilitation Integrated vision services within stroke units can improve the detection of visual problems in stroke survivors leading to earlier visual rehabilitation. Orthoptists within core stroke teams are beneficial to the delivery of a high quality service. This study illustrates clear practical elements to support the provision of high quality integrated stroke and vision services. Relatively little financial inputs are required to fund such services but with larger potential to improve patient care.

Visual dysfunction is underestimated in patients with acquired brain injury

“…Rowe et al (30), after interviewing personnel working in different units for integrated care of vision/ stroke patients, listed key elements in order to obtain high-quality stroke/vision services. Among these key elements were standardized screening/referral forms, an orthoptist as a core member of the team, formal support from stroke physician and a vision care pathway.…”

“…TVI has made it easier to provide specific information during referrals and thereby facilitates the necessary cooperation with the ophthalmologist. An important step was to integrate a person with visual-therapy competence into our rehabilitation team (30). As a result, the rehabilitation assessments and vision-related rehabilitation have improved, although much work remains to be done to fulfil the goal of high-quality vision care for patients with ABI.…”

Stroke survivors’ views and experiences on impact of visual impairment

“…Poor care provision with resultant unmet need for stroke survivors who experience visual impairment has been previously documented (Rowe et al., ). Clear recommendations exist for the delivery of appropriate service provision (Rowe et al., ).…”

Vision In Stroke cohort: Profile overview of visual impairment

“…Given that poststroke visual impairment is estimated at 65% (Hepworth et al., ) and in view of the confirmed unmet needs reported by stroke survivors with visual impairment (Rowe et al., ) there is an urgent requirement to implement comprehensive, wide‐spread screening of stroke survivors to ensure identification of their visual issues. National guidance exists for provision of specialist services on stroke units for poststroke visual impairment with orthoptists being recommended as part of the core acute stroke unit team (British Irish Orthoptic Society, ; Intercollegiate Stroke Working Party, ); services that are proven to be feasible and acceptable for delivery on acute stroke units and neuro‐rehabilitation units and which are cost effective (Pollock, Hazelton, & Brady, ; Rowe et al., ). Recent research reports vision screening to be achievable at a median of 3 days post stroke with full visual examinations achieved at a median of 4 days post stroke (Rowe, Hepworth, Hanna, & Howard, ).…”