How important is communication for stroke recovery? What we learned from hospital records.

1. Are people with communication support needs after a stroke different to other people who had a stroke?
2. Does getting better at communication in stroke rehabilitation improve quality of life and the number of trips back to the hospital?
3. Do people who have communication support needs after a stroke have a higher chance of death within a year after their stroke?

This study used records from stroke patients in Australia.

Information was linked from

1) acute hospitals (where people first go when they have a stroke) and

2) rehabilitation hospitals (where people go to do treatments).

Sixty-four percent (64%) of people with stroke had communication support needs when they entered a rehabilitation hospital.

People with improved communication in rehabilitation were more likely to have improved:

• physical health (like walking),
• ability to take care of themselves (like washing or getting dressed)
• ability to do everyday activities (like work or hobbies).
• at three (3) months after stroke.

People with communication support needs after their stroke had higher death rates in the first (1st) year after stroke. 

We don't know enough about people with communication support needs after stroke, such as:

• Personal factors (like age and other health conditions).
• Communication improvements in rehabilitation hospitals.
• Health outcomes after leaving hospital.

Most (64%) stoke patients need communication support in rehabilitation hospitals.

Rehabilitation hospitals should make it a top priority to:

• Help patients communicate more easily.
• Train staff to support people with communication needs.
• Create a hospital environment that supports good communication. 

We used information collected about stroke patients in hospital. This included:

• Who people are (like age and sex)
• How much support people needed when they started rehabilitation, measured by a standard test (Functional Independence Measure).
• How people rated their quality of life three (3) months after their stroke, as measured by a standard survey (EuroQol EQ-5D).
• Whether patients had to go back to hospital.
• Information about deaths from national records.

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Communication is important for everyday activities and relationships.

After a stroke, between 21% and 88% of people need support to communicate. These support needs can be because of:

• a previous stroke
• dementia
• problems with hearing or seeing, and/or
• different cultural or language backgrounds.

Information about stroke patients is collected in many hospitals across Australia.

But researchers haven't studied this real-life information yet to learn about people with communication support needs after a stroke.

This study used information already collected in hospitals.

There were no risks to patients.

• Went to an acute (emergency) and rehabilitation (treatment) hospital after their stroke.
• Went to hospitals that collect data for the Australian Stroke Clinical Registry and the Australasian Rehabilition Outcomes Centre.

Information from 8,394 stroke patients were included in the study.

Patients with communication support needs were:

• older (average 75.6 years old)
• more likely to be male (58%)
• more likely to have had a stroke before (23%)
• have aphasia (22%)

than patients without communication support needs after a stroke.

Studying data from hospitals helps researchers understand:

• The stroke care pathway of patients.
• Information on a large scale.
• The real-life outcomes of patients.

This research reports on stroke patients who were in hospital from 2014 to 2017. 

Hospital settings in Australia.

• Australian Government Research Training Program scholarship awarded to Sally Zingelman.
• National Health and Medical Research Council fellowship support to Professor Cadilhac (1154273), Associate Professor Wallace (1175821) and Associate Professor Kilkenny (1109426).
• National Heart Foundation of Australia fellowship support to Associate Professor Kilkenny (105737).
• Heart Foundation Future Leader Fellowship support to Professor Lannin (106762).

The standard test that gave information about communication support needs has limitations (Functional Independence Measure).

More information about patients' communication support needs from medical files was not available.

Information about speech and language treatments in rehabilitation was not available.

This means that researchers did not have enough information:

• to describe the type of communication needs.
• to report relationships between treatments and patients' outcomes. 

Yes.

• The information in this study was collected with standard data collection processes to make sure it was correct.
• The research was reported following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. 

• It is recommended that\stroke rehabilitation hospitals make communication support a priority.
• Researchers need to study the Functional Independence Measure more, to understand if it is the best tool for collecting information about people with communication support needs after a stroke.

The Australian Stroke Clinical Registry AuSCR 

The Australasian Rehabilitation Outcomes Centre Australasian Rehabilitation Outcomes Centre - University of Wollongong – UOW