Transitioning to home and beyond following stroke: a prospective cohort study of outcomes and needs

O’Callaghan, G. et al. (2024) Transitioning to home and beyond following stroke: a prospective cohort study of outcomes and needs. BMC Health Services Research, 24, p. 449. (doi: 10.1186/s12913-024-10820-8) (PMID:38600523) (PMCID:PMC11005232)

Abstract

Introduction: Understanding of the needs of people with stroke at hospital discharge and in the first six-months is limited. This study aim was to profile and document the needs of people with stroke at hospital discharge to home and thereafter. Methods: A prospective cohort study recruiting individuals with stroke, from three hospitals, who transitioned home, either directly, through rehabilitation, or with early supported discharge teams. Their outcomes (global-health, cognition, function, quality of life, needs) were described using validated questionnaires and a needs survey, at 7–10 days, and at 3-, and 6-months, post-discharge. Results: 72 patients were available at hospital discharge; mean age 70 (SD 13); 61% female; median NIHSS score of 4 (IQR 0–20). 62 (86%), 54 (75%), and 45 (63%) individuals were available respectively at each data collection time-point. Perceived disability was considerable at hospital discharge (51% with mRS ≥ 3), and while it improved at 3-months, it increased thereafter (35% with mRS ≥ 3 at 6-months). Mean physical health and social functioning were “fair” at hospital discharge and ongoing; while HR-QOL, although improved over time, remained impaired at 6-months (0.69+/-0.28). At 6-months cognitive impairment was present in 40%. Unmet needs included involvement in transition planning and care decisions, with ongoing rehabilitation, information, and support needs. The median number of unmet needs at discharge to home was four (range:1–9), and three (range:1–7) at 6-months. Conclusion: Stroke community reintegration is challenging for people with stroke and their families, with high levels of unmet need. Profiling outcomes and unmet needs for people with stroke at hospital-to-home transition and onwards are crucial for shaping the development of effective support interventions to be delivered at this juncture.

• Item Type: Articles
• Additional Information: Funding for this study was provided by the Health Research Board (HRB) in Ireland through the Collaborative Doctoral Award Scheme (iPASTAR-Improving Pathways for Acute STroke And Rehabilitation) (HRB-CDA-2019-004).
• Keywords: Post-stroke transition hospital-to-home, Community reintegration, Needs assessment, Outcomes assessment, Rehabilitation intervention
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Langhorne, Professor Peter
• Authors: O’Callaghan, G., Fahy, M., O’Meara, S., Chawke, M., Waldron, E., Corry, M., Gallagher, S., Coyne, C., Lynch, J., Kennedy, E., Walsh, T., Cronin, H., Hannon, N., Fallon, C., Williams, D. J., Langhorne, P., Galvin, R., and Horgan, F.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: BMC Health Services Research
• Publisher: BioMed Central
• ISSN: 1472-6963
• ISSN (Online): 1472-6963
• Copyright Holders: Copyright © The Author(s) 2024
• First Published: First published in BMC Health Services Research 24:449
• Publisher Policy: Reproduced under a creative commons licence