Stroke Survivors Research Articles

Patients’ experiences of very early supported discharge after stroke: safety, emotional support and feelings of control in everyday life

Objective Early supported discharge (ESD) aims to enable the transition of care from specialised stroke units to patients’ homes. Even though ESD is well-researched, little is known about the experiences faced by persons with stroke in very early supported discharge (VESD). The aim of this study was to understand these experiences when participating in a VESD rehabilitation program. Methods Qualitative individual and semi-structured interviews were held (at 3 months post-discharge) with stroke survivors discharged home at a very early stage and participating in a VESD programme. A thematic analysis process was applied. Results Nine participants living in Sweden and following a mild or moderate stroke expressed their narratives through the following themes: “The importance of the VESD team intervention during the initial home rehabilitation”; “Everyday life was perceived as a struggle depending on close relatives”; “Experiencing problems with fatigue and low energy” and “Feeling angrier or more worried in everyday life” Conclusions Home-based VESD rehabilitation was important for increasing patients’ sense of independence and control in daily life, while at the same time making them feel secure in the support from the rehabilitation team. Future research may investigate how VESD functions in other countries and healthcare systems.

The Online Health Information-Seeking Behaviors of People Who Have Experienced Stroke: Qualitative Interview Study.

Stroke is a leading cause of death and disability worldwide. As health resources become digitized, it is important to understand how people who have experienced stroke engage with online health information. This understanding will aid in guiding the development and dissemination of online resources to support people after stroke. This study aims to explore the online health information-seeking behaviors of people who have experienced stroke and any related barriers or navigational needs. Purposeful sampling was used to recruit participants via email between March and November 2022. The sampling was done from an existing cohort of Australian stroke survivors who had previously participated in a randomized controlled trial of an online secondary prevention program. The cohort consisted of people with low levels of disability. Semistructured one-on-one interviews were conducted via phone or video calls. These calls were audio recorded and transcribed verbatim. The data were analyzed by 2 independent coders using a combined inductive-deductive approach. In the deductive analysis, responses were mapped to an online health information-seeking behavior framework. Inductive thematic analysis was used to analyze the remaining raw data that did not fit within the deductive theoretical framework. A sample of 15 relatively independent, high-functioning people who had experienced stroke from 4 Australian states, aged between 29 and 80 years, completed the interview. A broad range of online health information-seeking behaviors were identified, with most relating to participants wanting to be more informed about medical conditions and symptoms of their own or of a family member or a friend. Barriers included limited eHealth literacy and too much generalization of online information. Online resources were described to be more appealing and more accessible if they were high-quality, trustworthy, easy to use, and suggested by health care providers or trusted family members and friends. Across the interviews, there was an underlying theme of disconnection that appeared to impact not only the participants' online health information seeking, but their overall experience after stroke. These responses were grouped into 3 interrelated subthemes: disconnection from conventional stroke narratives and resources, disconnection from the continuing significance of stroke, and disconnection from long-term supports. People who have experienced stroke actively engage with the internet to search for health information with varying levels of confidence. The underlying theme of disconnection identified in the interviews highlights the need for a more comprehensive and sustained framework for support after stroke beyond the initial recovery phase. Future research should explore the development of tailored and relatable internet-based resources, improved communication and education about the diversity of stroke experiences and ongoing risks, and increased opportunities for long-term support.

Measuring Exercise Self-Efficacy After Stroke: Validity and Reliability of Current Measures.

Many physically capable stroke survivors are insufficiently active, with low self-efficacy considered an important contributor. However, validity and reliability of self-efficacy measures in stroke survivors have not been established. This research aims to evaluate the test-retest reliability and construct validity of 3 self-efficacy measures: Self-Efficacy for Exercise Scale (SEE), Spinal Cord Injury Exercise Self-Efficacy Scale (SCI-ESES), and Participation Strategies Self-Efficacy Scale (PS-SES). A repeated measures study with community-dwelling, independently mobile adult stroke survivors (n=51, mean age 74years, 45% female, median 22months poststroke) was completed. Test-retest reliability was assessed using intraclass correlation coefficients and Bland-Altman analyses. Construct validity was assessed using 8 pre-determined hypotheses concerning physical activity level (subjective and objective), comorbidities, work and volunteering, and measures of function. Retest reliability was established for the SEE (intraclass correlation coefficient, ICC=0.77) and PS-SES (ICC=0.78) but not for the SCI-ESES (ICC=0.68). Bland-Altman analysis showed participants consistently scored higher on the second test for all measures. The SEE achieved construct validity by meeting 75% of hypotheses, whereas the PS-SES and SCI-ESES did not. Self-efficacy was positively related to steps/day, functional capacity, self-reported activity levels, and work or volunteering participation. The SEE was found to be the most appropriate tool to measure exercise self-efficacy in independently mobile chronic stroke survivors in terms of retest reliability and validity. N/A. for more insights from the authors (see the Video, Supplemental Digital Content 1 "Espernberger-JNPT-Video-Abstract," available at: http://links.lww.com/JNPT/A489).

Are Optometrists Prepared to Be Involved in Post-Stroke Rehabilitation?

Stroke survivors often experience various visual consequences that impact their daily life and may benefit from visual interventions. However, some of these usually go unaddressed as optometrists are rarely included in the post-stroke care pathway. Yet, optometrists are interested in contributing to the care of these patients. This survey evaluated the readiness of optometrists in diagnosing and managing visual disorders specific to stroke survivors. A questionnaire was developed by the researchers, pilot tested by 5 research optometrists and 15 community optometrists, and modified based on the feedback. Practicing optometrists were invited to complete the anonymous online survey through optometric organizations in Canada, the US, Hong Kong, India, and the UK. Most respondents displayed strong knowledge, but 61.6% indicated that enhancing their knowledge would be helpful. The majority (87%) agreed that stroke is related to an increased incidence of falls. Participants' knowledge regarding the natural history of post-stroke visual disorders was poorer. There were also inconsistencies regarding what optometrists considered ideal interventions and what they undertook in practice. More than 50% of respondents reported that the quality of published evidence on post-stroke visual consequences was low or nonexistent. Overall, survey respondents displayed sufficient knowledge. However, there are areas of uncertainty in their knowledge, which in many cases correspond to real gaps in the available evidence. There is a need to identify and remediate these gaps to enable optometrists to deliver quality optometric care as collaborative members of the post-stroke professional team, which would eventually improve the rehabilitation of stroke survivors.

Benzodiazepine Utilization in Ischemic Stroke Survivors: Analyzing Initial Excess Supply and Longitudinal Trends.

Benzodiazepines are commonly prescribed for post-acute ischemic stroke for anxiety, insomnia, and agitation. While guidelines discourage use in those aged ≥65 years, little is known about prescription patterns at the national level. We analyzed a 20% sample of US Medicare claims from April 1, 2013, to September 30, 2021. We selected beneficiaries aged ≥65 years discharged alive following an acute ischemic stroke who had traditional Medicare coverage and 6 months' prior enrollment in Parts A (hospital insurance), B (Medical insurance), and D (drug coverage). We excluded those with prior benzodiazepine prescriptions, self-discharges, or discharge to skilled nursing facilities. We examined demographics, comorbidities, first prescription days' supply, cumulative incidences of benzodiazepine first prescription fills within 90 days after discharge, and geographic and yearly trends. We included 126 050 beneficiaries with a mean age of 78 years (SD, 8); 54% were female and 82% were White. Within 90 days, 6127 (4.9%) initiated a benzodiazepine. Among new prescriptions, lorazepam (40%) and alprazolam (33%) were the most prescribed. Most (76%) of first fills had a day's supply over 7 days and 55% between 15 and 30 days. Female initiation rates were higher (5.5% [95% CI, 5.3-5.7]) than male initiation rates (3.8% [95% CI, 3.6%-3.9%]). Rates were highest in the southeast (5.1% [95% CI, 4.8%-5.3%]) and lowest in the midwest (4.0% [95% CI, 3.8%-4.3%]), with a modest nationwide initiation decline from 2013 to 2021 (cumulative incidence difference, 1.6%). Despite a gradual decline in benzodiazepine initiation from 2013 to 2021, we noted excessive supplies in prescriptions post-acute ischemic stroke discharge, underscoring the need for improved policies.

The Turkish version of the cognitive assessment scale for stroke patients (CASP-TR): a reliability and validity

ABSTRACT Background Stroke, a prevalent neurological condition globally, is associated with a high mortality and often affects cognitive function. The Cognitive Assessment Scale for Stroke Patients (CASP) was developed to quickly identify and measure primary cognitive deficits, focusing particularly on stroke survivors. Within the Turkish context, there is a limited availability of validated cognitive screening tests for use after stroke. Aims The study aimed to translate CASP into Turkish (CASP-TR) and validate it in stroke patients. Methods and procedures After the translation of the CASP items into culturally appropriate Turkish versions, a pilot testing of the pre-final version was administered to post-stroke patients and healthy controls by two raters. Following completion of the final version of CASP-TR, 40 stroke patients were consecutively enrolled in validation process. Three blinded raters conducted all assessments with intervals of 1- or 2 days between evaluation sessions. The accuracy of CASP-TR was assessed using sensitivity, specificity, predictive values, likelihood ratios, and area under curve. CASP-TR performance in post-stroke patients with and without cognitive dysfunction was compared using the Mini-Mental State Examination (MMSE). CASP-TR data obtained by two raters were compared based on the presence of aphasia. Outcomes and results The study assessed inter-rater agreement using intraclass correlation coefficient (ICC), yielding a score of 0.92 (95% CI 0.85–0.96) between raters. Across subtests, moderate to good agreement was observed in most domains. Correlation analyses showed a strong positive relationship (r = 0.80) between mean CASP-TR and MMSE scores. CASP-TR and MMSE scores were stratified based on the presence of aphasia. CASP-TR scores from both raters were notably lower in the aphasia group compared to the non-aphasia group (p < 0.001). Similarly, MMSE scores were significantly lower in the aphasia group (p < 0.001). The patients were also classified into cognitive dysfunction and non-cognitive dysfunction groups based on MMSE scores. No statistically significant score differences were found between examiners in the cognitive dysfunction group (p = 0.267) or non-cognitive dysfunction group (p = 0.156) (p > 0.05). CASP-TR demonstrated a sensitivity of 82.4%, specificity of 78.6%, positive predictive value of 87.5%, negative predictive value of 68.7%, a positive likelihood ratio of 3.77, a negative likelihood ratio of 0.25, and an area under curve of 0.88. Conclusions This study proposes that CASP-TR is a valuable cognitive screening tool for assessing cognitive deficits in stroke patients, and it also demonstrates sensitivity to cognitive deficits in stroke patients with aphasia. The thorough validation within the acute post-stroke Turkish population demonstrates remarkably good accuracy and very good Area Under Curve (AUC) values.

Neuropsychological outcomes following endovascular clot retrieval and intravenous thrombolysis in ischemic stroke.

Cognitive impairment, anxiety, depression, fatigue, and dependence in instrumental activities of daily living (ADL) are common after stroke; however, little is known about how these outcomes may differ following treatment with endovascular clot retrieval (ECR), intravenous tissue plasminogen activator (t-PA), or conservative management. Patients were recruited after acute treatment and invited to participate in an outcome assessment 90-120 days post-stroke. The assessment included a cognitive test battery and several questionnaires. The COVID-19 pandemic led to significant disruptions in recruitment and data collection, and the t-PA and conservative management groups were combined into a standard medical care (SMC) group. Sixty-two participants were included in the study (ECR = 31, SMC = 31). Mean age was 66.5 (20-86) years, and 35 (56.5%) participants were male. Participants treated with ECR had significantly higher National Institutes of Health Stroke Scale scores at presentation and significantly lower education. After adjusting for stroke severity, premorbid intellectual ability, and age, treatment with ECR was associated with significantly better performances on measures of cognitive screening, visual working memory, and verbal learning and memory. Participants treated with ECR also experienced less fatigue and were more likely to achieve independence in basic and instrumental ADLs. Despite this, cognitive impairment and fatigue were still common among participants treated with ECR and anxiety and depression symptoms were experienced similarly by both groups. Cognitive impairment and fatigue were less common but still prevalent following treatment with ECR. This has important practical implications for stroke rehabilitation, and routine assessment of cognition, emotion, and fatigue is recommended for all stroke survivors regardless of stroke treatment and functional outcome.

Electrophysiological evidence of dry needling efficacy on spasticity in poststroke patients: A randomized control trial

Abstract: CONTEXT: Therapists use dry needling (DN) to treat myofascial trigger points and various pain conditions. Need for study: A gap analysis showed that more information about how DN works on spastic muscles through alpha motor neurofiring and what role it plays in clinical and functional outcomes. Currently, the objective evidence for the usefulness of DN in neurological diseases is required. AIMS: The purpose of this research was to examine how DN affects spasticity in stroke patients using the H reflex and a Modified Tardieu Scale (MTS). SETTINGS AND DESIGN: We conducted a randomized controlled trial. We randomly assigned 81 stroke survivors to one of two groups: one group underwent six sessions of DN over the muscles with conventional treatment, whereas the other group received conventional care. We assessed spasticity using the H reflex and the MTS. We analyzed all outcome measures before, after, and 2 weeks later names as H1, H2, H3 and T1, T2, and T2 receptivity. RESULTS: After the intervention, people who received DN had improvement in spasticity. H3-H1 is statistically significant (P = 0.42) in the experimental group against the control group. T3-T1 and T2-T3 are statistically significant (P = 0.00) in the experimental group compared to the control group. CONCLUSIONS: The DN is effective for lowering spastic muscle tone and local muscle stiffness. This could be because DN diminishes the nodular zone of spastic muscle and reduces the firing of alpha motor neurons. These findings are very promising in terms of lowering spasticity.

The Hidden Heart: Exploring Cardiac Damage Post-Stroke: A Narrative Review

Stroke–heart syndrome (SHS), a critical yet underrecognized condition, encompasses a range of cardiac complications that arise following an ischemic stroke. This narrative review explores the pathophysiology, clinical manifestations, and implications of SHS, focusing on the complex interplay between the brain and the heart. Acute ischemic stroke (AIS) triggers autonomic dysfunction, leading to a surge in catecholamines and subsequent myocardial injury. Our review highlights the five cardinal manifestations of SHS: elevated cardiac troponin (cTn) levels, acute myocardial infarction, left ventricular dysfunction, arrhythmias, and sudden cardiac death. Despite the significant impact of these complications on patient outcomes, there is a notable absence of specific guidelines for their management. Through a comprehensive literature search, we synthesized findings from recent studies to elucidate the mechanisms underlying SHS and identified gaps in the current understanding. Our findings underscore the importance of early detection and multidisciplinary management of cardiac complications post-stroke. Future research should focus on establishing evidence-based protocols to improve clinical outcomes for stroke patients with SHS. Addressing this unmet need will enhance the care of stroke survivors and reduce mortality rates associated with cardiac complications.

Handgrip Strength and Cognitive Recovery in Older Stroke Survivors: A Prospective Study

Background and Objectives: Handgrip strength (HGS) is an important indicator of overall physical capability and is linked to various health outcomes in older adults. Despite extensive research on the relationship between HGS and cognitive decline, longitudinal studies on poststroke cognitive changes in relation to HGS are scarce. This study aimed to observe whether HGS at discharge from acute stroke rehabilitation affects cognitive function 6–12 months after stroke onset and to compare cognitive outcomes between patients with normal and low HGS at discharge. Materials and Methods: This prospective cohort study was conducted in the Department of Rehabilitation Medicine at a tertiary care hospital. In agreement with the Asian Working Group for Sarcopenia 2019 criteria, low muscle strength was defined as an HGS of less than 28 kg for men and less than 18 kg for women, and participants were categorized into normal and low HGS groups. Neuropsychological evaluations were conducted before discharge (approximately one month after stroke onset) and between 6 and 12 months after stroke onset. Results: The low HGS group was older and had lower Montreal Cognitive Assessment scores. However, after adjusting for covariates, the linear mixed model analysis showed no significant differences between the groups in global cognition or specific cognitive domains, except for psychomotor speed during the subacute phase. Notable improvements in language ability were observed in both groups over time, while significant improvements in executive function were observed exclusively in the low HGS group. Conclusions: This longitudinal study is the first to explore the relationship between HGS and changes in cognitive function in older adults with stroke, providing insights into physical strength and cognitive recovery during stroke rehabilitation.

Feeling lonely and dissatisfied – understanding social network functioning in stroke survivors

BackgroundPost-stroke social networks are associated with functional recovery. However, there is little information on the social networks of stroke survivors and whether institutionalised and community-dwelling stroke survivors view their social relationships differently.PurposeTo i) examine social networks of stroke survivors and any influencing sociodemographic factors, as well as to ii) compare differences between institutionalised and community-dwelling stroke survivors.MethodsStroke survivors were recruited from eight healthcare institutions in Singapore. Stroke Social Network Scale (SSNS) was administered to assess the social network functioning. Multidimensional State Boredom Scale (MSBS) was used to evaluate state boredom levels.Results160 stroke survivors completed the study. Stroke survivors reported a mean (SD) of 53.7(17.2) on the SSNS total score. Institutionalised stroke survivors reported significantly lower SSNS scores than community-dwelling stroke survivors, (U = 1856.5, z=-4.234, p < .001). Nearly a third (30.6%, n = 49) of the stroke survivors reported feeling lonely. Only 28.1% (n = 45) stroke survivors reported being ‘Very Satisfied’ with their overall social network. Compared to community-dwelling stroke survivors, institutionalised stroke survivors felt more lonely (40.7%) and only 25% were very satisfied with their social network with all p < .05. A moderate correlation was found between SSNS ‘Satisfaction’ subdomain score and MSBS total score, r=-.401, p < .001.ConclusionsStroke survivors had poor functioning social relationships. This study found that the perceived social support of institutionalised stroke survivors was poorer than community dwelling stroke survivors. A large proportion of stroke survivors reported feeling lonely and were not satisfied with their social networks. Identifying those at risk may be a means to prevent loneliness, increase social network satisfaction to improve well-being and quality of life.

Effectiveness of website-based education program on activities of daily living and fear of falls among sub-acute stroke survivors: a pilot study in South Gujarat Region of India

BackgroundStroke survivors and their caregivers have numerous and diverse educational needs, many of which are unmet because of inadequate training from healthcare professionals. As stroke recovery and rehabilitation can continue for years post-stroke, it is critical that stroke survivors are provided with and have access to a range of support options and evidence-based information. Website-based education programs (WEP) have been adopted in recent years to manage health problems. The present pilot study aims to evaluate the effect of WEP on activities of daily living (ADLs) and the fear of falls among sub-acute stroke survivors.MethodsA total of 16 eligible post-stroke survivors were recruited from multiple study settings across Surat City of Gujarat state in western India and were randomly assigned using a lottery method to either the experimental group (n = 8) receiving WEP or the control group (n = 8) receiving conventional physiotherapy for 4 weeks. Outcome measures were the Indian Stroke Scale (ISS), Modified Barthel Index (MBI), and Falls Efficacy Scale-International (FES-I).ResultsBoth groups showed statistically significant improvements in all outcomes but the experimental group showed more significant improvements in ADLs and fear of falls among sub-acute stroke survivors (p < 0.05).ConclusionWEP for sub-acute stroke survivors is an effective intervention. It improves the performance of ADLs for stroke survivors and helps in better fall management indicating that web-based education programs shall be implemented on a regular basis to improve patient care.

From passenger to driver: an interview study on person-centeredness in clinical reasoning during stroke rehabilitation

Purpose To explore how stroke survivors experience and prefer to participate in clinical reasoning processes in the subacute phase of stroke rehabilitation. Methods An explorative qualitative design was used. Individual interviews were conducted with 10 stroke survivors (4 women and 6 men, mean age 68 years) 4 weeks after their stroke, and follow-up interviews were conducted with 6 of them after 10 weeks. The interview settings were the patient’s home during their home rehabilitation, an inpatient and an outpatient rehabilitation unit. A reflexive thematic analysis was performed. Results Four themes were identified: discharge as a critical point for participation, describing a stressful time with varying involvement; supportive actions and context as crucial for participation, describing collaboration with the stroke team, the team’s consideration of the stroke survivor’s resources and needs, and a supportive home environment; the importance of goals and follow-up, describing goals as motivational and an unstructured use of goals; and difficulties in participation, describing a lack of dialogue with the stroke team and undetected resources and needs. Conclusions The stroke survivors experienced changes in their participation in the clinical reasoning process as their rehabilitation progressed. They moved from perceiving themselves as passengers at the time of their hospital discharge to gradually seeing themselves as the driver of their rehabilitation process. Some person-centered attributes, such as respectful relationships and a health focus, were incorporated into the clinical reasoning, while others, such as a holistic view and shared goal-setting, required further emphasis for improved person-centeredness in stroke rehabilitation.

Relationship of subjective and objective cognition with post-stroke mood differs between early and long-term stroke

Objective: Depression and anxiety affects approximately 1 in 3 stroke survivors. Performance on standardized objective cognitive tests and self-reported subjective cognitive symptoms are associated with concurrent depression and anxiety, but longitudinal data on whether and how objective and subjective cognition relate to emotional outcomes are lacking. Method: N = 99 stroke survivors (M age = 68.9, SD = 13.1; Median NIH Stroke Severity = 5) completed measures of depression and anxiety (Hospital Anxiety and Depression Scale; HADS), objective cognition (Oxford Cognitive Screen) and subjective cognitive symptoms (Cognitive Failures Questionnaire) at 6-months, 4.5, and 5.5 years post-stroke. The contribution of objective and subjective cognition to depression and anxiety was determined via mixed-effects models. Results: We found no evidence that age, stroke severity, years of education, and participant sex related to changes in HADS-Depression or HADS-Anxiety scores (Marginal R 2=0.03 and 0.05, respectively). Objective cognitive impairments at 6-months and increases in subjective cognitive symptoms at 5.5 years significantly related to increased HADS-Depression scores (Marginal R 2=0.22). Only increases in subjective cognitive symptoms at 5.5 years significantly related to increased HADS-Anxiety scores (Marginal R 2=0.20). When conducting models in reverse, HADS-Depression and HADS-Anxiety scores did not reciprocally explain changes in subjective cognitive symptoms. Conclusions: Objective cognitive abilities are more strongly associated with depression at 6-months post-stroke, while subjective cognitive symptoms are more relevant to both long-term post-stroke depression and anxiety. There may be a unique unidirectional influence of subjective cognitive symptoms to post-stroke depression and anxiety.

An example of the adaptation of the Nominal Group Technique (NGT) to a virtual format (vNGT) within healthcare research

The Nominal Group Technique (NGT) has been used to establish clinical priorities and generate guidelines within healthcare since its creation over fifty years ago. It is characterised by its five distinct stages; introduction, silent idea generation, ‘round robin’, clarifications and rating or ranking. A key element traditionally has been the inclusion of face-to-face discussion, however in the context of COVID-19 innovations were required. This article provides a case study illustrating an adaptation of the NGT to a virtual format (vNGT) and outlines the processes involved in a virtual NGT (vNGT), using an illustrative study exploring the rehabilitation of stroke survivors. The vNGT offers opportunities for global collaborations without the constraints of geography or incurred costs. Future studies should evaluate it’s acceptability for stroke survivors to enable their participation within research.Summary statement1. This study provides a guide for the use of virtual nominal group technique (vNGT), using a freely available video-conferencing platform2. vNGT increases opportunities for global collaborations whilst incurring minimal costs.3. It remains unclear how feasible this procedure is with patient populations who have potentially less digital confidence and access.This work was supported by NIHR ARC-East Midlands, Grant number NIHR200171.

Impairments in Proprioceptively-Referenced Limb and Eye Movements in Chronic Stroke.

Upper limb proprioceptive impairments are common after stroke and affect daily function. Recent work has shown that stroke survivors have difficulty using visual information to improve proprioception. It is unclear how eye movements are impacted to guide action of the arm after stroke. Here, we aimed to understand how upper limb proprioceptive impairments impact eye movements in individuals with stroke. Control (N = 20) and stroke participants (N = 20) performed a proprioceptive matching task with upper limb and eye movements. A KINARM exoskeleton with eye tracking was used to assess limb and eye kinematics. The upper limb was passively moved by the robot and participants matched the location with either an arm or eye movement. Accuracy was measured as the difference between passive robot movement location and active limb matching (Hand-End Point Error) or active eye movement matching (Eye-End Point Error). We found that individuals with stroke had significantly larger Hand (2.1×) and Eye-End Point (1.5×) Errors compared to controls. Further, we found that proprioceptive errors of the hand and eye were highly correlated in stroke participants (r = .67, P = .001), a relationship not observed for controls. Eye movement accuracy declined as a function of proprioceptive impairment of the more-affected limb, which was used as a proprioceptive reference. The inability to use proprioceptive information of the arm to coordinate eye movements suggests that disordered proprioception impacts integration of sensory information across different modalities. These results have important implications for how vision is used to actively guide limb movement during rehabilitation.

Healthcare professionals' perceptions on providing support to informal carers within stroke care.

The sudden nature of stroke onset does not provide carers with sufficient time to prepare for the demands associated with caring. Healthcare professionals can have a vital role in providing carers with support and training, which may reduce carer stress and strain, and allow for better health and rehabilitation outcomes for the stroke survivor. The experiences of healthcare professionals on supporting carers in stroke care, however, remain unclear. To understand the experiences and perceptions of healthcare professionals working in stroke care on implementing resources and support to informal stroke carers. Semi-structured interviews were conducted with 11 healthcare professionals (5 occupational therapists, 5 physiotherapists, 1 psychologist) with at least 12 months' experience in working with stroke survivors. Interviews ranged from 25-70 minutes in duration, and were recorded, transcribed, and analysed using thematic analysis. Three overarching categories that were explored were: (1) Experiences of working in stroke care and supporting carers; (2) Recommendations for a program designed for carers; and (3) Future priorities in stroke care. Participants discussed a variety of strategies they utilised to support carers including collaborating with other healthcare professionals and utilising skills and experience. Healthcare professionals highlighted the need for additional resources that are designed specifically for carers and explored key topics including carer stress and fatigue, support services, stroke education, and how to look after oneself. Participants identified priorities for stroke care including additional professional training and resource availability. This study provided a unique insight from the perspectives of healthcare professionals on supporting carers. Participants identified the need for additional training and resources to equip healthcare professionals to better support carers. Future programs designed for carers should be informed by the needs and experiences of both informal carers and healthcare professionals.

Balance impairment and associated factors among stroke survivors in public hospitals of Amhara regional state: a multicenter cross-sectional study

IntroductionBalance impairment is one of the common impairments in patients after stroke. It can lead to depression reduced speed of mobility, dependent on assistive device and reduce quality of life. However, evidence on balance impairment and its risk factors among stroke survivors in Ethiopia was lacking particularly in the study area. Therefore, this study aimed to investigate prevalence and associated factors of balance impairment among stroke survivor’s attendee at an outpatient clinic in Amara regional state comprehensive specialized hospital.MethodsAn institutional based cross-sectional study was conducted from April1-June 30, 2022. A total of 400 participants were selected using the systematic random sampling technique. Standard Berg balance scale tool and semi-structure questionnaire was used. Multicollinearity and model fitness were checked. Variables with a p-value of less than 0.25 in the Bivariable regression were entered into a multivariable logistic regression and p value < 0.05 was used as cutoff point for significant variables.ResultThe prevalence of balance impairment was 51.5% (95% CI (46.58, 56.39). Being depressed (AOR = 12.25:95% CI (4.727, 31.779), using walking aids (AOR = 8.76:95%CI3.469, 22.117)), abnormal speed (AOR = 6.73:95%CI (2.671, 16.977)), did not have physiotherapy treatment (AOR = 3.96:95%CI (1.483, 10.586), and unmarried (AOR = 2.71, 95% CI = 1.061, 6.903) were significantly associated with balance impairment.Conclusion and recommendationThe prevalence of balance impairment in the study was high. Being depressed, use walking aids, did not have physiotherapy treatment, abnormal speed of mobility, and unmarried were significantly associated factors. Therefore; it is better to give greater emphasis for those factors.

Impact of Cognitive Impairment and Impostor Syndrome on Mental Health Issues among Hemiplegic Stroke Survivors

Impact of Cognitive Impairment and Impostor Syndrome on Mental Health Issues among Hemiplegic Stroke Survivors

Lesion Volume as a Predictor for Return to Work After Endovascular Treatment: A 4‐Year Prospective Cohort Study

BACKGROUND There are no known objective biomarkers for predicting return to work (RTW) in ischemic stroke survivors. This study aims to explore the predictive utility and defines a cutoff value of lesion volume on RTW after endovascular treatment. METHODS We included patients aged &lt;65 years undergoing endovascular treatment at Oslo University Hospital between January 2017 and May 2019. Employment status was obtained at both baseline and a 4‐year follow‐up. Stroke lesion volumes were segmented using magnetic resonance imaging scans 24 hours after endovascular treatment. Logistic regression models were conducted to assess the impact of lesion volume on RTW status at follow‐up, adjusted for patients’ characteristics, stroke‐related factors, and treatment. We calculated the receiver operating characteristic curve to determine the optimal lesion volume cutoff. Machine learning regression models were used to assess the predictive abilities of baseline clinical and imaging variables for RTW. RESULTS Of the 109 individuals treated, 81 (74%) were employed at baseline. Among these, 60 completed 4‐year follow‐up with magnetic resonance imaging available for stroke lesion segmentation and were included in the analyses. Mean age at stroke onset was 51.8 years (range, 23.5–64.9 years), and 50% were female. Median lesion volume was 18 mL (interquartile ranges, 45—47 mL). After 4 years, 34 (57%) had successfully RTW. The odds for not RTW increased by 5% for every 1 mL increase in lesion volume (adjusted odds ratio, 1.05 [95% CI, 1.02–1.11]; P = 0.02). A lesion volume cutoff value of 29 cm 3 yielded a sensitivity of 0.91 and specificity of 0.65 for predicting RTW. Notably, the most influential feature in the machine learning model for predicting RTW was lesion volume. CONCLUSION Lesion volume was the most robust predictor of RTW 4 years after endovascular treatment. Our findings suggest that a cutoff of 29 cm 3 is suitable to distinguish between those with high and low chance of RTW.