Date Presented 04/04/19
Individuals with mild stroke, their caregivers, and healthcare professionals identified the cognitive, psychosocial, and physical impairments resulting from mild stroke. These deficits are not identified through diagnosis and thus not addressed by practitioners, contributing to the practice of discharging individuals home from acute care without services. This research shows that OTs must identify and treat deficits of individuals with mild stroke along the continuum of care.
Primary Author and Speaker: Samantha Eagle
Contributing Authors: Carolyn Baum, Marna Ghiglieri
BACKGROUND AND PURPOSE: Individuals with mild stroke are typically sent home following acute hospitalization without receiving inpatient rehabilitation services because they do not appear to have impairments that limit their everyday function. However, mild stroke is on the rise, eclipsing the prevalence of other types of stroke and affecting the working population. Little is known about the impairments these individuals experience once they go home, but emerging research shows that survivors have impairments warranting further attention from occupational therapists. This study had two objectives: to identify functional impairments resulting from a mild stroke, and to compare what professionals and patients reported as problems to be addressed following mild stroke. This research is needed to help occupational therapists recognize and address functional impairments following mild stroke rather than sending these patients home without services.
METHOD: In this qualitative study, two focus groups were conducted: one with healthcare professionals (N=9), and one with individuals with mild stroke (N=10) and their caregivers (N=7). The healthcare professionals were selected via purposive sampling in recognition of their years of experience in stroke care. Individuals with mild stroke were recruited from a stroke registry at a large teaching hospital. The focus groups were conducted in a round robin format to ensure all participants had a chance to speak. Participants were prompted to discuss what they saw as the main challenges of mild stroke. They also created a list of the barriers and impairments experienced following mild stroke.
DATA ANALYSIS: The focus groups were recorded and transcribed. Transcripts were coded by two coders who were blind to the group discussion using content analysis with NVivo software. Codes were generated based on the problem lists created by the participants, then refined and derived by the data. The coders were in complete agreement of the final codes after three collaborative revisions. Codes were then organized into themes by grouping together similar topics.
RESULTS: Four themes were identified: ‘Life Redefined,’ ‘Physical Symptoms,’ ‘Activity Loss,’ and ‘Grievances with the System.’ Individuals with mild stroke gave examples of cognitive challenges that contributed to frustration and exacerbated emotional changes. Healthcare professionals did not provide the same rich detail or discuss the emotional toll of lingering deficits. The two groups agreed on the main physical challenges following mild stroke, including fatigue, balance, and visual impairments. Healthcare professionals were optimistic that activity limitations could be addressed in rehabilitation, while individuals with mild stroke were concerned with the financial and social implications of activity loss. Both groups spent the most time discussing proposed additional services and identified barriers within the healthcare system.
CONCLUSIONS: Individuals with mild stroke experience physical, cognitive, and emotional impairments, as well as activity limitations that make it difficult to return to life as they knew it before their stroke. These deficits are not identified through diagnosis of a mild stroke and thus are not addressed by the medical team. Occupational therapists should use observation, clinical reasoning, and assessments to identify deficits and provide services to address the needs of individuals with mild stroke along the continuum of care. This research will have a powerful influence on occupational therapy because it identifies a population that does not receive the services needed in the post-acute phase. It delineates specific impairments and barriers that can be addressed by occupational therapists along the continuum of care.
References
Moran, G. M., Fletcher, B., Feltham, M. G., Calvert, M., Sackley, C., & Marshall, T. (2014). Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review. Eur J Neurol, 21(10), 1258-1267. doi:10.1111/ene.12469
Schlegel, D., Kolb, S. J., Luciano, J. M., Tovar, J. M., Cucchiara, B. L., Liebeskind, D. S., & Kasner, S. E. (2003). Utility of the NIH Stroke Scale as a predictor of hospital disposition. Stroke, 34(1), 134-137.
