Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review

Hanna, Kerry; Rowe, Fiona

doi:10.1080/01658107.2017.1279640

Cited by 7 publications

(4 citation statements)

References 70 publications

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“…The National Clinical Guidelines for Stroke recommend orthoptists as a core stroke team member and all stroke survivors should be offered vision screening ( Intercollegiate Stroke Working Party 2016 ). This does not happen in some stroke units, representing a health inequality for stroke survivors ( Hanna and Rowe 2017 ). There is a high risk that stroke survivors without obvious signs of visual impairment never have their visual impairment detected and thus live with undiagnosed visual impairment and the consequences of this.…”

Section: Discussionmentioning

confidence: 99%

Ten Years On – A Survey of Orthoptic Stroke Services in the UK and Ireland

Hepworth¹,

Rowe

2019

British and Irish Orthoptic Journal

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In 2007 a national orthoptic survey identified poor provision of vision assessment for stroke survivors. The purpose of this study is to report a 10-year update of this survey to identify changes in clinical practice over recent years. Methods: An online practice survey of registered orthoptists (British and Irish Orthoptic Society, BIOS) was undertaken to scope vision services for stroke survivors. Results: At the time of this survey, there were 223 orthoptic departments and 227 stroke units in the UK and Ireland. 317 responses were received representing 178 orthoptic departments-an 80% response rate for orthoptic departments. Of the respondents, 92% reported having a stroke unit in their hospital. A stroke/vision service was provided by 98% of responding orthoptic departments for 77% of stroke units but with only half providing a vision service on the stroke unit. Only 33% of vision services were funded and funding remains the primary barrier to providing a stroke/vision service. About 85% of respondents were aware of the national clinical guidelines for stroke and the BIOS extended practice guidelines for stroke. Conclusions: There has been a positive increase in awareness of stroke-related visual impairment and a steady improvement in provision of eye care for stroke survivors. However, there remains a lack of provision of specialist vision services specifically on stroke units which infers a health inequality for stroke survivors who have visual impairment. Their visual impairments can remain undetected and thus undiagnosed and unmanaged due to unsatisfactory patient care.

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Section: Discussionmentioning

confidence: 99%

Ten Years On – A Survey of Orthoptic Stroke Services in the UK and Ireland

Hepworth¹,

Rowe

2019

British and Irish Orthoptic Journal

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“…Furthermore, inequalities may exist within the visually impaired stroke population on an individual level, in relation to demographic differences. A recent systematic review reporting health inequalities within the visually impaired stroke population concluded a lack of specific evidence within this area (Hanna & Rowe, 2017). However, unequal access to vision services after stroke based on area of residence was identified and called for national improvement (Rowe, 2013), although qualitative exploration is required to explore the views from this group specifically, in terms of health inequalities and psychosocial impact.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Furthermore, stroke and visually impaired groups individually presented with health inequalities (Hanna & Rowe, 2017), such as increased prevalence of stroke, poor recovery of impairments, and poor access to health services in subgroups such as older age, female gender, and lower socioeconomic status (Cumberland, Rahi, & UK Biobank Eye and Vision Consortium, 2016; Knight & Lindfield, 2015; Redfern, McKevitt, Rudd, & Wolfe, 2002). Therefore, it is possible that the combined group are facing issues that have not been fully explored.…”

Section: Introductionmentioning

confidence: 99%

A qualitative exploration of the sociology of poststroke visual impairments and the associated health inequalities

2020

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Introduction Inequalities have been found to exist within the visually impaired stroke population on an individual level, in relation to demographic differences, unequal access to vision services, transport, employment, and financial repercussions. The long‐term impact of living with poststroke visual impairments must be explored, in order to identify complications accessing NHS services and to inform possible changes to service planning and delivery in order to tackle such complications. Aim To explore the extent of health inequalities within visually impaired stroke survivors in the northwest of England and discuss potential solutions to these. Methods Focus groups and individual interviews ( n = 13 stroke survivors and n = 1 spouse) were conducted between October 2016 and January 2017. Transcription and thematic analysis of the transcripts was undertaken, using line‐by‐line coding, underpinned with social constructionism. Results The findings draw on lived experiences of stroke survivors across their journey from prestroke to life after stroke. The three overarching experiences of stroke and visual impairment that emerged in respondent accounts were constructed in terms of “loss,” concerning (a) the physical being, (b) the psychosocial being and, (c) the systematic organization of health care. Conclusion The stroke survivors frequently reported a complete lack of visual care, with many recounting apathetic experiences, often resonating power imbalance in the healthcare system. Where suitable care is being offered after stroke, a desire for a personalized approach to rehabilitation, with adapted communication methods specific to individual needs, featured strongly in many of the respondent accounts. The findings emphasize a need to ensure vision rehabilitation is offered to all stroke survivors suffering from poststroke visual impairment, and to educate stroke clinicians and patients of the bigger picture of life after stroke, highlighting all forms of available support.

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“…In Norway and internationally, there are lack of national care pathways for VIs after stroke in health care services [ 15 – 18 ], which has led to a variation in the quality of assessment and follow-up of VIs in stroke care [ 19 ]. In stroke services, there is a gap between research evidence on how to assess and follow up on VIs after stroke and clinical practice [ 11 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services

Mathisen

Eilertsen

Ormstad

et al. 2021

BMC Health Serv Res

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Background Stroke is a leading cause of disability worldwide. Visual impairments (VIs) affect 60% of stroke survivors, and have negative consequences for rehabilitation and post-stroke life. VIs after stroke are often overlooked and undertreated due to lack of structured routines for visual care after stroke. This study aims to identify and assess barriers and facilitators to the implementation of structured visual assessment after stroke in municipal health care services. The study is part of a larger knowledge translation project. Methods Eleven leaders and municipal interdisciplinary health care professionals participated in qualitative interviews. During two workshops, results from the interviews were discussed with 26 participants from municipal health care services and user representatives. Data from interviews and workshops were collected before the intervention was implemented and analyzed using content analysis. Results The analysis identified individual and contextual barriers and facilitators. The individual barriers were related to the participants' experiences of having low competence of visual functions and vision assessment skills. They considered themselves as generalists, not stroke experts, and some were reluctant of change because of previous experiences of unsuccessful implementation projects. Individual facilitators were strong beliefs that including vision in stroke care would improve health care services. If experienced as useful and evidence based, the new vision routine would implement easier. Contextual barriers were experiences of unclear responsibility for vision care, lack of structured interdisciplinary collaboration and lack of formal stroke routines. Time constraints and practical difficulties with including the vision tool in current medical records were also expressed barriers. Contextual facilitators were leader support and acknowledgement, in addition to having a flexible work schedule. Conclusions This study shows that improving competence about VIs after stroke and skills in assessing visual functions are particularly important to consider when planning implementation of new vision routines in municipal health care services. Increased knowledge about the consequences of living with VIs after stroke, and the motivation to provide best possible care, were individual facilitators for changing clinical practice. Involving knowledge users, solutions for integrating new knowledge in existing routines, along with easily accessible supervision in own practise, are essential facilitators for promoting a successful implementation.

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Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review

Cited by 7 publications

References 70 publications

Ten Years On – A Survey of Orthoptic Stroke Services in the UK and Ireland

Ten Years On – A Survey of Orthoptic Stroke Services in the UK and Ireland

A qualitative exploration of the sociology of poststroke visual impairments and the associated health inequalities

Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services

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