This week’s chat will be hosted by Jennifer Crow (@JenniferNCrow); HEE/NIHR Integrated Clinical Academic Doctoral Research Fellow and Clinical Specialist Occupational Therapist in Stroke.
People admitted to a Hyperacute Stroke Unit with a confirmed stroke or TIA and who are physically independent on the ward and ‘pass’ a cognitive screen, typically have a very short inpatient stay. They are thought to have made a full recovery and deemed too good for existing post-discharge stroke pathways and so are discharged home with no onward referrals except for the stroke six-month review and routine medical follow-up appointments.
These stroke survivors report unmet information needs and feeling abandoned on discharge (1, 2). Critically, hidden impairments not apparent in hospital become evident after discharge. If unaddressed these effect participation, return to work, relationships, quality of life and well-being (3-6). Even when a full clinical recovery appears to have occurred, cognitive impairment is often found (7-10). Psychological changes, particularly anxiety and depression are often reported (3, 11-15). Longitudinal studies show that problems with mood, fatigue and cognition persist, reducing participation and well being even years after a so called ‘minor’ stroke. Stroke survivors seeking support and attempting to access follow-up care describe being bounced between primary care and stroke services. There is often disagreement amongst the professional as to who should be managing ongoing mood and adjustment issues as well as fatigue and cognition (16, 17).
Join Jennifer and colleagues from the RCOT SSNP Stoke Forum (@RCOT_NP) to explore this important topic in more detail. We will be discussing the questions below and hope to learn from services where there are new and innovative practices addressing the needs of this specific stroke survivor group.
Question 1 – Assessing hidden impairments within 24 to 48 hours of admission to a HASU is challenging – in what ways are your MDT’s trying to do this?
Question 2 – What follow-up pathways exist within your services for this stroke survivor group and what is the role of the Occupational Therapist in these services?
Question 3 – Support with self-management and navigating post-stroke pathways is key to managing the ongoing effects of the stroke – what techniques or interventions are people using to empower stroke survivors and their families and when are they introduced?
Question 4 – What about stroke survivors that are not admitted to hospital eg those seen in TIA clinics or those diagnosed and discharged from the emergency department? What if any support or guidance are provided to these people within your services?
REFERENCES:
Pindus DM, Mullis R, Lim L, Wellwood I, Rundell AV, Abd Aziz NA, et al. Stroke survivors’ and informal caregivers’ experiences of primary care and community healthcare services – A systematic review and meta-ethnography. PLoS One. 2018;13(2):e0192533.
Crow J. A 2-week stroke review identifies unmet needs in patients discharged home from a hyperacute stroke unit. British Journal of Neuroscience Nursing. 2018;14(1):29-35.
Verbraak ME, Hoeksma AF, Lindeboom R, Kwa VI. Subtle problems in activities of daily living after a transient ischemic attack or an apparently fully recovered non-disabling stroke. J Stroke Cerebrovasc Dis. 2012;21(2):124-30.
Edwards DF, Hahn M, Baum C, Dromerick AW. The impact of mild stroke on meaningful activity and life satisfaction. J Stroke Cerebrovasc Dis. 2006;15(4):151-7.
Sangha RS, Caprio FZ, Askew R, Corado C, Bernstein R, Curran Y, et al. Quality of life in patients with TIA and minor ischemic stroke. Neurology. 2015;85(22):1957-63.
Carlsson GE, Moller A, Blomstrand C. Managing an everyday life of uncertainty–a qualitative study of coping in persons with mild stroke. Disabil Rehabil. 2009;31(10):773-82.
Jokinen H, Melkas S, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, et al. Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol. 2015;22(9):1288-94.
Fens M, van Heugten CM, Beusmans GH, Limburg M, Haeren R, Kaemingk A, et al. Not as transient: patients with transient ischaemic attack or minor stroke experience cognitive and communication problems; an exploratory study. Eur J Gen Pract. 2013;19(1):11-6.
Pendlebury ST, Wadling S, Silver LE, Mehta Z, Rothwell PM. Transient cognitive impairment in TIA and minor stroke. Stroke. 2011;42(11):3116-21.
Wolf TJ, Barbee AR, White D. Executive dysfunction immediately after mild stroke. OTJR (Thorofare N J). 2011;31(1):S23-9.
Altieri M, Maestrini I, Mercurio A, Troisi P, Sgarlata E, Rea V, et al. Depression after minor stroke: prevalence and predictors. Eur J Neurol. 2012;19(3):517-21.
Terrill AL, Schwartz JK, Belagaje SR. Best Practices for The Interdisciplinary Rehabilitation Team: A Review of Mental Health Issues in Mild Stroke Survivors. Stroke Res Treat. 2018;2018:6187328.
Sackley CM, Mant J, McManus RJ, Humphreys G, Sharp L, Mares K, et al. Functional and emotional outcomes after transient ischemic attack: A 12-month prospective controlled cohort study. Int J Stroke. 2019;14(5):522-9.
Kellett N, Drummond AER, Palmer T, Munshi S, Lincoln NB. Impact of transient ischaemic attack and minor stroke on daily life. International Journal of Therapy and Rehabilitation. 2014;21(7):318-23.
Alenljung M, Ranada ÅL, Liedberg GM. Struggling with everyday life after mild stroke with cognitive impairments – The experiences of working age women. British Journal of Occupational Therapy. 2018;82(4):227-34.
Lim L, Mant J, Mullis R, Roland M. When is referral from primary care to specialist services appropriate for survivors of stroke? A modified RAND-appropriateness consensus study. BMC Fam Pract. 2020;21(1):66.
Tang EYH, Price C, Stephan BCM, Robinson L, Exley C. Gaps in care for patients with memory deficits after stroke: views of healthcare providers. BMC Health Serv Res. 2017;17(1):634-.
POST CHAT
Host: @JenniferNCrow
Support on OTalk Account: @paulwilkinson94
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