The 6-month review process post-stroke: policy and practice

Introduction: Reducing stroke related mortality and morbidity is a Government priority. In 2007, the National Stroke Strategy recommended reviewing stroke survivors at 6 week, 6 months and annually thereafter but there has been limited evaluation. This study focused on the 6-month review when statutory services have withdrawn and patients report feeling abandoned.

Methods: A multiple case study approach used interviews, observations and policy analysis. Overall, 46 patients, 30 carers and 27 professionals were interviewed. 29 reviews were observed. Data was analysed within and across sites to develop a theoretical understanding of the review that could be extended to a broader context.

Results: The review identified unmet needs and acted as a gateway to further services. 6-month reviews carried out by stroke nurse specialists were underpinned by a biomedical approach whereas those carried out by the Stroke Association focused on social issues. Patients valued both models but their views were influenced by their experiences of the care pathway, orientation to rehabilitation and the nature of their relationships with clinicians during rehabilitation. Self-management was incorporated into the review but was limited by its one-off nature and gaps in community services.

Conclusion: The 6-month review needs to be embedded into the care pathway and strategies for secondary prevention reviewed and consolidated at each stage. Reviewers should be allowed the freedom to individualise the process on a needs-led basis. The 6-month review ought to relate back to therapy goals and forward to community services to encourage participation in valued activities and community integration.