Perspectives of healthcare professionals involved in providing stroke care on impact of post-stroke cognitive impairment

Abstract

Background: Cognitive impairment (CI) is a pervasive outcome of ischaemic stroke, reported in over half of patients six months post-stroke. However, cognitive rehabilitation receives considerably less attention than physical rehabilitation. This qualitative study explores the perspectives of healthcare professionals on the impact of post-stroke CI and necessary components of a cognitive rehabilitation programme. Methods: Healthcare professionals involved in providing stroke care were identified from a method of snowballing in a hospital and community setting. Following informed consent, qualitative in-depth interviews were conducted face-to-face, audio-recorded (with participant permission) and transcribed. Thematic analysis was employed to analyse the data. Findings: Twelve healthcare professionals were interviewed and had between 1 and 10 years clinical experience. Four major themes were identified from the analysis: i) absence of a coherent cognitive rehabilitation infrastructure for stroke patients following hospital discharge, ii) rehabilitation of post-stroke CI not seen as a priority, iii) impact of patient’s insight into their deficits on rehabilitation gains and, iv) need for cognitive rehabilitation delivered in a way that is meaningful for the patient. Discussion:These findings provide an insight into the fractured cognitive rehabilitation programmes available to stroke patients post-discharge and the prioritisation of more ‘visible’ deficits in the face of such limited resources. These qualitative data, in combination with a systematic review of cognitive interventions for post-stroke cognitive impairment and qualitative interviews with patients and family members, are being used to inform the development of a cognitive intervention that will be tested in a pilot feasibility randomised controlled trial.