Abstract NS12: Stroke Mobile: Implementing A Novel Family Centered, Home-Based Post-Discharge System of Care

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Bethany Jennings ◽  
Lynn Eckhardt ◽  
Raymond Egger ◽  
Antonio Batiquin ◽  
Aaron Bridges ◽  
...  
Keyword(s):  
Stroke Care ◽  
System Of Care ◽  
Assessment Tools ◽  
Stroke Recurrence ◽  
Post Discharge ◽  
Discharge System ◽  
Effective Prevention ◽  
Post Stroke ◽  
Home Based ◽  
Family Centered

Total annual costs of stroke-related care and loss of post-stroke productivity are projected to reach $241 billion by 2030, an increase of 129% since 2010. Although comprehensive stroke care programs have contributed to reductions in recurrent strokes, readmissions, and stroke-related complications, this population is vulnerable to non-adherence to the plan of care during the first year. Innovative in-home programs that coordinate team-based care hold promise for positively impacting this public health threat through greater emphasis on effective prevention, adherence, and optimizing outcomes. Purpose: The purpose of this project was to evaluate the implementation of a home-based post-discharge stroke mobile program to existing comprehensive stroke care. Methods: An inter-professional team of stroke specialists (physicians, advanced practice nurses, registered nurses), and administrative and financial specialists collaborated to develop an innovative, family-centered, home-based approach to post-discharge stroke care. The team identified project goals, assessment tools, and 12-month post-discharge outcome metrics. Telemedicine technology enabled a direct link between the mobile team, patient, and an APN or Neurologist to reduce office/emergency visits, and lower costs. Results: Training of the home-based team included stroke specific education, along with training in communication skills and family-based interventions. Home visits were structured to occur once per month for 1 year post stroke. Each visit was designed to impact specific elements related to enhancing physical recovery, preventing readmissions and stroke recurrence, improving medication compliance, risk factor management, and caregiver support. Fifteen of 24 (63%) received all scheduled visits, and all planned visits did not occur in 9/24 (37%) due to patient’s schedule. Only 2/24 (8%) were readmitted for stroke recurrence. Lessons learned include need to validate contact information before discharge; develop a brochure that targets program enrollment; and explore options to visit in other settings. Conclusion: A family centered, home-based, post-discharge system of care is a viable solution to addressing the complex needs of the stroke patient.

Abstract 55: An Integrated Stroke Practice Unit Model Can Impact Blood Pressure Management Post-Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Patricia Commiskey ◽  
Kenneth Gaines
Keyword(s):  
Blood Pressure ◽  
Lifestyle Modification ◽  
Medication Compliance ◽  
Stroke Care ◽  
Stroke Recurrence ◽  
Post Discharge ◽  
Post Stroke ◽  
Unit Model ◽  
Risk Education ◽  
Suspected Stroke

Introduction: Stroke care involves multiple mechanisms and high risk and cost. Even when initial acute events are managed successfully, patient risk remains high for stroke recurrence and readmission for stroke-related causes that negatively impact recovery. Hypertension, the main modifiable risk factor for stroke, accounts for ≤50% of recurrent strokes. Blood pressure (BP) management for stroke post-discharge often combines risk education, lifestyle modification, and medication compliance, but insufficient evidence has complicated provider response. Methods: An Integrated Stroke Practice Unit (ISPU) Model was implemented in New Orleans (2012-2015) that combines integrated technology and real time response to improve care coordination from symptom onset through 12-months post-discharge. Stroke Central included patients hospitalized with suspected stroke symptoms, and Stroke Mobile included patients discharged with a stroke diagnosis residing in St. Tammany or Jefferson Parishes. Stroke Mobile patients were followed at home monthly to assess recovery, manage comorbidities, and provide risk/recovery/recurrence education and caregiver/family support; comprehensive BP management and education were key goals. BP at goal was defined as 140/90 and was measured at each visit (12 total); BP issues were proactively followed and resolved. Results: From February 2013-December 2015, 558 patients were seen at least one time in Stroke Mobile, and 192 patients completed 12 visits. Of those who completed the program, patients whose blood pressure was controlled at each visit ranged from 78.2%-93.2%, which is higher than in previously reported studies. Overall, increased control was seen overtime from visits 1-12; additional analyses will examine this in more detail. Conclusions: A comprehensive ISPU approach, combined with targeted education and caregiver/family focus, can be effective for managing BP post-stroke.

Abstract P839: ‘Stroke Home Care’- A Mobile Application: Home Based Innovative Nursing Care Intervention Developed by Stroke Nurse: A Need of the Time in Covid-19 Pandemic Like Situation

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ashok Kumar ◽  
Dheeraj Khurana ◽  
Smita Pattanaik ◽  
Mukesh Kumar ◽  
Manish Modi ◽  
...  
Keyword(s):  
Home Care ◽  
Nursing Care ◽  
Mobile Application ◽  
Frozen Shoulder ◽  
Tube Feeding ◽  
Stroke Care ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Post Stroke ◽  
Home Based

Introduction: Stroke nurse is functioning as a vital member of the stroke team. She/he provides care to the stroke patients in acute as well as post-acute periods. She/he coordinates among other team members to facilitate the stroke care continuum. Post-stroke care is always a challenge for health care professional as well as caregivers. During current pandemic conditions, it is essential to provide quality care at their home. Purpose: To develop a mobile application to provide home based care for prevention and management of post stroke complications among survivors. Methods: Survey was carried out among 170 bedridden stroke survivors and their caregivers to assess problems faced like aspiration pneumonia, bedsore, urinary tract infection, deep vein thrombosis, frozen shoulder, contractures, and caregiver burden. On the basis of findings ‘Stroke home care’ a bilingual (in Hindi and English) mobile application was developed which contains step by step nursing-care-procedural videos to prevent bedsore, bedsore dressing, positioning change, Ryle’s tube feeding, Foley’s catheter care, active and passive range of motion exercises, hand washing with soap-water as well with sanitizer, psychological support to patients. Results: Through this intervention, caregivers of bedridden stroke patients get trained for care procedures so that they can provide best possible nursing care to their patients at home and can prevent post stroke complications and ultimately enhances quality of life of survivors and reduce caregivers’ burden. Conclusion: ‘Stroke Home Care’ is a novel intervention developed by a stroke nurse which has been developed and tested not just for its feasibility and acceptability but also proven for its clinical applicability through PROBE designed study. This web based intervention can provide rehabilitation services to bedridden stroke survivors at their home in this pandemic.

Abstract TP162: Case Manager Guided Organized Post-stroke Care Aids in Achieving Risk Factor Goals

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jessica Kepplinger ◽  
Kristian Barlinn ◽  
Uwe Helbig ◽  
Lars-Peder Pallesen ◽  
Timo Siepmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hemorrhagic Stroke ◽  
Case Manager ◽  
Care Program ◽  
Stroke Care ◽  
Stroke Recurrence ◽  
Vascular Risk ◽  
Post Stroke ◽  
Persistent Disability

Introduction: Our ongoing post-stroke care program aims at risk factors control, life-style changes and adherence to secondary prevention medication to reduce stroke recurrence and persistent disability. Methods: Consecutive acute ischemic and hemorrhagic stroke patients were prospectively included in a 1-year post stroke care program that is accomplished through a certified stroke case manager. Scheduled and non-scheduled personal contacts were regularly provided to check on risk factor control and whenever felt necessary. Target values for vascular risk factors followed current recommendations of the European stroke guidelines. Results: Between 12/2011 and 07/2014 we enrolled 101 of 155 screened patients: 58/101 (57%) were male, mean age was 71+/-13 years, median baseline NIHSS score was 2 (range 0-16), 80/101 (79%) had an ischemic stroke, 3/101 (3%) hemorrhagic stroke and 18/101 (18%) patients had a TIA. Twelve out of 101 patients withdrew from the program and three patients died due to non-vascular causes. In total 628 personal (6.2/patient) and 2683 phone contacts (26.6/patient) were conducted by the case manager. Three hundred-seventy nine specific interventions were necessary mostly due to missing medication, non-compliance and social needs. No recurrent stroke occurred during the program. Achieved vascular risk factor values are presented in the Table. Conclusion: Our findings underline that organized post-stroke care may aid in achieving pre-defined goals for secondary prevention of stroke. Further data is needed to explore its impact on stroke recurrence, prevention of persistent disability and health-care costs.

scholarly journals Oral Care Practices in Stroke: Findings from the UK and Australia

2020 ◽  
Author(s):  
Munirah Bangee ◽  
Cintia Martinez-Garduno ◽  
Marian Brady ◽  
Dominique Cadilhac ◽  
Simeon Dale ◽  
...  
Keyword(s):  
Oral Care ◽  
Stroke Care ◽  
Assessment Tools ◽  
Care Practice ◽  
Factors Affecting ◽  
Post Stroke ◽  
Care Protocol ◽  
Care Assessment ◽  
Care Practices ◽  
The Uk

Abstract AimsTo examine current practice, perceptions of healthcare professionals and factors affecting provision for oral care post-stroke in the UK and Australia.BackgroundPoor oral care has negative health consequences for people post-stroke. Little is known about oral care practice in hospital for people post-stroke and factors affecting provision in different countries.DesignA cross-sectional survey.MethodsQuestionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing inpatient acute or rehabilitation care post-stroke. The survey was conducted between April and November 2019. Non-respondents were contacted up to five times.ResultsCompleted questionnaires were received from 150/174 (86%) hospitals in the UK, and 120/162 (74%) in Australia. A total of 52% of UK hospitals and 30% of Australian hospitals reported having a general oral care protocol, with 53% of UK and only 13% of Australian hospitals reporting using oral care assessment tools. Of those using oral care assessment tools, 50% of UK and 38% of Australian hospitals used local hospital-specific tools. Oral care assessments were undertaken on admission in 73% of UK and 57% of Australian hospitals. Staff had received oral care training in the last year in 55% of UK and 30% of Australian hospitals. Inadequate training and education on oral care for pre-registration nurses were reported by 63% of UK and 53% of Australian respondents.ConclusionUnacceptable variability exists in oral care practices in hospital stroke care settings. Oral care could be improved by increasing training, performing individual assessments on admission, and using standardised assessment tools and protocols to guide high quality care. The study highlights the need for incorporating staff training and the use of oral care standardised assessments and protocols in stroke care in order to improve patient outcomes.

Abstract WP451: “Development, Feasibility and Validation of “Stroke Home Care” Application in a Resource Limited Setting: A Proof of Concept Study”

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ashok Kumar ◽  
Dheeraj Khurana ◽  
Smita Pattanaik ◽  
Mukesh Kumar ◽  
Manish Modi ◽  
...  
Keyword(s):  
Home Care ◽  
Stroke Care ◽  
Medical Application ◽  
Mobile App ◽  
Resource Limited Setting ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Resource Limited ◽  
Home Based ◽  
Limited Setting

Introduction: Stroke rehabilitation and caregivers training is central to improve post stroke care and reduce caregivers’ burden. Mobile applications(app) may provide a patient and caregiver centric modality to improve stroke care Aim: To develop and evaluate feasibility of a medical application for delivering post stroke care. Methods: A mobile app was developed on an android operating system following a preliminary assessment of post stroke complications to train caregivers. App consists of videos of home based care strategies for bedsore prevention, feeding, mouth care, ROM exercises, catheter care, psychological support to patients etc. App includes awareness videos on stroke, problems faced after stroke, follow up schedule, feedback option. App feasibility was assessed among 25 bedridden stroke survivors and their caregivers selected purposely. App validation was done by 16 stroke experts including neurologists, nurses, psychologists, physiotherapists using semi-structured-questionnaire for data collection. Following this, final "Stroke Home Care" app was developed. Results Feasibility: Mean age of patients and caregivers was 52.6±14.8 and 32.4±8.9years, respectively. 64% patients females, 75% caregivers males. 56% lived in rural. Median NIHSS 14 (IQR: 12-17). Complications were 56% Ryle’s tube, 72% Foley’s catheter, 12% bedsore. 64% caregivers were graduates. 52% sons. All caregivers responded that app contents, videos and language was understandable and appropriate. 92% preferred ‘Hindi’ language. All agreed to App enhancing their stroke knowledge. All were satisfied. Validation: Mean age of experts was 33.2±4years. 75% females. 56% nursing experts and postgraduates,19% MDs. 50% Nursing teachers, 19% Neurology fellows. None faced any app installation problem. 81.3% experts highly satisfied with app functions, its contents, voice clarity, video clarity and duration, contents’ sequence, understandability. Discussion/Conclusion: “Stroke Home Care” App is feasible, pragmatic and user-friendly for use by caregivers of stroke survivors in a resource limited setting/developing country. It should be tested by an RCT to evaluate its efficacy in reducing post stroke complications and reducing caregivers’ burden.

Abstract 185: Residual Stroke Morbidity and Post-acute Care Cost: the IMS III Economic Data Cohort

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kit N Simpson ◽  
Annie N Simpson ◽  
Michael D Hill ◽  
Yuko Y Palesh ◽  
Edward C Jauch ◽  
...  
Keyword(s):  
Hospital Readmissions ◽  
Cost Savings ◽  
Stroke Care ◽  
Office Visits ◽  
Economic Data ◽  
Post Discharge ◽  
Post Stroke ◽  
Initial Hospital ◽  
The Cost

Introduction: The IMS III trial included 1-year follow-up with prospectively collected data on resource use after stroke. While the trial showed no difference in 90-day clinical outcomes by treatment group, this cohort provides invaluable information on cost variations associated with post-stroke morbidity. We report the effect of residual stroke morbidity on cost of stroke care after discharge at 12 months post stroke. Methods: Among 470 subjects with moderate to severe stroke for whom economic data were collected (316 randomized to IV t-PA and endovascular therapy, 154 to IV t-PA alone), we estimated cumulative cost post discharge using cost weights derived from a 5% sample of US Medicare patients in 2012 with an admission for acute ischemic stroke with IV t-PA treatment. Cost weights included post-stroke rehabilitation hospital days, emergency care visits, hospital readmissions, medical office visits, rehabilitation therapy visits and nursing home days. Costs were summed at the level of the subject and estimated for the subset defined by NIH Stroke Scale Score (NIHSS) at day 5, and Modified Rankin Score (mRS) and Barthel Index (BI) at 3 months post stroke. Subjects who died during the initial hospital admission or who had no score at day 5 or at 3 months were not included in our analysis. Age-adjusted, log-transformed costs were compared. Results: There was a 6 fold difference in the cost of follow-up care by lowest and highest NIHSS at day 5 (p<.0001). Similarly large differences by outcome category were observed for both the mRS (p<.0001) groups and subjects defined by the BI (p<.0001) at 3 months (see Figure). Conclusion: Residual stroke morbidity has a large effect on the long-term cost of stroke care, with an effect size of over 600%. Interventions that improve the residual morbidity after stroke as early as day 5 may be expected to result in substantial post discharge cost savings.

Abstract WP468: Follow Up After Stroke, Screening and Treatment Clinic: Advancing Post-Stroke Care

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Imama A Naqvi ◽  
Jennifer Andres ◽  
Charles Ruchalski ◽  
Sean V Cleymaet ◽  
Seung Kim ◽  
...  
Keyword(s):  
Risk Factor ◽  
Stroke Prevention ◽  
Vascular Risk Factor ◽  
Integrated Approach ◽  
Stroke Care ◽  
Secondary Stroke Prevention ◽  
Post Discharge ◽  
Post Stroke ◽  
Patient Reported

Objective: To assess feasibility and replicability of a multidisciplinary, specialized clinic in optimization of secondary stroke prevention and stroke related complications. Background: Recommendations exist for secondary stroke prevention, but it is unclear which outpatient model of care optimizes vascular risk factor control and decreases post-stroke complications most effectively. Designed after the Stroke Transitions, Education, and Prevention clinic in Houston, TX, the Follow up After Stroke, Screening and Treatment (FASST) clinic is an integrated, multidisciplinary, specialized clinic designed to optimize secondary stroke prevention. It provides post discharge stroke education and medication adherence counseling by Pharmacists, as well risk factor and complications management by Vascular Neurologists. Validated patient reported surveys screen for complications: depression, anxiety, sleep disorders, cognitive impairment, disability, social support, quality of life and functional status. Our approach and the characteristics of patients enrolled in the clinic is described. Methods: Patients attending one FASST clinic visit are included. Institutional Board Review approved consent is obtained. Demographic and clinical data are recorded including risk factors, surveys and outcome scores. Data is entered in Redcap and analyzed through the Statistical Analysis Software (SAS) program. Results: Of the 25 patients enrolled in the clinic, 83.3% are African American. A high prevalence of hyperlipidemia (100%) and hypertension (100%) exists, with 44% of patients having concomitant diabetes mellitus. Overall 26.7% screened positive for depression with PHQ-9, and 20% screened positive for anxiety with GAD-7. These patients were started on medications and referred for psychotherapy. Abnormal ESS scores were noted in 31.3% and directed for sleep apnea evaluation. Eighteen medical and pharmacy trainees rotated through the clinic. Conclusion: The FASST clinic represents a reproducible model for an integrated approach to post-stroke care. Adapted to academic centers across the country, a collaborative network would provide best practices, and measure patient reported outcomes to optimize stroke care.

Abstract T P259: Study of Factors Contributing to Reduce Cost in an Innovative Post-Stroke Program

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Aaron J Bridges ◽  
Patricia Commiskey ◽  
Kenneth Gaines
Keyword(s):  
Stroke Care ◽  
Final Diagnosis ◽  
The United States ◽  
Cost Of Care ◽  
Innovative Technology ◽  
Care Model ◽  
Post Discharge ◽  
Post Stroke ◽  
Personal Transportation

Background and Purpose: Stroke is the 4 th leading cause of death in the United States. Stroke-related medical costs and disability in the US cost approximately $73.7 billion in 2010 and is projected to cost $185 billion by 2030. Decreasing costs of care among post-stroke patients requires a combination of follow-up care and monitoring and targeted risk factor reduction. Ochsner Neuroscience Institute (ONI) has implemented a Comprehensive Stroke Care Model designed to increase quality and decrease costs of stroke across the continuum from symptom onset through 12 months post-discharge. This Model combines evidence-based, streamlined in-hospital care with monthly post-discharge follow-up and education in the home for patients and caregivers. Innovative technology that connects patients and caregivers with ONI stroke and internal medicine providers to address issues real-time during outpatient visits. This research will describe this innovative Stroke Care Model, including its impact on mortality, length of stay, stroke reoccurrence rate, and cost of care. Methods: This research will include patients seen as part of this Model from 1/3/2013-7/31/2014. Stroke Central, the in-hospital component, coordinated patients who presented at Ochsner’s Emergency Department via transfer, EMS, or personal transportation (n=1,711). Stroke Mobile, the outpatient component, includes a subsample of patients and their caregivers who were discharged with a stroke diagnosis and who reside in St. Tammany and Jefferson Parishes in Louisiana (n=288). Results: Stroke Mobile includes patients discharged from Ochsner’s Stroke Program with a final diagnosis of stroke who reside in St. Tammany or Jefferson Parishes in Louisiana from 2013-2014 (n=288 as of 7/31/2014). Patients that participated in stroke mobile reported a stroke reoccurrence rate 40% lower than patients not participating in stroke mobile. Conclusions: These results suggest a significant cost reduction in post stroke care through personalized patient visits that resulted in reduced readmissions rates, reduced stroke reoccurrence rates, and decreased clinic visits.

Oral care practices in stroke: findings from the UK and Australia

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Munirah Bangee ◽  
Cintia Mayel Martinez-Garduno ◽  
Marian C. Brady ◽  
Dominique A. Cadilhac ◽  
Simeon Dale ◽  
...  
Keyword(s):  
Oral Care ◽  
Stroke Care ◽  
Assessment Tools ◽  
Care Practice ◽  
Factors Affecting ◽  
Post Stroke ◽  
Care Protocol ◽  
Care Assessment ◽  
Care Practices ◽  
The Uk

Abstract Aims To examine current practice, perceptions of healthcare professionals and factors affecting provision for oral care post-stroke in the UK and Australia. Background Poor oral care has negative health consequences for people post-stroke. Little is known about oral care practice in hospital for people post-stroke and factors affecting provision in different countries. Design A cross-sectional survey. Methods Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing inpatient acute or rehabilitation care post-stroke. The survey was conducted between April and November 2019. Non-respondents were contacted up to five times. Results Completed questionnaires were received from 150/174 (86%) hospitals in the UK, and 120/162 (74%) in Australia. A total of 52% of UK hospitals and 30% of Australian hospitals reported having a general oral care protocol, with 53% of UK and only 13% of Australian hospitals reporting using oral care assessment tools. Of those using oral care assessment tools, 50% of UK and 38% of Australian hospitals used local hospital-specific tools. Oral care assessments were undertaken on admission in 73% of UK and 57% of Australian hospitals. Staff had received oral care training in the last year in 55% of UK and 30% of Australian hospitals. Inadequate training and education on oral care for pre-registration nurses were reported by 63% of UK and 53% of Australian respondents. Conclusion Unacceptable variability exists in oral care practices in hospital stroke care settings. Oral care could be improved by increasing training, performing individual assessments on admission, and using standardised assessment tools and protocols to guide high quality care. The study highlights the need for incorporating staff training and the use of oral care standardised assessments and protocols in stroke care in order to improve patient outcomes.

scholarly journals Development and evaluation of tools and an intervention to improve patient- and carer-centred outcomes in Longer-Term Stroke care and exploration of adjustment post stroke: the LoTS care research programme

2014 ◽  
Vol 2 (6) ◽  
pp. 1-224 ◽  
Author(s):  
Anne Forster ◽  
Kirste Mellish ◽  
Amanda Farrin ◽  
Bipin Bhakta ◽  
Allan House ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Research Programme ◽  
Stroke Care ◽  
System Of Care ◽  
Evidence Based ◽  
Initial Development ◽  
Retest Reliability ◽  
Post Stroke ◽  
Reference Number ◽  
Test Retest Reliability

BackgroundEvidence-based care pathways are required to support stroke patients and their carers in the longer term.AimsThe twofold aim of this programme of four interlinking projects was to enhance the care of stroke survivors and their carers in the first year after stroke and gain insights into the process of adjustment.Methods and resultsWe updated and further refined a purposely developed system of care (project 1) predicated on a patient-centred structured assessment designed to address areas of importance to patients and carers. The structured assessment is linked to evidence-based treatment algorithms, which we updated using a structured protocol: reviewing available guidelines, Cochrane reviews and randomised trials. A pragmatic cluster randomised controlled trial evaluation of the clinical effectiveness and cost-effectiveness of this system of care was undertaken in 29 community-based UK stroke care co-ordinator services (project 2). In total, 15 services provided the system of care and 14 continued with usual practice. The primary objective was to determine whether the intervention improved patient psychological outcomes (General Health Questionnaire-12) at 6 months; secondary objectives included functional outcomes for patients, outcomes for carers and cost-effectiveness, as measured through self-completed postal questionnaires at 6 and 12 months. A total of 800 patients and 208 carers were recruited; numbers of participants and their baseline characteristics were well balanced between intervention and control services. There was no evidence of statistically significant differences in primary or secondary end points or adverse events between the two groups, nor evidence of cost-effectiveness. Intervention compliance was high, indicating that this is an appropriate approach to implement evidence into clinical practice. A 22-item Longer-term Unmet Needs after Stroke (LUNS) questionnaire was developed and robustly tested (project 3). A pack including the LUNS questionnaire and outcome assessments of mood and social activity was posted to participants 3 or 6 months after stroke to assess acceptability and validity. The LUNS questionnaire was re-sent 1 week after return of the first pack to assess test–retest reliability. In total, 850 patients were recruited and the acceptability, validity and test–retest reliability of the LUNS questionnaire as a screening tool for post-stroke unmet need were confirmed. This tool is now available for clinical use. An in-depth qualitative investigation was undertaken with 22 patients (and carers) at least 1 year after stroke (project 4) to gain further insights into the experience of adjustment. This included initial semistructured interviews, limited observations and solicited diaries with a follow-up interview 3–4 months after the initial interview and highlighted a range of different trajectories for post-stroke recovery.ConclusionsThe programme has been completed as planned, including one of the largest ever stroke rehabilitation trials. This work highlights that successfully addressing the needs of a heterogeneous post-stroke population remains problematic. Future work could explore stratifying patients and targeting services towards patients (and carers) with specific needs, leading to a more specialised bespoke service. The newly developed LUNS questionnaire and the qualitative work will help inform such services.Trial registrationCurrent Controlled Trials ISRCTN67932305.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme. The Bradford Teaching Hospitals NHS Foundation Trust received additional funding for project 2 in the submitted work from the Stroke Association, reference number TSA 2006/15. The initial development work for the LUNS tool and the Longer-Term Stroke care (LoTS care) trial carried out before the start of the programme grant was funded by the Stroke Association, reference number TSADRC 2006/01.

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