YOU will have to force your doctors to take responsibility and create EXACT PROTOCOLS FOR THIS!
Post-stroke Vascular Cognitive Impairment in India: A National Survey of Healthcare Professionals’ Clinical Practices
Abstract
Background and rationale
International guidelines recommend treatment for post-stroke cognitive impairment (PSCI), yet there are few evidence-based approaches to guide intervention, leaving clinicians uncertain about how to intervene. Little is known about healthcare professionals’ approach to post-stroke cognitive rehabilitation. This survey provides the first data on how PSCI is recognized and managed in stroke units in India.
Aim
This survey aimed to understand whether and how healthcare professionals, including neurologists, physiotherapists (PTs), nurses, occupational therapists (OTs), and speech-language pathologists (SLPs), assess and treat patients with PSCI in India, and to explore barriers and facilitators that influence treatment delivery.
Study method
A multicenter online survey was conducted across 50 hospitals within the Indian Stroke Clinical Trial Network (INSTRuCT). We used a purposive sampling approach to enroll healthcare professionals involved in stroke care.
Results
Of the 110 respondents, 47% were neurologists, 19% PTs, 22% nurses, 10% OTs, and 0.9% SLPs. Approximately 67% reported performing routine cognitive screening, primarily using the Montreal Cognitive Assessment (MoCA; 46%) and the Mini-Mental State Examination (MMSE; 37%). Seventy percent reported providing cognitive rehabilitation interventions, primarily aerobic exercises, strategy-based interventions, and cognitive skills training. Key barriers to providing cognitive rehabilitation included lack of time, insufficient training and expertise, and the team prioritizing other aspects of recovery before cognition.
Conclusion
This first national multicenter survey provides important insight into the current state of PSCI assessment and rehabilitation in India, identifying variation in clinical practice and persistent barriers to cognitive care. Given India’s large and growing stroke burden, these findings are clinically significant as unrecognized and undertreated PSCI may adversely affect long-term recovery and quality of life. The study highlights an urgent need for context-specific cognitive rehabilitation pathways and workforce training, with implications not only for India but also for other low-and middle-income countries facing similar resource and rehabilitation challenges.
Introduction
Post-stroke cognitive impairment (PSCI) affects over 60% of stroke survivors [1,2] and is increasingly recognized as an important component of post-stroke disability. Cognitive rehabilitation is therefore an integral component of multidisciplinary post-stroke care. Healthcare professionals play a pivotal role in identifying and addressing cognitive impairment following stroke, from initial screening to assessment and intervention. The Canadian Stroke Best Practice Recommendations (CSBPR) recommend that stroke survivors be screened for cognitive changes, with screening undertaken before discharge from acute care or inpatient rehabilitation and repeated at transition points and follow-up visits [3]. Individuals with identified cognitive impairment should undergo further standardized assessments, with referral for comprehensive assessment where appropriate [3]. Similar recommendations have been made in European stroke guidelines, which emphasize the importance of cognitive assessment following stroke while acknowledging limited evidence regarding the optimal timing and content of screening [4]. Although cognitive rehabilitation and other interventions are increasingly incorporated into post-stroke care, the evidence supporting their effectiveness remains heterogeneous, and uncertainty persists regarding the optimal type, timing, intensity, and delivery of interventions [4,5]. The need for post-stroke cognitive rehabilitation is therefore evident, but there remains limited clarity on the optimal methods to assess and intervene for PSCI in routine clinical practice. This uncertainty may contribute to variation in clinicians’ approaches to the assessment and management of PSCI.
Evidence from high-income nations has identified multiple system-level barriers to the delivery and implementation of post-stroke cognitive care, including workforce and resource constraints, unclear roles and responsibilities, limited training, unclear referral pathways, and inconsistent service organization [5,6]. Studies also note that inconsistent access to standardized tools and evidence-based interventions may further constrain the delivery of post-stroke cognitive rehabilitation [5-7]. We expect similar issues in India, at both a system level and in terms of professional educational barriers, but to a much greater magnitude. In India, PSCI affects approximately one-third of stroke survivors [8]. However, evidence regarding routine clinical practices and the implementation of PSCI care in India remains limited [9].
The Indian healthcare system faces several challenges that may further hinder the delivery of optimal cognitive rehabilitation, such as limited access to rehabilitation services and financial constraints. Understanding healthcare professionals’ perspectives could be an essential starting point; once current practices and barriers are understood, strategies to address barriers can be developed. To better understand current clinical practices related to PSCI in India, we surveyed healthcare professionals involved in post-stroke care to assess their knowledge and approaches to PSCI screening, assessment, and intervention, as well as their perceived barriers and facilitators to implementing these practices.
More at link.
No comments:
Post a Comment