Predicting Compliance With Treatment Following Stroke: A New Model of Adherence Following Rehabilitation

Abstract

B ackground and purpose: Adherence to medication is fundamental to optimal health recovery yet compliance to medication rates are lower than 50% in most studies. This study aimed to investigate the correlates of adherence in stroke patients. Method: Twenty-six stroke patients and 29 amputee patients who had completed a rehabilitation program at Melbourne Rehabilitation Centre were investigated. Medical adherence was determined from computed adherence metrics based on pill counts and subjective reports of patient knowledge of medication use. Model components that were believed to contribute to poor adherence, included emotional and cognitive dysfunction, beliefs about medication, and social support. These factors were assessed by patient and partner self-rating questionnaires. Results: Stroke patients showed a lower level of adherence compared to amputee patients. Cognitive and emotional dysfunction, beliefs about medication, and the level of care were significantly associated with low adherence to medicine regimes in stroke patients. Level of cognitive impairment and emotional impairment were significantly associated with low adherence to medicines in amputee patients. Emotional dysfunction was the best predictor of poor adherence in both patient groups. Conclusion: The findings are in keeping with past adherence studies with other patient groups and support the position that emotional, cognitive, and social factors are important factors in adherence. The specific nonadherence profile for this brain-damaged group is modeled and the application for outpatients following rehabilitation is discussed.

Psychological Determinants of Medication Adherence in Stroke Survivors: a Systematic Review of Observational Studies

“…Settings for participant recruitment included hospital (5/12, 4/7) [ 39 – 41 , 43 , 44 ], community (6/12, 2/7) [ 36 – 38 , 42 , 45 , 46 ] and an outpatient setting (1/12, 1/7) [ 13 ]. The reported stroke subtypes included ischaemic (6/12, 5/7) [ 13 , 39 – 41 , 43 , 44 ], haemorrhagic (3/12, 3/7) [ 39 , 40 , 42 ] and TIA (6/12, 2/7) [ 37 , 38 , 43 – 46 ], with the majority of papers reporting samples with mixed subtypes (75%). In seven papers (3/7 samples), the stroke subtype was either undefined or only some of the sample’s stroke subtypes were defined.…”

“…Time periods between measurement of determinants and adherence varied, with 6/12 papers, 2/7 samples using cross-sectional designs [ 36 – 38 , 41 , 45 , 46 ] and follow-up time frames for prospective studies of 5–6 weeks (1/12, 1/7) [ 13 ], 3 months (2/12, 2/7) [ 42 , 43 ], 12 months (2/12, 2/7) [ 39 , 44 ] and 24 months (1/12, 1/7) [ 40 ]. A range of questionnaire items (validated and non-validated) was used to measure psychological determinants.…”

“…Six articles (50%, 5/7 samples) named the specific medications being assessed for adherence. Of these, five considered antiplatelet, anti-hypertensive, cholesterol-lowering and anti-coagulant medications [ 39 – 41 , 43 , 44 ] and one assessed adherence to antiplatelet, anti-hypertensive and cholesterol-lowering medications [ 13 ].…”

Perspectives on the design and performance of upper-limb wearable stimulation devices for stroke survivors with hemiplegia and spasticity

“…The most prevalent therapies available today are based on intensive limb use, such as constraint-induced movement therapy. However, for nearly 50% of stroke survivors this method is inaccessible due to low dexterity [5,9] and adherence is a known challenge [10,11,12].…”

Evaluation of Medication Adherence among Elderly Patients at the time of stroke Onset in Southeast Rajasthan

“…13 Barriers to medication adherence consist of multiple factors including patient-related factors, social/economic-related factors, condition-related factors, therapy-related factors and health care team-related factors, complex treatment regimens, patient's lack of belief in the treatment, patient's knowledge about the disease, superstitious beliefs, pill size, pill burden. 14,15 A better understanding of these adherence barriers is vital to determine strategies to improve medication adherence. Socioeconomic factors play a very important role in affecting adherence.…”