Understanding patients’ expectations key to improving preventive care after stroke

Key takeaways:

• Fear of falling is the main concern of stroke survivors who do not engage in recommended physical activity.
• Future clinical trials must address gaps in knowledge of proper post-stroke care.

ORLANDO, Fla. — For stroke survivors, participation in preventive health behaviors, such as adhering to blood pressure medication and physical activity, depended on their outcome expectations, self-efficacy and agency, data show.

“We know that blood pressure is the most modifiable risk factor after stroke and we also know that about half of stroke survivors have uncontrolled blood pressure,” Imama A. Naqvi, MD, MS, assistant professor of neurology at Columbia University Irving Medical Center, said during a presentation at the American Neurological Association annual meeting. “We know that physical inactivity impairs recovery and that most of our stroke survivors are physically inactive.”

Naqvi and colleagues assessed various influential factors which led to preventive post-stroke behaviors — including medication adherence and physical activity — in a cohort of Black and Hispanic individuals from an underserved community in New York City.

They conducted two rounds of qualitative interviews with 14 adults (mean age, 58.9; 50% women) who survived minor stroke and who were discharged from a comprehensive stroke center to their homes. Primary subjects of the interviews were based on patient knowledge of blood pressure management and behavior intended to stimulate physical activity.

The assessment also included collection of sociodemographic information, knowledge of post-treatment health recommendations, perceptions of barriers to successful community reintegration and knowledge of persons or actions which could facilitate recovery. In addition, patient-reported measures such as the International Physical Activity Questionnaire (IPAQ) and Short Form and Stages of Change – Continuous Measure (URICA-E2) were included for analysis along with data logged from wearable devices to track physical activity for 1 month.

According to results of the assessment, gaps existed between knowledge of and participation in healthy behaviors related to post-stroke recovery.

Naqvi and colleagues identified three themes that were likely to lead to increased participation and greater patient adherence to post-stroke recovery: positive outcome expectations; the ability to effectively take control of a journey to recovery; and the agency to make decisions that aid the process.

Data such as the mean daily step count (5,533±2,861) registering significantly lower than the recommended 10,000 per day, as well as lower than mean scores on the Patient Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) scale (patient reported, 44.9 ±9.8; population mean, 50 ±10) as a function of limited knowledge of existing recommendations, along with fear of falling, provided context for these discrepancies.

The researchers posited that addressing these themes in future clinical studies may alter existing behaviors that are likely to promote continued health.

“[The study] was helpful in creating an advisory group,” Naqvi said. “These are mildly disabled patients. These are not people who have severe disability, but they are self-restricting because they are afraid of falling.”