A process evaluation of patient care needs using the Post-Stroke Checklist: A prospective study

Abstract

Objective: To assess the utility of the modified Post-Stroke Checklist (mPSC) to identify impairments and care needs of patients with stroke (PwS) in an inpatient rehabilitation setting. Methods: Prospective observational design with consecutive admission of PwS (n = 44) at a tertiary rehabilitation facility. The post-stroke checklist was administered at hospital discharge (T1) and 3 months post-discharge (T2). Furthermore, validated questionnaires assessed function and participation, including the Clinical Functioning Information Tool (ClinFIT) on admission (T0), T1 and T2. Results: Participants’ mean age was 67.7 years (standard deviation; SD) 14.6), 58% of participants were female, and the mean length of inpatient stay was 32.7 days (SD 22.4). At T1, 80% and at T2 only 60% of participants reported ≥1 stroke-related problem (mean 5.3 (SD 3.3) and 3.6 (SD 2.8), respectively). Half of participants were referred to physiotherapy/occupational therapy, and 36% to specialist clinics following discharge. The most prevalent problems included: life after stroke (62.2%), fatigue (55.6%), activities of daily living, and mobility (51.1% each). Compared with T1, at T2 there was an observed reduction in all mPSC items, except pain and incontinence. Participants showed improved function at T1 and T2 (Extension Index, ClinFIT set), from T0 to T1 and T0 to T2 (p<0.001, with large effect sizes). Conclusion: The mPSC is feasible to implement in an inpatient rehabilitation setting and community. It can identify relevant stroke-related problems, and hence facilitate targeted intervention. Lay Abstract Patients with stroke can develop significant long-term functional, communication and psychosocial disability, which can limit their daily activities and quality of life. Hence, regular follow-up is important to identify the patients’ clinical needs after discharge from the hospital to the community. This study used a universal tool, the modified Post-Stroke Checklist (mPSC) to identify common persisting stroke-related issues of patients admitted to a rehabilitation unit to facilitate appropriate referrals during discharge. The mPSC is feasible to implement in an inpatient rehabilitation setting and community for treating clinicians to identify relevant stroke-related problems and provide appropriate intervention.

Keywords

• Stroke
• Rehabilitation
• Care needs
• Post Stroke Checklist