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Published in: BMC Primary Care 1/2019

Open Access 01-12-2019 | Stroke | Research article

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

Authors: Grace M. Turner, Christel McMullan, Lou Atkins, Robbie Foy, Jonathan Mant, Melanie Calvert

Published in: BMC Primary Care | Issue 1/2019

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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. Data was analysed using 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 information about TIA/minor stroke diagnosis and secondary stroke prevention using lay language, and improve their identification of and response to important residual impairments affecting patients.
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Literature
1.
go back to reference Scarborough P, Peto V, Bhatnagar P, et al. Stroke statistics. London: British Heart Foundation and Stroke Association; 2009. Scarborough P, Peto V, Bhatnagar P, et al. Stroke statistics. London: British Heart Foundation and Stroke Association; 2009.
2.
go back to reference Intercollegiate Stroke Working Party. National clinical guideline for stroke. London: Royal College of Physicians; 2016. Intercollegiate Stroke Working Party. National clinical guideline for stroke. London: Royal College of Physicians; 2016.
3.
go back to reference Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2014;45(7):2160–236.CrossRef Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2014;45(7):2160–236.CrossRef
4.
go back to reference European Stroke Organisation (ESO) Executive Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457–507.CrossRef European Stroke Organisation (ESO) Executive Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457–507.CrossRef
5.
go back to reference Moran GM, Fletcher B, Feltham MG, et al. Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review. Eur J Neurol. 2014;21(10):1258–67.CrossRef Moran GM, Fletcher B, Feltham MG, et al. Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review. Eur J Neurol. 2014;21(10):1258–67.CrossRef
6.
go back to reference Sackley CM, Mant J, McManus RJ, et al. Functional and emotional outcomes after transient ischemic attack: a 12-month prospective controlled cohort study. Int J Stroke. 2019;14(5):1747493018823158.CrossRef Sackley CM, Mant J, McManus RJ, et al. Functional and emotional outcomes after transient ischemic attack: a 12-month prospective controlled cohort study. Int J Stroke. 2019;14(5):1747493018823158.CrossRef
7.
go back to reference Turner GM, Calvert M, Feltham MG, et al. Ongoing impairments following transient ischaemic attack: retrospective cohort study. Eur J Neurol. 2016;23(11):1642–50.CrossRef Turner GM, Calvert M, Feltham MG, et al. Ongoing impairments following transient ischaemic attack: retrospective cohort study. Eur J Neurol. 2016;23(11):1642–50.CrossRef
8.
go back to reference van Rooij FG, Kessels RP, Richard E, et al. Cognitive impairment in transient ischemic attack patients: a systematic review. Cerebrovasc Dis. 2016;42(1–2):1–9.CrossRef van Rooij FG, Kessels RP, Richard E, et al. Cognitive impairment in transient ischemic attack patients: a systematic review. Cerebrovasc Dis. 2016;42(1–2):1–9.CrossRef
9.
go back to reference Muus I, Petzold M, Ringsberg KC. Health-related quality of life among Danish patients 3 and 12 months after TIA or mild stroke. Scand J Caring Sci. 2010;24(2):211–8.CrossRef Muus I, Petzold M, Ringsberg KC. Health-related quality of life among Danish patients 3 and 12 months after TIA or mild stroke. Scand J Caring Sci. 2010;24(2):211–8.CrossRef
10.
go back to reference Verbraak ME, Hoeksma AF, Lindeboom R, Kwa VI. Subtle problems in activities of daily living after a transient ischemic attack or an apparently fully recovered non-disabling stroke. J Stroke Cerebrovasc Dis. 2012;21(2):124–30.CrossRef Verbraak ME, Hoeksma AF, Lindeboom R, Kwa VI. Subtle problems in activities of daily living after a transient ischemic attack or an apparently fully recovered non-disabling stroke. J Stroke Cerebrovasc Dis. 2012;21(2):124–30.CrossRef
11.
go back to reference Wang YL, Pan YS, Zhao XQ, et al. Recurrent stroke was associated with poor quality of life in patients with transient ischemic attack or minor stroke: finding from the CHANCE trial. CNS Neurosci Ther. 2014;20(12):1029–35.CrossRef Wang YL, Pan YS, Zhao XQ, et al. Recurrent stroke was associated with poor quality of life in patients with transient ischemic attack or minor stroke: finding from the CHANCE trial. CNS Neurosci Ther. 2014;20(12):1029–35.CrossRef
12.
go back to reference Carlsson GE, Moller A, Blomstrand C. Consequences of mild stroke in persons <75 years -- a 1-year follow-up. Cerebrovasc Dis. 2003;16(4):383–8.CrossRef Carlsson GE, Moller A, Blomstrand C. Consequences of mild stroke in persons <75 years -- a 1-year follow-up. Cerebrovasc Dis. 2003;16(4):383–8.CrossRef
13.
go back to reference Edwards DF, Hahn M, Baum C, Dromerick AW. The impact of mild stroke on meaningful activity and life satisfaction. J Stroke Cerebrovasc Dis. 2006;15(4):151–7.CrossRef Edwards DF, Hahn M, Baum C, Dromerick AW. The impact of mild stroke on meaningful activity and life satisfaction. J Stroke Cerebrovasc Dis. 2006;15(4):151–7.CrossRef
14.
go back to reference Fride Y, Adamit T, Maeir A, et al. What are the correlates of cognition and participation to return to work after first ever mild stroke? Top Stroke Rehabil. 2015;22(5):317–25.CrossRef Fride Y, Adamit T, Maeir A, et al. What are the correlates of cognition and participation to return to work after first ever mild stroke? Top Stroke Rehabil. 2015;22(5):317–25.CrossRef
15.
go back to reference Hommel M, Trabucco-Miguel S, Joray S, et al. Social dysfunctioning after mild to moderate first-ever stroke at vocational age. J Neurol Neurosurg Psychiatry. 2009;80(4):371–5.CrossRef Hommel M, Trabucco-Miguel S, Joray S, et al. Social dysfunctioning after mild to moderate first-ever stroke at vocational age. J Neurol Neurosurg Psychiatry. 2009;80(4):371–5.CrossRef
16.
go back to reference Mc Sharry J, Baxter A, Wallace LM, et al. Delay in seeking medical help following transient ischemic attack (TIA) or “mini-stroke”: a qualitative study. PLoS One. 2014;9(8):e104434.CrossRef Mc Sharry J, Baxter A, Wallace LM, et al. Delay in seeking medical help following transient ischemic attack (TIA) or “mini-stroke”: a qualitative study. PLoS One. 2014;9(8):e104434.CrossRef
17.
go back to reference Mellor RM, Bailey S, Sheppard J, et al. Decisions and delays within stroke patients' route to the hospital: a qualitative study. Ann Emerg Med. 2015;65(3):279–87.e3.CrossRef Mellor RM, Bailey S, Sheppard J, et al. Decisions and delays within stroke patients' route to the hospital: a qualitative study. Ann Emerg Med. 2015;65(3):279–87.e3.CrossRef
18.
go back to reference Wilson A, Coleby D, Regen E, et al. Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives. BMJ Open. 2016;6(5):e011654.CrossRef Wilson A, Coleby D, Regen E, et al. Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives. BMJ Open. 2016;6(5):e011654.CrossRef
19.
go back to reference Kirkpatrick S, Locock L, Giles MF, Lasserson DS. Non-focal neurological symptoms associated with classical presentations of transient ischaemic attack: qualitative analysis of interviews with patients. PLoS One. 2013;8(6):e66351.CrossRef Kirkpatrick S, Locock L, Giles MF, Lasserson DS. Non-focal neurological symptoms associated with classical presentations of transient ischaemic attack: qualitative analysis of interviews with patients. PLoS One. 2013;8(6):e66351.CrossRef
20.
go back to reference Taule T, Raheim M. Life changed existentially: a qualitative study of experiences at 6-8 months after mild stroke. Disabil Rehabil. 2014;36(25):2107–19.CrossRef Taule T, Raheim M. Life changed existentially: a qualitative study of experiences at 6-8 months after mild stroke. Disabil Rehabil. 2014;36(25):2107–19.CrossRef
21.
go back to reference Spurgeon L, James G, Sackley C. Subjective experiences of transient ischaemic attack: a repertory grid approach. Disabil Rehabil. 2013;35(26):2205–12.CrossRef Spurgeon L, James G, Sackley C. Subjective experiences of transient ischaemic attack: a repertory grid approach. Disabil Rehabil. 2013;35(26):2205–12.CrossRef
22.
go back to reference Kamara S, Singh S. What are the patient-held illness beliefs after a transient ischaemic attack, and do they determine secondary prevention activities: an exploratory study in a North London general practice. Prim Health Care Res Dev. 2012;13(2):165–74.CrossRef Kamara S, Singh S. What are the patient-held illness beliefs after a transient ischaemic attack, and do they determine secondary prevention activities: an exploratory study in a North London general practice. Prim Health Care Res Dev. 2012;13(2):165–74.CrossRef
23.
go back to reference Green TL, King KM. Experiences of male patients and wife-caregivers in the first year post-discharge following minor stroke: a descriptive qualitative study. Int J Nurs Stud. 2009;46(9):1194–200.CrossRef Green TL, King KM. Experiences of male patients and wife-caregivers in the first year post-discharge following minor stroke: a descriptive qualitative study. Int J Nurs Stud. 2009;46(9):1194–200.CrossRef
24.
go back to reference Gibson J, Watkins C. People’s experiences of the impact of transient ischaemic attack and its consequences: qualitative study. J Adv Nurs. 2012;68(8):1707–15.CrossRef Gibson J, Watkins C. People’s experiences of the impact of transient ischaemic attack and its consequences: qualitative study. J Adv Nurs. 2012;68(8):1707–15.CrossRef
25.
go back to reference Croot EJ, Ryan TW, Read J, et al. Transient ischaemic attack: a qualitative study of the long term consequences for patients. BMC Fam Pract. 2014;15:174.CrossRef Croot EJ, Ryan TW, Read J, et al. Transient ischaemic attack: a qualitative study of the long term consequences for patients. BMC Fam Pract. 2014;15:174.CrossRef
26.
go back to reference Carlsson GE, Moller A, Blomstrand C. Managing an everyday life of uncertainty--a qualitative study of coping in persons with mild stroke. Disabil Rehabil. 2009;31(10):773–82.CrossRef Carlsson GE, Moller A, Blomstrand C. Managing an everyday life of uncertainty--a qualitative study of coping in persons with mild stroke. Disabil Rehabil. 2009;31(10):773–82.CrossRef
27.
go back to reference Rochette A, Desrosiers J, Bravo G, et al. Changes in participation after a mild stroke: quantitative and qualitative perspectives. Top Stroke Rehabil. 2007;14(3):59–68.CrossRef Rochette A, Desrosiers J, Bravo G, et al. Changes in participation after a mild stroke: quantitative and qualitative perspectives. Top Stroke Rehabil. 2007;14(3):59–68.CrossRef
28.
go back to reference Hillsdon KM, Kersten P, Kirk HJ. A qualitative study exploring patients' experiences of standard care or cardiac rehabilitation post minor stroke and transient ischaemic attack. Clin Rehabil. 2013;27(9):845–53.CrossRef Hillsdon KM, Kersten P, Kirk HJ. A qualitative study exploring patients' experiences of standard care or cardiac rehabilitation post minor stroke and transient ischaemic attack. Clin Rehabil. 2013;27(9):845–53.CrossRef
29.
go back to reference Green J, Thorogood N. Qualitative Methods for Health Research. 4th ed. London: SAGE Publications Ltd; 2018. Green J, Thorogood N. Qualitative Methods for Health Research. 4th ed. London: SAGE Publications Ltd; 2018.
31.
go back to reference Fischer U, Baumgartner A, Arnold M, et al. What is a minor stroke? Stroke. 2010;41(4):661–6.CrossRef Fischer U, Baumgartner A, Arnold M, et al. What is a minor stroke? Stroke. 2010;41(4):661–6.CrossRef
32.
go back to reference Ritchie J, Lewis J. Qualitative research practice: a guide for social science students and researchers. 2nd ed. London: SAGE Publications Ltd; 2003. Ritchie J, Lewis J. Qualitative research practice: a guide for social science students and researchers. 2nd ed. London: SAGE Publications Ltd; 2003.
33.
go back to reference Chun HY, Whiteley WN, Dennis MS, et al. Anxiety after stroke: the importance of subtyping. Stroke. 2018;49(3):556–64.CrossRef Chun HY, Whiteley WN, Dennis MS, et al. Anxiety after stroke: the importance of subtyping. Stroke. 2018;49(3):556–64.CrossRef
Metadata
Title
TIA and minor stroke: a qualitative study of long-term impact and experiences of follow-up care
Authors
Grace M. Turner
Christel McMullan
Lou Atkins
Robbie Foy
Jonathan Mant
Melanie Calvert
Publication date
01-12-2019
Publisher
BioMed Central
Keywords
Stroke
Care
Published in
BMC Primary Care / Issue 1/2019
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-019-1057-x

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