Impact of depression following a stroke on the participation component of the International Classification of Functioning,Disability and Health

Purpose: To assess the impact of post-stroke depression on the participation component of the International Classification of Functioning, Disability and Health (ICF).

Method: Thirty-five stroke survivors with chronic hemiparesis were divided into two groups: those with and without depression. The Geriatric Depression Scale (GDS) was used for the analysis of depressive symptoms. Participation was analysed using the Stroke Specific Quality of Life scale. The Mann–Whitney test was used to compare the participation scores between the two groups. Spearman’s correlation coefficients were calculated to determine the strength of the association between the assessment tools. Simple linear regression was used to determine the impact of depression on participation. An alpha risk of 0.05 was considered indicative of statistical significance.

Results: The group with depression had low participation scores (p?=?0.04). A statistically significant negative correlation of moderate magnitude was found between depression and participation (r?= ?0.6; p ?=?0.04). The linear regression model demonstrated that depression is a moderate predictor of participation (r²?=?0.51; p?=?0.001).

Conclusions: Depression is a moderate predictor of participation among stroke survivors, explaining 51% of the decline of this aspect. Thus, depression should be diagnosed, monitored and treated to ensure a better prognosis regarding social participation following a stroke.

• Implications for Rehabilitation

• Individuals with post-stroke depression experience a lower degree of social participation.

• Depression explains 51% of the decline in participation following a stroke.

• The present findings can serve as a basis to assist healthcare professionals involved in the rehabilitation of stroke survivors and can assist in the establishment of adequate treatment plans in stroke rehabilitation.

     

Exploring the experience of psychological morbidity and service access in community dwelling stroke survivors: a follow-up study

Abstract

Purpose: Post-stroke depression occurs in one-third of stroke survivors with a similar risk of development across short, intermediate and long-term recovery stages. Knowledge of factors influencing psychological morbidity beyond the first year post-stroke can inform long-term interventions and improve community service access for stroke survivors. This paper aimed to identify the physical and psycho-social functioning status of stroke survivors beyond 12 months post-stroke. Qualitative processes explored the longer term experiences of psychological morbidity and service access needs. Method: A cross-sectional follow-up of participants from a prospective cohort study. In that study, patients and were followed for 12 months post-stroke. In this study, participants from that cohort study were interviewed up to five years post-stroke. Data generation and analysis were concurrent and were analysed thematically, employing a process of constant comparison. Results: Our sample included 14 participants, aged 58–89 years at an average of three years post-stroke (range 18 months to five years). Our qualitative key themes emerged as follows: physical impacts on post-stroke psychological morbidity, the experience of psychological distress, factors attenuating distress and service delivery implications. Conclusions: The experience of psychological morbidity persists beyond 12 months post-stroke, having a profound impact on community access, and social participation. Clinical implications are a need for long-term psychological monitoring post-stroke and for ongoing rehabilitation that addresses disability, community participation and social support.

• Implications for Rehabilitation

• Psychological distress post-stroke is complex and persists over time, thus requiring longer term monitoring beyond the first 12 months of stroke onset.

• Longer term access to allied health can play a significant role in providing interventions that address distress and maintain community participation.

• If patients meet threshold scores at any time, then GPs should consider initiating appropriate treatment, including pharmacotherapy, referral to psychotherapy and referral to community stroke rehabilitation.

     

Correlates of depressive symptoms in individuals attending outpatient stroke clinics

Background and purpose Depressive symptoms are common post-stroke. We examined stroke deficits and lifestyle factors that are independent predictors for depressive symptomology. Methods A retrospective chart review was performed for patients’ post-stroke who attended outpatient clinics at a hospital in Southwestern Ontario between 1 January 2014 and 30 September 2014. Demographic variables, stroke deficits, secondary stroke risk factors and disability study measures [Patient Health Questionnaire-9 (PHQ-9) and Montreal Cognitive Assessment (MoCA)] were analyzed. Results Of the 221 outpatients who attended the stroke clinics (53% male; mean age?=?65.2?±?14.9 years; mean time post-stroke 14.6?±?20.1 months), 202 patients were used in the final analysis. About 36% of patients (mean?=?5.17?±?5.96) reported mild to severe depressive symptoms (PHQ-9?≥?5). Cognitive impairment (CI), smoking, pain and therapy enrollment (p?r=??0.39, p?Conclusions High levels of depressive symptoms are common in the chronic phase post-stroke and were partially related to cognition, pain, therapy enrollment and lifestyle factors.

• Implications for Rehabilitation

• Stroke patients who report cognitive deficits, pain, tobacco use or being enrolled in therapy may experience increased depressive symptoms.

• A holistic perspective of disease and lifestyle factors should be considered while assessing risk of depressive symptoms in stroke patients.

• Patients at risk for depressive symptoms should be monitored at subsequent outpatient visits.

     

Performance and capacity-based measures of locomotion,compared to impairment-based measures,best predicted participation in individuals with hemiparesis due to stroke

Purpose: To determine the potential predictors of participation of individuals with post-stroke hemiparesis, taking into account modifiable variables of impairments, activity limitations, and environmental factors.

Methods: One hundred and nine individuals (58?±?12 years; 64 men) participated in this study. Outcomes included measures of impairments (depressive symptoms: Geriatric Depression Scale and motor-based impairments: finger-to-nose test, lower extremity (LE) motor coordination test, and handgrip strength, isometric strength of the LE muscles), activity (capacity: 10-meter walking speed test and Test d'Évaluation des Membres Supérieurs de Personnes Agées; performance: locomotion and manual abilities; environmental factors (Measure of the Quality of the Environment); and participation: Assessment of Life Habits (LIFE-H 3.1 Brazil)).

Results: Regression analyses revealed that the explanatory variables accounted for 59% and 49% of the variance in the LIFE-H 3.1 Brazil daily activity and social role sub-scales, respectively. Locomotion performance (R²?=?39%; p?R²?=?32%; p?Conclusions: Performance and capacity-based measures of locomotion showed to be the best predictors of participation. Additionally, depressive symptoms should not be underlooked.

• Implications for Rehabilitation

• Activity-related measures of locomotion showed to be the main predictors of participation in individuals with post-stroke hemiparesis, as assessed by the daily activity and social role sub-scales of the LIFE-H 3.1.

• The daily activity model was best predicted by measures of performance, whereas the social role sub-scale, by measures of capacity.

• Although small, the impact of depressive symptoms on participation should not be underlooked.

• Locomotion appeared to be essential for participation and increases in walking speed and locomotion ability should be the main goals for both professionals and individuals, when the aim is to increase participation.

     

Fall-related experiences of stroke survivors: a meta-ethnography

Purpose: Health professionals view falls after stroke as common adverse events with both physical and psychological consequences. Stroke survivors’ experiences are less well understood. The aim of this systematic review was to explore the perception of falls-risk within the stroke recovery experience from the perspective of people with stroke. Methods: A systematic literature search was conducted. Papers that used qualitative methods to explore the experiences of individuals with stroke around falls, falls-risk and fear of falling were included. Two reviewers independently assessed the methodological quality of papers. Meta-ethnography was conducted. Concepts from each study were translated into each other to form theories that were combined through a “lines-of-argument” synthesis. Results: Four themes emerged from the six included qualitative studies: (i) Fall circumstances, (ii) perception of fall consequences, (iii) barriers to community participation and (iv) coping strategies. The synthesis revealed that stroke survivors’ perceived consequences of falls exist on a continuum. Cognitive and emotional adjustment may be required in the successful adoption of coping strategies to overcome fall-related barriers to participation. Conclusions: Stroke survivors’ fall-related experiences appear to exist within the context of activity and community participation. Further research is warranted due to the small number of substantive studies available for synthesis.

• Implications for Rehabilitation

• Health care professionals should recognize that cognitive and emotional adjustment may berequired for stroke survivors to accept strategies for overcoming falls-risk, including dependenceon carers and assistive devices.

• Several factors in addition to physical interventions may be needed to minimize falls-risk whileincreasing activity participation.

• These factors could include increasing public awareness about the effects of stroke and falls-risk,and ensuring access to psychological services for stroke survivors.

• Rehabilitation professionals should reflect on whether they perceive there to be an appropriatelevel of fear of falling post-stroke.

• They should understand that stroke survivors might not conceptualize falls-risk in this way.

     

Long-term restrictions in participation in stroke survivors under and over 70 years of age

Purpose: This study aims to (1) assess differences in participation restrictions between stroke survivors aged under and over 70 years and (2) identify predictors associated with favorable and unfavorable long-term participation in both age groups.

Methods: Prospective cohort study in which 326 patients were assessed at stroke onset, two months and one year after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was used to measure participation restrictions one year after stroke. Bivariate and multivariate logistic regression analyses were performed including demographic factors, stroke-related factors, emotional functioning and comorbidity as possible predictors.

Results: Stroke survivors aged over 70 years perceived more participation restrictions in comparison to stroke survivors aged under 70 years one year after stroke. Independently significant predictors for unfavorable participation outcomes were advancing age, more severe stroke and anxiety symptoms in patients aged over 70 years, and female gender, more severe stroke, impaired cognition and depression symptoms in patients aged under 70 years. Lower age was the only independent predictor associated with favorable participation after one year in stroke survivors aged over 70 years.

Conclusions: This study emphasizes the need to pay more attention to participation restrictions in elderly stroke survivors.

• Implications for rehabilitation

• More attention in the rehabilitation process should be paid to restrictions in participation of stroke survivors aged older than 70 years, taking into account the different participation needs and predictors of older stroke survivors.

• Early screening on the presence of anxiety symptoms could potentially prevent long-term restrictions in participation in stroke survivors aged over 70-year old.

• Stroke survivors experience considerable restrictions in physical activity and mobility after one year, highlighting the need for the development of community-based exercise programs for stroke survivors.

     

The process of re-engagement in personally valued activities during the two years following stroke

Purpose: Engagement in valued activities is often difficult for people who have experienced stroke. A deeper understanding of the process of re-engagement in personally valued activities would be helpful to those designing interventions to address participation post-stroke. Method: Six community-dwelling individuals recovering from a first stroke were interviewed at 6, 9, 12, 18 and 24 months post-stroke. A grounded theory approach was used to construct a substantive theory of re-engagement in valued activities during this period. Results: Two core concepts, social connection and being in charge were identified. Both led to activity engagement and risk taking to test abilities. These led to lowering of current expectations and activity adaptation which supported hope for recovery and further testing. Alternatively, difficulties perceived to be related to ageing led to disengagement. Conclusions: Rehabilitation practice that addresses and supports autonomy, social connection, risk taking, adaptation and hope among stroke survivors may help individuals regain personally valued activities post-stroke.

Implications for Rehabilitation

• This qualitative study shows that the process of re-engagement in valued activities during the 2 years following stroke was constructed around two core concepts: social connection and being in charge.

• Rehabilitation practice that supports autonomy, social connection, risk taking, adaptation and hope among stroke survivors may help individuals regain personally valued activities post-stroke.

     

From physical and functional to continuity with pre-stroke self and participation in valued activities: A qualitative exploration of stroke survivors’, carers’ and physiotherapists’ perceptions of physical activity after stroke

Abstract

Purpose: Physical activity (PA) improves fitness, functioning, health and wellbeing after stroke. However, many survivors are inactive. This study explored survivors’, carers’ and physiotherapists’ beliefs about PA to identify how these support or hinder PA participation. Methods: Semi-structured in-depth interviews with community dwelling stroke survivors (n?=?38); two focus groups involving six carers each; two focus groups, respectively, involving seven and eight stroke rehabilitation physiotherapists from clinical and community settings. Data were audio-recorded and transcribed. Analysis was structured using the Framework Approach to identify themes and a dynamic, conceptual model. Findings: Desired outcomes and control over outcome achievement were key concepts. For survivors and carers, PA supported participation in valued activities, providing continuity with pre-stroke sense of self. Carers adopted motivating strategies for PA to support recovery and participation in shared activities. In contrast, physiotherapists prioritised physical and functional outcomes and viewed survivors’ control of outcomes as limited which was reflected by the support they provided. Conclusions: Individualised interventions that account for social and environmental influences on behaviour appear vital to enabling survivors to participate in meaningful physical activities. Such interventions should facilitate development of shared perspectives among physiotherapists, carers and survivors of PA and related outcomes and provide tailored strategies to facilitate PA participation.

• Implications for Rehabilitation

• Physical activity after stroke rehabilitation is important for fitness, health, functioning and well-being.

• Reasons for survivors participating or not in physical activity after stroke are complex and varied.

• Physiotherapists and carers influence survivors’ participation in physical activity but their views about how to do this do not always match, or do they always complement the views of survivors.

• Integrated approaches to supporting physical activity that account for survivors’ preferences and recognise the carers’ role should be developed and applied by physiotherapists and other health professionals.

     

A single robotic session that guides or increases movement error in survivors post-chronic stroke: which intervention is best to boost the learning of a timing task?

Purpose: Timing deficits can have a negative impact on the lives of survivors post-chronic stroke. Studies evaluating ways to improve timing post stroke are scarce. The goal of the study was to evaluate the impact of a single session of haptic guidance (HG) and error amplification (EA) robotic training interventions on the improvement of post-stroke timing accuracy.

Materials and methods: Thirty-four survivors post-chronic stroke were randomly assigned to HG or EA. Participants played a computerized pinball-like game with their affected hand positioned in a robot that either helped them perform better (HG) or worse (EA) during the task. A baseline and retention phase preceded and followed HG and EA, respectively, in order to assess their efficiency at improving absolute timing errors. The impact of the side of the stroke lesion on the participants’ performance during the timing task was also explored for each training group.

Results: An improvement in timing performance was only noted following HG (8.9?±?4.9?ms versus 7.8?±?5.3?ms, p?=?0.032). Moreover, for the EA group only, participants with a left-sided stroke lesion showed a worsening in performance as compared to those with a right-sided stroke lesion (p?=?0.001).

Conclusion: Helping survivors post-chronic stroke perform a timing-based task is beneficial to learning. Future studies should explore longer and more frequent HG training sessions in order to further promote post stroke motor recovery.

• Implications for Rehabilitation

• Timing is crucial for the accomplishment of daily tasks.

• The number of studies dedicated to improving timing is scarce in the literature, even though timing deficits are common post stroke.

• This innovative study evaluated the impact of a single session of haptic guidance-HG and error amplification-EA robotic training interventions on improvements in timing accuracy among survivors post chronic stroke.

• HG robotic training improves timing accuracy more than EA among survivors post chronic stroke.

     

Acute phase factors associated with the course of depression during the first 18 months after first-ever stroke

Purpose: The aim of this study was to describe the course of post-stroke depression (PSD) during the first 18 months after first-ever stroke and to examine differences in the course of depressive symptoms in relation to patient demographic and clinical characteristics in the acute phase. Methods: As part of a longitudinal cohort study, data were collected from medical records and in face-to-face interviews using standardized questionnaires within 15 days after stroke and 6, 12 and 18 months later. The sample consisted of 94 patients with first-ever stroke. PSD was measured with the Beck Depression Inventory II. Repeated measures analysis of variance was used to evaluate the course of depressive symptoms over time and in relation to demographic and clinical variables. Results: Depression levels were stable during the 18 months after first-ever stroke. However, depression scores were significantly higher among patients who had lower physical functioning in the acute phase, were living alone or were not employed at the time of stroke. Conclusions: Several demographic and acute phase factors were associated with a more severe PSD course following stroke. Psychosocial support that begins in the acute phase and continues throughout the rehabilitation process may be helpful in improving both physical and psychological outcomes following stroke.

• Implications for Rehabilitation

• Depression levels are stable during the first 18 months after first-ever stroke.

• The course of post-stroke depression is related to the level of physical functioning in the acute phase, whether the stroke survivors live alone and their employment status at the time of stroke.

• Psychological support that begins in the acute phase and continues throughout the rehabilitation process may be helpful in improving both physical and psychological outcomes following stroke.

     

Perceived confidence relates to driving habits post-stroke

Abstract

Purpose: Returning to driving post-stroke is a step towards independence. On return to driving following stroke, confidence is related to performance in on-road assessment and self-regulation of driving behaviours occurs. The aim of this study was to examine the relationship between driver’s confidence and driving habits post-stroke. Method: Structured telephone surveys were completed with 40 stroke survivors (62% men), of mean age 65 years SD 12.17 who returned to driving post-stroke within the previous 3 years. The survey included: (1) socio-demographics, (2) Adelaide Driving Self Efficacy Scale (ADSES) and (3) Driving Habits Questionnaire (DHQ). Results: Male stroke survivors were more likely to return to driving, drive further and more often. Stroke survivors under 65 years were likely to drive further. Driving confidence was significantly associated with kilometres driven (p?=?0.006), distance driven (p?=?0.027) and self-limiting driving (p?=?0.00). Conclusion: Findings indicate a relationship between confidence and driving behaviours post-stroke. Early recognition of driving confidence will help professionals target specific strategies, encouraging stroke survivors to return to full driving potential, access activities and positively influence quality of life.

• Implications for Rehabilitation

• Findings indicate a relationship between confidence and driving behaviours post-stroke.

• Early recognition of driving confidence will help professionals target specific strategies, encouraging stroke survivors to return to full driving potential, access activities and positively influence quality of life.

     

Effects of lateralized light flash and color on unilateral neglect

Abstract

Purpose: Bottom-up-based sensory stimulation has been useful in promoting recovery from post-stroke neglect. Light and color are salient stimuli for guiding our orienting behaviors and influence the degree of spatial bias. This study evaluated the effects of lateralized light flash and color on spatial bias in unilateral neglect (UN). Method: We enrolled 15 individuals with UN as a consequence of a right hemispheric stroke of less than 65?d. This was a 3?×?3 design study with three conditions of lens color (colorless, red, and blue) and three conditions of flash light locations (no flash, left, and right). Results: All participants showed a decrease in ipsilesional spatial bias under left-side light flash and a red lens. Right-side light flash and a blue lens induced more rightward bias than other conditions. Conclusions: This evidence confirms the use of sensory stimulation to complement post-stroke UN remediation. Lateralized light flash to the contralesional space and red-colored lenses have beneficial effects on amelioration of UN, whereas ipsilesional light flash and the color blue may exacerbate ipsilesional spatial bias in stroke survivors with UN.

• Implications for Rehabilitation

• Contralesional light flash and the color red may ameliorate ipsilesional spatial bias in stroke survivors with unilateral neglect (UN).

• Ipsilesional flash of light and the color blue may worsen ipsilesional spatial bias in stroke survivors with UN.

     

Developing a personalised self-management system for post stroke rehabilitation; utilising a user-centred design methodology

Abstract

Purpose: To develop and evaluate an information and communication technology (ICT) solution for a post-stroke Personalised Self-Managed Rehabilitation System (PSMrS). The PSMrS translates current models of stroke rehabilitation and theories underpinning self-management and self-efficacy into an ICT-based system for home-based post-stroke rehabilitation. Methods: The interdisciplinary research team applied a hybrid of health and social sciences research methods and user-centred design methods. This included a series of home visits, focus groups, in-depth interviews, cultural probes and technology biographies. Results: The iterative development of both the content of the PSMrS and the interactive interfaces between the system and the user incorporates current models of post-stroke rehabilitation and addresses the factors that promote self-managed behaviour and self-efficacy such as mastery, verbal persuasion and physiological feedback. Conclusion: The methodological approach has ensured that the interactive technology has been driven by the needs of the stroke survivors and their carers in the context of their journey to both recovery and adaptation. Underpinned by theories of motor relearning, neuroplasticity, self-management and behaviour change, the PSMrS developed in this study has resulted in a personalised system for self-managed rehabilitation, which has the potential to change motor behaviour and promote the achievement of life goals for stroke survivors.

• Implications for Rehabilitation

• Radical innovation and the adoption of a self-management paradigm need to be considered as a way of delivering home-based post-stroke rehabilitation.

• A hybrid of health and social sciences research and user-centred design methods are required to ensure that technology for post-stroke rehabilitation has been driven by the needs of the stroke survivors and their carers.

• Personalised technology systems for self-managed post-stroke rehabilitation have the potential to change motor behaviour and promote the achievement of life goals for stroke survivors.

     

Are patients 1 year post-stroke active enough to improve their physical health?

Purpose: This study aimed to quantify physical activity one year post-stroke ? by means of a multifaceted approach combining absolute, relative, and self-reported measures of physical activity (PA) ? and to investigate their mutual associations. The determinants of PA were explored. Method: Daily PA was measured in 16 mildly disabled stroke patients (median RMA-GF score of 12 (IQR?=?10–12.5)) using a heart rate monitor, a pedometer, the Baecke Physical Activity Questionnaire and the Physical Activity Scale for individuals with physical disabilities. Potential determinants were age, gender, functional mobility, peak exercise capacity, mood, participation and hours of daylight. Results: On average, stroke participants had a good baseline level of activity (44?±?39?min/day spent moderate active, 6428?±?4117 steps/day), but only three (19%) performed more than 10,000 steps/day, required for health benefits. Functional mobility, cardiorespiratory fitness, mood and participation were related to the total daily steps, but not to the time spent in moderate intense activities. Discrepancies between absolute (frequency and duration) and relative (intensity) measures of PA exist regarding the achieved quantity and its potential determinants. Conclusions: It is not only important to be active, but to be active enough to improve health. Health recommendation for stroke survivors to perform moderate intense PA needs to be translated into a pedometer-based step goal.

Implications for Rehabilitation

• On average, stroke survivors had a good baseline level of physical activity (PA), but only some reached a level which could improve their physical health.

• Health recommendations for stroke survivors on amount of moderate intense PA should be translated into a pedometer-based step goal.

     

Explicit motor sequence learning with the paretic arm after stroke

Purpose: Motor sequence learning is important for stroke recovery, but experimental tasks require dexterous movements, which are impossible for people with upper limb impairment. This makes it difficult to draw conclusions about the impact of stroke on learning motor sequences. We aimed to test a paradigm requiring gross arm movements to determine whether stroke survivors with upper limb impairment were capable of learning a movement sequence as effectively as age-matched controls.

Materials and methods: In this case-control study, 12 stroke survivors (10–138 months post-stroke, mean age 64 years) attempted the task once using their affected arm. Ten healthy controls (mean 66 years) used their non-dominant arm. A sequence of 10 movements was repeated 25 times. The variables were: time from target illumination until the cursor left the central square (onset time; OT), accuracy (path length), and movement speed.

Results: OT reduced with training (p?p?>?0.1). We quantified learning as the OT difference between the end of training and a random sequence; this was smaller for stroke survivors than controls (p?=?0.015).

Conclusions: Stroke survivors can learn a movement sequence with their paretic arm, but demonstrate impairments in sequence specific learning.

• Implications for Rehabilitation

• Motor sequence learning is important for recovery of movement after stroke.

• Stroke survivors were found to be capable of learning a movement sequence with their paretic arm, supporting the concept of repetitive task training for recovery of movement.

• Stroke survivors showed impaired sequence specific learning in comparison with age-matched controls, indicating that they may need more repetitions of a sequence in order to re-learn movements.

• Further research is required into the effect of lesion location, time since stroke, hand dominance and gender on learning of motor sequences after stroke.

     

Sexuality after stroke: patient counseling preferences

Abstract

Purpose: Sexual dysfunction is common after stroke, but is frequently not addressed by healthcare providers. The aim of this study was to examine patient preferences for counseling related to sexuality post-stroke. Method: Two hundred and sixty-eight patients from a stroke registry were provided an anonymous paper or online survey. Thirty-eight patients responded and completed the survey. The survey included demographic information, and scales of sexual dysfunction, fatigue, depression and functional independence. In addition, we queried subjects about stroke-related sexual dysfunction and their preferences for counseling and education materials. Results: Most respondents (71%) identified sexuality as a moderately to very important issue in their post-stroke rehabilitation. Sexual dysfunction was common, with 47% of respondents indicating that their sexual function had declined since the stroke. Eighty-one percent reported receiving insufficient information about sexuality post-stroke, and the majority (60%) expressed a preference for receiving counseling regarding sexuality from a physician. A substantial portion (26.5%) of patients wanted to receive counseling prior to discharge from a hospital or rehabilitation center, with 71% wishing to receive counseling within 1 year post-stroke. Conclusions: Many stroke survivors experience sexual dysfunction and indicate a desire for additional information and counseling from healthcare providers. Preferences regarding the timing of such counseling vary, creating challenges for optimizing the delivery of this care.

• Implications for Stroke Rehabilitation

• Sexual dysfunction is common after stroke, but is frequently not addressed by healthcare providers.

• Many stroke survivors experience sexual dysfunction and indicate a desire for additional information and counseling from healthcare providers.

• Most stroke survivors identify sexuality as an important issue in their post-stroke rehabilitation.

• Exploring individual stroke survivor counseling preferences periodically over the course of recovery may be a useful strategy for delivering the desired information at the most appropriate time.

     

Community re-integration and long-term need in the first five years after stroke: results from a national survey

Abstract

Purpose: Acute stroke care continues to improve but the later stroke recovery phase remains less well understood. The aim of this study was to document self-reported need in relation to stroke recovery and community re-integration among community-dwelling persons up to five years post-stroke. Methods: A national survey was carried out in Ireland. Participants were recruited through stroke advocacy organisations and health professionals. Existing validated questionnaires were adapted with permission. The final questionnaire assessed respondents’ perceptions of their community re-integration and on-going needs. Results: A total of 196 stroke survivors, aged 24–89 years responded. Over 75% of respondents reported experiencing mobility, emotional, fatigue and concentration difficulties post-stroke. Emotional problems and fatigue demonstrated the highest levels of unmet need. Families provided much support with 52% of people needing help with personal care post-stroke. Forty-two per cent of respondents in a relationship felt that it was significantly affected by their stroke. In addition, 60% of respondents reported negative financial change. Only 23% of those <66 years had worked since their stroke, while 60% of drivers returned to driving. Conclusions: Stroke had a personal, social and economic impact. Emotional distress and fatigue were common and satisfaction with the help available for these problems was poor.

• Implications for Rehabilitation

• Professionals should recognise that family members provide high levels of support post-stroke while dealing with changes to personal relationships.

• Emotional, concentration and fatigue problems post-stroke require recognition by health professionals.

• A greater focus on return-to-work as part of stroke rehabilitation may be of value for patients of working age.