Improving Follow up Care for People After Minor Stroke

A Feasibility Study Investigating an Early, Personalised, Follow-up Programme for People After Minor Stroke

The goal of this feasibility study is to ascertain if this follow-up programme of care can feasibly be implemented within a healthcare system with people after minor stroke. The main feasibility questions are: i) To establish recruitment uptake ii) To establish treatment adherence iii) To determine participant retention. Participants will be randomly allocated to the intervention and control group. Those in the intervention group will receive a follow-up telephone call at two weeks after discharge and a second follow-up appointment at six weeks after discharge. Outcome measures will be taken at twelve weeks after discharge.

Appointment 1 (two weeks after discharge): Address participants knowledge gaps as regards their stroke, medication and secondary prevention. Detailed biopsychosocial review. Understand participant priorities and jointly set goals. Agreeing onward referrals if needed. Written summary sent to GP with copy to participant. Appointment 2 (six weeks): Review priorities identified in post stroke review checklist. Review goals and plans from first appointment. Address any new or persistent information gaps. Review hidden impairments that may be impacting on return to work, activities of daily living, relationships or general well-being. Agreeing onward referrals and action plan. Written summary and plan sent to GP.

Inclusion Criteria: Adult ≥18 Clinical or radiological diagnosis of minor stroke from a stroke consultant. Admitted to HASU or seen in rapid assessment/TIA clinic. Pre-admission mRS of 0-3 with no formal package of care prior to stroke. Discharge mRS of 0-3. No onward referral to community therapy team or for package of care. Has capacity to consent. Exclusion Criteria: Any serious co-morbidities that would impact a person's ability to participate in the follow-up appointments and outcome measurement. Insufficient English to engage in intervention and outcome measures and no family or friends to support with this. Not resident in England. Pregnant women.