Screening Interventions Do Not Improve Societal Participation After Stroke

Screening for emotional and cognitive issues after ischemic stroke does not improve societal participation at 1 year, according to study results published in Neurology.

Current guidelines recommend screening for emotional and cognitive issues after stroke. Researchers used data from a multicenter, cluster-randomized controlled trial to test whether screening improves societal participation 1 year after an ischemic stroke.

Patients (N=531; women, 40%; mean [SD] age, 70.6 [9.7] years) aged 18 and older who had an ischemic stroke and were discharged home without rehabilitation were assigned to receive the intervention (n=257) or usual care (n=254). The intervention and control cohorts comprised 41.3% and 39.7% women, and they had a mean (SD) age of 70.6 (9.9) and 70.6 (9.4) years, respectively. Exclusion criteria included mild cognitive impairment and dementia, life expectancy less than 6 months, hemorrhagic stroke, and serious comorbidities.

The intervention consisted of an in-person consultation lasting 1 hour with a specialized stroke nurse 6 weeks after stroke. It included emotional and cognitive screening, screening for participation restrictions, self-management support, and rehabilitation referrals if needed. While stroke aftercare varied by hospital, all participants in the usual care group received a 30-minute consultation focused on cardiovascular risk factors and emotional and cognitive issues. Societal participation was measured with the Utrecht Scale for Evaluation of Rehabilitation at the Participation level questionnaire.

At 1 year post-stroke, societal participation did not differ significantly between intervention recipients and the control group (mean difference, 0.77; 95% CI, -2.47 to 4.06; P =.652). Mean difference in quality of life index score was 0.043 (95% CI, 0.021–0.064).

Secondary outcomes also showed minimal differences between cohorts at 3 months post-stroke, with mean differences of −0.86 (95% CI, −1.33 to−0.39) for symptoms of anxiety, 0.044 (95% CI, 0.022–0.065) for quality of life, and 0.97 (95% CI, 0.16–1.78) for self-efficacy.

Study limitations include unequal baseline characteristic distribution and short duration of self-management support.

“… [I]n patients recovering from an ischemic stroke, active screening for emotional and cognitive problems 6 weeks after stroke did not improve societal participation at 1 year,” the researchers concluded.