Six-month reviews for stroke survivors: a study of the modified Greater Manchester Stroke Assessment Tool with care home residents.
Emma Patchwood, Kate Woodward-Nutt, Katy Rothwell and 3 others
PMID 32202130WHAT IT FOUND
Six-month stroke reviews using the modified GM-SAT in care homes took an average of 51 minutes, were viewed as acceptable, and found many unmet needs.
Action plans often did not make clear who would follow them up.
Key findings
01The modified GM-SAT was used for 74 reviews across 51 care homes, took an average of 51 minutes, and was viewed as highly acceptable.
02Forty-five of the 74 stroke survivors had multiple unmet needs, with an average of 2.5 needs per person and 111 needs in total.
03For many identified needs, the summary reports did not make clear who should act: referrals were noted for 29 of 111 needs, but it was often unclear who should make them, and 82 of 111 needs were hard to separate into action and agent.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was observational and mixed-methods, with no comparison group, so it cannot show that the modified GM-SAT improves health, function or quality of life. Only the one-page summary reports were available, not the full review forms, so the context of each need and action was limited. Researchers needed considerable consultation to decide what counted as an unmet need and to interpret actions, so consistency may have been affected. The study captured unmet needs only, not met needs, so it does not show whether all possible review domains were addressed or how well existing care worked. Stroke survivor recall was poor: seven of eight stroke survivors interviewed could not remember review specifics, and planned three-month follow-up interviews were stopped, limiting survivor viewpoints. The qualitative sample was small: 12 assessors and 13 review participants, including only 8 stroke survivors, 3 family members and 2 care home staff. Services were already using the original GM-SAT and were based in North West England, so their experience may not match services that do not conduct these reviews. One eligible NHS service did not conduct any care home reviews during the study period, and administrative support for reviews varied between services.
Declared interests
The authors declared no potential conflicts of interest. The study was jointly funded by the Stroke Association and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester. The University of Manchester was the sponsor and had no role in design, execution, analysis, interpretation or write-up. One author's salary was partly funded by the Stroke Association and other NIHR grants, and another author's salary was fully funded by the Stroke Association.