Stroke family care workers. Study shows importance of patients' feelings.
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Caregivers↗
Biomedical subjects
P Gompertz
Publications and source records attributed to P Gompertz.
Determinants of handicap 1 and 3 years after a stroke.
A total of 361 consecutive admissions to hospital with acute stroke were followed up to examine the determinants of handicap 1 year and 2-3 years later. Handicap was measured using the London Handicap Scale, and data were collected on initial stroke severity, disability, mood and sociodemographic variables. Ninety-five of 170 survivors returned handicap questionnaires at 1 year, 102 of 149 survivors at 2-3 years, and 58 on both occasions. Mean handicap score decreased slightly between 1 and 2-3 years (45-48 on a 0-100 scale, 95% confidence interval for difference -1 to +7, p = 0.09). At both 1 and 2-3 years handicap was associated with pre-stroke disability, 1-year score disability, initial stroke severity and mood. Age and sex were associated at 1 year but not at 2-3 years. In multivariate analyses disability, stroke severity and mood were independently associated with handicap. None of the variables examined predicted change in handicap score. The study demonstrates the overriding importance of stroke severity (impairment) and disability in determining handicap. In comparison, social variables were less important.
Activities of Daily Living↗
Stroke patients' views on their admission to hospital.
OBJECTIVE: To explore which components of care were valued by patients admitted to hospital following a stroke. DESIGN: Qualitative study using in depth interviews 10 months after the stroke. SETTING: Two adjacent districts in North Thames Regional Health Authority. SUBJECTS: 82 survivors of stroke taken consecutively from a stroke register, 40 of whom agreed to be interviewed. RESULTS: Patients reported that during the acute stage of the stroke they wanted to put their faith in experienced and trusted experts who would help them make sense of the event, take all the actions necessary to ensure survival, and provide comfort and human warmth during the crisis. In addition to being reassured by the clinical tests and practical nursing help they received, patients valued feeling cared about by the staff. In most cases patients reported that their needs were met; however, the institutional nature of the hospital sometimes obstructed the fulfillment of their needs. CONCLUSION: Patients have important psychosocial needs during the acute stage of the stroke, which are often met by hospital admission. Patients gained benefits from their admission over and above those measurable in terms of morbidity or function. They used a combination of criteria to evaluate their care, focusing on the process as well as the outcome of care. Researchers and clinicians should do likewise.
Adult↗
How useful are non-random comparisons of outcomes and quality of care in purchasing hospital stroke services?
We performed a prospective observational study using a stroke register, case-note review and survey of carers with 6 months of follow-up in two adjacent health districts in East London. District 1 was a teaching district and had no special stroke service; District 2 had a comprehensive stroke service comprising stroke unit, review of all stroke admissions and community follow-up. Three hundred and sixty-one consecutive patients with stroke admitted to hospital and 103 carers were surveyed at 6 months from admission using the Royal College of Physicians (London) Stroke Audit standards. We also assessed mortality, disability, perceived health, mood, and satisfaction with services 6 months after stroke, carer mood, perceived health and satisfaction with services. The standard of care was below that set by the Royal College of Physicians of London in both districts and there were no significant differences between the districts in age-standardized mortality at 1 and 6 months, Barthel score, extended ADL score, Geriatric Depression score, Nottingham Health Profile score and patient satisfaction with services at 6 months. Carer outcomes did not differ between districts. Service costs, particularly costs of rehabilitation services, were much lower in District 2. A comprehensive district stroke service was not associated with major differences in patient outcomes or standards of care. This may have been because the non-random nature of the comparison meant that the patients differed in other ways than in the nature of treatment. Caution is needed when using these techniques in making purchasing decisions.
Activities of Daily Living↗
Development and reliability of the Royal College of Physicians stroke audit form. UK Stroke Audit Group.
This article reports the development of an audit form for assessing the quality of stroke care from medical records. A consensus conference to define standards was followed by testing of pilot versions of the audit form. Then formal assessment of inter-rater reliability was carried out in four centres using 76 medical records, each assessed by two of eight auditors. Inter-rater reliability was acceptable, especially when medically qualified auditors were used.
Aged↗
Handicap one year after a stroke: validity of a new scale.
The aim was to determine the handicap experienced by subjects one year after a stroke, and assess the acceptability, validity, and reliability of a new handicap measurement scale. A cross sectional survey of 141 survivors of a cohort of consecutive hospital admissions with acute stroke was undertaken. The London handicap scale (a new health outcome measurement scale), Barthel index, Nottingham extended activities of daily living scale, Nottingham health profile, Geriatric depression score, and a global life satisfaction scale were used. 94 subjects (67%) responded to a single mailing; 89 (95%) responses were usable. Mean handicap was 0.40 (range 0.06-1.0, SD 0.20) on a scale of 0 (maximum handicap) to 1 (no handicap). All handicap dimensions showed a wide range of problems, with physical independence and occupation particularly affected. Correlations between handicap score and other outcome measures were all in the expected direction and of about the strength expected (0.36 < r < 0.69). The reliability coefficient was 0.91, limits of agreement +/- 0.19. The measurements demonstrated substantial handicap one year after a stroke, reflecting considerable unmet rehabilitation needs. The scale proved acceptable to subjects, and the results were consistent with good validity.
Activities of Daily Living↗
Predicting stroke outcome: Guy's prognostic score in practice.
This study aimed to cross validate the Guy's prognostic score in a new sample of patients of all ages admitted to hospital with a stroke and to devise and test a simpler version (the G-score). 361 consecutive acute patients with stroke who had been admitted to the acute hospitals in two adjacent health districts in East London were recruited and followed up for six months after the stroke. The G-score was derived by simplifying the weights used in calculating the Guy's score. With the conventional threshold of 0 for the Guy's score and 3 (out of 7) for the G-score, the sensitivity of both scores for predicting a bad outcome (death or Barthel score < 13 out of 20 at six months) was 0.72 and specificity was 0.63. The likelihood ratio for the Guy's score was 1.97 and for the G-score 1.95. Both versions of the score performed better than conscious level alone at predicting the outcome (sensitivity 0.47, specificity 0.73, likelihood ratio 1.74). Similar data are presented for different thresholds and prior probabilities. In addition, the G-score permits direct estimation of 95% confidence intervals for the probability of a bad outcome for five grades of stroke severity. Outcome prediction with multivariate techniques has the potential to improve and inform clinical decision making. The G-score should be used to define stroke severity for individual patients and for case mix adjustment.
Activities of Daily Living↗
Measuring patients' views of their health. Definitions of health status should be rationalised.
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Health Status↗
Development and results of a questionnaire to measure carer satisfaction after stroke.
STUDY OBJECTIVE: To develop a carer satisfaction questionnaire for use as an outcome measure in stroke, to test the measure for reliability and validity, and to survey levels of carer satisfaction with services for stroke patients. DESIGN: Postal survey of carer satisfaction with stroke services was carried out using the questionnaire we developed and tested. Internal consistency was tested and construct validation was explored by examining correlations with other outcome measures (the Faces Scale, the Nottingham Health Profile, the short form of the Geriatric Depression Scale, and the patient's Barthel Index score). SETTING: Two adjacent districts in North East Thames Regional Health Authority. PARTICIPANTS: A total of 103 carers were identified from 219 people who had survived a stroke to six months. During the pilot stage, six of seven carers who were invited to participate in in depth interviews and 15 of 23 carers (65%) who were invited to completed the first draft of the questionnaire. MAIN RESULTS: The questionnaire was divided into two sections, one on inpatient services (Carer Hospsat) and one on services after discharge (Carer Homesat). The questionnaire had construct validity, providing significant correlations with the Faces Scale (Carer Hospsat r = 0.59, p < 0.00001 and Carer Homesat r = 0.68, p < 0.00001), the patients' Barthel score (Carer Hospsat r = 0.25, p = 0.01), and the patients' Nottingham extended Activities of Daily Living (ADL) scale (Carer Hospsat r = 0.31, p = 0.002). Internal consistency was high for both sections (Cronbach's alpha: Carer Hospsat 0.87, Carer Homesat 0.79). Most carers (77%) were satisfied with the care their relative or friend received while in hospital, but only 39% were satisfied with services after discharge. CONCLUSIONS: Carer satisfaction is an important outcome measure in stroke research. This study has shown that carers are dissatisfied with services after hospital discharge. Our questionnaire is valid, reliable, and sensitive and could be used to test interventions aimed at improving services.
Aftercare↗