June 2019: Rejnö et al (In Press) Changes in functional outcome over five years after stroke. Brain and Behaviour https://doi.org/10.1002/brb3.1300
As the authors rightly claim, there is little evidence about the long-term, functional outcomes in survivors of stroke; which, when you think about it, is surprising! Stroke is a chronic disease, one that survivors will live with for the rest of their lives, yet we know very little about its long-term, functional impact. What I also find very surprising, is the lack of ongoing support that those with stroke, receive in the long-term. Australian researcher, Dr Jeni White, found that, once discharged, many feel “abandoned” by the healthcare system. So, its timely that we review an article about the long-term needs of people living with stroke. This article is freely available. Please find the abstract under Journal Club 2019, and my “humble opinion” attached as a comment to this post.
In those who were independent before they experienced their first-ever stroke, Rejnö et al used longitudinal data and methods to investigate patterns of functional recovery over the first 5 years, post-event. Factors positively associated with deterioration in activities of daily living, were <75 years old, diabetes, the NIHSS (National Institute of Health Stroke Scale) score and self-perceived un-met care needs at 12 months post-event, and improvement in ADL was less likely to occur in those who lived alone or were diagnosed with ischemic stroke. Because only 15-18% of all strokes are haemorrhagic, there has been much less research into outcomes in relation to this sub-type, but there has always been an understanding that this sub-type is associated with better recovery, and perhaps, recovery over a longer period of time, when compared to ischemic stroke. As the authors rightly point out, we've known for quite some time that those who live alone, can be disadvantaged when it comes to recovery after stroke.
This investigation used registry data, giving the findings extra integrity. Data were not collected for the purposes of this study, nor were the outcomes measures selected with this study in mind. In addition, around 90% of registrants had received Stroke Unit care. The investigators make an interesting observation about the differences between their findings and those of another Sweden-based investigation into ADL dependency in the first year post-event. They also comment, (and I quote): “For this phase of care, no new therapies have been introduced over the last decade”. It’s both true and worrisome! My thanks to these researchers for starting up an important conversation about what “best practice” care should and could look like, for those in the chronic phase post-stroke. These findings provide a baseline for what occurs when stroke survivors receive minimal ongoing care; so now its time to explore what could be achieved if they were offered a purposefully-designed, long-term, care plan.
As always, please be assured that this is just my humble opinion. To create your own, please read this article for yourself.
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