| Summary: | <p>Post-stroke cognitive impairment is highly prevalent and recent systematic reviews have identified managing cognitive changes as one of the most commonly reported unmet needs in the long term after stroke. In the UK, national clinical guidelines provide a clear outline of ‘best practice’ cognitive care, but audit data have shown that cognitive care falls below recommended standards in many respects. A pragmatic and scalable intervention that provides enhanced post-stroke cognitive care may help to address these clinical gaps and stroke survivor needs.</p>
<br>
<p>The overarching aim of the research presented in this thesis was to develop a UK-based intervention providing Level 1 post-stroke cognitive care. The research was guided by the Medical Research Council framework for complex intervention development and thus prioritised evidence, theory, and stakeholder perspectives. Four highly iterative and mutually informative research projects were conducted to develop the intervention. First, an online modified Delphi survey was conducted to establish expert consensus on the intervention features. Then, stroke survivors and family members participated in semi-structured interviews to share their perspectives on two of the core intervention features (cognitive screening and cognitive trajectory discussions). A scoping review was conducted to map and identify gaps within the current literature describing stroke survivor and family member psychoeducation needs about cognition. Finally, stroke survivors, family members, and healthcare professionals participated in a series of co-production activities to develop a novel cognition-focused psychoeducation resource to be used in the intervention. After synthesising key findings from these four projects to design the intervention and corresponding programme theory, the final empirical chapter presents preliminary results from initial feasibility testing of the intervention and the protocol for a future planned study to assess the feasibility of running a full-scale cluster randomised controlled trial to evaluate clinical effectiveness.</p>
<br>
<p>Overall, the research provides an important contribution to the field of post-stroke rehabilitation by offering a clearly delineated and pragmatic psychological care intervention. Should the intervention prove clinically and financially effective in a future planned cluster randomised controlled trial, it might meaningfully improve post-stroke psychological care within the UK. In the meantime, while this ambitious research programme is ongoing, key findings presented in this thesis may usefully inform local clinical service improvements.</p>
|
|---|