Experiences using the poststroke checklist in Sweden with a focus on feasibility and relevance: a mixed-method design

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Abstract

Objective

The wide range of outcomes after stroke emphasises the need for comprehensive long-term follow-up. The aim was to evaluate how people with stroke and health professionals (HPs) perceive the use of the poststroke checklist (PSC), with a focus on feasibility and relevance.

Design

An exploratory design with a mix of qualitative and quantitative methods.

Setting

Outpatient care at a university hospital and primary care centres in western Sweden.

Participants

Forty-six consecutive patients (median age, 70; range, 41–85; 13 women) and 10 health professionals (median age 46; range, 35–63; 7 women).

Results

Most patients (87%) had one or more problems identified by the PSC. The most common problem areas were life after stroke (61%), cognition (56%), mood (41%) and activities of daily living (39%). Three organisational themes emerged from the focus group discussions. The perception of the content and relevance of the PSC was that common poststroke problems were covered but that unmet needs still could be missed. Identifying needs was facilitated when using the PSC as a tool for dialogue. The dialogue between the patient and HP as well as HPs stroke expertise was perceived as important. The PSC was seen as a systematic routine and a base for egalitarian follow-up, but participants stressed consideration given to each individual. Addressing identified needs and meeting patient expectations were described as challenging given available healthcare services.

Conclusions

The PSC is a feasible and relevant tool to support egalitarian follow-up and identify patients who could benefit from targeted poststroke interventions. Stroke expertise, room for dialogue and caring for identified needs emerged as important issues to consider when using the PSC. Nutrition, sexuality and fatigue were areas mentioned that might need to be addressed within the discussions. The PSC can facilitate patients in expressing their needs, enhancing their ability to participate in decision-making.

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Most cited references 15

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Stroke, cognitive deficits, and rehabilitation: still an incomplete picture.

Dolores R R Lazar, Toby B. Cumming, Christian Marshall (2012)

Cognitive impairment after stroke is common and can cause disability with major impacts on quality of life and independence. There are also indirect effects of cognitive impairment on functional recovery after stroke through reduced participation in rehabilitation and poor adherence to treatment guidelines. In this article, we attempt to establish the following: ● whether there is a distinct profile of cognitive impairment after stroke; ● whether the type of cognitive deficit can be associated with the features of stroke-related damage; and ● whether interventions can improve poststroke cognitive performance. There is not a consistent profile of cognitive deficits in stroke, though slowed information processing and executive dysfunction tend to predominate. Our understanding of structure-function relationships has been advanced using imaging techniques such as lesion mapping and will be further enhanced through better characterization of damage to functional networks and identification of subtle white matter abnormalities. Effective cognitive rehabilitation approaches have been reported for focal cortical deficits such as neglect and aphasia, but treatments for more diffusely represented cognitive impairment remain elusive. In the future, the hope is that different techniques that have been shown to promote neural plasticity (e.g., exercise, brain stimulation, and pharmacological agents) can be applied to improve the cognitive function of stroke survivors. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

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The role of health literacy in patient-physician communication.

B. Weiss, Donna Parker, Sarah Williams … (2002)

Patients' health literacy is increasingly recognized as a critical factor affecting patient-physician communication and health outcomes. We reviewed research on health literacy, examined its impact on patient-physician communication, and offer recommendations to enhance communication with patients who have poor health literacy. We conducted a literature review using the MEDLINE database for January 1966 through July 2001. The keywords "literacy" and "health literacy" were searched independently and in combination with the medical subject headings (MeSH) "physician-patient communication," "communication," and "reading." Poor health literacy is common, especially among elderly patients. More than 33% of patients ages 65 and older have inadequate or marginal health literacy, as do up to 80% of patients in public hospital settings. Patients with poor health literacy have a complex array of communication difficulties, which may affect health outcomes. Such patients report worse health status and have less understanding about their medical conditions and treatment; they may have increased hospitalization rates. Professional and public awareness of the health literacy issue must be increased, beginning with education of medical students and physicians and improved patient-physician communication skills. Future research needs to address identification of optimal methods for communicating with patients who have low literacy skills. This should focus on the effect of poor health literacy on patients' ability to communicate their history and physicians' ability to solicit information, as well as identifying the most-effective techniques to educate patients.

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Understanding the multiple realities of everyday life: basic assumptions in focus-group methodology.

Synneve Dahlin-Ivanoff, John Hultberg (2006)

In recent years, there has been a notable growth in the use of focus groups within occupational therapy. It is important to understand what kind of knowledge focus-group methodology is meant to acquire. The purpose of this article is to create an understanding of the basic assumptions within focus-group methodology from a theory of science perspective in order to elucidate and encourage reflection on the paradigm. This will be done based on a study of contemporary literature. To further the knowledge of basic assumptions the article will focus on the following themes: the focus-group research arena, the foundation and its core components; subjects, the role of the researcher and the participants; activities, the specific tasks and procedures. Focus-group methodology can be regarded as a specific research method within qualitative methodology with its own form of methodological criteria, as well as its own research procedures. Participants construct a framework to make sense of their experiences, and in interaction with others these experiences will be modified, leading to the construction of new knowledge. The role of the group leader is to facilitate a fruitful environment for the meaning to emerge and to ensure that the understanding of the meaning emerges independently of the interpreter. Focus-group methodology thus shares, in the authors' view, some basic assumptions with social constructivism.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2019

Publication date (Electronic): 9 May 2019

Volume: 9

Issue: 5

Electronic Location Identifier: e028218

Affiliations

[1]departmentDepartment of Clinical Neuroscience, Sahlgrenska Academy , Institute of Neuroscience and Physiology , Gothenburg

Author notes

[Correspondence to ] Mrs Emma K Kjörk; emma.kjork@ 123456neuro.gu.se

Author information

Emma K Kjörk http://orcid.org/0000-0002-1005-7444

Article

Publisher ID: bmjopen-2018-028218

DOI: 10.1136/bmjopen-2018-028218

PMC ID: 6528008

PubMed ID: 31072862

SO-VID: dc41af37-de0d-4a96-ad65-0eb24819d17e

License:

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

History

Date received : 27 November 2018

Date revision received : 21 February 2019

Date accepted : 22 February 2019

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ScienceOpen disciplines: Medicine

Keywords: long-term care,feasibility,focus groups,follow-up,standard of care,stroke

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ScienceOpen disciplines: Medicine

Keywords: long-term care, feasibility, focus groups, follow-up, standard of care, stroke

Experiences using the poststroke checklist in Sweden with a focus on feasibility and relevance: a mixed-method design

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Abstract

Objective

Design

Setting

Participants

Results

Conclusions

Related collections

Stroke MRI

Most cited references 15

Stroke, cognitive deficits, and rehabilitation: still an incomplete picture.

The role of health literacy in patient-physician communication.

Understanding the multiple realities of everyday life: basic assumptions in focus-group methodology.

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