Awareness and support for post-stroke fatigue among medical professionals in the recovery phase rehabilitation ward.

Sato M, Hyakuta T. Awareness and support for post-stroke fatigue among medical professionals in the recovery phase rehabilitation ward. Jpn J Compr Rehabil Sci 2023; 14: 39-48. Objective: To clarify the level of awareness of and support for post-stroke fatigue among medical professionals working in recovery phase rehabilitation wards. Methods: We conducted a questionnaire survey targeting all medical professionals (physicians, nurses, physical therapists, occupational therapists, and speech therapists) working in recovery phase rehabilitation wards of three facilities to evaluate their awareness of post-stroke fatigue and the support they were offering to address this. Quantitative data were subjected to statistical analysis and free description data were subjected to content analysis. Results: Of the 130 participants, we obtained responses from 94 (collection rate, 72.3%; valid response rate, 100%). Those who felt that post-stroke patients are always tired or tire easily comprised 63.8%. Those who acknowledged the importance of post-stroke fatigue as a problem and that it is an issue that must be addressed comprised 70.2% and 73.4%, respectively. Issues emerging due to post-stroke fatigue were extracted as follows: "Difficulty continuing with rehabilitation," "Decreased drive," "Difficulty with emotional control/depression," "Fewer interactions with others," and "Loss of goals." Support for post-stroke fatigue was offered by 57.4% of medical professionals, most commonly as individual support such as "Ensure rest." The effects of support were described as "Cannot say either way" (44.4%), with 3.7% noting that they were not very effective. Awareness and support rates among therapists were significantly higher than those among nurses. Conclusions: Post-stroke fatigue is acknowledged by medical professionals as a critical issue that negatively influences the patient's physical, emotional, and daily living functions. Unfortunately, effective support is not currently being offered, demonstrating the need for the development of appropriate interventions.

Effects of an Education Program for Home Blood Pressure Measurements in Stroke Patients: A Randomized Controlled Trial.

ABSTRACT: BACKGROUND : Stroke patients must review their previous lifestyle and take daily actions to control risk factors for recurrence. METHODS : A nonblind, randomized controlled trial was conducted in stroke patients to determine whether an education program intervention would alter behavior concerning home blood pressure measurements. This prospective, randomized controlled trial recruited 48 inpatients with stroke randomly assigned to an intervention group (n = 24) or a usual care group (n = 24). The intervention involved 5 face-to-face support or telephone support sessions over 6 months to provide information regarding home blood pressure measurements and to confirm patient behavior using a textbook, a blood pressure recording form, and a blood pressure measurement device. RESULTS : There were no significant differences at baseline between the intervention and usual care groups. The median rate of performing home blood pressure measurements at 12 months was significantly higher in the intervention group (100.0% [99.1%-100.0%], n = 24) than the control group (62.5% [27.7%-87.5%], n = 24) ( P < .001). The rates of home blood pressure measurements (at 1, 3, and 7 months after registration) were also significantly higher in the intervention group. Seven months after registration, home blood pressure values (systolic blood pressure) were significantly lower in the intervention group than the control group ( P = .025). In contrast, there was no significant difference at 1, 3, or 12 months after registration. CONCLUSION : Our results suggest that although the rate of home blood pressure measurements in both groups decreased, the rate was higher in the intervention group compared with the usual care group, indicating that the intervention was effective.

Effects of a Disease Management Program for Preventing Recurrent Ischemic Stroke.

Background and Purpose- Disease management is a healthcare strategy that includes self-management education and treatment coordination. We conducted a randomized controlled trial to determine whether a disease management program intervention could improve risk factor profiles and, thus, reduce the recurrence of stroke and other cardiovascular diseases. Methods- This study is a prospective randomized, open-label, parallel group study involving outpatients with a history of stroke. Between September 2010 and November 2012, we enrolled patients aged between 40 and 80 years who experienced their last ischemic stroke event or transient ischemic attack within 1 year. After stratifying by the ischemic stroke subtype, 321 subjects (67.5±8.5 years, 95 female) were randomly assigned to either the disease management program intervention group (n=156) or the usual care group (n=165). The primary end point of this study was the difference in the Framingham risk score (general cardiovascular disease 10-year risk) from baseline. The secondary end points of this study included stroke recurrence, onset of cardiovascular disease, all-cause mortality, and all vascular events. Results- Regarding the primary end point, there was no significant difference in the changes in the Framingham risk score at any follow-up time between the groups. The incidence of stroke recurrence tended to be lower in the disease management program intervention group, although no significant difference was found (hazard ratio, 0.49; 95% CI, 0.19-1.29). Conclusions- We were unable to demonstrate a clear benefit of disease management program intervention. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02121327.

Baseline feature of a randomized trial assessing the effects of disease management programs for the prevention of recurrent ischemic stroke.

BACKGROUND: Comprehensive and long-term patient education programs designed to improve self-management can help patients better manage their medical condition. Using disease management programs (DMPs) that were created for each of the risk factor according to clinical practice guidelines, we evaluate their influence on the prevention of stroke recurrence. METHODS: This is a randomized study conducted with ischemic stroke patients within 1 year from their onset. Subjects in the intervention group received a 6-month DMPs that included self-management education provided by a nurse along with support in collaboration with the primary care physician. Those in the usual care group received ordinary outpatient care. The primary end point is a difference of the Framingham risk score-general cardiovascular disease 10-year risk [corrected]. Patients were enrolled for 2 years with plans for a 2-year follow-up after the 6-month education period (total of 30 months). RESULTS: A total of 321 eligible subjects (average age, 67.3 years; females, 96 [29.9%]), including 21 subjects (6.5%) with transient ischemic attack, were enrolled in this study. Regarding risk factors for stroke, 260 subjects (81.0%) had hypertension, 249 subjects (77.6%) had dyslipidemia, 102 subjects (31.8%) had diabetes mellitus, 47 subjects (14.6%) had atrial fibrillation, and 98 subjects (30.5%) had chronic kidney disease. There were no significant differences between the 2 groups with respect to subject characteristics. CONCLUSIONS: This article describes the rationale, design, and baseline features of a randomized controlled trial that aimed to assess the effects of DMPs for the secondary prevention of stroke. Subject follow-up is in progress and will end in 2015.

Multifactorial analysis of factors affecting recurrence of stroke in Japan.

Data on factors affecting stroke recurrence are relatively limited. The authors examined potential factors affecting stroke recurrence, retrospectively. The study participants were 1087 patients who were admitted to stroke centers suffering from first-ever ischemic stroke and returned questionnaires with usable information after discharge. The authors analyzed the association between clinical parameters of the patients and their prognosis. Recurrence rate of during an average of 2 years after discharge was 21.3%, and there were differences among stroke subtypes. It was found that the disability level of the patients after discharge correlated well with the level at discharge (r s = 0.66). Multivariate logistic regression analysis of the data shows that modified Rankin Scale score, National Institute of Health Stroke Scale score, gender, age, and family history had statistically significant impacts on stroke recurrence, and the impact was different depending on subtypes. These findings suggest that aggressive and persistent health education for poststroke patients and management of risk factors are essential to reduce stroke recurrence.