A process evaluation of a stroke-specific follow-up care model for stroke patients and caregivers; a longitudinal study.

BACKGROUND: There is a need for follow-up care after stroke, but there is no consensus about the way to organise it. An intervention providing follow-up care for stroke patients and caregivers showed favourable effects on the level of social activities, but no other effects were found. The intervention consists of a maximum of five home visits to patients and caregivers during a period of 18 months post-discharge. The home visits are conducted by a stroke care coordinator (SCC) using a structured assessment tool. The objective of this study was to examine process-related factors that could have influenced the effectiveness of the intervention. METHODS: 77 stroke patients, 59 caregivers and 4 SCCs participated in the study. Data on the organisational characteristics of and the satisfaction with the intervention were collected by means of structured assessments, interviews and self-administered questionnaires at 1, 6, 12 and 18 months of follow-up. The intervention was provided between April 2008 and June 2011. RESULTS: Patients received an average of 3.8 home visits (SD 1.4) and 55% of them had a follow-up period of a maximum of 18 months. There were 1074 problems identified and the SCCs initiated 363 follow-up care and referral options. Stroke patients and caregivers were very satisfied with the intervention. The SCCs were satisfied with the assessment tool, but would like to see a structured referral system. CONCLUSIONS: The intervention was only partially performed in accordance with the protocol and was positively evaluated by patients, caregivers and SCCs. It is recommended to add a structured referral system to the intervention.

Effect of a stroke-specific follow-up care model on the quality of life of stroke patients and caregivers: A controlled trial.

OBJECTIVE: To evaluate the effectiveness of a stroke-specific follow-up care model on quality of life for stroke patients, being discharged home, and their caregivers. DESIGN: A non-randomized, controlled trial, comparing an intervention group with a control group (usual care). SUBJECTS: Stroke patients and their caregivers. METHODS: Intervention involved 5 home visits by a stroke care coordinator over a period of 18 months, using a structured assessment tool. Outcome measures were conducted at baseline (T0) and every 6 months thereafter (T6, T12 and T18) in the domains of quality of life (primary), activities of daily living, social activities, depression, anxiety and caregiver strain. RESULTS: The intervention group (n = 62) had significantly increased its social activities after 18 months, whereas the control group (n = 55) showed significantly decreased levels of social activities. In the first 6 months, levels of depression decreased significantly in caregivers of the intervention group. No differences were found for quality of life and the other outcome measures. CONCLUSION: The intervention was not effective in improving quality of life, but was effective in improving levels of social activities. The intervention may have focussed too much on screening for stroke-related problems and not as much on adequate follow-up care and referral.

Multidisciplinary care for stroke patients living in the community: a systematic review.

OBJECTIVE: A systematic review of randomized controlled trials was performed to evaluate the effectiveness of multidisciplinary care for stroke patients living in the community. DATA SOURCES: Databases PubMed, EMBASE, CINAHL and the Cochrane Library from January 1980 until July 2012. STUDY SELECTION: Randomized controlled trials focused on multidisciplinary interventions for stroke patients living at home after hospitalization or inpatient rehabilitation were selected. The outcome domains were activities of daily living, social participation and quality of life. A total of 14 studies were included. DATA EXTRACTION: Two authors independently extracted the data and independently assessed the quality of reporting of the included studies using the Consolidated Standards of Reporting Trials (CONSORT) statement 2010. DATA SYNTHESIS: None of the studies showed favourable effects of the intervention on activities of daily living and none assessed social participation. Furthermore, two studies reported favourable effects of the intervention in terms of quality of life. These concerned an intervention combining assessment with follow-up care and a rehabilitation intervention. CONCLUSION: There is little evidence for the effectiveness of multidisciplinary care for stroke patients being discharged home. Additional research should provide more insight into potentially effective multidisciplinary care for community-living stroke patients.

Not as transient: patients with transient ischaemic attack or minor stroke experience cognitive and communication problems; an exploratory study.

BACKGROUND: Patients with transient ischaemic attack (TIA) or minor stroke generally receive, besides secondary prevention, no regular follow up care after discharge directly home from the Emergency Room or TIA outpatient clinic; because it is believed that they will experience no consequences. OBJECTIVES: To explore whether the TIA and minor stroke patients have persistent problems due to the event. METHODS: This study has a cross-sectional, comparative non-randomized, exploratory design. Patients with TIA or minor stroke, not requiring hospital admission, and a control group of stroke patients, recently discharged home, were selected and interviewed with a questionnaire by telephone or home visit, between one and eight months after the event. Patients with angina pectoris (AP) were recruited as a second control group. RESULTS: Data showed that 51% of the TIA and minor stroke patients and 71% of the stroke patients experienced five or more problems, as opposed to 32% of patients with AP. Between 39 and 49% of the TIA, minor stroke and the stroke patients reported cognitive and communicative difficulties. Moreover, the TIA and minor stroke patients had more cognitive deficits (n = 27, 49%) and communicative limitations (n = 23, 42%) than the AP group (n = 7, 10% and n = 4, 6%, respectively). CONCLUSION: About half of the TIA and minor stroke patients experienced problems regarding cognition and communication, which were specific to the event. General practitioners should be aware of these potential problems and monitor patients regularly. Future research should focus on prognostic indicators to identify patients at risk.