What is it about?

Reducing stroke related death and disability is a Government priority. In 2007, the National Stroke Strategy recommended reviewing stroke survivors at six weeks, six months and annually thereafter but this was not based on any evidence. While there is evidence of unmet need post-stroke there is little evidence to suggest that the review process ameliorates it. This study focuses on the six-month review as at six weeks most people are still receiving rehabilitation and few areas provide a yearly review.

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Why is it important?

Stroke is a major cause of disability and effects all areas of daily life; about 25% of people who have a stroke are of working age. Evidence shows that many people do not get sufficient support after discharge from hospital and community rehabilitation is limited. The recommendation of reviewing people at six-months was a 'better than nothing' idea but has turned into a bandwagon of implementation tools, data collection (Sentinel Stroke National Audit Programme) and commissioning opportunities yet there is no evidence of effectiveness.

Perspectives

Reviews carried out by stroke nurse specialists allowed for an individualised review of medication. Those carried out by the Stroke Association could not address medical issues and instead focused on social issues. However, the Stroke Association and policy guidelines claim outcomes that were not substantiated by the data, for example, reduced hospital readmissions. Reviewing at six months is an arbitrary timeframe and suited few people - more useful is reviewing when community services withdraw and people feel unsupported. The review did identify unmet needs but cannot ameliorate them if services are not available, particularly neuropsychology and exercise.

Dr Vanessa Abrahamson
University of Kent

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This page is a summary of: Positioning the six-month review in the recovery process post-stroke: The ideology of personal responsibility, Health & Social Care in the Community, October 2018, Wiley, DOI: 10.1111/hsc.12677.
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