Identifying unmet needs in long-term stroke care using in-depth assessment and the Post-Stroke Checklist – The Managing Aftercare for Stroke (MAS-I) study

This is so simple. You didn't get your stroke patients 100% recovered. That is the only goal you should be working on. Solve that and all these unmet need fall away. I don't give a shit that that is a BHAG(Big Hairy Audacious Goal) of 100% recovery for all survivors!
http://journals.sagepub.com/doi/full/10.1177/2396987318771174?

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Benjamin Hotter¹

Benjamin Hotter

1Center for Stroke Research Berlin and Department of Neurology, 14903Charité University Hospital Berlin, Berlin, Germany
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, Inken Padberg¹

Inken Padberg

1Center for Stroke Research Berlin and Department of Neurology, 14903Charité University Hospital Berlin, Berlin, Germany
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, Andrea Liebenau¹

Andrea Liebenau

1Center for Stroke Research Berlin and Department of Neurology, 14903Charité University Hospital Berlin, Berlin, Germany
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Petra Knispel¹

Petra Knispel

1Center for Stroke Research Berlin and Department of Neurology, 14903Charité University Hospital Berlin, Berlin, Germany
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, Sabine Heel²

Sabine Heel

2Zentrum für ambulante Neuropsychologie und Verhaltenstherapie, Berlin, Germany
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, Diethard Steube³

Diethard Steube

331616Zentrum für ambulante Rehabilitation, Berlin, Germany
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, Jörg Wissel⁴

Jörg Wissel

4Department Neurorehabilitation and Physical Therapy, Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany
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, Ian Wellwood⁵

Ian Wellwood

5Department of Public Health and Primary Care, 57228Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
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, Andreas Meisel¹

Andreas Meisel

1Center for Stroke Research Berlin and Department of Neurology, 14903Charité University Hospital Berlin, Berlin, Germany
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on behalf of the BSA Long Term Care Study Group

...

First Published April 19, 2018 Research Article

https://doi.org/10.1177/2396987318771174

Article information

Article Information

Article first published online: April 19, 2018
Received: November 03, 2017; Accepted: March 23, 2018

https://doi.org/10.1177/2396987318771174

Benjamin Hotter¹, Inken Padberg¹, Andrea Liebenau¹, Petra Knispel¹, Sabine Heel², Diethard Steube³, Jörg Wissel⁴, Ian Wellwood⁵, Andreas Meisel¹on behalf of the BSA Long Term Care Study Group

¹Center for Stroke Research Berlin and Department of Neurology, 14903Charité University Hospital Berlin, Berlin, Germany

²Zentrum für ambulante Neuropsychologie und Verhaltenstherapie, Berlin, Germany

³31616Zentrum für ambulante Rehabilitation, Berlin, Germany

⁴Department Neurorehabilitation and Physical Therapy, Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany

⁵Department of Public Health and Primary Care, 57228Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK

Corresponding Author: Benjamin Hotter, Center for Stroke Research Berlin and Department of Neurology, Charité University Hospital Berlin, Charitéplatz 1, Berlin 10117, Germany. Email: benjamin.hotter@charite.de

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Abstract

Section:

ChooseTop of pageAbstract <<IntroductionMethodsResultsDiscussionReferences

Introduction

Detailed data on the long-term consequences and treatment of stroke are scarce. We aimed to assess the needs and disease burden of community-dwelling stroke patients and their carers and to compare their treatment to evidence-based guidelines by a stroke neurologist.

Methods

We invited long-term stroke patients from two previous acute clinical studies (n = 516) in Berlin, Germany to participate in an observational, cross-sectional study. Participants underwent a comprehensive interview and examination using the Post-Stroke Checklist and validated standard measures of: self-reported needs, quality of life, overall outcome, spasticity, pain, aphasia, cognition, depression, secondary prevention, social needs and caregiver burden.

Results

Fifty-seven participants (median initial National Institutes of Health Stroke Scale score 10 interquartile range 4–12.75) consented to assessment (median 41 months (interquartile range 36–50) after stroke. Modified Rankin Scale was 2 (median; interquartile range 1–3), EuroQoL index value was 0.81 (median; interquartile range 0.70–1.00). The frequencies for disabilities in the major domains were: spasticity 35%; cognition 61%; depression 20%; medication non-compliance 14%. Spasticity (p = 0.008) and social needs (p < 0.001) had the strongest impact on quality of life. The corresponding items in the Post-Stroke Checklist were predictive for low mood (p < 0.001), impaired cognition (p = 0.015), social needs (p = 0.005) and caregiver burden (p = 0.031). In the comprehensive interview, we identified the following needs: medical review (30%), optimization of pharmacotherapy (18%), outpatient therapy (47%) and social work input (33%).

Conclusion

These results suggest significant unmet needs and gaps in health and social care in long-term stroke patients. Further research to develop a comprehensive model for managing stroke aftercare is warranted.(Wrong, further research needed to get to 100% recovery, work on the correct goal you blithering idiots.)
Clinical Trial Registration: clinicaltrials.gov NCT02320994.