Structured Post-stroke Follow-up in Malmö, Sweden (SUESIM) (SUESIM)

March 4, 2020 updated by: Region Skane

Structured Post-stroke Follow-up at Skåne University Hospital in Malmö, Sweden - a Feasibility and Validation Study (SUESIM)

Background Stroke-related medical complications and health problems are common among stroke survivors. Post-stroke Checklist (PSC), developed by an international expert group, and can be used as a clinical tool to identify common and treatable stroke-related health problems. PSC has not been systematically tested in Sweden.

Aims To test the feasibility of a structured and multimodal follow-up model for stroke systematically, to test the validity of the PSC as a screening tool for stroke-related health problems and to study the prevalence of, and changes over time, of stroke-related health problems Study population We plan to include 200 consecutive patients with acute stroke, treated in-hospital at Skåne University Hospital in Malmö and discharged straight to own home.

Procedure The intervention consists of a structured follow-up visit, managed by a stroke nurse, 3 months after stroke followed by a multidisciplinary team rounds resulting in an individual treatment plan for stroke-related health problems, and a final follow-up at 12 months.

Feasibility will be evaluated, as well as burden of stroke-related health problems and interventions prompted by the visits.

Researchers responsible for the study:

Teresa Ullberg, MD, Ph (Postdoctoral researcher) and Hélène Pessah-Rasmussen, MD, PhD, associate professor (PI).

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Background Approximately 600 patients with acute stroke are treated in-hospital at Skåne University Hospital in Malmö. Of those, approximately 450 patients can be discharged straight to their own home after hospital stay. Currently, there is no structured follow-up routine for patients with stroke discharged from Skåne University Hospital in Malmö, and Primary care health providers are managing most follow-ups for stroke depending on individual patient needs. Previous research has shown that one in four patients with stroke are not followed up within three months after hospital discharge in Skåne.

Stroke-related medical complications are common both in the acute phase after stroke and in the longer term. Acute medical complications comprise infections, falls and fractures, confusion, deep venous thrombosis and pulmonary embolism, and also epileptic seizures. The risk of medical complications increases with co-morbidity, but can also be a consequence of the stroke itself. Beyond the acute phase, other stroke-related health problems occur in the majority of patients. They comprise fatigue, impaired cognition, low mood, incontinence, sexual impairment, post-stroke pain, spasticity, relational problems, isolation, inadequate secondary preventive treatment and impaired mobility and daily activities. Previous studies have shown that these problems are common and can persist for years post-stroke. Knowledge of how to best organize and manage stroke and stroke-related health problems in the long-term is sparse, even though there are guidelines on some general principles for secondary prevention and rehabilitation.

Post-stroke Checklist (PSC) was developed by an international stroke expert group. It is a simple checklist collecting eleven common stroke-related health problems, and can be used as a clinical tool to identify common and treatable complications to stroke. The feasibility of the 11-items PSC as a screening tool for stroke-related health problems has been tested systematically and it has been considered implementable. Modified versions of PSC are being implemented in different countries.

PSC can be used both by nurses, physicians and other health professions. The National Guidelines for Stroke Care in Sweden from 2018 recommend the use of PSC for stroke follow-up. PSCs use has not been systematically tested in Sweden though and PSC is not yet routinely used. A modified 14-item PSC is recommended by Region Skåne (the county council of Southern Sweden).

Aims The aims of this study are to test the feasibility of a structured and multimodal follow-up model for stroke systematically, as well as to test the validity of the PSC as a screening tool for stroke-related health problems. The study aims further at studying the prevalence, and changes over time, of stroke-related health problems as well as survival, functional outcome following stroke, and patient satisfaction.

Working plan Study design The study design is longitudinal and explorative. This is a feasibility and validation study where the intervention consists of a structured follow-up visit, a multidisciplinary team rounds resulting in an individual treatment plan for stroke-related health problems, and a final follow-up at 12 months. Individual items in PSC will be validated towards routinely used validated tools. The prevalence, and changes over time, of stroke-related health problems will be investigated, as well as survival, functional outcome following stroke, and patient satisfaction. The study takes place in the clinical setting at the stroke unit, using clinical stroke team professional to mimic the normal clinical situation.

Study population We plan to include 200 consecutive patients with acute ischemic stroke or intracerebral hemorrhage, treated in-hospital at Skåne University Hospital in Malmö and discharged straight to own home. The estimated inclusion rate is 3- 5 patients per week, and the estimated time for including 200 patients is one year. Two hundred patients represent 40% of the total population of the 500 patients who can be discharged straight to own home, and are expected to be representable of the population with respect to age, sex, vascular risk and stroke severity. The generalizability of the population will be assessed through comparison to the Swedish Stroke Register.

Procedure for inclusion Eligible patients are identified daily in the stroke ward and included by written informed consent.

Follow-up procedure The three-months visit is managed by a stroke nurse and include the semi-structured PSC interview, additional validated diagnostic tools, secondary prevention status, comorbidity, and functional outcome.

The three-months visit is followed by a multidisciplinary team rounds with stroke physician, stroke nurse, occupational therapist and if needed physiotherapist, speech therapist, dietician, psychologist and/or social worker. The rounds result in an individual treatment recommendation plan that is sent to the family doctor and other relevant instances. The amount and type of referrals and other interventions warranted by the results of the follow-up visits and rounds are recorded.

The 12-months visit is managed by a stroke nurse and include a new semi-structured PSC interview, secondary prevention status, comorbidity, and a met needs assessment. The 12-month visit is followed by a multidisciplinary team rounds leading to referrals and other interventions are if warranted.

Use of other register data Patient baseline characteristics and three- and 12-month data on living conditions and functional level will be obtained from the Swedish Stroke Register (Riksstroke). Mortality at 12 and 18 months will be obtained by linkage to the Swedish Causes of Death register.

Data management, statistical analyses and ethical considerations The database will be built and managed in close cooperation with Clinical Studies Sweden, Forum South. Analyses will be performed on de-identified data after the dataset has been closed.

All statistical analyses will be performed in SPSS. Data will be presented using descriptive statistics and graphs, as well as linear models. Power calculations are not relevant for this study type.

The local Ethics approval committee has approved of the project (Dnr 2017/1028)

Study Type

Observational

Enrollment (Actual)

200

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Sweden
      • Malmö, Sweden, 205 02
        • Skane University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Probability Sample

Study Population

All patients with acute stroke, without dementia or other serious comorbidity, that can be discharged straight home. These patients have mild to moderate stroke and can be expected to be able to visit an out-patient clinic for follow-up and to benefit from a structured follow-up visit.

Description

Inclusion Criteria:

  • Acute stroke (ICD-10: ischemic stroke I.63 and intracerebral hemorrhage I.61)
  • Discharge to own home

Exclusion Criteria:

  • Co-morbidity such as dialysis, active cancer, severe heart failure or severe psychiatric illness or dementia
  • Patients with stroke, but who receive in-hospital treatment for another competing diagnosis
  • Already included with previous stroke
  • Does not want to participate

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Ecologic or Community
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Participants in Structured post-stroke follow-up in Malmö

Consecutive patients with acute ischemic stroke or intracerebral hemorrhage, treated in-hospital at Skåne University Hospital in Malmö and discharged straight to own home.

The intervention consists of a structured follow-up visit, managed by a stroke nurse, 3 months after stroke followed by a multidisciplinary team rounds resulting in an individual treatment plan for stroke-related health problems, and a final follow-up at 12 months
Other: Structured follow-up after stroke.
Stroke-nurse managed follow-up 3 and 12 months after stroke and multidisciplinary rounds resulting in individual treatment plans for stroke-related health problems.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of stroke-related health problems
Time Frame: 1 year
14-item Post-stroke Checklist, PSC, captures 14 stroke-related health problems. Scale ranges from 0-14 problems. We aim to analyse burden of problems as well as individual items.
1 year
Number of interventions
Time Frame: 1 year
Number of new interventions for stroke-related health problems identified with PSC. No scale used, we calculate the number of interventions done.
1 year

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time to perform and record the semi-structured Post-Stroke Checklist (PSC) interview (minutes).
Time Frame: 1 year
Feasibility of the post-stroke checklist-based follow-up. No scale used, only time in minutes.
1 year
Ability to complete all Post-Stroke Checklist (PSC) items (yes/no)
Time Frame: 1 year
Feasibility of the post-stroke checklist-based follow-up. No scale used. Dichotomous variable (yes/no)
1 year
Patient satisfaction assessment
Time Frame: 1 year
Questionnaire on met needs and satisfaction with follow-up. Five dichotomous questions on met needs and satisfaction with follow-up.
1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Region Skane

Collaborators

Lund University
The Kamprad Family Foundation for Entrepreneurship, Research & Charity
Clinical Studies Sweden - Forum South

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 1, 2018

Primary Completion (Actual)

February 28, 2020

Study Completion (Actual)

February 28, 2020

Study Registration Dates

First Submitted

April 28, 2019

First Submitted That Met QC Criteria

March 2, 2020

First Posted (Actual)

March 4, 2020

Study Record Updates

Last Update Posted (Actual)

March 6, 2020

Last Update Submitted That Met QC Criteria

March 4, 2020

Last Verified

March 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2017/1028

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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