Results of a UK-wide vignette study with occupational therapists to explore cognitive screening post stroke

Abstract

Background/Aims There is a paucity of evidence in the UK regarding cognitive screening performed by occupational therapists and whether, and how, cognitive impairments are identified and assessed. The aim of this study was to identify current occupational therapy practice for the assessment of cognitive problems in patients following stroke. Methods Occupational therapists were invited to complete an online vignette study. Participants were asked to: identify any presenting cognitive problems; decide whether to complete cognitive assessments; and list any assessments they would use. Data were analysed using descriptive analysis. Results A total of 53 occupational therapists from across the UK participated. Participants identified key cognitive issues, but some problems, such as apraxia and attention, were overlooked. A large number of potential assessments were suggested, the most common being the Montreal Cognitive Assessment and Oxford Cognitive Screen. Conclusions The variation found in occupational therapists' recognition and assessment of cognitive problems has the potential to impact on management and rehabilitation in stroke services, survivor outcomes, education and research.

Cognitive Management Pathways in Stroke Services (COMPASS): A qualitative investigation of key issues in relation to community stroke teams undertaking cognitive assessments

“…This variation seemed to depend on the occupational therapists’ judgement of the patients’ cognitive problems and of their circumstances. These findings reflect results from an earlier phase of the COMPASS study (Geraghty et al., 2019), where occupational therapists were asked to comment on patient scenarios. These findings demonstrated inconsistencies in the identification of cognitive problems and also found a large number of cognitive assessments to screen patients were being suggested.…”

“…All participants demonstrated sound working knowledge of community stroke rehabilitation. Sixteen of the participants had also taken part in an earlier phase of the COMPASS study (Geraghty et al., 2019).…”

“…We invited occupational therapists who were members of strategic groups or special interest groups (for example Royal College of Physicians Intercollegiate Stroke Working Party, the Royal College of Occupational Therapists Specialist Section and the UK Stroke Forum) to take part in the study. We also recruited from a pool of participants who had taken part in an earlier phase of the study, reported elsewhere (Geraghty et al., 2019). We aimed to recruit a purposive sample of 20 participants, a pragmatic recruitment target in line with the resources of the study but that would adequately address our research aims.…”

“…The semi-structured interview guide was developed based on existing literature, the results of the phase one study (Geraghty et al., 2019) and the study objectives. It was developed by the research team, with input from the COMPASS study steering group.…”

Turning the spotlight on assessment of severe cognitive impairment: Reducing disparity and inequality in stroke care

“…Four related studies (Geraghty et al, 2019; Koh et al, 2009; Korner-Bitensky et al, 2011; Pilegaard et al, 2014) focused on the assessment of individuals with mild cognitive impairment post stroke and participants were predominantly experienced OTs, with 5–10 years of stroke experience. These studies found that while OTs preferred using functional cognitive assessments, because they are client centred and meaningful to the patient (Koh et al, 2009), there was a wide variability in their content (Pilegaard et al, 2014).…”