An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging in patients with transient ischaemic attack and minor stroke : a systematic review, meta-analysis and economic evaluation

Erratum issued September 2015 Erratum DOI: 10.3310/hta18270-c201509Peer reviewedPublisher PD

People’s experiences of the impact of transient ischaemic attack and its consequences: qualitative study

Aim.  This paper is a report of a study of how people’s experiences of transient ischaemic attack affect their perception of their health and their uptake of health maintenance measures. Background.  Transient ischaemic attack is a well-recognized warning sign of subsequent stroke, but early diagnosis and management of risk factors can substantially reduce this risk. Even though the physical effects of a transient ischaemic attack are transient, it is known to negatively affect quality of life. However, no qualitative studies have explored the impact of transient ischaemic attack on people’s everyday lives. Methods.  Sixteen participants were recruited from a vascular surgery clinic in a district general hospital in North West England. All had a recent transient ischaemic attack. A qualitative grounded theory study using detailed interviews (n = 21) was conducted. Findings.  Participants experienced conflict between acknowledgement of the transient ischaemic attack as a significant illness episode with implications for their long-term health, and denial of its seriousness. Although they often ignored the initial signs, participants also experienced fear due to increased awareness of their risk of stroke. Often, they believed that they were having a permanent stroke. Many participants were prompted to seek medical advice by a family member or acquaintance. Having a transient ischaemic attack negatively changed their perception of their health and their quality of life, but some also viewed it as a positive event that had warned of their stroke risk and enabled them to take up health maintenance measures. Conclusions.  Having a transient ischaemic attack permanently changes people’s quality of life and their perception of their health, despite the transience of the symptoms. The ability of people to make positive health changes after a transient ischaemic attack to some extent ameliorates the negative effects of being aware of their heightened stroke risk. Their appreciation of their quality of life may also be enhanced. The transience of the symptoms and lack of knowledge of transient ischaemic attacks lead to delays in seeking medical advice

Stroke and Palliative Care

Meeting the palliative care needs of stroke patients requires stroke specialists to develop enhanced knowledge and skills in palliation in order to address the specific challenges that stroke presents. This requires investment from within the stroke field and a commitment to a more holistic approach to care which extends beyond rehabilitation goals. This chapter identifies a range of challenges in delivering palliative care for stroke patients. It considers generic palliative care pathways and tools, and their suitability in the context of stroke. The chapter presents case studies which illustrate how some of these care pathways and tools could be used with stroke patients. It discusses three palliative care approaches: the Liverpool Care Pathway; the Gold Standards Framework; and the Assessment, Management, Best practice, Engagement, and Recovery care bundle. The chapter concludes with recommendations to guide the development of improved palliative care in stroke

The 'Choice and Autonomy Framework' : implications for occupational therapy practice

Introduction This paper presents findings from a PhD study exploring autonomy of adults with physical disability. The plethora of descriptions of autonomy in psychological, occupational therapy and rehabilitation literature (e.g. Ryan and Deci 2000, Rogers 1982, Cardol et al 2002) detracts from the centrality of autonomy and results in difficulty incorporating it into occupational therapy practice. This paper presents a framework providing an integrated, clinically useful approach to autonomy. Methods Sixteen people were recruited, based on age, gender, impairment and living circumstances (community/residential settings). All have significant physical disability, use a wheelchair and require personal assistance for some/all self-care activities. Qualitative methods were used for data collection, including life-history narrative, diary information and extensive interview. An integrated method of analysis was used, including content analysis and bracketing. Results The ‘Choice and Autonomy Framework’ consists of five strands, including: • the meaning of autonomy • whether or not autonomy is a goal or value • the experience of autonomy • personality factors that impact autonomy • environmental features that enhance or negate autonomy. This paper will describe each strand, as derived from the research. The results suggest that, contrary to common wisdom (Hmel and Pincus 2002), autonomy is not necessarily a universal goal for people with physical disability; an understanding of the person’s own perspective will enhance person-centred practice and enable therapists to further recognise individuality of clients. It will argue that the concept of autonomy needs to be further understood and incorporated into occupational therapy practice