SUPPORT TIA: Structured follow-Up Pathway to imProve management Of Residual impairmenTs and patients’ quality of life after TIA and minor stroke

1. To refine an intervention pathway to improve the management of residual impairments and patients’ quality of life following TIA and minor stroke.

2. To test the feasibility and acceptability of the intervention pathway.

What is the aim of the research?

To design a care pathway that will help manage long-term problems after mini-stroke. The research will also test if the care pathway works practically to help decide if a larger study can be done.

What is the problem and why is this important?

Mini-strokes are similar to full strokes, but symptoms last less than 24 hours. Many people (up to 70%) have long-term problems after a mini-stroke, such as anxiety; depression; problems with brain functioning (like memory loss); and fatigue (feeling tired). However, the current healthcare pathway only focuses on preventing another stroke and care for other long-term problems is not routinely given. Without proper treatment, people with long-term problems after a mini-stroke could have worse quality of life and may find it difficult to return to work and their social activities.

How will you address the problem?

We have designed a new care pathway where people who have a mini-stroke will get a new follow-up appointment. At this appointment, a questionnaire will be used to identify which people have long-term problems and these people will be referred to local support services. More research is needed to help decide where the new follow-up appointment should be; to develop a database of local support services; and to design the details of how the new care pathway will be delivered. We will also test if the new care pathway works practically.

There will be four stages:

Stage 1: Understand the context of potential settings to follow-up and screen patients after TIA/minor stroke, through interviewing patients and healthcare professionals.

Stage 2: Refine the content and delivery of the intervention pathway through: (A) developing a directory of local support services in the West Midlands; (B) selecting the screening tools, time point and setting for follow-up using information from stage 1; and (C) refining the delivery of the intervention pathway through consulting key stakeholders.

Stage 3: Test the feasibility and acceptability of the intervention pathway.

Stage 4: Disseminate findings and design a definitive trial of the intervention.

There will be four stages to the project:

Stage 1: Interviews with patients and healthcare providers

Aim: To understand the context of potential settings to follow-up and screen TIA/minor stroke patients.

We will interview people who have had a mini-stroke and people who deliver healthcare in hospitals, GP practices and the community. We will ask people about their experiences of the current care available and their opinions on the new care pathway.

Stage 2: Refine the intervention pathway

Aim: To refine the content and delivery of the intervention pathway.

Part a) We will send a survey to people who have had a mini-stroke, doctors, nurses and volunteers to find out what services are available in the West Midlands to support people with anxiety, depression, fatigue and brain functioning. This information will be put on a website so that doctors and nurses can easily search for local services.

Part b) We will use the information from the interviews in stage one to decide where the follow-up appointment for the new care pathway should be, e.g. should it be in a hospital or in the community.

Part c) We will consider practical issues to help design how the care pathway will be delivered. We will get advice from people who the care pathway is relevant to, including people who will deliver the pathway, people who have had a mini-stroke, stroke doctors, GPs and stroke charities.

Stage 3: Feasibility study

Aim: To assess the feasibility and acceptability of the intervention

We will test the new care pathway to see if it works practically. 60 people who have had a mini-stroke will be involved: 30 will get the new care pathway and 30 will get normal care.

Stage 4: Dissemination and future research

We will share the findings from stages 1-3 with the general public and people who may want to use the new care pathway in the future, including patients, doctors and nurses, academics and politicians. We will also design a bigger study to test if the care pathway improves people's quality of life and management of long-term problems after mini-stroke.

 

• Chief Investigator: Dr Grace Turner
• Prof Melanie Calvert (University of Birmingham)
• Prof Jonathan Mant (University of Cambridge)
• Prof Robbie Foy (University of Leeds)
• Dr Lou Atkins (University of Central London)

If you would like more information about the study please contact:

Dr Grace Turner

Email: G.Turner.1@bham.ac.uk
Telephone: +44 (0)121 414 5463

For more information about TIAs and mini strokes there are useful resources on Stroke Association’s website.