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 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.

scholarly journals Can Cardiovascular Risk Management be improved by Shared Care with General Practice to Prevent Cognitive Decline Following Stroke/TIA? A feasibility randomised controlled Trial (SERVED Memory)

2020 ◽  
Author(s):  
William Davison ◽  
Phyo K Myint ◽  
Yoon K Loke ◽  
Garth Ravenhill ◽  
David A Turner ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Randomised Trial ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Risk Factor Management ◽  
Post Stroke ◽  
Observational Cohort ◽  
Normal Cognition

Abstract BackgroundCognitive impairment and dementia following cerebrovascular disease are increasingly common in the UK. One potential strategy to prevent post-stroke cognitive decline is multimodal vascular risk factor management. However, its efficacy remains uncertain and its application in vulnerable patients with incident cerebrovascular disease and early cognitive impairment has not been assessed.The primary aim of this study was to assess the feasibility of recruitment and retention of patients with early cognitive impairment post-stroke or transient ischaemic attack (TIA) to a trial of enhanced vascular risk factor management combining primary and secondary care.MethodsIn this single centre, open label trial adults with a recent stroke or TIA and mild cognitive impairment (MCI) were randomised 1:1 to a three-monthly multimodal vascular risk factor intervention jointly delivered by the trial team and General Practitioner (GP), or control (defined as usual care from the GP). Chosen risk factors were blood pressure (BP), total cholesterol, blood glucose (HbA1C) in those with diabetes, and heart rate and adequacy of anticoagulation in those with atrial fibrillation (AF). Similar patients with normal cognition were enrolled in an embedded observational cohort and also received usual care from the GP. Repeat cognitive screening was undertaken in all participants after 12 months.ResultsSeventy three participants were recruited to the randomised trial and 94 to the observational cohort (21.8% of those screened). From the randomised trial 35/73 (47.9%) dropped out before final follow-up. In all groups guideline based rates of risk factor control were mostly poor at baseline and did not significantly improve during follow-up. The observational cohort demonstrated greater decline in cognitive test scores at 12 months, with no difference between the randomised groups.ConclusionsRecruitment to such a study was feasible, but retention of participants was difficult and generally poor rates of risk factor control suggested insufficient application of the intervention. Consequently, successful scaling up of the trial would require protocol changes with less reliance on primary care services. Any future trial should include participants with normal cognition post-stroke as they may be at greatest risk of cognitive decline.Trial RegistrationISRCTN, ISRCTN42688361. Registered 16 April 2015, https://www.isrctn.com/ISRCTN42688361

scholarly journals Can cardiovascular risk management be improved by shared care with general practice to prevent cognitive decline following stroke/TIA? A feasibility randomised controlled trial (SERVED memory)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
William J. Davison ◽  
Phyo K. Myint ◽  
Yoon K. Loke ◽  
Garth Ravenhill ◽  
David Turner ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Randomised Trial ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Risk Factor Management ◽  
Post Stroke ◽  
Observational Cohort

Abstract Background Cognitive impairment and dementia following cerebrovascular disease are increasingly common in the UK. One potential strategy to prevent post-stroke cognitive decline is multimodal vascular risk factor management. However, its efficacy remains uncertain and its application in vulnerable patients with incident cerebrovascular disease and early cognitive impairment has not been assessed. The primary aim of this study was to assess the feasibility of recruitment and retention of patients with early cognitive impairment post-stroke or transient ischaemic attack (TIA) to a trial of enhanced vascular risk factor management combining primary and secondary care. Methods In this single centre, open label trial adults with a recent stroke or TIA and mild cognitive impairment (MCI) were randomised 1:1 to a three-monthly multimodal vascular risk factor intervention jointly delivered by the trial team and General Practitioner (GP), or control (defined as usual care from the GP). Chosen risk factors were blood pressure (BP), total cholesterol, blood glucose (HbA1C) in those with diabetes, and heart rate and adequacy of anticoagulation in those with atrial fibrillation (AF). Similar patients with normal cognition were enrolled in an embedded observational cohort and also received usual care from the GP. Repeat cognitive screening was undertaken in all participants after 12 months. Results Seventy three participants were recruited to the randomised trial and 94 to the observational cohort (21.8% of those screened). From the randomised trial 35/73 (47.9%) dropped out before final follow-up. In all groups guideline based rates of risk factor control were mostly poor at baseline and did not significantly improve during follow-up. The observational cohort demonstrated greater decline in cognitive test scores at 12 months, with no difference between the randomised groups. Conclusions Recruitment to such a study was feasible, but retention of participants was difficult and generally poor rates of risk factor control suggested insufficient application of the intervention. Consequently, successful scaling up of the trial would require protocol changes with less reliance on primary care services. Any future trial should include participants with normal cognition post-stroke as they may be at greatest risk of cognitive decline. Trial registration ISRCTN, ISRCTN42688361. Registered 16 April 2015.

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.

Abstract P207: Medication Use for Secondary Stroke Prevention and Vascular RIsk Factor Modification Remains Low Among Americans

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Karen C Albright ◽  
Rikki M Tanner ◽  
Amelia K Boehme ◽  
T. Mark Beasley
Keyword(s):  
Risk Factor ◽  
Stroke Prevention ◽  
Medication Use ◽  
Prescription Medication ◽  
Vascular Risk Factor ◽  
Secondary Stroke Prevention ◽  
Vascular Risk ◽  
Risk Factor Modification ◽  
History Of ◽  
Factor Modification

Background: With a US prevalence of 795,000 strokes per year and stroke recurrence rates up to 20%, the objective of this study was to determine the prevalence of prescription medication use for secondary stroke prevention and vascular risk factor modification among noninstitutionalized US adults and compare medication use in Whites and Blacks. Methods: A cross-sectional study was performed as part of the National Health and Nutrition Examination Survey (NHANES) 2009-2010. Demographic, disease, and prescription medication use were obtained via a standardized interview. Participants were asked if they had ever been told by a health professional that they had hypertension, diabetes, high cholesterol, or a stroke. Additionally, participants were asked if they had taken or used any prescription medicine in the past month as well as the names of each prescription medication. Statistical analyses used NHANES sample weights to provide prevalence estimates for the US population. Results: Among 11,375 participants (21% Black, 47.6% men, age 20-80), medication use for secondary stroke prevention and vascular risk factors remained low (Table 1). Participants who reported taking either an antiplatelet agent or an anticoagulant with a history of stroke remained low (7.9% Whites vs 6.2% Blacks). More Blacks with hypertension reported taking blood pressure lowering agents (38.9 vs 36.1% Whites). Diabetic medication use was lower in Blacks reporting a history of diabetes (24.5 vs 25.7% Whites). Medication use rates were lowest in participants reporting high cholesterol, with more Whites reporting use of a cholesterol lowering medication (19.3 vs 14.6%; p<0.001). Conclusion: Despite the prevalence of stroke and vascular risk factors, only a small proportion of people at risk are on medications for secondary stroke prevention and vascular risk factor modification. Overall, Blacks were taking fewer medications for secondary stroke prevention and vascular risk factor modification with the exception of anti-hypertension medication.

Abstract 105: Early But Not Too Early, High Intensity Physical Exercise Rehabilitation May be Beneficial: A Pilot Clinical Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yanna Tong ◽  
Jamie Y Ding ◽  
Mordechai G Sadowsky ◽  
Huishan Du ◽  
Xiaokun Geng ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Controlled Trial ◽  
Early Mobilization ◽  
Favorable Outcome ◽  
Initiation Time ◽  
Post Discharge ◽  
Post Stroke ◽  
Standard Medical Therapy ◽  
The Difference

Introduction: Very early mobilization (VEM) is thought to be beneficial for stroke-unit care, but many key factors, such as initiation time and intensity, have not been optimized. We attempted to determine an optimal mobilization plan with well-defined initiation time and intensity in clinical practice. Methods: We conducted a randomized controlled trial with blinded assessment at follow-up. Patients with ischemic stroke, first or recurrent, admitted to the stroke unit within 24 h of stroke onset who met physiological criteria were randomly assigned (1:1:1) to 3 groups: Routine Mobilization (RM) received a lower dose of out-of-bed mobilization (<1.5h/d) 24-48 h post-stroke, Very Early and Intensive Mobilization (VEIM) received a higher dose of out-of-bed mobilization (≥3h/d) within 24 h, and Early and Intensive Mobilization (EIM) received a higher dose of out-of-bed mobilization (≥3h/d) 24-48 h post-stroke. Out-of-bed mobilization involves sitting, standing, and walking with or without assistance. The intervention period lasted 10-14 days. All the patients received standard medical therapy according to their different conditions. Patient function was evaluated with the modified Rankin Scale (mRS) score at discharge, 3 months after, and 6 months after. The primary target was a favorable outcome at follow-up, defined as an mRS score of 0-2. We used the Friedman test and the chi-squared test on a fourfold table for significance. Results: A total of 150 patients were recruited, and 120 (80%) finished the training and follow-up assessment with 30 patients dropping out (10 in RM, 12 in VEIM and 8 in EIM). Patients receiving VEIM had lower odds of a favorable outcome at both 3 and 6 months, although the difference did not reach the p = 0.05 level of significance. In the VEIM group, only 42.1% of patients had a favorable outcome 6 months after discharge, as opposed to 55.0% of RM patients and 61.9% of EIM patients. Conclusions: The higher dose mobilization protocol started within 24 h post-stroke was not associated with an increase of favorable outcomes at both 3 and 6 months post-discharge, but rather with a trend toward poorer outcomes. However, the higher dose mobilization protocol started within 48 h post-stroke may lead to a better outcome.

Abstract 81: Translesional Pressure Gradient Alters the Relationship Between Blood Pressure and Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Disease

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xueyan Feng ◽  
Ka Lung Chan ◽  
Jill Abrigo ◽  
Linda Lan ◽  
Yannie Soo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pressure Gradient ◽  
Stroke Prevention ◽  
Primary Outcome ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention ◽  
Cfd Models ◽  
Intracranial Atherosclerotic Disease ◽  
The Relationship

Objective: Patients with symptomatic intracranial atherosclerotic stenosis (sICAS) have a high risk of stroke recurrence. There is debate over an optimal blood pressure (BP) lowering target in secondary stroke prevention in such patients, when some factors (e.g., impaired cerebral perfusion) may alter the relationship between BP and risk of stroke recurrence. In this study, we investigated whether translesional pressure gradient across sICAS lesions would also alter such relationship. Methods: We recruited patients with sICAS (50-99% stenosis) confirmed in CT angiography (CTA). Computational fluid dynamics (CFD) models were built based on CTA to simulate blood flow across sICAS and calculate the translesional pressure ratio (PR, the ratio of pressures distal and proximal to a lesion). PR ≤ median was defined as low PR, indicating larger translesional pressure gradient and hence restricted downstream perfusion. The primary outcome was recurrent ischemic stroke in the same territory in 1 year. We investigated the interaction of PR and mean systolic BP (SBP) during follow-up in determining the risk of the primary outcome. Results: Among 157 patients, the median PR was 0.93. Multivariate Cox regression revealed significant PR-SBP interaction on the primary outcome (p=0.025): in patients with normal PR, the risk of primary outcome significantly decreased with lower SBP during follow-up (for 10 mmHg decrement: HR 0.46; p=0.018); however, in those with low PR, mean SBP ≤130 mmHg was associated with significantly increased risk of primary outcome, compared with 130<SBP<150mmHg (HR 5.08; p=0.043) (Figure). Conclusion: Intensive BP lowering may increase the risk of stroke recurrence in sICAS patients with a large translesional pressure gradient, warranting further investigation. PR by CFD models may yield a promising indicator to differentiate sICAS patients for different BP management strategies for better secondary stroke prevention.

Incidence, clinical features and outcomes of atrial fibrillation and stroke in Qatar

2019 ◽  
Vol 15 (1) ◽  
pp. 85-89 ◽  
Author(s):  
Yahia Z Imam ◽  
Saadat Kamran ◽  
Naveed Akhtar ◽  
Dirk Deleu ◽  
Rajvir Singh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Clinical Features ◽  
Stroke Care ◽  
Newly Diagnosed ◽  
Limited Data ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Low Rate

Background Atrial fibrillation is an important risk factor for stroke but there are limited data on atrial fibrillation-related stroke from the Middle East. Methods We interrogated the Qatar Stroke Database to establish the occurrence, clinical features, and outcomes of atrial fibrillation-related stroke at Hamad General Hospital, the sole provider of acute stroke care in Qatar. Results A total of 4079 patients (81.4% male, mean age 55.4 ± 13.3 years) were enrolled in the stroke database between January 2014 and 21 October 2017. Atrial fibrillation was present in 260 (6.4%) patients, of whom 106 (2.6%) had newly diagnosed atrial fibrillation. The National Institute of Health Stroke Scale (NIHSS) was significantly higher (7.9 + 7.0 (median 6; IQR 11) vs. 5.9 + 6.4 (median 4; IQR 6), P < 0.001) in atrial fibrillation patients. The modified Rankin Score (mRS) (P < 0.001) and mortality at 90-day follow-up (P = 0.002) were significantly higher in atrial fibrillation compared to non-atrial fibrillation stroke patients. Conclusion We demonstrate a low rate of atrial fibrillation and stroke in Qatar, perhaps reflecting the relatively young age of these patients. Atrial fibrillation-related strokes had higher admission NIHSS, greater disability, and higher mortality at 90 days when compared to non-atrial fibrillation strokes.

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

2020 ◽  
Vol 12 (11) ◽  
pp. 1127-1131
Author(s):  
Lukas Meyer ◽  
Hannes Leischner ◽  
Goetz Thomalla ◽  
Lars Udo Krause ◽  
Stephan Lowens ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Stroke Prevention ◽  
Balloon Catheter ◽  
Intracranial Stenosis ◽  
Secondary Stroke Prevention ◽  
Stent Patency ◽  
Fatal Stroke ◽  
Stent Restenosis ◽  
In Stent Restenosis

Background and purposeStroke recurrence is high in patients with symptomatic intracranial stenosis despite best medical treatment. Based on evidence from past studies using previous stent generations, elective intracranial stenting (eICS) is considered in a minority of patients. This study aims to report on experience performing eICS with a novel device combination.MethodsWe retrospectively reviewed data from three high volume stroke centers and analyzed patients that were treated with eICS for symptomatic intracranial stenosis using the Acclino (flex) stent and the NeuroSpeed balloon catheter (Acandis GmbH, Pforzheim, Germany). Study endpoints were periprocedural rates of stroke regardless of territory or death at discharge and at the time of follow-up after eICS. Safety evaluation included asymptomatic and symptomatic intracranial hemorrhage, serious adverse events related to the intervention, and evaluation of stent patency at the time of follow-up.ResultsThe median age of patients that met the inclusion criteria (n=76) was 69 years. Target vessels were located in the anterior circulation in 55.3% (42/76) of patients. The periprocedural stroke rate was 6.5% (fatal stroke 2.6%; non-fatal stroke 3.9%) at discharge after eICS. Asymptomatic intracranial hemorrhage was observed in 5.2% (4/76) of patients. Follow-up DSA revealed in-stent restenosis of 25% (15/60), and percutaneous transluminal angioplasty was performed again in 11.6% (7/60) of patients.ConclusionStenting for symptomatic intracranial stenosis with the Acclino (flex)/NeuroSpeed balloon catheter seemed to be safe and reinforces eICS as an endovascular therapy option for secondary stroke prevention. Future studies are warranted to confirm these findings and investigate antithrombotic strategies and in-stent restenosis to minimize periprocedural complications and guarantee long term stent patency.

scholarly journals VOICES: the value of 6-month clinical evaluation in stroke. The protocol for a planned qualitative study to ascertain the value of stroke follow-up to people affected by stroke

BMJ Open ◽  
2014 ◽  
Vol 4 (10) ◽  
pp. e006384 ◽  
Author(s):  
Colin Jenkins ◽  
Fiona Price
Keyword(s):  
Narrative Analysis ◽  
Care Pathway ◽  
Scientific Journal ◽  
Unmet Need ◽  
Stroke Care ◽  
Final Report ◽  
Stroke Survivors ◽  
Post Discharge ◽  
Semistructured Interviews

IntroductionThe National Clinical Guidelines for Stroke recommend ‘routine follow-up of patients 6 months post discharge’. The Sentinel Stroke National Audit Programme sets a standard of 6 months postadmission follow-up, capturing data on process and outcomes. There appears to be no convincing model of stroke follow-up at 6 months, and despite evidence of unmet need in almost 50% of stroke survivors 1–5 years after their stroke, little work focuses on the first 12 months of recovery. By listening to the living experiences of stroke, the research aims to tailor the stroke care pathway to the needs of those affected.Methods and analysisA focus group of six stroke survivors and carers will be invited to identify appropriate interview questions about the value of follow-up at 6 months, ensuring that this study has its genesis in the participant experience. A pilot study of four stroke survivors will ascertain the feasibility of the method. Thirty stroke survivors from the follow-up clinic will be invited to take part in semistructured interviews. Raw data, in the form of digital recordings of the interviews, will be transcribed. Interview transcriptions will be checked by the participant for accuracy prior to analysis using NVivo software. Literal and reflective narrative analysis will be used to code transcribed text to examine shared themes and reflect on content.Ethics and disseminationStudy documentation has been reviewed by the Coventry and Warwickshire Research Ethics Committee; the chief investigator met with the committee to scrutinise the study and justify its methodology. The committee has approved this study. A copy of the final report will be given to participants, the Stroke Association, the local Clinical Commissioning Group and participants’ general practitioners. It is intended to disseminate the results locally by presentation to the Trust board, at academic conferences and by publication in a peer-reviewed scientific journal.

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