Deans' stroke musings: Screening and care for emotional and cognitive problems after stroke: a prospective mixed-methods process evaluation of a cluster-randomized controlled trial

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, March 10, 2025

Screening and care for emotional and cognitive problems after stroke: a prospective mixed-methods process evaluation of a cluster-randomized controlled trial

I'd have you all fired for working on 'care', NOT RECOVERY!

Screening and care for emotional and cognitive problems after stroke: a prospective mixed-methods process evaluation of a cluster-randomized controlled trial

March 2025
BMC Health Services Research 25(1)

DOI:10.1186/s12913-025-12470-w

License
CC BY-NC-ND 4.0

Authors:

Show all 6 authors

Background

Emotional and cognitive problems are prevalent after stroke. We developed an intervention including screening for emotional and cognitive problems, screening for participation restrictions, self-management support including education and, if needed, referral to rehabilitation services. This intervention was delivered through a nurse-led outpatient consultation at six weeks after stroke. Its effectiveness was examined in a patient-blinded, cluster-randomized controlled trial and its feasibility in a process evaluation. This process evaluation aims to (1) assess the reach, dose and fidelity of the intervention, (2) evaluate barriers and facilitators to implementation and (3) explore experiences from the perspective of healthcare providers.

Methods

A mixed-methods study was conducted. Specialized nurses offering the intervention completed registration forms to evaluate the reach, dose and fidelity of the intervention. The Barriers and Facilitators Instrument (BFAI) was used to evaluate barriers and facilitators. Furthermore, the specialized nurses participated in a group interview to explore experiences in delivering the intervention. Group interviews were analysed using inductive thematic analysis.

Results

In total, 262 of 264 patients (99.2%) attended the intervention. In 233 patients (88.9%), all screening instruments were completed. The BFAI demonstrated that the intervention was feasible and was not considered time-consuming or hindered by contextual factors. Barriers to deliver the intervention were limited to patient characteristics. During group interviews, specialized nurses reported that the intervention significantly overlapped with care as usual prior to start of the trial, yet indicated that the intervention provided a more profound understanding of post-stroke sequelae.

Conclusions

The implementation of a nurse-led intervention, comprising screening and care for emotional and cognitive problems after stroke, was generally well executed and deemed feasible. If this intervention proves to be clinically and/or cost-effective in our upcoming primary analyses, we will advocate to incorporate it in daily clinical practice and to adhere to the implementation strategy as presented in this process evaluation. Trial registration This study was registered at 25 September 2018 in the Netherlands Trial Register (NL7295).