Subtle Problems in Activities of Daily Living after a Transient Ischemic Attack or an Apparently Fully Recovered Non-disabling Stroke

Verbraak, Marieke E.; Hoeksma, Agnes F.; Lindeboom, Robert; Kwa, Vincent I H

doi:10.1016/j.jstrokecerebrovasdis.2010.05.012

Cited by 49 publications

(34 citation statements)

References 25 publications

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“…Patients with severe stroke in Australia are not always referred for ongoing rehabilitation [9]. Similarly, patients with mild stroke tend not to be referred to rehabilitation services despite frequently experiencing ongoing difficulties with community mobility, return to leisure and work activities, or having altered cognition or mood [10, 11]. It is important that staff working with patients with stroke accurately and consistently assess patients’ rehabilitation needs in order to identify patients who require referrals to rehabilitation services.…”

Section: Introductionmentioning

confidence: 99%

Education-only versus a multifaceted intervention for improving assessment of rehabilitation needs after stroke; a cluster randomised trial

2015

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BackgroundIn 2011, more than half of the patients with stroke in Australian hospitals were not assessed for the need for rehabilitation. Further, there were no recommended criteria to guide rehabilitation assessment decisions. Subsequently, a decision-making tool called the Assessment for Rehabilitation Tool (ART) was developed. The ART was designed to assist Australian hospital clinicians to identify the rehabilitation needs of patients with stroke using evidence-based criteria. The ART was released and made freely available for use in 2012. This study evaluated the effectiveness of an education-only intervention (1 onsite education session and distribution of the ART) and a multifaceted intervention (2 or more onsite education sessions, distribution of the ART, audit and feedback, barrier identification, site-specific strategy development, promotion of interdisciplinary teamwork, opinion leaders and reminders) for improving assessments of rehabilitation needs after stroke.MethodsTen hospitals in 2 states of Australia were randomly assigned to an education-only or a multifaceted intervention. Medical records were audited by assessors blinded to group allocation before and after the implementation period. Difference in the proportion of patients assessed for rehabilitation before and after the intervention was analysed using mixed-effects logistic regression analysis, with time period as the dependent variable, an interaction between intervention type and time included to test for differences between the interventions, and hospital included as the random effect to account for patient clustering.ResultsData from 586 patients (284 pre-intervention; 302 post-intervention; age 76 years, 59 % male) showed that the multifaceted intervention was not more effective than education-only in improving the proportion of patients whose rehabilitation needs were assessed (reference category education-only; odds ratio 1.29, 95 % confidence interval 0.63–2.67, p = 0.483). Post-intervention, the odds of a patient’s rehabilitation needs being assessed was 3.69 times greater than pre-intervention (95 % confidence interval 2.57–5.30, p < 0.001). Evidence-based criteria were not consistently used when patients were deemed to have no rehabilitation needs.ConclusionsA multifaceted intervention was not more effective than education-only in improving the assessment of rehabilitation needs of patients with stroke. Further interventions are required to ensure that all patients are assessed for the need for rehabilitation using evidence-based criteria.Trial registrationANZCTR (Australian New Zealand Clinical Trials Registry), ACTRN12616000340437 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0487-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Education-only versus a multifaceted intervention for improving assessment of rehabilitation needs after stroke; a cluster randomised trial

2015

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“…Whilst there have been many studies focusing on the life post-stroke [7], research focusing on the lived experience of TIA is limited. Studies have implicated TIA in changes in function [8-10], reduced quality of life [11,12], elevated levels of fatigue, anxiety and depression [8,13], and other negative psycho-social outcomes [9,14,15]. However these studies did not include TIA patients below the age of 50 [9,11,15], followed patients for less than six months [8,11,15] and did not include an in depth exploration of patients’ lived experience [8,10,12-15].…”

Section: Introductionmentioning

confidence: 99%

Transient ischaemic attack: a qualitative study of the long term consequences for patients

et al. 2014

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BackgroundTransient ischaemic attack (TIA) is characterised by its transient nature with symptoms of neurological dysfunction resolving within 24 hours. The occurrence of TIA is a major risk factor for stroke with 10–15% of TIA patients going on to have ischaemic stroke. Internationally, recommendations for the management of TIA focus on the need for early diagnosis and medical management of the acute increased risk of ischaemic stroke. However there is a limited amount of evidence that some patients suffer enduring consequences as a result of this ‘transient’ event. This paper focusses on patients’ long term lived experience following a TIA.MethodsSemi structured interviews were carried out with patients who had a TIA between two and 24 months previously. Participants were asked about their TIA, the advice and management received and any changes made as a result of the TIA. Interviews were recorded and transcribed verbatim. Thematic content analysis involved scrutinising transcripts to look for links and associations within and between accounts in a process similar to the grounded theory approach of open coding. The category of transience emerged and was explored in more detail to examine the enduring consequences of TIA.ResultsThirty nine patients aged between 31 and 89 years were interviewed. Accounts detailed the long term impact of the TIA and the subsequent ‘at risk’ status, on the physical and psychosocial wellbeing of participants. Some participants sought to proactively manage the consequences of their TIA but found it difficult to obtain the information and support they needed, whereas others felt that no further action was needed to prevent future stroke.ConclusionCurrent definitions conceptualise TIA as a transient event however our study suggests that some patients experienced long term consequences as a result of their TIA. These included anxiety and uncertainty in the light of their increased stroke risk. TIA patients need access to detailed, evidence based stroke prevention information from a credible source, and support to help them understand and apply the information over time, if they are to effectively self-manage the long term consequences of TIA and reduce their risk of future stroke.

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“…HRQOL has been evaluated in multiple populations and has been found to be important in patients with ischemic stroke and TIA. 3,22,23 While no formal comparison has been conducted between Neuro-QOL and other stroke-specific QOL measures such as the Stroke Impact Score, some advantages of Neuro-QOL might include (1) domain selection based on the outcomes most likely to be affected by the disease (i.e., upper and lower extremity function, cognition, and executive function), (2) continuous normalized scores that simplify analysis and interpretation, and (3) the ability to compare scores across different diseases (i.e., executive function in stroke vs executive function in multiple sclerosis).…”

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confidence: 99%

Quality of life in patients with TIA and minor ischemic stroke

et al. 2015

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Objective: We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system.Methods: Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of #5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke, disability by mRS and Barthel Index, and Neuro-QOL scores in 5 prespecified domains were prospectively recorded. We assessed the proportion of patients with impaired HRQOL, defined as T scores more than 0.5 SD worse than the general population average, and identified predictors of impaired HRQOL using logistic regression.Results: Among 332 patients who met study criteria (mean age 65.7 years, 52.4% male), 47 (14.2%) had recurrent stroke within 90 days and 41 (12.3%) were disabled (mRS .1 or Barthel Index ,95) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17-1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06-4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54-10.10) were independent predictors of impaired HRQOL at 3 months.Conclusions: Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL include age, index stroke severity, and recurrent stroke. Future studies should include HRQOL measures in outcome assessment, as these may be more sensitive to mild deficits than traditional disability scales. Neurology ® 2015;85:1957-1963 GLOSSARY BI 5 Barthel Index; CI 5 confidence interval; DWI 5 diffusion-weighted imaging; HRQOL 5 health-related quality of life; MIS 5 minor ischemic stroke; mRS 5 modified Rankin Scale; NIHSS 5 NIH Stroke Scale; OR 5 odds ratio.Patients with TIA and minor ischemic stroke (MIS) account for the majority of stroke patients who present for emergency care in the United States.1 Mild symptoms on presentation is a common reason for exclusion from IV tissue plasminogen activator administration.2 Acute ischemic stroke leads to decreases in health-related quality of life (HRQOL), even among those who have no or minimal poststroke disability.3 Although the outcomes of most patients with minor symptoms, defined by a low NIH Stroke Scale (NIHSS) score, are favorable, approximately 25% of such patients become disabled. 2Stroke outcomes traditionally have utilized disability scales of functional status, which often fail to represent the full effect of disease and treatment. The modified Rankin Scale (mRS) and Barthel Index (BI) are the most frequently used tools to measure disability and handicap after stroke. 4 With National Institute of Neurological Disorders and Stroke funding to address these limitations, Neuro-QOL was developed as a clinically robust and validated patient-reported HRQOL assessment tool for adults and children wit...

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Subtle Problems in Activities of Daily Living after a Transient Ischemic Attack or an Apparently Fully Recovered Non-disabling Stroke

Cited by 49 publications

References 25 publications

Education-only versus a multifaceted intervention for improving assessment of rehabilitation needs after stroke; a cluster randomised trial

Education-only versus a multifaceted intervention for improving assessment of rehabilitation needs after stroke; a cluster randomised trial

Transient ischaemic attack: a qualitative study of the long term consequences for patients

Quality of life in patients with TIA and minor ischemic stroke

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