Title: The Six-Month Review for Stroke Survivors: Is it Fit for Purpose?
Funder: Health Education England

Abstract: BackgroundStroke is a common and often debilitating condition. Studies have shown that stroke survivors have ongoing needs that are not met by healthcare services. National guidelines recommend all patients are offered a review of their healthcare needs at six months, however there remains large variability across the UK with regards to how this has been implemented. There is also a lack of evidence regarding the optimal method of providing the review and its effectiveness has not been adequately evaluated. Understanding why this variation exists will help to establish what are the key components of the review and what are the features that can be adapted in response to local context. This will help inform policy for future implementation. Research questionIs the Six-Month Review for Stroke Survivors (6MR) fit for purpose in its current form? AimTo understand if, why and how the 6MR meets the needs of stroke survivors and how contextual factors influence this. MethodsWork package 1A UK-based, online survey will be undertaken to collect data on the structure, content and outcomes of the 6MR. The Consolidated Framework for Implementation Research (CFIR) will be used to guide the development of the survey. Results will be used to frame the qualitative analysis and to aid purposive sampling in work package 2. Work package 2A multiple case study design will be used to collect qualitative data. Semi-structured interviews of patients and service providers will form the main basis for data collection. The CFIR will be used to develop the interview schedule. To validate findings, further data will be collected from direct observations and documentary analysis.Work package 3The findings from the two work packages will be triangulated to evaluate their convergence. A range of assumptions about how the 6MR works will be formulated and checked by study participants at an online workshop. Once consensus is reach, the findings will guide the development of a logic model aimed at enabling context-specific implementation strategies. Timelines for deliveryThe study will run from September 2022 to August 2025 with anticipated publishable reports produced in August 2023, February 2025, and July 2025. The information produced will be immediately available to service providers, via regional Integrated Stroke Delivery Networks (ISDNs), to facilitate improvements to be made to service provisions. Anticipated impact and disseminationThe developed logic model will facilitate the implementation of future services and the improvement of current services. It will articulate the essential components of the 6MR and identify the adaptable features that will promote local tailoring. It will also highlight any differences between what patients actually want from the 6MR and what clinicians feel they want, thereby directing clinicians to better adapt services to meet the needs of patients. A comprehensive dissemination plan will be developed. Various routes will be utilised to share the findings, including academically (e.g. peer-reviewed publications), clinically (e.g. ISDN meetings), and publicly (e.g. plain English video abstract to share on social media such as Twitter).

Lay abstract: What is the problem?In the UK, stroke affects 100,000 people a year and by 2035 it is expected that there will be 2.1 million stroke survivors in our society. A large number of stroke survivors have long-term problems that aren't helped by current services (for example: difficulty walking, depression, eyesight problems, and difficulty gaining employment). Living with these effects is known to significantly impact their quality of life and can lead to other problems in later life. Unfortunately, some of these effects can't be fixed, but some could be removed or improved with the right help.The Six-Month Review for Stroke Survivors was put in place to address this by identifying these problems and then directing patients to the appropriate support. However, recommendations for this service were not based on evidence about how it should be done. This has led to large variations in how the review is conducted across the country and in some areas it doesn't happen at all.The aim of this research is to understand if the Six-Month Review is doing what it was intended to do, and if not, then what should be done differently to improve the quality of life for stroke survivors. I will also look at why this service is carried out differently in different settings.What will I do?I will send questionnaires out to healthcare professionals who provide the Six-Month Review to find out how and why they do it. I will also ask about what factors were important when they set up the service.I will then look at 3-4 services in greater depth. I will spend time at each service, observing how the service is run and interviewing the staff who work there. I will also interview patients and their carers to understand what they feel the purpose of the Six-Month Review is, and whether they found it helpful or not. This information will be used to look at the differences and similarities between the services.Finally, I will put all of the findings together to build a picture of how the Six-Month Review should work in different settings. I will invite patients and healthcare professionals involved in the study to review the findings. Together, through a series of workshops, we will develop the final recommendations to help guide future services.To ensure that our research is grounded in the needs of patients, I will get feedback and advice from stroke survivors at each stage. Stroke survivors have helped to develop the research plan and two patients will be part of the steering group throughout the research. I will also seek advice from stroke patients when producing documents to make sure they are appropriate for them. For example, ensuring that any information given to patients with communication difficulties is presented in an accessible format. How will this help?This study will assess whether or not the Six-Month Review is fit for purpose. If it is, then I will identify which elements of the review are important for future services to replicate. If it is not fit for purpose then I shall suggest alternatives that better address patients' needs.It is anticipated that this research will be completed by 2025. Findings will be shared with healthcare professionals through presentations and academic publications. I will also share findings more widely through relevant organisations (for example, Stroke Association, Different Strokes) and by producing a short video explaining the research to share on social media platforms. By working with national leaders, the findings will be used to update current recommendations and help to improve services.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: STROKE