Patient perspectives of barriers and facilitators of treatment-seeking behaviors for stroke care.

OBJECTIVE: Delays in seeking treatment for stroke care are associated with greater disability and reductions in stroke outcomes. The objective of this study was to qualitatively examine facilitators and barriers to urgently seeking stroke-related care. METHODS: A qualitative analytic approach was used to explore facilitators and barriers to seeking stroke care in an urgent manner. Sixty-four stroke survivors offered information related to facilitators and barriers to stroke care via a structured survey as part of a larger mixed-methods study designed to measure stroke outcomes. RESULTS: Three themes emerged related to facilitators and barriers: (a) recognition of symptoms, (b) social support, and (c) knowledge and ability to call emergency medical services as a first response. Facilitators to urgent care-seeking behaviors included classic stroke symptoms, severe symptoms, sudden symptom onset, and high perceived level of emergency. Social support and knowledge/ability to call emergency medical services also emerged as facilitators of urgent care. Barriers to urgent care-seeking behaviors included atypical symptoms, mild symptoms, gradual symptom onset, and low perceived level of emergency. CONCLUSIONS: Individuals who experience strokes face a number of facilitators and barriers to seeking urgent care for their condition. Facilitators and barriers are associated with stroke symptoms and their personal environments. Additional study of barriers to stroke care is needed to adequately design interventions to reduce delays in seeking treatment.

Racial/Ethnic differences in poststroke rehabilitation outcomes.

Background. Significant racial and ethnic disparities in stroke incidence, severity, and morbidity have been consistently reported; however, less is known about potential differences in poststroke rehabilitation outcomes. Objective. To examine racial and ethnic differences in poststroke rehabilitation outcomes. Methods. We completed an in-depth search of Medline and several major journals dedicated to publishing research articles on stroke, rehabilitation, and racial-ethnic patterns of disease over a 10-year period (2003-2012). We identified studies that reported rehabilitation outcomes and the race or ethnicity of at least two groups. Results. 17 studies involving 429,108 stroke survivors met inclusion criteria for the review. The majority (94%) of studies examined outcomes between Blacks and Whites. Of those studies examining outcomes between Blacks and Whites, 59% showed that Blacks were generally less likely to achieve equivalent functional improvement following rehabilitation. Blacks were more likely to experience lower FIM gain or change scores (range: 1-60%) and more likely to have lower efficiency scores (range: 5-16%) than Whites. Conclusions. Black stroke survivors appear to generally achieve poorer functional outcomes than White stroke survivors. Future studies are warranted to evaluate the precise magnitude of these differences, whether they go beyond chance, and the underlying contributory mechanisms.