Structured follow-up pathway to address unmet needs after transient ischaemic attack and minor stroke (SUPPORT TIA): Feasibility study and process evaluation

Care following transient ischaemic attack (TIA) and minor stroke is variable and often leaves patients feeling abandoned and uncertain. We developed a theoretically-informed, multifaceted intervention which comprised nurse-led, structured follow-up at 4 weeks after TIA/minor stroke to identify and a...

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Bibliographic Details
Published in:PloS one Vol. 20; no. 3; p. e0317425
Main Authors: Turner, Grace M., Calvert, Melanie, Foy, Robbie, Atkins, Lou, Collis, Philip, Tearne, Sarah, Jowett, Sue, Handley, Kelly, Mant, Jonathan
Format: Journal Article
Language:English
Published: United States Public Library of Science 13.03.2025
Public Library of Science (PLoS)
Subjects:
Acceptability
Aftercare - methods
Aged
Care and treatment
Cerebral ischemia
Consent
Cost effectiveness
Data collection
Feasibility Studies
Female
Humans
Intervention
Ischemia
Ischemic Attack, Transient - therapy
Male
Medicine and Health Sciences
Methods
Middle Aged
Outcome and process assessment (Health Care)
Patient outcomes
Patient Reported Outcome Measures
Patients
People and Places
Qualitative analysis
Qualitative research
Questionnaires
Research and Analysis Methods
Stroke
Stroke (Disease)
Stroke - therapy
Support services
Transient ischemic attack
United Kingdom
United Kingdom > UK
England
United States > US
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Care following transient ischaemic attack (TIA) and minor stroke is variable and often leaves patients feeling abandoned and uncertain. We developed a theoretically-informed, multifaceted intervention which comprised nurse-led, structured follow-up at 4 weeks after TIA/minor stroke to identify and address patient needs. This study evaluated the feasibility and acceptability of both the intervention and procedures to inform a future randomised controlled trial. We conducted a multicentre, randomised feasibility study with mixed-methods process evaluation (ISRCTN registry reference: ISRCTN39864003). We collected patient reported outcome measures (PROMs) at 1, 12 and 24 weeks and clinical data at baseline and 24 weeks. The process evaluation comprised qualitative interviews with a sub-sample, feedback questionnaires, and observations of intervention delivery. We recruited 54 patients over 12 months, achieving 90% of the target sample size (n = 60). PROMs return rates were 94.4% (51/54), 85.2% (46/54) and 71.1% (27/38) at 1, 12, and 24-weeks, respectively. Intervention fidelity was high and the intervention largely aligned with the theoretical underpinnings. The process evaluation illustrated how patients benefitted from the intervention through support they would not have received through usual care. This included direct referral or signposting to support services, information and education, actionable advice, and reassurance about and normalisation of recovery. The trial design was feasible and acceptable for both patients and clinicians. Nurse-led, structured follow-up after TIA and minor stroke is feasible, acceptable and valued by patients and clinicians. Our intervention can identify and help address unmet needs. A definitive randomised trial to evaluate intervention effectiveness and cost-effectiveness is feasible and acceptable.
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Competing Interests: GT received grant funding to deliver this project from a National Institute for Health and Care Research (NIHR) Post-Doctoral Fellowship Scheme grant number PDF-2017-10-047. RF receives grant funding from the NIHR (with funds paid to his institution) and chairs the NICE Implementation Strategy Group (non-paid). SJ reports grants from NIHR and Wellcome outside the submitted work. MC receives grant funding from the NIHR Birmingham Biomedical Research Centre, NIHR Applied Research Collaboration West Midlands, NIHR BTRU Precision Transplant and Cellular Therapeutics, Health Data Research UK, Innovate UK, Macmillan Cancer Support, GSK, UCB Pharma, Research England, European Commission and EFPIA, Brain Tumor Charity, Gilead, Janssen, NIHR, UKRI, UK Research and Innovation, Merck; Royalties or licenses from Symptom Burden Questionnaire-Long COVID (as part of development team received revenue share from commercial license); Consulting fees from Aparito Ltd, Boehringer Ingelheim, CIS Oncology, Takeda, Merck, Daiichi Sankyo, Glaukos, GSK, PCORI, Genentech, Vertex, ICON, Halfloop, Pfizer; Payment or honoraria for lecture fees from University of Maastricht, reviewer fees from South-Eastern Norway Regional Health Authority and Singapore National Medical Research Council, speaker fee from Cochrane Portugal. PC, JM, KH and LA declare no conflict of interest.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0317425