TIA and minor stroke: A qualitative study of long-term impact and experiences of follow-up care

Abstract

Background Transient ischaemic attack (TIA) and minor stroke are often considered transient events; however, many patients experience residual problems and reduced quality of life. Current follow-up healthcare focuses on stroke prevention and care for other long-term problems is not routinely provided. We aimed to explore patient and healthcare provider (HCP) experiences of residual problems post-TIA/minor stroke, the impact of TIA/minor stroke on patients’ lives, and current follow-up care and sources of support. Methods This qualitative study recruited participants from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Semi-structured interviews were conducted with 12 TIA/minor stroke patients and 24 HCPs from primary, secondary and community care with framework analysis. Results A diverse range of residual problems were reported post-TIA/minor stroke, including psychological, cognitive and physical impairments. Consultants and general practitioners generally lacked awareness of these long-term problems; however, there was better recognition among nurses and allied HCPs. Residual problems significantly affected patients’ lives, including return to work, social activities, and relationships with family and friends. Follow-up care was variable and medically focused. While HCPs prioritised medical investigations and stroke prevention medication, patients emphasised the importance of understanding their diagnosis, individualised support regarding stroke risk, and addressing residual problems. Conclusion HCPs could better communicate lay information about TIA/minor stroke diagnosis and secondary stroke prevention, and improve their identification of and response to important residual impairments affecting patients.

Physical Activity After Transient Ischemic Attack or Mild Stroke Is Business as Usual

“…Our findings suggest a discrepancy between participant perceptions of the information received and evidence recommendations. This is consistent with previous research that suggests a widespread or persistent lack in the communication of stroke-related information between stroke survivors and health team members 4,37,38…”

“…Evidence accumulated over the past decade identifies the need for secondary prevention measures for people with TIA or mild stroke 4,46,47. However, participants of this study perceived that there is little or no information to convince them of the need to make changes to their physical activity behavior.…”

“…A mild stroke (the National Institutes of Health Stroke Scale ≤4 and the modified Rankin Scale 0-1) causes residual infarction, but minimal to no residual physical deficits 1,3. There is generally no need for rehabilitation services following a TIA or mild stroke 1,4. Although this patient population is assumed to return to prestroke functional and physical activity capabilities,1,2,4 evidence shows a long-term risk of recurrent stroke 1,5,6…”

“…Substantial evidence supports the provision of secondary stroke prevention protocols for people with TIA and mild stroke, which includes identifying and supporting changes to modifiable risk factors 5,6. Previous qualitative investigations of people's experiences of the impact of their TIA and long-term sequelae have predominantly focused on factors associated with symptom recognition,29 seeking knowledge to inform decision-making,30 and variability in the ability of current health care to address their complex needs 4. Evidence highlights long-term physical, practical, and psychological consequences that affect the individual's perception of health after TIA or mild stroke, creating a sense of uncertainty and increasing levels of anxiety 31.…”

An Exploratory Study of the Development and Pilot Testing of an Interactive Visual Tool of Neuropsychological Test Results in Memory Clinics

“…A dementia diagnosis has a huge impact on patients and their significant others. Understanding the consequences of this diagnosis may, however, enable them to make positive adjustments and cope with the experienced loss [1][2][3]. Therefore, accurate and clear communication during the diagnostic process and disclosure are required.…”