INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Shubert Complex (Posters 1-60) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #32 “I felt like I was not a priority”: A Qualitative Study of the Lived Experience of Ischaemic Stroke Patients Treated with Endovascular Clot Retrieval and Intravenous Thrombolysis Sam Humphrey, La Trobe University, Melbourne, Australia Kerryn Pike, Griffith University, Gold Coast, Australia Brian Long, North Metropolitan Health Service, Perth, Australia Henry Ma, Monash Health, Melbourne, Australia Robert Bourke, Monash Health, Melbourne, Australia Bradley Wright, La Trobe University, Melbourne, Australia Dana Wong, La Trobe University, Melbourne, Australia Category: Stroke/Cerebrovascular Injury and Disease (Adult) Keyword 1: stroke Keyword 2: stroke recovery Objective: Endovascular clot retrieval (ECR) is a highly effective acute treatment for ischaemic stroke, with treated patients demonstrating significantly reduced disability and greater functional independence compared to those treated with intravenous tissue plasminogen activator (t-PA) and conservative management. While quantitative studies investigating functional outcomes have been informative, they offer limited insight into the lived experience and unmet needs of patients who receive different treatments for ischaemic stroke. We aimed to investigate the experience of ischaemic stroke patients treated with ECR, t-PA, or conservative management, with a particular focus on their experience of the stroke, view of acute and community services, unmet needs, and physical, cognitive, and emotional outcomes. Participants and Methods: Thirty-one participants completed semi-structured interviews about their experiences, needs, and outcomes, 90 to 120 days post-stroke. Interviews were conducted by one doctoral researcher under the supervision of two senior researchers with experience in qualitative research. Data were analysed using reflexive thematic analysis. Results: The mean age was 62.9 (±17.5) years; 20 participants were male (64.5%); and mean education was 12.3 (±2.7) years. Left hemisphere strokes were more common (61.3%) and the mean National Institutes of Health Stroke Scale (NIHSS) score at presentation (n=29) was 5.9 (±4.9). Of the 31 participants, 11 were treated with ECR, 10 were treated with t-PA, and 10 were managed conservatively. Baseline demographic and clinical characteristics were similar for all three groups of participants. From 67 codes, three main themes were generated: (1) Experiencing ongoing impairments after stroke; (2) Coping with life after stroke; and (3) Invisible difficulties are easily missed when visible outcomes are positive. Participants experienced ongoing impairments after stroke including physical, motor, and sensory problems, fatigue and sleep issues, communication difficulties, and cognitive impairment. They described the negative impact of these impairments on their ability to cope with life after stroke, including reduced participation and loss of independence. This led to adjustment difficulties and identity changes, together with negative emotions. Participants with positive “visible” (e.g., physical and motor) outcomes, particularly those in the ECR group, described more unmet needs. From their perspective, this was because “invisible” (e.g., cognitive, fatigue, and mood) difficulties were underrecognised and untreated due to a lack of services post-discharge. This may be in the context of traditional models of stroke rehabilitation which focus on physical disability and developing functional independence. The lack of communication and follow-up post-discharge appeared to underpin uncertainty in recovery and fear of stroke recurrence for ECR participants in particular. Conclusions: Overall, this study has important practical implications for the rehabilitation and management of stroke survivors. Traditional service models may be poorly suited to ECR patients, who need greater emphasis on managing and treating invisible difficulties earlier in the recovery process. This could involve more timely stroke clinic follow-up and routine assessment of cognition, emotions, and fatigue so that appropriate community rehabilitation resources can be allocated.

Poster

02/15/2024
09:30 am - 10:40 am
Room: Shubert Complex (Posters 1-60)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #32

“I felt like I was not a priority”: A Qualitative Study of the Lived Experience of Ischaemic Stroke Patients Treated with Endovascular Clot Retrieval and Intravenous Thrombolysis

Sam Humphrey, La Trobe University, Melbourne, Australia
Kerryn Pike, Griffith University, Gold Coast, Australia
Brian Long, North Metropolitan Health Service, Perth, Australia
Henry Ma, Monash Health, Melbourne, Australia
Robert Bourke, Monash Health, Melbourne, Australia
Bradley Wright, La Trobe University, Melbourne, Australia
Dana Wong, La Trobe University, Melbourne, Australia

Category: Stroke/Cerebrovascular Injury and Disease (Adult)

Keyword 1: stroke
Keyword 2: stroke recovery

Objective:

Endovascular clot retrieval (ECR) is a highly effective acute treatment for ischaemic stroke, with treated patients demonstrating significantly reduced disability and greater functional independence compared to those treated with intravenous tissue plasminogen activator (t-PA) and conservative management. While quantitative studies investigating functional outcomes have been informative, they offer limited insight into the lived experience and unmet needs of patients who receive different treatments for ischaemic stroke. We aimed to investigate the experience of ischaemic stroke patients treated with ECR, t-PA, or conservative management, with a particular focus on their experience of the stroke, view of acute and community services, unmet needs, and physical, cognitive, and emotional outcomes.

Participants and Methods:

Thirty-one participants completed semi-structured interviews about their experiences, needs, and outcomes, 90 to 120 days post-stroke. Interviews were conducted by one doctoral researcher under the supervision of two senior researchers with experience in qualitative research. Data were analysed using reflexive thematic analysis.

Results:

The mean age was 62.9 (±17.5) years; 20 participants were male (64.5%); and mean education was 12.3 (±2.7) years. Left hemisphere strokes were more common (61.3%) and the mean National Institutes of Health Stroke Scale (NIHSS) score at presentation (n=29) was 5.9 (±4.9). Of the 31 participants, 11 were treated with ECR, 10 were treated with t-PA, and 10 were managed conservatively. Baseline demographic and clinical characteristics were similar for all three groups of participants. From 67 codes, three main themes were generated: (1) Experiencing ongoing impairments after stroke; (2) Coping with life after stroke; and (3) Invisible difficulties are easily missed when visible outcomes are positive. Participants experienced ongoing impairments after stroke including physical, motor, and sensory problems, fatigue and sleep issues, communication difficulties, and cognitive impairment. They described the negative impact of these impairments on their ability to cope with life after stroke, including reduced participation and loss of independence. This led to adjustment difficulties and identity changes, together with negative emotions. Participants with positive “visible” (e.g., physical and motor) outcomes, particularly those in the ECR group, described more unmet needs. From their perspective, this was because “invisible” (e.g., cognitive, fatigue, and mood) difficulties were underrecognised and untreated due to a lack of services post-discharge. This may be in the context of traditional models of stroke rehabilitation which focus on physical disability and developing functional independence. The lack of communication and follow-up post-discharge appeared to underpin uncertainty in recovery and fear of stroke recurrence for ECR participants in particular.

Conclusions:

Overall, this study has important practical implications for the rehabilitation and management of stroke survivors. Traditional service models may be poorly suited to ECR patients, who need greater emphasis on managing and treating invisible difficulties earlier in the recovery process. This could involve more timely stroke clinic follow-up and routine assessment of cognition, emotions, and fatigue so that appropriate community rehabilitation resources can be allocated.