Advertisement
Special Communication| Volume 102, ISSUE 8, P1645-1657, August 2021

Download started.

Ok

Reimagining Stroke Rehabilitation and Recovery Across the Care Continuum: Results From a Design-Thinking Workshop to Identify Challenges and Propose Solutions

  • Julie A. DiCarlo
    Affiliations
    Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
    Search for articles by this author
  • Galina Gheihman
    Affiliations
    Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
    Search for articles by this author
  • David J. Lin
    Correspondence
    Corresponding author David J. Lin, MD, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA 02114.
    Affiliations
    Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA

    Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA

    Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA
    Search for articles by this author
  • on behalf of the2019 Northeast Cerebrovascular Consortium Conference Stroke Recovery Workshop Participants
Published:February 05, 2021DOI:https://doi.org/10.1016/j.apmr.2021.01.074

      Abstract

      Systems for stroke rehabilitation and recovery are variable and fragmented; stroke survivors often experience gaps in care with detrimental effects on their recovery. We designed and hosted a multidisciplinary and interactive workshop to discuss challenges facing patients recovering from stroke and to brainstorm solutions.
      Forty-one participants including clinicians, researchers, and stroke survivors attended the workshop. Participants were surveyed beforehand about challenges facing stroke recovery and results were tabulated as a word cloud. An interactive, design-thinking exercise was conducted that involved completing workbooks, hands-on prototype designing, and presentations, which were then analyzed through qualitative content analysis using an inductive approach.
      High frequency words in the word cloud of survey responses included access, fragmented, and uncertainty. Qualitative analysis revealed 6 major challenge themes including poor (1) transitions in and (2) access to care; (3) barriers to health insurance; (4) lack of patient support; (5) knowledge gaps; and (6) lack of standardized outcomes. Eleven unique solutions were proposed that centered around new technologies, health care system changes, and the creation of new support roles. Analysis of the alignment between the challenges and solutions revealed that the single proposed solution that solved the most identified challenges was a “comprehensive stroke clinic with follow-up programs, cutting edge treatments, patient advocation and research.”
      Through our interactive design-thinking workshop process and inductive thematic analysis, we identified major challenges facing patients recovering from stroke, collaboratively proposed solutions, and analyzed their alignment. This process offers an innovative approach to reaching consensus among interdisciplinary stakeholders.

      Keywords

      List of abbreviations:

      NECC (The Northeast Cerebrovascular Consortium)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Benjamin E.J.
        • Virani S.S.
        • Callaway C.W.
        • et al.
        Heart disease and stroke statistics-2018 update: a report from the American Heart Association.
        Circulation. 2018; 137: e67-e492
        • Kwakkel G.
        • Kollen B.J.
        • van der Grond J.
        • Prevo A.J.
        Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke.
        Stroke. 2003; 34: 2181-2186
        • Melkas S.
        • Jokinen H.
        • Hietanen M.
        • Erkinjuntti T.
        Poststroke cognitive impairment and dementia: prevalence, diagnosis, and treatment.
        Degener Neurol Neuromuscul Dis. 2014; 4: 21-27
        • Sun J.H.
        • Tan L.
        • Yu J.T.
        Post-stroke cognitive impairment: epidemiology, mechanisms and management.
        Ann Transl Med. 2014; 2: 80
        • Dar S.
        • Venigalla H.
        • Khan A.
        • et al.
        Post stroke depression frequently overlooked, undiagnosed, untreated.
        Neuropsychiatry. 2017; 7: 906-919
        • Lai S.-M.
        • Studenski S.
        • Duncan P.W.
        • Perera S.
        Persisting consequences of stroke measured by the stroke impact scale.
        Stroke. 2002; 33: 1840-1844
        • Higashida R.
        • Alberts M.J.
        • Alexander D.N.
        • et al.
        Interactions within stroke systems of care: a policy statement from the American Heart Association/American Stroke Association.
        Stroke. 2013; 44: 2961-2984
        • Wechsler L.R.
        • Demaerschalk B.M.
        • Schwamm L.H.
        • et al.
        Telemedicine quality and outcomes in stroke: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2017; 48: e3-e25
        • Broderick J.P.
        • Abir M.
        Transitions of care for stroke patients: opportunities to improve outcomes.
        Circ Cardiovasc Qual Outcomes. 2015; 8: S190-S192
        • Reeves M.J.
        • Fritz M.C.
        • Woodward A.T.
        • et al.
        Michigan stroke transitions trial.
        Circ Cardiovasc Qual Outcomes. 2019; 12e005493
        • Cameron J.I.
        • Tsoi C.
        • Marsella A.
        Optimizing stroke systems of care by enhancing transitions across care environments.
        Stroke. 2008; 39: 2637-2643
        • Duncan P.W.
        • Bushnell C.D.
        • Rosamond W.D.
        • et al.
        The Comprehensive Post-Acute Stroke Services (COMPASS) study: design and methods for a cluster-randomized pragmatic trial.
        BMC Neurol. 2017; 17: 133
        • Byruck C.
        • Jackson K.
        In Review: Notes from the 2016 dmi: Design Management Conference.
        Design Management Review. 2016; 27: 41-53
        • Faems D.
        Open innovation: researching a new paradigm – by H. Chesbrough, W. Vanhaverbeke and J. West.
        Creativity and Innovation Management. 2008; 17: 334-335
        • Chapman A.L.
        • Hadfield M.
        • Chapman C.J.
        Qualitative research in healthcare: an introduction to grounded theory using thematic analysis.
        J R Coll Physicians Edinb. 2015; 45: 201-205
        • Guest G.
        • MacQueen K.M.
        • Namey E.E.
        Applied thematic analysis.
        Sage Publications, Thousand Oaks2012: 3-20
        • Harrison M.
        • Ryan T.
        • Gardiner C.
        • Jones A.
        Psychological and emotional needs, assessment, and support post-stroke: a multi-perspective qualitative study.
        Top Stroke Rehabil. 2017; 24: 119-125
        • Krishnan S.
        • Hay C.C.
        • Pappadis M.R.
        • et al.
        Stroke survivors' perspectives on post–acute rehabilitation options, goals, satisfaction, and transition to home.
        J Neurol Phys Ther. 2019; 43: 160-167
        • Adeoye O.
        • Nyström K.V.
        • Yavagal D.R.
        • et al.
        Recommendations for the establishment of stroke systems of care: a 2019 update.
        Stroke. 2019; 50: e187-e210
        • Pandian J.D.
        • Kalkonde Y.
        • Sebastian I.A.
        • Felix C.
        • Urimubenshi G.
        • Bosch J.
        Stroke systems of care in low-income and middle-income countries: challenges and opportunities.
        Lancet. 2020; 396: 1443-1451