Information provision after stroke:
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- Brenda Turner
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1 BACKGROUND Information provision after stroke: Sally Eames 1 Tammy Hoffmann 2, Linda Worrall 3, Stephen Read 4, Andrew Wong 4&5 1 Senior Occupational Therapist - Rehabilitation Unit, Brighton Health Campus & Services / The Prince Charles Hospital, and PhD Candidate, The University of Queensland (UQ) 2 Faculty of Health Sciences and Medicine, Bond University is a crucial component of post-stroke care (NSF, 2010) can improve stroke client and carer knowledge, reduce client depression, and increase some aspects of client satisfaction (Smith, et al. 2008) 3 Communication Disability Centre & the CCRE in Aphasia Rehabilitation, UQ 4 The Royal Brisbane and Women s Hospital 5 Neurology Department, The Princess Alexandra Hospital BACKGROUND Study 1: Survey of community health services Literature review Study 2: Survey of clients and carers (Eames et al., 2008) (Eames et al., 2010) Development of education and support package Recommended features of stroke education package: mix of active (interactive) and passive delivery styles repeat or reinforce information; continue beyond discharge range of topics and formats well-designed, tailored written material in addition to verbal Study 3: RCT of education and support package BACKGROUND Tailored written information booklets can: improve knowledge (Lowe et al, 2007) EDUCATION AND SUPPORT PACKAGE tailored written booklet (Hoffmann et al., 2007) improved client satisfaction with information received and met their information needs (Hoffmann et al. 2007)
2 EDUCATION AND SUPPORT PACKAGE tailored written booklet Participants select: from 34 topics brief or detailed font size (12, 14, 16) verbal reinforcement - face-to-face prior to discharge and telephone-based following discharge telephone support option for 3 months following discharge Aims was to evaluate the effectiveness of this package of the knowledge, health and psychosocial outcomes of stroke clients and their carers identify potential influences on stroke knowledge Design multisite, randomised controlled trial comparing the education and support package with usual care concealed, random allocation Design multisite, randomised controlled trial comparing the education and support package with usual care concealed, random allocation Participants consecutive clients with stroke and their carers Eligibility criteria diagnosis of stroke/tia, or carer for someone with same contactable by telephone within Australia following discharge adequate English, cognition, communication, vision and hearing to complete consent and interview medical stability from one of two acute stroke units in the Brisbane metropolitan area
3 Exclusion criteria living in residential care prior to admission having residential care as planned discharge destination Outcome measures prior to discharge (face-to-face) and 3 months post-discharge (over the telephone) no significant differences between telephone and face-to-face administration (Hoffmann et al, 2010) Stroke knowledge Self-efficacy Anxiety and depression Client QOL Carer strain Satisfaction Feeling informed Risk-related behaviour Awareness of risk factors Clinical/demographics 138 initial interviews (77 clients and 61 carers) randomised to intervention (n=67), control (n=71) 119 follow-up interview (66 clients and 53 carers) 14% lost to follow-up Analysis STATA, intention-to-treat basis ANCOVAs to control for baseline difference multi-level modelling to explore influences on knowledge RESULTS RESULTS Demographic and clinical details Control group Intervention group Female n (%) 32 (54%) 30 (50%) Mean age, SD (range) 61.8, (37-86) 55.1, (27-87) Type of (N=31) (N=35) stroke Ischemic 27 (87%) 27 (78%) n (%) Haemorrhagic 4 (13%) 7 (20%) TIA 0 1 (3%) Side of stroke Left (N=31) 11 (35%) (N=35) 13 (37%) n (%) Right 17 (55%) 21 (60%) Bilateral 3 (10%) 1 (3%) RESULTS RESULTS RESULTS ANCOVAs indicated significant differences between the groups in: stroke knowledge (p=0.013) self efficacy for accessing stroke information (p=0.013) feeling informed (p=0.027) satisfaction with practical (p=0.026), medical (p<0.001) and secondary prevention (p<0.001) information received in favour of the intervention group Multi-level modeling indicated: follow-up time point (p<0.001) carer status (p<0.001) more years of schooling (p=0.001) higher self efficacy for accessing practical help (p=0.036) higher feelings of being informed (p=0.029) were significantly related to higher stroke knowledge
4 RESULTS Multi-level modeling indicated: allocation to intervention group (p=0.242) was NOT a significant influence on higher stroke knowledge. Why the conflicting results for stroke knowledge? multilevel modeling takes into account two time points versus one Interpretation Knowledge is not significantly influenced by the intervention in this sample, over two time points. The intervention may still hold benefit clients and carers for other outcomes Lack of other significant effect of the intervention follow-up time too short? intensity of intervention? not tailored enough? Limitations small sample size validity of some outcome measures exclusion of clients with residential care needs or those with severe cognition, communication and NES-backgrounds limit generalisability of results as an important precursor to behaviour, greater self efficacy has the potential to enhance participants own initiation of accessing stroke information CONCLUSION CONCLUSION Knowledge is not significantly influenced by the intervention in this sample, over two time points. The intervention may still hold benefit clients and carers for other outcomes clients and participants with low education likely to have poor stroke knowledge target as a priority
5 References Stroke Education Booklet: National Stroke Foundation (2010) Clinical Guidelines for Stroke Management. Melbourne, Australia. Smith J., A. Forster, et al. (2008) Information provision for stroke patients and their caregivers. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD DOI: / CD pub2 Lowe, D., A. Sharma, et al. (2007). "The CareFile Project: a feasibility study to examine the effects of an individualised information booklet on patients after stroke." Age and Ageing 26: Hoffmann, T., K. McKenna, et al. (2007). "Randomised trial of a computergenerated tailored written education package for patients following stroke." Age and Ageing 36(3): Eames, S., T. Hoffmann, et al. (2008). "Community-based stroke information for clients with stroke and their carers: is there congruency between actual and recommended practice?" Topics in Stroke Rehabilitation 15(4): Eames, S., T. Hoffmann, et al. (2010). "Delivery styles and formats for different stroke information topics: patient and carer preferences." Patient Education & Counseling. (Advanced online publication) Hoffmann, T., L. Worrall, et al. (2010). "Measuring outcomes in people who have had a stroke and their carers: Can the telephone be used?" Topics in Stroke Rehabilitation 17(2):
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