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Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes

BACKGROUND: Until recently, public education campaigns aimed at improving help-seeking behavior by acute stroke patients have achieved only limited or even no effects. Better understanding of psychological factors determining help-seeking behavior may be relevant in the design of more effective futu...

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Autores principales: Tarantini, Luca, Merzou, Fatma, Luley, Maxine, Rollmann, Aline, Schwindling, Michael Peter, Lesmeister, Martin, Gläss, Marietheres, Wollenburg, Jennifer, Schwindling, Lenka, Fassbender, Klaus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10556741/
https://www.ncbi.nlm.nih.gov/pubmed/37808509
http://dx.doi.org/10.3389/fneur.2023.1241391
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author Tarantini, Luca
Merzou, Fatma
Luley, Maxine
Rollmann, Aline
Schwindling, Michael Peter
Lesmeister, Martin
Gläss, Marietheres
Wollenburg, Jennifer
Schwindling, Lenka
Fassbender, Klaus
author_facet Tarantini, Luca
Merzou, Fatma
Luley, Maxine
Rollmann, Aline
Schwindling, Michael Peter
Lesmeister, Martin
Gläss, Marietheres
Wollenburg, Jennifer
Schwindling, Lenka
Fassbender, Klaus
author_sort Tarantini, Luca
collection PubMed
description BACKGROUND: Until recently, public education campaigns aimed at improving help-seeking behavior by acute stroke patients have achieved only limited or even no effects. Better understanding of psychological factors determining help-seeking behavior may be relevant in the design of more effective future campaigns. METHODS: In this prospective, cross-sectional study, we interviewed 669 acute stroke patients within 72 h after hospital admission. The primary endpoint was the effect of psychological factors on the decision to call emergency medical services (EMS). Secondary endpoints were the effects of such factors on treatment rates and clinical improvement (difference between modified Rankin scale (MRS) scores at admission and at discharge). RESULTS: Only 48.7% of the study population called the EMS. Multivariate logistic and linear regression analyses revealed that perception of unimpaired performance of activities of daily living (ADL) was the only psychological factor that predicted EMS use and outcomes. Thus, patients who perceived only minor impairment in performing ADL were less likely to use EMS (odds ratio, 0.54 [95% confidence interval, 0.38–0.76]; p = 0.001), had lower treatment rates, and had less improvement in MRS scores (b = 0.40, p = 0.004). Additional serial mediation analyses involving ischemic stroke patients showed that perception of low impairment in ADL decreased the likelihood of EMS notification, thereby increasing prehospital delays, leading to reduced thrombolysis rates and, finally, to reduced clinical improvement. CONCLUSION: Perception of unimpaired performance of ADL is a crucial barrier to appropriate help-seeking behavior after acute stroke, leading to undertreatment and less improvement in clinical symptoms. Thus, beyond improving the public’s knowledge of stroke symptoms, future public education campaigns should focus on the need for calling the EMS in case of stroke symptoms even if daily activities do not seem to be severely impaired.
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spelling pubmed-105567412023-10-07 Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes Tarantini, Luca Merzou, Fatma Luley, Maxine Rollmann, Aline Schwindling, Michael Peter Lesmeister, Martin Gläss, Marietheres Wollenburg, Jennifer Schwindling, Lenka Fassbender, Klaus Front Neurol Neurology BACKGROUND: Until recently, public education campaigns aimed at improving help-seeking behavior by acute stroke patients have achieved only limited or even no effects. Better understanding of psychological factors determining help-seeking behavior may be relevant in the design of more effective future campaigns. METHODS: In this prospective, cross-sectional study, we interviewed 669 acute stroke patients within 72 h after hospital admission. The primary endpoint was the effect of psychological factors on the decision to call emergency medical services (EMS). Secondary endpoints were the effects of such factors on treatment rates and clinical improvement (difference between modified Rankin scale (MRS) scores at admission and at discharge). RESULTS: Only 48.7% of the study population called the EMS. Multivariate logistic and linear regression analyses revealed that perception of unimpaired performance of activities of daily living (ADL) was the only psychological factor that predicted EMS use and outcomes. Thus, patients who perceived only minor impairment in performing ADL were less likely to use EMS (odds ratio, 0.54 [95% confidence interval, 0.38–0.76]; p = 0.001), had lower treatment rates, and had less improvement in MRS scores (b = 0.40, p = 0.004). Additional serial mediation analyses involving ischemic stroke patients showed that perception of low impairment in ADL decreased the likelihood of EMS notification, thereby increasing prehospital delays, leading to reduced thrombolysis rates and, finally, to reduced clinical improvement. CONCLUSION: Perception of unimpaired performance of ADL is a crucial barrier to appropriate help-seeking behavior after acute stroke, leading to undertreatment and less improvement in clinical symptoms. Thus, beyond improving the public’s knowledge of stroke symptoms, future public education campaigns should focus on the need for calling the EMS in case of stroke symptoms even if daily activities do not seem to be severely impaired. Frontiers Media S.A. 2023-09-22 /pmc/articles/PMC10556741/ /pubmed/37808509 http://dx.doi.org/10.3389/fneur.2023.1241391 Text en Copyright © 2023 Tarantini, Merzou, Luley, Rollmann, Schwindling, Lesmeister, Gläss, Wollenburg, Schwindling and Fassbender. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Tarantini, Luca
Merzou, Fatma
Luley, Maxine
Rollmann, Aline
Schwindling, Michael Peter
Lesmeister, Martin
Gläss, Marietheres
Wollenburg, Jennifer
Schwindling, Lenka
Fassbender, Klaus
Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes
title Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes
title_full Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes
title_fullStr Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes
title_full_unstemmed Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes
title_short Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes
title_sort perceived performance of activities of daily living by stroke patients: key in decision to call ems and outcomes
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10556741/
https://www.ncbi.nlm.nih.gov/pubmed/37808509
http://dx.doi.org/10.3389/fneur.2023.1241391
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