Abstract
BackgroundThere is recent evidence supporting that a comprehensive post-stroke treatment program improves outcome. However, the prevalence of stroke-related health problems and the extent of needed interventions have not been well-delineated. The Struct-FU study aims to assess the feasibility of a comprehensive stroke follow-up model and to map stroke-related problems and subsequent multidisciplinary interventions using a modified Post-stroke Checklist (PSC). MethodsWe consecutively screened all acute stroke patients at Skåne University Hospital, Sweden during an eight-month period in 2018–2019. Patients discharged to own home were eligible for inclusion. We defined a stroke-related health problem as a health- or social issue corresponding to one of the 14 items in the modified PSC, and with onset after the stroke event. Three-months post-stroke, a semi-structured interview using a 14-item modified PSC was completed to map the prevalence of stroke-related health problems, as well as any subsequent multidisciplinary stroke team interventions prompted by the visit. ResultsThe number of included patients was 200. Of these, 165 (82.9%) completed three-month follow-up, one died, and 34 were lost to follow-up. All patients completed the full PSC, and the majority (92.7%) reported stroke-related problems identified using the PSC, with the median number being three per patient, and half having four or more problems. Patients <=65 years (n=44) presented with more stroke-related problems than patients >65 years (n=121) (5 vs. 3, p=0.003). The median number of interventions was two per patient. Doctor's interventions (changes in medication, referrals or further work-up) were done in 53% of patients, 77% needed a nurse's or other stroke team professional's intervention (tailored advice, information, audits, rehabilitation assessments) and 15% needed no intervention. Only 3.6% of patients reported other stroke-related challenges (PSC item 14) than those specified in item 1–13. ConclusionWe report a high burden of stroke-related health problems in community dwelling stroke patients with mild to moderate stroke. Multidisciplinary interventions were prompted in the vast majority (85%). Only 3.6% of patients reported challenges not captured with the Post-stroke Checklist, reflecting that the comprehensive approach captures the majority of stroke-related health problems, and gives a good estimate of the total stroke-related health burden for each individual.
Highlights
As the number of stroke survivors increases, organization and quality of post-stroke care becomes increasingly important
We found a high prevalence of post-stroke health problems to that reported by previous studies using the Post-stroke checklist.3,9À11 We found that the number of stroke-related health problems increased with increasing level of dependency, reflecting the need for similar interventions in patients with moderate or severe stroke
We present a comprehensive picture of patient characteristics, comorbidities, secondary prevention status, stroke-related health problems and their interventions
Summary
As the number of stroke survivors increases, organization and quality of post-stroke care becomes increasingly important. A comprehensive program aimed at treating both vascular risk factors and other stroke-related health problems may be more effective than narrower approaches, which has been shown for the first time in the STROKE-CARD study.[7]. The Struct-FU study aims to assess the feasibility of a comprehensive stroke follow-up model and to map stroke-related problems and subsequent multidisciplinary interventions using a modified Post-stroke Checklist (PSC). Three-months post-stroke, a semi-structured interview using a 14-item modified PSC was completed to map the prevalence of stroke-related health problems, as well as any subsequent multidisciplinary stroke team interventions prompted by the visit. 3.6% of patients reported challenges not captured with the Post-stroke Checklist, reflecting that the comprehensive approach captures the majority of stroke-related health problems, and gives a good estimate of the total stroke-related health burden for each individual.
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