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O'Callaghan G, Fahy M, O'Meara S, Chawke M, Waldron E, Corry M, Gallagher S, Coyne C, Lynch J, Kennedy E, Walsh T, Cronin H, Hannon N, Fallon C, Williams DJ, Langhorne P, Galvin R, Horgan F. Transitioning to home and beyond following stroke: a prospective cohort study of outcomes and needs. BMC Health Serv Res 2024; 24:449. [PMID: 38600523 PMCID: PMC11005232 DOI: 10.1186/s12913-024-10820-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Understanding of the needs of people with stroke at hospital discharge and in the first six-months is limited. This study aim was to profile and document the needs of people with stroke at hospital discharge to home and thereafter. METHODS A prospective cohort study recruiting individuals with stroke, from three hospitals, who transitioned home, either directly, through rehabilitation, or with early supported discharge teams. Their outcomes (global-health, cognition, function, quality of life, needs) were described using validated questionnaires and a needs survey, at 7-10 days, and at 3-, and 6-months, post-discharge. RESULTS 72 patients were available at hospital discharge; mean age 70 (SD 13); 61% female; median NIHSS score of 4 (IQR 0-20). 62 (86%), 54 (75%), and 45 (63%) individuals were available respectively at each data collection time-point. Perceived disability was considerable at hospital discharge (51% with mRS ≥ 3), and while it improved at 3-months, it increased thereafter (35% with mRS ≥ 3 at 6-months). Mean physical health and social functioning were "fair" at hospital discharge and ongoing; while HR-QOL, although improved over time, remained impaired at 6-months (0.69+/-0.28). At 6-months cognitive impairment was present in 40%. Unmet needs included involvement in transition planning and care decisions, with ongoing rehabilitation, information, and support needs. The median number of unmet needs at discharge to home was four (range:1-9), and three (range:1-7) at 6-months. CONCLUSION Stroke community reintegration is challenging for people with stroke and their families, with high levels of unmet need. Profiling outcomes and unmet needs for people with stroke at hospital-to-home transition and onwards are crucial for shaping the development of effective support interventions to be delivered at this juncture. ISRCTN REGISTRATION 02/08/2022; ISRCTN44633579.
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Affiliation(s)
- Geraldine O'Callaghan
- iPASTAR Collaborative Doctoral Award Programme, School of Physiotherapy, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland.
- iPASTAR Collaborative Doctoral Award Programme, RCSI Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Martin Fahy
- iPASTAR Collaborative Doctoral Award Programme, RCSI Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Sigrid O'Meara
- iPASTAR Collaborative Doctoral Award Programme, RCSI Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Mairead Chawke
- Early Supported Discharge Team for Stroke, Galway University Hospital, Newcastle Rd, H91 YR71, Galway, Ireland
| | - Eithne Waldron
- Early Supported Discharge Team for Stroke, Galway University Hospital, Newcastle Rd, H91 YR71, Galway, Ireland
| | - Marie Corry
- Early Supported Discharge Team for Stroke, Galway University Hospital, Newcastle Rd, H91 YR71, Galway, Ireland
| | - Sinead Gallagher
- Acute Stroke Team, Regional Hospital Mullingar, N91 NA43, Co. Westmeath, Ireland
| | - Catriona Coyne
- Acute Stroke Team, Regional Hospital Mullingar, N91 NA43, Co. Westmeath, Ireland
| | - Julie Lynch
- Acute Stroke Team, Beaumont Hospital, D09V2N0, Dublin 9, Ireland
| | - Emma Kennedy
- Acute Stroke Team, Beaumont Hospital, D09V2N0, Dublin 9, Ireland
| | - Thomas Walsh
- Consultant Geriatrician / Stroke Physician, Stroke and Geriatric Medicine, Galway University Hospital, Newcastle Rd, H91 YR71, Galway, Ireland
| | - Hilary Cronin
- Consultant Geriatrician, Regional Hospital Mullingar, N91 NA43, Co. Westmeath, Ireland
| | - Niamh Hannon
- Consultant Stroke Physician, Stroke and Geriatric Medicine, Galway University Hospital, Newcastle Rd, H91 YR71, Galway, Ireland
| | - Clare Fallon
- Consultant Geriatrician, General Internal Medicine Physician & RCSI Undergraduate Dean, Regional Hospital Mullingar, N91 NA43, Co. Westmeath, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine and iPASTAR Collaborative Doctoral Award Programme, RSCI University of Medicine and Health Sciences and Beaumont Hospital, Dublin 9, Ireland
| | - Peter Langhorne
- School of Cardiovascular and Metabolic Health (SCMH), University of Glasgow, G12 8QQ, Glasgow, Scotland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, V94 T9PX, Limerick, Ireland
| | - Frances Horgan
- iPASTAR Collaborative Doctoral Award Programme, School of Physiotherapy, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
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Wong AKC, Wang SL, So C, Lian J, Yan Y, Li H, Wu L, Pei H, Wang W, Wong FKY. Economic Evaluation of an Enhanced Post-Discharge Home-Based Care Program for Stroke Survivors. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:405-414. [PMID: 38309655 DOI: 10.1016/j.jval.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/15/2023] [Accepted: 01/19/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES To examine the cost-effectiveness of an enhanced postdischarge home-based care program for stroke survivors compared with usual care. METHODS This was a trial-based economic evaluation study. One hundred and sixteen patients with ischemic stroke were recruited from neurology units in a Chinese hospital and randomized into intervention (n = 58) or usual care groups (n = 58). The intervention commenced with predischarge planning and transitioned to home follow-up postdischarge. Trained nurse case managers supported by an interdisciplinary team provided comprehensive assessment, individualized goal setting, and skill training to support home-based rehabilitation for intervention group participants. Standard care was provided to usual care group participants. Total cost and quality-adjusted life-years gained at 3-month (T1), 6-month (T2), and 12-month (T3) follow-ups were calculated. The incremental cost-effectiveness ratios between the groups were obtained. RESULTS The intervention group showed a significant increase in utility compared with the usual care group at T1 (P = .003), T2 (P = .007), and T3 (P < .001). The average total QALY gain from baseline for the intervention group was higher than for the usual care group at all time points. The likelihood of being cost-effective ranged from 61.9% to 67.2% from the provider perspective, and from 59.7% to 66.8% from the societal perspective. CONCLUSIONS The results showed that the intervention program was cost-effective with significantly higher quality-adjusted life-years for stroke survivors when compared with usual care. It provides economic evidence to support the development of home-based stroke rehabilitation program, especially in the low- and middle-income countries.
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Affiliation(s)
| | - Shao Ling Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ching So
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jinxiao Lian
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ying Yan
- Nursing Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Haiyan Li
- Nursing Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Lijie Wu
- Nursing Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Haixia Pei
- Rehabilitation Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Wei Wang
- Neurology Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
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Lynch EA, Bulto LN, West M, Cadilhac DA, Cooper F, Harvey G. Codesigning implementation strategies to improve evidence-based stroke rehabilitation: A feasibility study. Health Expect 2023; 27:e13904. [PMID: 37990469 PMCID: PMC10757151 DOI: 10.1111/hex.13904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/09/2023] [Accepted: 10/21/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION People with lived experience are rarely involved in implementation science research. This study was designed to assess the feasibility of codesigning and delivering implementation strategies with people with lived experience of stroke and health professionals to improve evidence-based stroke rehabilitation. METHODS We used Experience-Based CoDesign to design and deliver strategies to implement Stroke Clinical Guideline recommendations at one Australian inpatient stroke rehabilitation unit. Workgroups were formed with health professionals and people with 6-12 months experience of living with stroke (survivors and carers). Feasibility of the codesign approach (focusing on acceptability, implementation fidelity, signal of promise) was evaluated using mixed methods, using data from interviews, observations and inpatient self-reported outcomes. RESULTS Of 18 people with stroke invited, eight (44%) agreed to join the lived experience workgroup. All disciplines with ≥1 full-time staff members on the stroke unit were represented on the health professional workgroup. Median workgroup attendance over 6 months was n = 8 health professionals, n = 4 survivors of stroke and n = 1 carers. Workgroup members agreed to focus on two Guideline recommendations: information provision and amount of therapy. Workgroup members indicated that the codesign approach was enjoyable and facilitated effective partnerships between health professionals and lived experience workgroup members. Both cohorts reported contributing valuable input to all stages of the project, with responsibility shifting between groups at different project stages. The codesigned strategies signalled promise for improving aspects of information provision and creating additional opportunities for therapy. We could not compare patient-reported outcomes before and after the implementation period due to high variability between the preimplementation and postimplementation patient cohorts. CONCLUSION It is feasible to codesign implementation strategies in inpatient rehabilitation with people with lived experience of stroke and health professionals. More research is required to determine the effect of the codesigned strategies on patient and service outcomes. PATIENT OR PUBLIC CONTRIBUTION People with lived experience of stroke codesigned and evaluated implementation strategies. Author F. C. has lived experience of stroke and being an inpatient at the inpatient rehabilitation service, and has provided input into analysis of the findings and preparation of this manuscript.
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Affiliation(s)
- Elizabeth A. Lynch
- College of Nursing and Health Sciences, Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Lemma N. Bulto
- College of Nursing and Health Sciences, Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Maria West
- College of Nursing and Health Sciences, Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
- Occupational Therapy DepartmentCentral Adelaide Health ServiceAdelaideSouth AustraliaAustralia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
- Stroke Theme, The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneHeidelbergVictoriaAustralia
| | | | - Gillian Harvey
- College of Nursing and Health Sciences, Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
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Cho SJ, Kim SR, Cho KH, Shin NM, Oh WO. Effect of a Hospital-To-Home Transitional Intervention Based on an Interaction Model of Client Health Behavior for Adult Patients with Stroke. J Community Health Nurs 2023; 40:273-288. [PMID: 37431105 DOI: 10.1080/07370016.2023.2227154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
To develop and identify the effectiveness of a hospital-to-home transitional intervention based on an interaction model of client health behavior in adult patients with stroke. A non-equivalent control group pretest-posttest. Thirty-eight patients participated (18=intervention, 20=control); the intervention group received 12 weeks of the intervention. The intervention influenced anxiety, disease severity, health behavior adherence, patient satisfaction, and quality of life in adult patients with stroke. Transitional programs have potential to improve the health behaviors of subjects, and community health nurses can assist in the implementation of these programs. Health behaviors and quality of life scores were significantly higher in the intervention group than in the control group; these findings support the need for continuity of nursing care during the transitional period for patients with stroke. Given the challenges faced by adult stroke patients after stroke, community nurses should pay attention to patients' transitional experiences.
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Affiliation(s)
- Su-Jin Cho
- Research Institute of Nursing Science, Pusan National University, Yangsan, Republic of Korea
| | - Sung Reul Kim
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, Republic of Korea
| | - Kyung-Hee Cho
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Nah-Mee Shin
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, Republic of Korea
| | - Won-Oak Oh
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, Republic of Korea
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Pădureanu V, Albu CV, Caragea DC, Bugă AM, Florescu MM, Pădureanu R, Biciușcă V, Sub£irelu MS, Turcu-Știolică A. Quality of life three months post‑stroke among stroke patients and their caregivers in a single center study from Romania during the COVID‑19 pandemic: A prospective study. Biomed Rep 2023; 19:52. [PMID: 37456656 PMCID: PMC10345898 DOI: 10.3892/br.2023.1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023] Open
Abstract
The aim of the present study was to determine the health-related quality of life of stroke patients and their caregivers during the fifth wave of the COVID-19 pandemic. A total of 70 patients who had been diagnosed with stroke between October 2021 and March 2022 and 70 caregivers were included in the present study. A prospective follow-up study assessing the quality of life at baseline was conducted after 3 months for both patients and their caregivers. A linear regression analysis was performed to evaluate potential associations between quality of life and assessed factors. The results revealed that age, sex, employment status, hospitalization period, type of stroke, Barthel index for activities of daily living (ADL) and discharge Modified Rankin Scale (mRS), were significant determinants of the 90-day Health-Related Quality of Life (HRQoL). An important clinical change in the QoL score was estimated for both post-stroke patients and their caregivers. The decrease of the HRQoL of patients was statistically influenced by a higher value of ADL (P=0.014), whereas, in the case of their caregivers, the decrease of HRQoL was primarily influenced by the QoL of patients after 3 months (P=0.043). The present study identified some important key factors with direct consequences on HRQoL regarding stroke survivors and their caregivers.
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Affiliation(s)
- Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Carmen Valeria Albu
- Department of Neurology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniel Cosmin Caragea
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ana Maria Bugă
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mirela Marinela Florescu
- Department of Morphology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Rodica Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Viorel Biciușcă
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Simona Sub£irelu
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Adina Turcu-Știolică
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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