Post-stroke Care Research Articles

Preliminary Evidence to Support the use of Startle Adjuvant Rehabilitation Therapy (START) via tele-health sessions to promote accessibility and reduce socioeconomic disparities in post-stroke care

Preliminary Evidence to Support the use of Startle Adjuvant Rehabilitation Therapy (START) via tele-health sessions to promote accessibility and reduce socioeconomic disparities in post-stroke care

Post-stroke care pathways and spasticity treatment: a retrospective study in Alberta.

Post-stroke care pathways and spasticity treatment: a retrospective study in Alberta.

Cost-effectiveness of tirofiban for acute ischemic stroke without large or medium-sized vessel occlusion: A Markov modelling analysis from the Chinese and United States perspectives.

The RESCUE BT2 trial recently showcased the efficacy of tirofiban in treating acute ischemic stroke (AIS) without large or medium-sized vessel occlusion. To further assess the value of tirofiban from the perspectives of Chinese and US healthcare system, a study was conducted to evaluate its cost-effectiveness. A hybrid model, integrating a short-term decision tree with a long-term Markov model, was developed to assess cost-effectiveness between tirofiban and aspirin for stroke patients without large or medium-sized vessel occlusion. Efficacy data for tirofiban was sourced from the RESCUE BT2 trial, while cost information was derived from published papers. Outcomes measured included respective cost, effectiveness, and incremental cost-effectiveness ratio (ICER). We conducted a one-way sensitivity analysis to assess the robustness of the results. Additionally, we performed probabilistic sensitivity analysis (PSA) through 10,000 Monte Carlo simulations to evaluate the uncertainties associated with the results. The study revealed that tirofiban treatment in AIS patients without large or medium-sized vessel occlusion led to a considerable reduction of 2141 Chinese Yuan (CNY) in total cost, along with a lifetime gain of 0.14 quality-adjusted life years (QALYs). In the US settings, tirofiban also exhibited a lower cost ($197,055 versus $201,984) and higher effectiveness (4.15 QALYs versus 4.06 QALYs) compared to aspirin. One-way sensitivity analysis revealed that post-stroke care costs and stroke utility had the greatest impact on ICER fluctuation in both Chinese and US settings. However, these variations did not exceed the willingness-to-pay threshold. PSA demonstrated tirofiban's superior acceptability over aspirin in over 95% of potential scenarios. Tirofiban treatment for AIS without large or medium-sized vessel occlusion appeared dominant compared to aspirin in both China and the US.

Abstract TP92: Feasibility of a Poststroke Without-Fail Care Rate to Assess Rehabilitation and Follow-Up Care

Introduction: Large cohort studies show substantial variability in poststroke care. We developed a guideline-based poststroke without-fail care rate (PWR) to measure rehabilitation and follow-up care quality (Table 1). Our primary aim was to test PWR feasibility to measure guideline-concordant poststroke care among individuals discharged from an urban safety net hospital. Secondarily, we evaluated socioeconomic strain’s (SES) relationship with PWR. Methods: We reviewed electronic medical records of individuals with acute ischemic stroke (AIS) admitted to an urban safety net hospital from July 1 - August 31, 2022. Individuals were given a pass/fail or ineligible for each process. The PWR, calculated per individual, was passes/total number of eligible processes (score 0-1.0). Results: Out of 30 persons with AIS, 20 were eligible for PWR assessment (Table 2). Mean PWR was 0.598 (SD .210, range .273-.900). Most processes were readily available, with no observable floor or ceiling effects. Lowest pass rates were seen in therapy continuance, PCP follow-up, blood pressure control, and exercise. The PWR difference between individuals with SES (M = .443, SD =.135) and without SES (M = .634, SD = .246) lacked statistical significance but demonstrated a high effect size; t(10) = 1.66, p = .064, d = .961. Conclusion: The PWR is a feasible tool to assess quality of poststroke care and may be useful to identify and evaluate interventions to improve equity and quality of poststroke care. The high effect size of SES warrants further examination in a larger sample.

Abstract TP101: Disposition Disparities: Differences in Discharge and Rehabilitation Post-Stroke Between Racial and Ethnic Groups

Background and Purpose: Racial and ethnic disparities affect stroke treatment, altering patient outcomes. Previous studies have shown that white patients often arrive at the Emergency Department more quickly and use Emergency Medical Services more than minority patients. They also receive specific treatments more frequently, including tPA. Our study investigates whether these disparities continue in post-stroke care in Florida. Methods: We conducted a retrospective review using our comprehensive Get with the Guidelines database. We categorized patients by stroke type, risk factors, and stroke severity. The focus was comparing discharge dispositions and rehabilitation plans across racial and ethnic groups. Results: Data gathered from Get with the Guidelines database, including 6,426 records between 2012-present. Discharge disposition disparities were observed across racial and ethnic groups with comparable stroke severity (p<0.001). Black people were more frequently discharged home compared to White people (p=0.029), and Asian people more often went to hospice, especially inpatient (p<0.001). Asian people and White people had the highest in-hospital death rates (p<0.001), while Hispanic people had lower in-hospital deaths(p=0.26) and were more likely discharged home (p=0.001). Black people received the greatest in-patient rehabilitation services (p<0.001), whereas Asian people were least likely to get in-patient or outpatient rehabilitation (p=0.016). Hispanic people had higher inpatient rehabilitation rates than non-Hispanic people (p=0.007). Conclusions: Our study highlights post-stroke disparities across racial and ethnic groups. Recognizing and addressing these disparities may improve outcomes in these populations, increasing stroke management equity. Elucidating the causes of these findings is the next step in this research.

Abstract TP113: Racial Disparities in Dysphagia Screening Outcomes Among Acute Stroke Patients at a United States Comprehensive Stroke Center

Introduction: Screening for dysphagia is vital in post-stroke care, with the Yale Swallow Protocol being a widely recognized tool. While passing the screening indicates a lower risk of dysphagia, racial disparities in screening results may also preclude patients from receiving a more comprehensive evaluation. Objective: This study aimed to investigate racial disparities in dysphagia screening outcomes in acute stroke patients at high risk for dysphagia based on initial NIHSS, explicitly focusing on the likelihood of black patients compared to non-black patients passing the Yale Swallow Protocol screening. Methods: Using data from a single US comprehensive stroke center, we examined the Yale Swallow Protocol dysphagia screening results amongst patients admitted for acute ischemic and hemorrhagic stroke with an initial NIHSS of 12 or greater between January 1 and December 31, 2022. Our NIHSS inclusion criteria was based on prior literature proposing an NIHSS score of 12 as a cutoff for a formal swallow evaluation. The primary outcome was the rate of passing the Yale Swallow Protocol screening, with data stratified by race. The association between race and swallow screening results was assessed using the chi-square test. A p-value of <0.05 was considered statistically significant. Results: This study included 243 acute ischemic/hemorrhagic stroke patients, of which 99 were black. The chi-square test revealed a significant association between race and passing the dysphagia screen (p <0.05). The odds of passing dysphagia screening were 2.13 times higher in black vs. non-black patients (OR 2.13, 95% CI 1.67-2.73). No statistically significant associations were found between passing the dysphagia screen and other factors such as age, gender, or NIHSS (p >0.05 for all). Conclusion: These results underscore significant racial disparity in dysphagia screening outcomes, with black patients more likely to pass the initial screening. These findings raise concerns about potential missed opportunities for comprehensive speech and language pathology assessments in black patients. Further research to understand the underlying reasons for these disparities is needed to ensure comprehensive and equitable care for all patients.

Abstract HUP4: Can A Remote Telehealth-based Program Support Survivors With Varying Social Needs Post-stroke?

Introduction: There are significant and longstanding inequities in stroke prevalence and care as well as outcomes. Social determinants of health (SDOH) are known to be a risk factor in post-stroke recovery. SDOH also put individuals at higher risk for 90-day mortality. Social determinants are a significant contributor to disparities in health and specifically addressing SDOH needs may improve the health and outcomes of stroke survivors. Methods: An app-based, virtual care model was used to impact survivor quality of life and outcomes for stroke survivors and their care partners. As a part of program onboarding, the clinical navigator utilized the CMS Accountable Health Communities Health-Related Social Needs Screening Tool to assess survivor needs in five core domains including housing instability, food insecurity, transportation problems, utility needs, and interpersonal safety. As needs were identified, they were cross-walked to pre-populated community resource maps to aid the survivor in their recovery and support subsequent stroke prevention. Results: Of the (n=50) stroke survivors (median age of 62) that completed the 12-week survivor-led Navigator support program, 35% had one SDOH need, 16% had 2 SDOH needs, 16% had 3 SDOH needs, 3% had 4 SDOH needs and 28% had 5 or more SDOH needs. The most regularly identified areas of social need in the cohort were mental health (20%), financial strain (15.7%), employment (13.6%) and transportation (12.9%). These SDOH were addressed throughout the 90-day program based on individual access considerations. The 30- and 90-day all-cause readmission rates for survivors were 5% and 10%, respectively, superior to recent publications reporting 30-day unplanned readmission rates after stroke ranging from 8.7%-12.5%, and 90-day readmissions ranging from 18.9% to 20.7%. Conclusion: By assessing SDOH and providing specifically tailored post-acute resources to meet those needs, a tech-enabled platform with clinical navigator support can improve outcomes for stroke survivors with a variety of SDOH needs. Additional post-acute stroke care and targeted programming are needed to address the ongoing inequalities in the healthcare system as they relate to post-stroke care and recovery in populations with high SDOH needs.

Abstract NS4: Can a Remote Telehealth-Based Program Support Survivors With Varying Social Needs Post-Stroke?

Introduction: There are significant and longstanding inequities in stroke prevalence and care as well as outcomes. Social determinants of health (SDOH) are known to be a risk factor in post-stroke recovery. SDOH also put individuals at higher risk for 90-day mortality. Social determinants are a significant contributor to disparities in health and specifically addressing SDOH needs may improve the health and outcomes of stroke survivors. Methods: An app-based, virtual care model was used to impact survivor quality of life and outcomes for stroke survivors and their care partners. As a part of program onboarding, the clinical navigator utilized the CMS Accountable Health Communities Health-Related Social Needs Screening Tool to assess survivor needs in five core domains including housing instability, food insecurity, transportation problems, utility needs, and interpersonal safety. As needs were identified, they were cross-walked to pre-populated community resource maps to aid the survivor in their recovery and support subsequent stroke prevention. Results: Of the (n=50) stroke survivors (median age of 62) that completed the 12-week survivor-led Navigator support program, 35% had one SDOH need, 16% had 2 SDOH needs, 16% had 3 SDOH needs, 3% had 4 SDOH needs and 28% had 5 or more SDOH needs. The most regularly identified areas of social need in the cohort were mental health (20%), financial strain (15.7%), employment (13.6%) and transportation (12.9%). These SDOH were addressed throughout the 90-day program based on individual access considerations. The 30- and 90-day all-cause readmission rates for survivors were 5% and 10%, respectively, superior to recent publications reporting 30-day unplanned readmission rates after stroke ranging from 8.7%-12.5%, and 90-day readmissions ranging from 18.9% to 20.7%. Conclusion: By assessing SDOH and providing specifically tailored post-acute resources to meet those needs, a tech-enabled platform with clinical navigator support can improve outcomes for stroke survivors with a variety of SDOH needs. Additional post-acute stroke care and targeted programming are needed to address the ongoing inequalities in the healthcare system as they relate to post-stroke care and recovery in populations with high SDOH needs.

Abstract TP18: A 15-Minute Cognitive Screen Identifies Post-Stroke Cognitive Impairment

Introduction: While comprehensive neuropsychological evaluations are a valuable part of post-stroke care, time-intensive assessments may not always be feasible or well-tolerated in certain clinical settings. There is a need for a brief cognitive battery that can detect post-stroke cognitive impairment while being efficient with regard to time and resources. Methods: As part of the parallel StrokeCog and Stroke-IMPaCT studies, 127 participants with chronic ischemic stroke completed comprehensive neuropsychological testing at Stanford. They underwent a cognitive battery consisting of 13 tests that encompassed 5 cognitive domains. Partial least square analyses identified a set of candidate tests that were most associated with cognitive impairment on this comprehensive battery, defined as 2 domain z-scores <-1 or 1 domain z-score <-1.5. We used these candidate tests to construct a brief battery of 5 tests (StrokeCog-Brief). Psychometric properties were compared amongst StrokeCog-Brief, the MoCA, and another established 30-minute battery (NINDS-30). Initial findings were cross-validated in an independent sample of 61 participants at University of Manchester. Results: The StrokeCog-Brief battery consisted of 5 measures of language, working memory, learning, and attention/processing speed (HVLT Immediate Recall, Trails A, Trails B, Digit Span Forward/Backward, Phonemic Fluency) that took approximately 15 minutes to complete. StrokeCog-Brief demonstrated high sensitivity (0.97) and adequate specificity (0.78) in detecting cognitive impairment on the comprehensive battery, outperforming both the MoCA (0.77, 0.73) and NINDS-30 (0.97, 0.35). In the cross-validation sample, StrokeCog-Brief similarly demonstrated high sensitivity (0.93) and adequate specificity (0.67), again outperforming both the MoCA (0.60, 0.86) and NINDS-30 (0.81, 0.08). Conclusions: We identified a brief, 15-minute battery of 5 tests that has high sensitivity in detecting cognitive impairment in people who have had a stroke. This brief battery covers multiple cognitive domains commonly impacted by stroke and represents an efficient means to identify chronic post-stroke cognitive impairment.

Abstract 137: Post-Stroke Blood Pressure Control and Follow Up Care in Real-World Setting

Introduction: Within 5 years of a stroke, approximately 25% of patients will have a recurrent event. Blood pressure (BP) reduction can reduce this risk; every 10 mmHg decrease in systolic BP is associated with a 20% risk reduction. Despite this benefit, 50% of patients with hypertension remain uncontrolled after a stroke. Reasons for poor control may be related to poor post-stroke follow up care. We aim to quantify post-stroke BP control and follow up in a large health system. Methods: We performed a retrospective analysis of patients with stroke admitted to Yale New Haven Health System (YNHHS) between 2013-2021. YNHHS has 5 hospitals and a large outpatient network. Eligible patients included those who received primary care within YNHHS, were discharged alive, and not on dialysis. We analyzed patient features, time to outpatient encounter, and vital signs. The primary outcome was uncontrolled BP (>140/90) obtained during the office visit closest to and before 6 months from the date of discharge. Results: During the study period 12,561 patients were admitted with stroke to YNHHS. After exclusions, the final cohort was 2,867 patients. Among these patients, 48 % were male, 65% non-Hispanic White, 22% non-Hispanic Black, 9% Hispanic, and 4% other. Mean (standard deviation) age was 68 (12) years. Approximately 25% of patients had uncontrolled BP. When the updated ACC/AHA (2017) BP goal (<130/80) was applied, the amount of patient with uncontrolled BP increased to 52%. After 6 months, 318 (11%) had no visit with a medical provider, 250 (9%) patients had 1 follow up visit, and 2,299 (80%) patients had >2 follow up visits. The median (interquartile range [IQR]) number of days to first visit with a PCP or neurologist was 30 (10-97) days and 45 (27-99) days, respectively. The median (IQR) number of visits with either a PCP or neurologist was 0 (0-2). Conclusion: Among patients with recent stroke, more than half do not achieve BP control per current guidelines. The majority of patients do not engage with a PCP or neurologist within 6 months following a stroke, even though they have an established provider within the system. Gaps in follow up represents a notable opportunity for improving post-stroke care.

Abstract TMP32: Race and Ethnic Differences in Rehabilitation and Functional Recovery Post-Stroke Within the Florida Stroke Registry - Transitions of Care

Introduction: Historically, non-Hispanic black (NHB) and Hispanic stroke survivors have been discharged at a poorer functional level than non-Hispanic whites (NHW). The purpose of this study was to examine race and ethnic differences in rehabilitation prescription and participation at time of discharge (DC) and in modified Rankin Scale (mRS) at 30- and 90-days post-stroke. Methods: The Transitions of Stroke Care Disparities Study is designed to reduce disparities and optimize post-stroke care in hospital-to-home transitions. Survivors of ischemic stroke and intracerebral hemorrhage from a subset of 165 hospitals in the Florida Stroke Registry were included in the Get with the Guidelines-Stroke® (GWTG-S) database. Race and ethnicity, therapy prescription and participation, and mRS were extracted from GWTG-S, and by self-report at 30- and 90-days after DC. Race and ethnic differences were assessed in therapy prescription, participation, and mRS using binary logistic regression adjusted for age, sex, stroke severity (NIHSS), and DC walking ability. Results: In 1,129 stroke survivors (mean age 64y, 45% women, 55% NHW, 23% NHB, 22% Hispanic, 76% independent walkers at DC), 29% were prescribed inpatient and 50% outpatient rehabilitation at DC. Multivariable analysis showed NHW were significantly less likely to be prescribed inpatient therapy compared to NHB [OR 0.56, 95%CI (0.35-0.88)] or Hispanics [OR 0.50, 95%CI (0.31-0.80)]. Hispanic individuals [OR 1.69, 95%CI (1.20-2.38)] were significantly less likely to be prescribed outpatient therapy compared to NHW or NHB. No differences in therapy participation were seen between NHW and NHB [OR 1.16, 95%CI (0.69-1.97)] or Hispanics [OR 1.41, 95%CI (0.82-2.43)]. No differences in mRS were seen between NHW and NHB [30-days, OR 0.85, 95% CI (0.52-1.39); 90-days, OR 0.68, 95%CI (0.42-1.11)] or Hispanics [30-days, OR 0.63, 95% CI (0.37-1.10); 90-days, OR 0.61, 95%CI (0.36-1.03)]. Conclusions: Although there were significant race and ethnic differences in therapy prescription setting, no race and ethnic differences were seen in therapy participation or in mRS at either 30- or 90-days. Further research is warranted to examine race and ethnic differences in stroke recurrence and readmission rates.

Empowering palliative care health cadres in the homecare-based management of post-stroke patients

Stroke causes disability and weakness, resulting in decreased functional ability. Palliative care is actively provided for stroke sufferers in the terminal phase. The majority of stroke clients experience residual symptoms such as paralysis, slurred speech, difficulty swallowing, difficulty speaking, and inability to understand other people's speech. The prolonged illness or the difficulty of recovering as usual creates stressors for both the patient and the family caring for them. The aim of this activity is to provide accurate information regarding post-stroke patient care by empowering palliative care health cadres (KAK LIA). This activity employs a participant active learning approach, where participants actively engage in training and mentoring activities. The methods used include lectures, question and answer sessions, and practical exercises. The activity consists of six stages: preparation, initial intervention, internal intervention, final intervention, mentoring, and evaluation. The result of this community service activity was an increase in participants' knowledge, with the majority shifting from poor knowledge (75%) to very good (90%).

Factors associated with family caregiver readiness to care for post-stroke patients after hospital discharge

BackgroundPost-stroke patients often need support from their family caregivers to continue their care after hospital discharge. Family caregiver readiness in caring for stroke patients is needed to improve the patient's quality of life. This study aimed to analyze factors affecting family caregivers' readiness for post-stroke patient care after hospital discharge.MethodsA cross-sectional study of family members of stroke patients admitted to the neurology inpatient unit from February to April 2023, and they were selected through purposive sampling. The general demographic questionnaire, the stroke knowledge questionnaire, and the Family Readiness for Hospital Discharge Scale (FAM-RHDS) were used to gather the data. Data analysis was performed with IBM SPSS 26 software. Data were examined through the descriptive, Pearson correlation, and multiple linear regression tests.ResultsFifty-nine respondents completed the questionnaires. Factors that were significantly related to family readiness to care for stroke patients were age (p = 0.000), gender (p = 0.000), income (p = 0.000), occupation (p = 0.000), marital status (p = 0.000), and knowledge (p = 0.000). Education level was the one that didn’t correlate with family readiness (p = 0.452). Gender is the most dominant factor affecting the readiness of family caregivers to care for stroke patients (coefficient B = 10.847).ConclusionMale family caregivers should be given special attention to improve their readiness to care for post-stroke patients. Assessment of family caregivers’ readiness for discharge should be part of discharge planning and those who are unprepared may be provided with additional interventions prior to discharge.

Outcomes and Experiences of Patients and Their Caregivers After Severe Stroke Requiring Tube Feeding in Peru

ObjectivesEvaluate clinical outcomes of stroke survivors in Peru discharged with artificial nutrition via a feeding tube (FT), and explore perspectives and experiences of these patients and their caregivers. MethodsRetrospective chart review to describe the prevalence of FT placement and characteristics of patients admitted with stroke to the Instituto Nacional de Ciencias Neurológicas in Lima, Peru between January 2019 and 2021. Follow-up calls to stroke survivors discharged home with FTs or their caregivers included quantitative and qualitative questions to assess long-term outcome and explore perspectives around poststroke care and FT management. We analyzed quantitative data descriptively and applied thematic analysis to qualitative data using a consensus-driven codebook. ResultsOf 812 hospitalized patients with stroke, 146 (18%) were discharged home with FT, all with nasogastric tubes (NGTs). Follow-up calls were performed a median of 18 months after stroke with 96 caregivers and three patients. Twenty-five patients (25%) had died, and 82% of survivors (n = 61) remained dependent for some care. Four themes emerged from interviews: (1) perceived suffering (physical, emotional, existential) associated with the NGT and stroke-related disability, often exacerbated by lack of preparedness or prognostic awareness; (2) concerns around compromised personhood and value-discordant care; (3) coping with their loved-one's illness and the caregiving role; and (4) barriers to NGT care and skill acquisition. ConclusionWe identified a high burden of palliative and supportive needs among severe stroke survivors with NGTs and their caregivers suggesting opportunities to improve poststroke care through education, communication, and support.

Impact of the PCMH model on post-stroke healthcare utilization

The patient-centered medical home (PCMH) model has aimed to enhance chronic care in a primary care setting where providers are expected to provide timely post-discharge follow-up and decrease potentially preventable hospital readmissions through coordinated disease management. The study examined PCMH and other (risk) factors associated with 30-day unplanned readmission as well as 7- and 28-day follow-up visit with primary care providers (PCPs). We identified 8424 New York State Medicaid patients having initial stroke discharges during 2016–2018 from the Medicaid claims database and Statewide Planning and Research Cooperative System. A patient was in the PCMH group if the attributed provider had a valid National Committee for Quality Assurance PCMH recognition upon patient’s discharge. Cox regression and competing risk analyses were used to estimate the hazard ratios of readmissions and follow-up visits between PCMH and non-PCMH groups. The PCMH group had slightly but not statistically significant lower all-cause and recurrent stroke unplanned readmission rates. While the general follow-up rates between the two groups are similar, the PCMH group had significantly higher rates of stroke-specific 7-day (HR = 1.27, P < 0.01) and 28-day follow-up visits (HR = 1.22, P < 0.01). PCPs play an essential role in post stroke care. Our findings show a significantly higher rate of stroke-specific follow-up visits and a trend towards lower readmissions among patients in the PCMH group. The intervals between stroke discharge and follow-up visit time in our study population were generally greater than the recommended timeframe. We recommend the PCMH care model to improve patients’ primary care follow-up and prevent potential readmissions.

A retrospective analysis of the social determinants of health affecting stroke outcomes in a small hospital situated in a health professional shortage area (HPSA).

Where someone lives is a major determinant of population health. In the United States, people who live in Health Professional Shortage Areas are considered medically underserved and have a higher propensity for conditions such as stroke, hypertension, and diabetes. Our goal was to better understand the diverse needs of patients presenting to the Crouse Hospital emergency department with stroke symptoms. Crouse Hospital is a small community hospital located in a shortage area serving both urban and rural populations in and around Syracuse, New York. Despite its small size, Crouse Hospital quickly became a major comprehensive stroke center in Central New York. With this study we assessed the social factors affecting the stroke patient population in the community and compared these characteristics between those living in served and underserved areas. Informed by the social determinants of health framework, we analyzed 1731 incidents of stroke that occurred between January 2019 and January 2021, and observed that the circumstances associated with stroke varied by service category and race, with White patients and those from served areas having better stroke outcomes compared to those residing in underserved areas and those that were not White. Our analyses help us to understand the underlying factors influencing the observed disparities and allow us to move forward by implementing informed community-based interventions to decrease stroke incidence and improve post-stroke care. Using our example other small hospitals can enact similar strategies to address the social determinants affecting their patients to improve stroke outcomes in their region.

The emerging role of a Stroke Clinical Nurse Specialist (CNS) in Early Supported Discharged: Developing a pathway for stroke nursing for secondary prevention in the community. A scoping review protocol.

Background Stroke represents a major source of mortality and morbidity globally. The role of a stroke Clinical Nurse Specialist (CNS) as an expert team member in early supported discharge (ESD) for stroke, is not well defined or described although it is well established in other models of after-hospital and out-reach specialist care in the community. A greater focus has been on patients receiving rehabilitation post-stroke, however there is a need for a more holistic approach to care which clinical nurse specialists can offer to patients as part of ESD. Nurses are often the cohesive point of contact for other after-hospital services, managing many aspects of secondary prevention. Objective The aim of this scoping review is to explore the evidence in relation to the role of the stroke nurse providing secondary prevention interventions to stroke patients in a community setting. Methods We will conduct a scoping review in accordance with the Arksey and O’Malley, 2005 1 scoping review framework and the PRISMA-ScR guidelines to map available literature on the role of the stroke nurse in post-stroke care of patients in the community. The Cochrane Central Register of Controlled Trials and Systematic literature searches including databases MEDLINE, EMBASE, CINAHL, google scholar and grey literature will be searched using keyword searches. Data will be charted and synthesised and a narrative synthesis will be conducted. Conclusions This scoping review will be used to identify gaps in the current literature and identify areas for future research in the role of the stroke nurse in ESD in relation to secondary prevention for stroke patients and inform the development of a pathway for stroke nursing in ESD.

Stroke survivors' telemedicine experiences during the COVID-19 pandemic: A phenomenological investigation.

This study aimed to describe stroke survivors' experiences receiving telemedicine visits at the Lone Star Stroke Consortium during the COVID-19 pandemic. A qualitative descriptive phenomenological design was applied to gather patients' telemedicine experiences through in-depth interviews, using a study guide. Audio-recorded interviews were conducted via ZOOM and transcribed verbatim. Two independent reviewers used the Giorgi descriptive method to analyze the data and search for the essence of stroke survivors' follow-up telemedicine experiences during the COVID-19 pandemic. Fifteen underserved patients were recruited: mean age, 51.8 (15.7), and 9 (60%) females. Three themes emerged: (1) vivid memory of the stroke acute phase, (2) poststroke care experiences, and (3) perceived telemedicine experiences. The phenomenon of follow-up telemedicine visits during COVID-19 pandemic, as experienced by the stroke survivors, was positive. It showed patients' improved care access for poststroke visits. Telemedicine was satisfactory, except where the full medical exam was needed. Study findings highlight the individual approach was important, as well as the need for reliable internet and training to improve patients' technological skills. A hybrid approach for post-pandemic follow-up visits (in-person and telemedicine) was recommended by stroke survivors. These findings suggest that telemedicine is feasible and effective for poststroke care. Additional strategies are needed to improve future telemedicine integration into the continuum of care.

Biographical continuation: recovery of stroke survivors and their family caregivers in Taiwan.

To explore the experiences pertaining to long-term care services from the perspectives of dyads of stroke survivors and their family caregivers in indigenous and non-indigenous communities. Stroke occurrence is a life-changing event associated with quality of life for stroke survivors and their families, especially those who provide primary support. Indigenous people are more likely to experience a stroke at a younger age and have a higher likelihood of hospitalisation and death due to health disparities. Few studies have investigated family dyads or indigenous populations to understand their experiences of coping with changed body-self and to contextualise their reintegration into communities post-stroke. Ethnographic fieldwork over nine months in 2018-2019 with indigenous, urban-based, and non-indigenous populations, resulting in 48 observations and 24 interviews with 12 dyads in three geo-administrative communities. The post-stroke recovery trajectory is illuminated, delineating the dyads' life transitions from biographical disruption to biographical continuation. The trajectory is shaped by seven states involving four mindsets and three status passages. The four mindsets are sense of loss and worry, sense of interdependence, sense of independence, and wellbeing state. The status passages identified in this study are acceptance, alteration, and identification. A community-based and family-centred long-term care system, aligning with medical healthcare and community resources, underpinned each dyad's biographical continuation by: (1) providing rehabilitation that afforded time and space for recovery adaptation; (2) acknowledging the individuality of family caregivers and helping to alleviate their multitasking; and (3) reintegrating stroke survivors into their communities. Key to determining the quality of recovery for the indigenous participants was their reintegration into their native community and regaining of identity. Therefore, integrating post-stroke care into various care contexts and incorporating indigenous-specific needs into policymaking can support dyads in adapting to their communities.

Home Care Practices that Improve Performance of Activities of Daily Living of Patients Post-stroke:A Systematic Review.

Evidence is inconsistent on the effectiveness of home rehabilitation for patients post-stroke. This review aims to explore home care practices that improve the performance of activities of daily living of patients post-stroke. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), clinical trials and mixed-methods studies published from 2012 to 2022 were gathered from PubMed, ScienceDirect, EBSCO, and ProQuest in December 2022. The Mixed Method Appraisal Tool (MMAT) was used for quality appraisal. Narrative synthesis approach was utilized to present the findings. A total of 758 articles were screened, and 10 were included in the final analysis. Five out of ten programs were found superior compared with usual care. Factors that influence the effectiveness of the programs include the age of the participants, severity of disabilities, family participation, and presence of a multidisciplinary team. A multidisciplinary healthcare team approach toward the enhancement of knowledge, skills, and behaviors of patients and their families is common in effective home care. The role of nurses is emphasized not only as providers of direct patient care but also as coordinators of the healthcare team and patients and their families. This study provides insights for policymakers in developing healthcare system for post-stroke care. J. Med. Invest. 71 : 197-204, August, 2024.