Improving post-stroke recovery: the role of the multidisciplinary health care team

David J Clarke, Anne Forster, David J Clarke, Anne Forster

Abstract

Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway.

Keywords: interdisciplinary; multidisciplinary; rehabilitation; stroke care; team working.

Figures

Figure 1
Figure 1
The stroke care pathway. Abbreviations: TIA, transient ischemic attack; ED, emergency department.

References

    1. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. on behalf of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Diseases Study 2010. Lancet. 2014;383(9913):245–255.
    1. Stroke Association UK State of the Nation. Stroke Statistics. [Document on the Internet] 2015. [Accessed March 23, 2015]. Available from: .
    1. Centers for Disease Control and prevention Stroke Facts. [Document on the Internet] 2014. [Accessed November 23, 2014]. Available from: .
    1. Mallick A, O’Callaghan F. The epidemiology of childhood stroke. Eur J Paediatr Neurol. 2010;14(3):197–205.
    1. National Audit Office . Progress in Improving Stroke Care. London: The Stationery Office Limited; 2010.
    1. Lakshminarayan K, Schissel C, Anderson DC, et al. Five-year rehospitalization outcomes in a cohort of patients with acute ischemic stroke: Medicare linkage study. Stroke. 2011;42(6):1556–1562.
    1. Bravata D, Ho S, Meehan T, Brass L, Concato J. Readmission and death after hospitalization for acute ischemic stroke: 5-year follow-up in the Medicare population. Stroke. 2007;38(6):1899–1904.
    1. Mohan K, Wolfe C, Rudd A, Heuschmann P, Kolominsky-Rabas P, Grieve A. Risk and cumulative risk of stroke recurrence: a systemic review and meta analysis. Stroke. 2011;42(5):1489–1494.
    1. Stroke Unit Trialists’ Collaboration Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2013;(9) Art No: CD000197.
    1. Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. 2014;(7) Art No: CD000213.
    1. Murray J, Young J, Forster A. Review of longer-term problems after a disabling stroke. Rev Clin Gerontol. 2007;17(04):277–292.
    1. Hare R, Rogers H, Lester H, McManus R, Mant J. What do stroke patients and their carers want from community services? Fam Pract. 2006;23(1):131–136.
    1. Salter K, Hellings C, Foley N, Teasell R. The experience of living with stroke: a qualitative meta-synthesis. J Rehabil Med. 2008;40(8):595–602.
    1. McKevitt C, Fudge N, Redfern J, et al. Self-reported long-term needs after stroke. Stroke. 2011;42(5):1398–1403.
    1. Hackett M, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke. 2014;9:1017–1025.
    1. Guidetti S, Andersson K, Andersson M, Tham K, Von Koch L. Client-centred self-care intervention after stroke: a feasibility study. Scand J Occup Ther. 2010;17(4):276–285.
    1. Rigby H, Gubitz G, Phillips S. A systematic review of caregiver burden following stroke. Int J Stroke. 2009;4(4):285–292.
    1. Greenwood N, Mackenzie A, Cloud GC, Wilson N. Informal carers of stroke survivors–factors influencing carers: a systematic review of quantitative studies. Disabil Rehabil. 2008;30(18):1329–1349.
    1. Intercollegiate Stroke Working Party . National Clinical Guidelines for Stroke. 4th ed. London: Royal College of Physicians; 2012.
    1. Clarke DJ. The role of multidisciplinary team care in stroke rehabilitation. Prog Neurol Psychiatry. 2013;17(4):5–10.
    1. Harris R, Sims S, Hewitt G, et al. Interprofessional Teamwork Across Stroke Care Pathways: Outcomes and Patient and Career Experience. Final Report. London: NIHR service Delivery and Organisation Programme; 2013.
    1. Department of Health . National Stroke Strategy. London: HMSO; 2007.
    1. Reeves S, Lewin S, Espin S, Zwarenstein M. Interprofessional Teamwork for Health and Social Care. Chichester: Wiley Blackwell; 2010.
    1. Payne M. Teamwork in Multiprofessional Care. Basingstoke: McMillan; 2000.
    1. Miller C, Ross N, Freeman M. Interprofessional Practice in Health and Social Care. London: Arnold; 2001.
    1. Clarke DJ, Hawkins R, Sadler E, et al. Introducing structured caregiver training in stroke care: findings from the TRACS process evaluation study. BMJ Open. 2014;4:e004473.
    1. Hewitt G, Sims S, Greenwood N, Jones F, Ross F, Harris R. Interprofessional teamwork in stroke care: is it visible or important to patients and carers? J Interprof Care. 2014;28(6):501–506.
    1. Morris R, Payne O, Lambert A. Patient, carer and staff experience of a hospital based stroke service. Int J Qual Health Care. 2007;19:105–112.
    1. Suddick KM, de Souza LH. Therapists’ experiences and perceptions of teamwork in a neurological rehabilitation: critical happenings in effective and ineffective teamwork. J Interprof Care. 2007;21:669–686.
    1. Atwal A, Caldwell K. Do all health and social care professionals interact equally: a study of interactions in multidisciplinary teams in the United Kingdom. Scand J Caring Sci. 2005;19(3):268–273.
    1. Baxter SK, Brumfitt SM. Benefits and losses: a qualitative study exploring healthcare staff perceptions of team working. Qual Saf Health Care. 2008;17:127–130.
    1. McCallin AM, McCallin MCH. Factors affecting successful team working and strategies to facilitate successful collaborative teamwork. NZ J Physiother. 2009;37:62–68.
    1. Clarke DJ. Achieving teamwork in stroke units: the contribution of opportunistic dialogue. J Interprof Care. 2010;24(3):285–297.
    1. Stroke Sentinel National Audit Programme Summary Report October to December 2014. England: Royal College of Physicians; 2015.
    1. McCallin AM. Pluralistic dialoguing: a theory of interdisciplinary team working. Grounded Theory Rev. 2004;4(1):25–42.
    1. Mandy P. Interdisciplinary rather than multidisciplinary or generic practice. Brit J Ther Rehabil. 1996;3:110–112.
    1. Fisher RJ, Gaynor C, Kerr M, et al. A consensus on stroke early supported discharge. Stroke. 2011;42:1392–1397.
    1. Cobley CS, Fisher RJ, Chouliara N, Kerr M, Walker MF. A qualitative study exploring patients’ and carers’ experiences of Early Supported Discharge Services after stroke. Clin Rehabil. 2013;27(8):750–757.
    1. Dombrowski SU, White M, Mackintosh JE, et al. The stroke ‘Act FAST’ campaign: remembered but not understood? Int J Stroke. 2015;10(3):324–330.
    1. Jones S, Carter B, Ford GA, et al. The identification of acute stroke: an analysis of emergency calls. Int J Stroke. 2013;8(6):408–412.
    1. Wilson AD, Coleby D, Taub NA, Weston C, Robinson TG. Delay between symptom onset and clinic attendance following TIA and minor stroke: the BEATS study. Age Ageing. 2014;43(2):253–256.
    1. Jones S. Doctoral Thesis. University of Central Lancashire; 2013. Acute stroke and the public’s response to symptoms.
    1. Lecouturier J, Rodgers H, Murtagh MJ, White M, Ford GA, Thomson RG. Systematic review of mass media interventions designed to improve public recognition of stroke symptoms, emergency response and early treatment. BMC Public Health. 2010;10:784.
    1. Lin CB, Peterson ED, Smith EE, et al. Emergency medical service hospital pre-notification is associated with improved evaluation and treatment of acute ischemic stroke. Circ Cardiovasc Qual Outcomes. 2012;5:514–522.
    1. Watkins CL, Jones S, Leathley MJ, et al. Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – A Programme of Research to Facilitate Recognition of Stroke by Emergency Medical Dispatchers. Vol. 2. London: Programme Grants for Applied Research; 2014.
    1. Mikulik R, Bunt L, Hrdlicka D, Dusek L, Vaclavik D, Kryza J. Calling 911 in response to stroke: a nationwide study assessing definitive individual behaviour. Stroke. 2008;39(6):1844–1849.
    1. Alberts MJ, Latchaw RE, Jagoda A, et al. Brain Attack Coalition; for the Brain Attack Coalition Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition. Stroke. 2011;42:2651–2665.
    1. The IST-3 collaborative group The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the Third International Stroke Trial [IST-3]): a randomised controlled trial. Lancet. 2012;379(9834):2352–2363.
    1. Bradley EH, Nallamothu BK, Herrin J, et al. National efforts to improve door-to-balloon time results from the Door-to-Balloon Alliance. J Am Coll Cardiol. 2009;54(25):2423–2429.
    1. Fonarow GC, Smith EE, Saver JL, et al. Improving door-to-needle times in acute ischemic stroke. The design and rationale for the American Heart Association/American Stroke Association’s target: stroke initiative. Stroke. 2011;42:2983–2989.
    1. Meretoja A, Strbian B, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012;79(4):306–313.
    1. Meretoja A, Weir L, Ugalde M, et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology. 2013;81(12):1071–1076.
    1. Berkhemer OA, Fransen PS, Beumer D, et al. MR CLEAN Investigators A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20.
    1. Goyal M, Demchuk AM, Menon BK, et al. ESCAPE Trial Investigators Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–1103.
    1. Campbell BC, Mitchell PJ, Kleinig TJ, et al. EXTEND-IA Investigators Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–1018.
    1. Saver JL, Goyal M, Bonafe A, et al. SWIFT PRIME Investigators Stent-retriever thrombectomy after intravenous t-PA vs t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–2295.
    1. National Stroke Foundation . Clinical Guidelines for Stroke Management. Melbourne Australia: 2010. [Accessed March 6, 2015]. [Online]. Available from:
    1. Jauch EC, Saver JL, Adams HP, Jr, et al. on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.
    1. Heart and Stroke Foundation, Canada Canadian Stroke Best Practice Recommendations. 2015 Canada. [Accessed March 18, 2015]. [Online]. Available from:
    1. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377:1693–1702.
    1. Legg L, Drummond A, Leonardi-Bee J, et al. Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials. BMJ. 2007;335:922.
    1. Brady MC, Kelly H, Godwin J, Enderby P. Speech and language therapy for aphasia following stroke. Cochrane Database of Syst Rev. 2012:5. Art No: CD000425.
    1. Pollock A, Baer G, Campbell P, et al. Cochrane Database Syst Rev. 2014. Physical rehabilitation approaches for the recovery of function and mobility following stroke; p. 4. Art No: CD001920.
    1. Bernhardt J, Chitravas N, Meslo IL, Thrift AG, Indredavik B. Not all stroke units are the same: a comparison of physical activity patterns in Melbourne, Australia, and Trondheim, Norway. Stroke. 2008;39(7):2059–2065.
    1. Purvis T, Bernhardt J, Indredavik B, Cadilhac DA. Interdisciplinary team interactions in stroke units: can team dynamics influence patient outcomes from a clinician’s perspective. Int J Phys Med Rehabil. 2014;S3:007.
    1. De Wit L, Putman K, Dejaeger E, et al. Use of time by stroke patients. A comparison of four European rehabilitation centers. Stroke. 2005;36:1977–1983.
    1. De Wit L, Putman K, Lincoln N, et al. Stroke rehabilitation in Europe. What do physiotherapists and occupational therapists actually do? Stroke. 2006;37:1483–1489.
    1. Putman K, De Wit L, Schupp W, et al. Use of time by physiotherapists and occupational therapists in a stroke rehabilitation unit: a comparison between four European rehabilitation centres. Disabil Rehabil. 2006;28:1417–1424.
    1. De Wit L, Putman K, Schuback B, et al. Motor and functional recovery after stroke: a comparison of 4 European rehabilitation centers. Stroke. 2007;38:2101–2107.
    1. Kilbride C, Perry L, Flatley M, Turner E, Meyer J. Developing theory and practice: creation of a Community of Practice through Action Research produced excellence in stroke care. J Interprof Care. 2011;25(2):91–97.
    1. Langhorne P, for the Early Supported Discharge Trialists Services for reducing duration of hospital care for acute stroke patients (review) Cochrane Database Sys Rev. 2005;(2):CD000443.
    1. Gladman JR, Lincoln NB, Barer DH. A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital. J Neurol Neurosurg Psychiatry. 1993;56(9):960–966.
    1. Young JB, Forster A. The Bradford community stroke trial: results at six months. BMJ. 1992;304(6834):1085–1089.
    1. Jaracz K, Grabowska-Fudala B, Górna K, Jaracz J, Moczko J, Kozubski W. Burden in caregivers of long-term stroke survivors: prevalence and determinants at 6 months and 5 years after stroke. Patient Educ Couns. 2015;98(8):1011–1016.
    1. Corben S, Rosen R. Self-Management for Long-Term Conditions: Patients’ Perspectives on the Way Ahead. London: King’s Fund; 2005.
    1. de Silva D. Evidence: Helping People Help Themselves: A Review of the Evidence Considering Whether it is Worthwhile to Support Self-Management. London: The Health Foundation; 2011.
    1. Sadler E, Wolfe CDA, McKevitt C. Lay and health care professional understandings of self-management: a systematic review and narrative synthesis. Sage Open Med. 2014;2

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner