The Post-Stroke Checklist: longitudinal use in routine clinical practice during first year after stroke

The Post-Stroke Checklist: longitudinal use in routine clinical practice during first year after stroke | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Post-Stroke Checklist: longitudinal use in routine clinical practice during first year after stroke Kristina Månsson, MD, Martin Söderholm, MD, PhD, Ida Berhin, Hélène Pessah-Rasmussen, MD, PhD, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3876821/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Oct, 2024 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 3 You are reading this latest preprint version Abstract Background Few studies describe the use of the Post-Stroke Checklist (PSC) as a tool for longitudinal stroke follow-up in clinical practice. We mapped the prevalence of stroke-related health problems and targeted interventions at 3 and 12 months post-stroke by using the PSC. Methods Patients with acute stroke discharged home in 2018–2019 at Skåne University Hospital, Sweden, were invited to participate in a comprehensive nurse-led follow-up based on a 14-item PSC 3 and 12 months post-stroke. We measured time consumption, screened for stroke-related health problems, compared the findings, and recorded targeted healthcare interventions. Problems at 12 months were grouped into new, persistent, or none compared to the 3-month evaluation. Results Of 200 consecutively included patients, 146 (77%) completed both the 3- and 12-month follow-ups. At 12-month follow-up, 36% of patients reported no stroke-related health problems, 24% reported persistent problems, and 40% reported new problems since the 3-month evaluation. New problems at 12 months were most common within the domains: secondary prevention (23%) and life after stroke (10%). Stroke recurrence rate was 7.5%, 43% had high blood pressure, and few smokers had quit smoking. At 12 months, 53% received at least one new healthcare intervention, compared to 84% at 3 months. Conclusions Stroke-related health problems decreased beyond 3 months but were still present in two-thirds of patients at 1 year. This emphasizes the relevance of continuous structured follow-up using the PCS. However, the follow-up alone was insufficient to adequately achieve treatment targets for secondary prevention, which require intensified focus. Trial registration ClinicalTrials.gov ID NCT04295226, (04/03/2020) stroke stroke prevention stroke rehabilitation outcome quality of care follow-up modifiable stroke risk factors complications Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background As a result of a growing aging population and improved stroke survival, the absolute number of stroke survivors is predicted to increase. 1–3 Developing resource-effective and sustainable models for the management and care of stroke survivors in a long-term setting is highly relevant. The Stroke Action Plan for Europe, a European collaborative project with an overall aim to reduce the burden of stroke by improving stroke care, has introduced Life after stroke as a new domain important to address in stroke survivors. The Stroke Action Plan provides a recommendation that stroke survivors should be offered follow-up at 3–6 months post-stroke based on the Post-Stroke Checklist (PSC). 4–5 This is in line with recommendations in the Swedish national guidelines for stroke care. 6 Still, structured stroke follow-up is not yet fully established on a national or even regional basis, indicating a major gap between guideline recommendations and long-term management of stroke survivors. According to SSNAPP (The Sentinel Stroke National Audit Programme), which measures quality of stroke care in the U.K, only 35% of patients applicable for follow-up completed a 6-month follow-up. 7 In Sweden, there are no reliable data on the proportion of stroke survivors that receive follow-up visits, confirming the gap. Unfortunately, the transition between in- and outpatient care is an area in which problems often occur. Individuals who are discharged home risk inconsistencies in follow-up care and therefore are an important group to study, especially having in mind that this stroke population represents 75% of all stroke patients in Sweden. 8 A systematic review from 2021 summarizes the current knowledge on the organization of post-stroke care by targeting the several crucial aspects (neurological deficit, any post-stroke complications, inadequately treated risk factors, and unmet psychosocial needs) affecting the long-term impairments and quality of life of stroke survivors. 9 The STROKE-CARD care trial showed that a comprehensive post-stroke care program handling the multifaceted stroke-related problems can successfully lower the incidence of recurrent stroke and other cardiovascular events while also improving quality of life and functional outcome of patients with stroke. 10 Other studies are limited by relatively short follow-up periods; however, it is important to evaluate patient needs and benefits over longer periods. 11–15 Encouragingly, there is an enhanced focus on follow-up care of stroke survivors, as evidenced by a recent review on interventions provided to people with minor stroke. However, the review concluded that follow-up care mainly emphasizes secondary prevention rather than the wide range of other post-stroke consequences. 16 The aim of this longitudinal study was to evaluate a comprehensive and structured follow-up model over the first year after stroke using the Post-stroke Checklist (PSC). In a first phase of this study, we evaluated a structured follow-up at 3 months for patients with stroke, using a 14-item PSC to identify and intervene against stroke-related problems. 17, 18 In the present extension of the study, we evaluated the prevalence, cumulative number, and distribution of stroke-related health problems and their targeted healthcare interventions at 12 months after stroke. We also reported changes between 3 and 12 months and evaluated the longitudinal use of the PSC from a feasibility perspective. Methods Study population The study population is described in a previous publication 17 and under ClinicalTrials.gov ID: NCT04295226. In short, all patients admitted to Skåne University hospital in Malmö, Sweden, for acute ischemic stroke (ICD-10 I.63) or intracerebral hemorrhage (ICD-10 I.61) and discharged directly to their own homes between February and April 2018 and June 2018 and February 2019 were invited to participate in the study. We excluded patients with dementia, severe comorbidity (severe psychiatric illness, kidney failure on dialysis, active cancer), or pre-stroke assisted living at the time of the index stroke. Home visits were not performed. Study design This longitudinal explorative study included a face-to-face semi-structured nurse interview based on the PSC at 3 months and 12 months post-stroke, while also collecting information on risk factors, comorbidities, medications, and blood pressure. The overall purpose was to examine the feasibility of a comprehensive and structured follow-up program over time in stroke patients. We also recorded whether the PSC could be used in its entirety ( yes/no ), time used for screening each patient, and number of stroke-related health problems. The Swedish 14-item Post-Stroke Checklist The Swedish modified PSC consists of 14 items with yes/no questions identifying patient-reported common stroke-related health problems. Beyond the 11 original items of the checklist, the 14-item version includes fatigue , oral health and nutrition , and other challenges related to stroke. 18 To be defined as a stroke-related problem at 12 months, the problem had to be presumably linked to the index stroke, be covered by any of the 14 PSC items, and be new/persistent since 3-month follow-up, e.g., found it more difficult to take care of themselves (activities of daily living), communicating with others (communication), or had increased muscular stiffness (spasticity). At 12 months, items 2–4 in the PSC were defined as follows: New problem : patient did not report a problem within an item at 3-month follow-up, but experienced a new problem within the item at 12-month follow-up Persistent problem : patient reported a problem within an item at 3-month follow-up, and the problem was persistent at 12-month follow-up Resolved problem : patient reported a problem within an item at 3-month follow-up but did not report this at 12-month follow-up. PSC items 2–14 were used in the same manner at 3 and 12 months using the questions “since your stroke…” and “since 3-month follow-up…”, respectively. However, PSC item 1 (secondary prevention) with the question “ Since your last visit, have you received any advice on health-related lifestyle changes or medications for preventing another stroke? ” was interpreted differently from items 2–14 at 12 months since absence of no advice since 3-month follow-up did not necessarily equal a problem. Therefore, item 1 in the PSC was defined as follows: New problem : need of an intervention related to secondary prevention at 12-month follow-up ( regardless of the answer at 3-month follow-up) Multidisciplinary stroke team interventions The nurse-led follow-up was followed by a multidisciplinary team conference where nurse(s), stroke physician(s), and occupational therapist(s) assessed the need of further interventions and tailored recommendations and advice. Other stroke team professions such as physiotherapists, speech therapists, welfare officers, or dietitians were consulted if required. The number of interventions and time used for team discussions and administering interventions were registered for each patient as part of the feasibility evaluation. Interventions were primarily of two types: ( 1 ) additional patient-tailored advice and information and ( 2 ) referrals for rehabilitation, to general practice or to a specialist care clinic. Interventions made by doctors included referrals, changes in medication, and patient information. Interventions provided by other professions were information, tailored advice, referrals, and rehabilitation assessments. Interventions undertaken in the study were given in addition to standard care. Characteristics and follow-up data Baseline characteristics including sex, age, pre-stroke living conditions, pre-stroke functional dependence (modified Rankin Scale (mRS) score 0–2 vs. 3–5), previous stroke or TIA, smoking status, secondary preventive medication prescribed at discharge, comorbidities diagnosed before or during hospitalization for stroke (hypertension, atrial fibrillation, diabetes), stroke subtype (ischemic stroke or intracerebral hemorrhage) were collected from the Swedish Stroke Register (Riksstroke), a nationwide hospital-based stroke register that covers > 90% of stroke patients admitted to hospital. 19 At the 12-month follow-up visit, we measured blood pressure, collected information about mRS, new stroke or transitory ischemic attack since index stroke, smoking status, and current secondary preventive medication. Statistics Categorical variables were presented as proportions and quantitative variables as means or medians. Comparisons between groups were performed using the X 2 test for categorical variables and t -test for continuous variables. The association between mRS and stroke-related health problems was evaluated using the Kruskal–Wallis H test, and for comparing the mRS scores at 3 vs. 12 months we used the Wilcoxon signed-ranks test. The significance level was set to p ≤ 0.05 for all analyses. Statistical analyses were conducted using SPSS 26.0. Results Stroke survivors and patients lost to follow-up We included a total of 200 patients at baseline. The follow-up rate at 12 months post-stroke was 77% (154/200): 8 patients died and 146 attended both 3- and 12-month follow-up visits. Reasons for loss to 12-month follow-up are shown in Fig. 1 . There were no significant differences in age, sex, previous stroke status, stroke subtype, country of birth, or median number of reported stroke-related health problems at 3-month follow-up between those that were followed up and those who discontinued the study between 3 and 12 months. Demographics, comorbidity, recurrence, and secondary prevention Data on patient demographics, comorbidities, and secondary prevention are presented in Table 1. The mean age at 12-month follow-up was 72 years (SD 12) and the proportion of women was 39%. Stroke recurrence between index stroke and 3-month evaluation was 1.4% ( n = 2), whereas 6.2% ( n = 9) had a recurrence beyond 3 months. Table 1. Demographics, comorbidities, and secondary prevention in 146 patients followed up at 3 and 12 months post-stroke. Variable Included patients N = 146 % n Demographics Mean age (SD) 12-month FU 72 ( 12 ) Female sex 39% 57 Single household 38.4% 53/138 Pre-stroke living Own home without HCS 93.2% 136 Own home with HCS 5.5% 8 Other 1.4% 2 Pre-stroke function Independent (mRS 0–2) 93.7% 134/143 Dependent (mRS 3–5) 6.3% 9/143 Highest education 12 years 32.9% 48 Country of birth Sweden 77.4% 113 European 12.3% 18 Non-European 10.3% 15 Stroke subtype Ischemic 91.8% 134 Hemorrhagic 8.2% 12 Vascular risk factors Hypertension 78.1% 114 Diabetes mellitus 24.0% 35 Previous stroke 11.6% 17 Previous TIA 7.5% 11 Atrial fibrillation 24.7% 26 Congestive heart failure 11.6% 17 Coronary heart disease 15.2% 22/145 Baseline smoking habit 20.5% 30 Other comorbidities COPD 9.7% 14/145 Chronic pain 17.8% 26 Depression 8.9% 13 Anxiety 2.7% 4 Sleep disturbance 9.6% 14 Recurrence and secondary prevention 3 months 12 months % n % n Recurrent stroke after index stroke 1.4% 2 6.2% 9 Mean systolic BP (mmHg) (SD) 140 ( 20 ) 140 ( 20 ) Mean systolic MP (mmHg) (SD) 82 ( 12 ) 82 ( 12 ) Hypertension at FU (> 140 SBP / >90 DPB) 49% 71/145 42.8% 62/145 Antihypertensive treatment 82.9% 121 80.1% 117 Antiplatelet treatment (non-cardioembolic IS) 91.3% 94/103 88.3% 91/103 Statin treatment (all IS) 94.8% 127/134 87.3% 117/134 Anticoagulant treatment (AF and IS) 96.8% 30/31 87.1% 27/31 Current smoking habit 73.3% 22/30 76.7% 23/30 Smoking cessation (in smokers) 26.7% 8/30 23.3% 7/30 SD = standard deviation, HCS = Home care service, mRS = modified Rankin Scale, COPD = Chronic obstructive pulmonary disease, FU = Follow-up, BP = blood pressure, AF = atrial fibrillation, IS = ischemic stroke, TIA = Transitory ischemic attack Missing data: 5.5% for single household, ≤ 2% for all variables, the number of observations is stated under each carriable with missing data Functional outcome Twelve months after the index stroke, 78% compared to 83% at 3 months, were functionally independent defined as a mRS score ≤ 2, see Fig. 2. We found no significant association between the median number of new stroke-related problems and level of dependency (dependent/independent) at 12 months, as opposed to the 3-month evaluation, where the median number of problems increased with increasing level of dependency. A total of 24% declined in functional status (higher mRS score) between 3 and 12 months, while 19% improved (lower mRS score) and 57% had an unchanged mRS score. Patients with worsened functional status were more likely to have had a new stroke (14.3%, n = 5 vs. 3.6%, n = 4, p = 0.022) than patients with improved or unchanged functional status based on the mRS score. Furthermore, they had higher prevalence of congestive heart failure (20% vs. 9.0%, p = 0.039), atrial fibrillation (37.1% vs. 20.7%, p = 0.049), and anxiety (8.6% vs. 0.9%, p = 0.015) (Supplemental Table 1). The supplemental table 1 should be placed here! Changes in stroke-related health problems over the first year after stroke Patients were divided into three groups based on their report of stroke-related health problems at 12 months: ( 1 ) new problems, ( 2 ) persistent problems and ( 3 ) no problems (including resolved problems), see Fig. 3. The prevalence of problems for every PSC item at 3 and 12 months is presented separately in Table 2. A more detailed presentation of the prevalence of problems can be seen in Supplemental Table 2. Table 2. Stroke-related health problems identified using the Post-Stroke Checklist at 3 and 12 months post-stroke. PSC item 3 months N = 146 12 months N = 146 % n % n 1. Secondary prevention Unmet need of medical advice on health-related lifestyle changes or medications to prevent another stroke Have not received medical advice on health-related lifestyle changes or medications to prevent another stroke) since index stroke Required a new intervention of any kind within secondary prevention 57.5% 84 23.3% 34 Stroke-related health problem ( new since index stroke ) Stroke-related health problem ( new and persistent since 3 months ) % n % n 2. ADL (activities of daily living) Difficulties in ADL 22.6% 33 17.9% 26/145 3. Nutrition Oral health/nutrition problem 19.9% 29 12.5% 18/145 4. Mobility Difficulties walking or moving safely 31.5% 46 21.4% 31/145 5. Spasticity Increased muscular stiffness 8.2% 12 9.2% 12/145 6. Pain New pain 22.8% 33/145 15.7% 23 7. Incontinence Problems controlling bladder or bowel 17.1% 25 15.1% 22/145 8. Communication Difficulties communicating 26.7% 39 20% 29/145 9. Mood Anxiety or depressed mood 36.3% 53 24.9% 36/144 10. Cognition Difficulties to think, concentrate, or remember things 37.0% 54 30.2% 44 11. Mental fatigue Fatigue interfering with ability to do daily activities 47.3% 69 36.1% 52/144 12. Life after stroke Difficulties to carry out work, hobbies, sexuality, other activities, driving car 42.8% 62/145 33.4% 48/143 13. Relationship with family Difficulties in personal relationships 15.1% 22 10.2% 15 14. Other challenges Other challenges related to stroke 3.4% 5 2.1% 3 Missing data: ADL n = 1, nutrition n = 1, mobility n = 1, spasticity n = 1, incontinence n = 1, communication n = 1, mood n = 2, mental fatigue n = 2, life after stroke n = 3 Supplemental table 2 should be placed here! Patients with new problems The proportion of patients reporting any new problem at 12 months was 40% (58/146), compared to 90% (131/146) at 3 months. The highest proportion of new problems at 12 months was seen within secondary prevention (23%), followed by life after stroke (10%), cognition (6%), and mood (4.1%). No patient reported new problems within PSC item 14 – other challenges related to stroke. The median number of new stroke-related health problems was zero per patient (IQR = 0–1) at 12 months and four (IQR = 2–6) at 3 months. Approximately one-third of patients (34%) reported 1–2 new problems, while only 6% reported three or more problems at 12-month follow-up. A comparison of new stroke-related health problems at 3 vs. 12 months post-stroke can be seen in Fig. 4. Regarding PSC item 1 (secondary prevention) half of the patients (73/146) reported not having received advice on health-related lifestyle changes or medications to prevent new stroke since the 3-month follow-up. Approximately a fourth of patients (23%, 34/146) required an intervention of any kind within secondary prevention at 12-month follow-up, indicating a new problem within secondary prevention. Patients with persistent problems The proportion of patients that reported persistent but no new problems at 12-month follow-up was 24% (35/146). Persistent problems were most commonly reported within fatigue (33%), cognition (25%), life after stroke (23%), and mood (21%). Patients with no problems Approximately one third (36%, 53/146) of patients reported resolved problems or no new problems at 12 months, compared to 10% (15/146) at 3 months. Interventions for stroke-related health problems Approximately half (53%, 78/146) of the patients received at least one new intervention at 12 months, compared to 84% (122/146) at 3 months. Specifically, in 49% (71/146) an intervention was prompted by a nurse or other stroke team professional and in 27% (39/146) by a physician. Interventions were mostly required within secondary prevention (23%), mood (17%), fatigue (16%), and cognition (15%), similar to interventions prompted at 3 months. Regarding secondary prevention, the most common areas for intervention were information/advice concerning stroke preventive measures given by a nurse (32%), information/advice concerning medications given by a nurse (21%), and primary care referral/information undertaken by a physician (50%). All new interventions for the individual PSC items at 3 and 12 months are presented in Fig. 5a. The median number of interventions per patient at 12 months was one (IQR = 0–2): one nurse or other stroke team professional intervention (IQR = 0–2) and zero physicians’ interventions (IQR = 0–1). It should be noted that not all identified stroke-related health problems generated new interventions since some patients already had ongoing interventions within routine healthcare. A comparison of the cumulative number of interventions at the 3- and 12-month follow-ups is shown in Fig. 5b. The most common type of intervention was information and tailored advice (49%), primary care referral (19%), and specialist care/rehab/other referral (8%), see Fig. 5c. Feasibility evaluation The semi-structured PSC interview containing 14 items could be completed in its entirety in all 146 patients. The median time to complete the PSC interview at 12 months was 28 minutes (IQR 18.5–40, range: 6–100) compared to 30 minutes (IQR = 22–45, range: 5–140) at 3 months. Discussion Summary of findings We found that one-third of the patients had completely recovered, reporting no stroke-related health problems during the 12-month evaluation according to the PSC. However, the remaining two-thirds experienced persistent or new problems related to their strokes. Notably, the proportion reporting new problems was 40% at 12 months, compared to the 90% at 3 months. The most commonly reported new problems were within the domains of secondary prevention, life after stroke , and cognition. Additionally, at 12 months, half of the patients needed new healthcare interventions, compared to 86% at 3 months. Despite the reduction in stroke-related health problems and their targeted interventions between the 3- and 12-month evaluations, problems were experienced by two-thirds of the patients at 1 year, emphasizing the relevance of continuous follow-up of stroke survivors. From a feasibility perspective, the PSC was completed in all patients at 12 months with a median time of 28 minutes. PSC item 1 ( secondary prevention ) had to be modified for the 12-month follow-up, whereas the rest of the PSC items ( 2 – 14 ) could be used without change at the two timepoints. Item 14 ( other challenges related to stroke ) was not reported by any patient at 12 months and by 1.4% at 3 months. Although our findings confirm the comprehensiveness of items 1–13, the continued clinical use of item 14 could be questioned. Most interventions could be carried out by a nurse, supporting the overall feasibility of the nurse-based model. We observed a functional decline in a fourth of the patients between 3 and 12 months, predominantly in patients with recurrent stroke or significant comorbidity. On the other hand, the functional status improved in approximately one-fifth of patients. No significant association between the median number of new stroke-related problems and the level of dependency at 12 months was found. Of note, 64% of patients experienced new or persistent stroke-related problems, while 74% remained functionally independent (mRS ≤ 2) at 12 months, thereby showing that stroke-related health problems are poorly reflected by the mRS. It has previously been shown that patients with a favorable mRS outcome often experience cognitive impairment, difficulties with social reintegration, and depression. 20 Our research in context of current knowledge The PSC has been validated in several studies, supporting its feasibility in different settings. 11, 12, 14 A study investigating the prevalence of worsening problems using the PSC at 3, 6, and 12 months post-stroke found that mood disturbances were the most frequently and continuously identified worsened problem and that PSC was useful for the detection of worsened problems. 15 A cross-sectional study comparing stroke-related health problems using the PSC across seven countries at 6 months post-stroke implied that the most prevalent problems were cognition, life after stroke, and mood. 13 These results are in line with our findings that stroke-related health problems are often persistent and even worsened beyond the sub-acute phase and are particularly common within the non-motor symptoms of stroke. Long-term risk factor control and adherence to recommended medications and guidelines are often suboptimal in routine healthcare. 21–24 Reasons for lack of adherence include insufficient monitoring or treatment modifications/intensification when therapeutic response is not obtained, but also include patients making decisions about medications independently of their general practitioner, or prioritizing other aspects like quality of life rather than striving for treatment targets. 25–28 Despite our targeted interventions regarding secondary prevention, results were discouraging. The reduction in patients presenting with high blood pressure from 49% at 3 months to 43% at 12 months was modest at best. Eighty percent of all patients were on antihypertensives at 12 months, implying that dose titration or intensification of treatment may be important challenges. Statin use was discontinued by 8% of patients between the two follow-ups, and 77% of baseline smokers still smoked at 12 months. Our intervention, which was an add-on to routine healthcare, did not include a doctor’s visit and did not have resources for continuous contact with the patient but served as a tool to identify problems. Thus, we had to rely on primary care to reach secondary prevention treatment targets. The rate of stroke recurrence was 7.5%. Some of these strokes might have been prevented by improved risk factor control. We acknowledge that use of our model alone for follow-up is insufficient for reaching long-term treatment targets. Primary care differs between countries, but patients are severely underserved in Sweden, which may affect patients with chronic diseases and regular follow-up needs. It could be argued that patients with stroke are best managed at a stroke clinic during the first important year post-stroke, but this warrants further study. Strengths and limitations The strengths of this study include a consecutive cohort of patients with detailed data and a longitudinal design, allowing for analyses of changes over time. The study has numerous limitations. Firstly, the lack of a control group provides limited ability to analyze the effectiveness of our model compared to standard of care. An additional limitation is that follow-up was limited to patients that were discharged home. However, it should be taken into account that 75% of stroke patients in Sweden are discharged to home. 8 As home discharge represents the majority within the stroke population it is seemingly relevant to conduct a study on this population and the results applicable on a large scale. Another study assessing patients with severe strokes that were discharged to nursing homes found the PSC to be useful in that patient group. 29 Interestingly, the nature of stroke-related health problems differed markedly between patients discharged home and those discharged to nursing homes and ought to be studied separately. The follow-up rate was 77%. Patients lost to follow-up at 3 months were older, and the most common reason for study exclusion was declined function (9/34). Twelve patients were lost between 3 and 12 months, and the most common reason for discontinuing the study was declined need for continued follow-up. Home visits were not offered but might have prevented drop-out due to decline in function. Single blood pressure measurements, which are known to be less precise than 24-hour measurements, were used at 3 and 12 months and may have overestimated the prevalence of hypertension. Conclusions Stroke-related health problems decreased over time but were still experienced by two-thirds of patients 1 year after the stroke. Continuous stroke follow-up therefore remains highly relevant. The nurse-based follow-up model with stroke team support used in this study was feasible, but its use alone is insufficient to reach secondary prevention targets. With few modifications, we found the PSC to be feasible for longitudinal use and to capture stroke-related health problems during the first year. Further development of PSC-based follow-up models could focus on sustainable and intensified secondary prevention strategies. Abbreviations PCS Post stroke checklist SSNAPP The Sentinel Stroke National Audit Programme ICD International Statistical Classification of Diseases and Related Health Problems mRS Modified Rankin Score IQR Interquartile range Declarations Consent for publication Not applicable Availability for data and materials Requests to access an anonymized dataset supporting the conclusions of this article may be sent to the corresponding author after obtaining the appropriate ethics approval. Competing interests The authors declare that they have no competing interests. Funding This work was supported by with research grants from the Kamprad Family Foundation, the Bundy Academy, national ALF research funding, the Swedish Stroke Association, and Sparbanksstiftelsen Färs och Frosta. Ethical approval and consent to participate The ethics committee of Sweden approved this study (REC number: EPN LUND 2020/07148). Clinical studies Sweden managed all collected data. ClinicalTrials.gov ID: NCT04295226 Written informed consent was obtained from the patient(s). Patients who were unable to sign their name due to stroke were allowed to use witness informed consent. Guarantor KM Authors contributions TU, HPR, and KM researched literature and conceived the study. TU and HPR was involved in protocol development, gaining ethical approval (TU, HPR), patient recruitment (KM, TU, IB) and data analysis (KM, TU, IB, HPR). KM wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript. Acknowledgements We would like to thank all participating patients and their next of kin for offering their time and trust to help us improve care for future patients. We would also like to thank Riksstroke for providing data, and occupational therapist Gerd Andersson for generously sharing her knowledge. References Rajsic S, Gothe H, Borba HH, et al. 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Int J Stroke. 2014;9(Suppl A):76–84. 10.1111/ijs.12291 . Philp I, Brainin M, Walker MF, et al. Development of a poststroke checklist to standardize follow-up care for stroke survivors. J Stroke Cerebrovasc Dis. 2013;22:e173–180. 10.1016/j.jstrokecerebrovasdis.2012.10.016 . Olver J, Yang S, Fedele B, et al. Post Stroke Outcome: Global Insight into Persisting Sequelae Using the Post Stroke Checklist. J Stroke Cerebrovasc Dis. 2021;30:105612. 10.1016/j.jstrokecerebrovasdis.2021.105612 . Iosa M, Lupo A, Morone G, et al. Post Soft Care: Italian implementation of a post-stroke checklist software for primary care and identification of unmet needs in community-dwelling patients. Neurol Sci. 2018;39:135–9. 2017/11/01. Im HW, Kim WS, Kim S, et al. Prevalence of Worsening Problems Using Post-Stroke Checklist and Associations with Quality of Life in Patients with Stroke. J Stroke Cerebrovasc Dis. 2020;29:105406. 10.1016/j.jstrokecerebrovasdis.2020.105406 . Crow J, Savage M, Gardner L, et al. What follow-up interventions, programmes and pathways exist for minor stroke survivors after discharge from the acute setting? A scoping review. BMJ Open. 2023;13:e070323. 10.1136/bmjopen-2022-070323 . Ullberg T, Mansson K, Berhin I, et al. Comprehensive and Structured 3-month Stroke Follow-up Using the Post-stroke Checklist (The Struct-FU study): A Feasibility and Explorative Study. J Stroke Cerebrovasc Dis. 2021;30:105482. 2020/12/01. Skåne R. Post stroke checklist, https://vardgivare.skane.se/siteassets/1.-vardriktlinjer/regionala-riktlinjer---fillistning/checklista_2018-final.pdf (2018,). Riksstroke, editor. The Swedish Stroke Register (Riksstroke), https://www.riksstroke.org/eng/ . Kapoor A, Lanctôt KL, Bayley M, et al. Good Outcome Isn't Good Enough: Cognitive Impairment, Depressive Symptoms, and Social Restrictions in Physically Recovered Stroke Patients. Stroke. 2017;48:1688–90. 10.1161/strokeaha.117.016728 . Esenwa C, Gutierrez J. Secondary stroke prevention: challenges and solutions. Vasc Health Risk Manag 2015; 11: 437–450. 20150807. 10.2147/vhrm.S63791 . Heuschmann PU, Kircher J, Nowe T, et al. Control of main risk factors after ischaemic stroke across Europe: data from the stroke-specific module of the EUROASPIRE III survey. Eur J Prev Cardiol. 2015;22(20140819):1354–62. 10.1177/2047487314546825 . Brewer L, Mellon L, Hall P, et al. Secondary prevention after ischaemic stroke: the ASPIRE-S study. BMC Neurol. 2015;15:216. 10.1186/s12883-015-0466-2 . Hotter B, Padberg I, Liebenau A, et al. Identifying unmet needs in long-term stroke care using in-depth assessment and the Post-Stroke Checklist - The Managing Aftercare for Stroke (MAS-I) study. Eur Stroke J. 2018;3(20180419):237–45. 10.1177/2396987318771174 . Hughes LD, McMurdo ME, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing. 2013;42:62–9. 10.1093/ageing/afs100 . Jamison J, Sutton S, Mant J, et al. Barriers and facilitators to adherence to secondary stroke prevention medications after stroke: analysis of survivors and caregivers views from an online stroke forum. BMJ Open. 2017;7:e016814. 10.1136/bmjopen-2017-016814 . Pindus DM, Mullis R, Lim L, et al. Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography. PLoS ONE. 2018;13:e0192533. 10.1371/journal.pone.0192533 . Gynnild MN, Aakerøy R, Spigset O, et al. Vascular risk factor control and adherence to secondary preventive medication after ischaemic stroke. J Intern Med. 2021;289:355–68. 10.1111/joim.13161 . Kjörk EK, Gustavsson M, El-Manzalawy N, et al. Stroke-related health problems and associated actions identified with the post-stroke checklist among nursing home residents. BMC Cardiovasc Disord. 2022;22:50. 10.1186/s12872-022-02466-3 . Additional Declarations No competing interests reported. Supplementary Files Supplementaltable1.docx SupplementalTable2.docx Cite Share Download PDF Status: Published Journal Publication published 29 Oct, 2024 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editor invited by journal 19 Feb, 2024 Submission checks completed at journal 19 Feb, 2024 First submitted to journal 18 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3876821","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":273708342,"identity":"604ff28c-f365-4fa8-bfc6-30066e2a1dc3","order_by":0,"name":"Kristina Månsson, MD","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYBACCR4Yi70BSBhYkKKF5wBIiwQpWiQSwCRhLZI9pxM/F/ypkzOXfH51w48CCQb+9u4EvFqkeXs3S89sO2xsOTun7GYP0GESZ85uwKtFjp93gzRvw4HEDbdz0m7wALUYSOQS1LL5N8+fusQNN8+k3fxDjBagw7ZJ87AxJ264wX7sNlG2SPac3WbNC/SLwZkcttsyBhI8BP0icSZ3822gw+QMjh9/dvPNHxs5/vZe/FqQAI8BmCRWOQiwPyBF9SgYBaNgFIwgAADB1kXB9oprpAAAAABJRU5ErkJggg==","orcid":"","institution":"Skåne University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Kristina","middleName":"","lastName":"Månsson","suffix":"MD"},{"id":273708343,"identity":"a9d1f141-4f6b-4295-8c36-d0e997b9c449","order_by":1,"name":"Martin Söderholm, MD, PhD","email":"","orcid":"","institution":"Skåne University Hospital","correspondingAuthor":false,"prefix":"","firstName":"","middleName":"MD Martin","lastName":"Söderholm","suffix":"MD"},{"id":273708344,"identity":"ab83e6c0-3148-47a9-bcf4-d18de0410eee","order_by":2,"name":"Ida Berhin","email":"","orcid":"","institution":"Skåne University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ida","middleName":"","lastName":"Berhin","suffix":""},{"id":273708345,"identity":"22db6a24-bf70-4799-a174-fb9025b2537d","order_by":3,"name":"Hélène Pessah-Rasmussen, MD, PhD","email":"","orcid":"","institution":"Skåne University Hospital","correspondingAuthor":false,"prefix":"","firstName":"","middleName":"MD Hélène","lastName":"Pessah-Rasmussen","suffix":"MD"},{"id":273708346,"identity":"14dbcc4f-745e-474a-a435-583e40b6dd0f","order_by":4,"name":"Teresa Ullberg, MD, PhD","email":"","orcid":"","institution":"Skåne University Hospital","correspondingAuthor":false,"prefix":"","firstName":"","middleName":"MD Teresa","lastName":"Ullberg","suffix":"MD"}],"badges":[],"createdAt":"2024-01-18 20:29:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3876821/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3876821/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-024-04239-6","type":"published","date":"2024-10-29T16:20:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":51445159,"identity":"61caa0bd-b242-4b96-a02b-301a47979ddc","added_by":"auto","created_at":"2024-02-21 18:09:07","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":578329,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eStudy Flowchart\u003c/em\u003e\u003cem\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3876821/v1/3b0d0bb4e3573ca6ea36bf01.jpg"},{"id":51445165,"identity":"e0a78f2f-4415-4c34-bb79-dbe5b7eb7731","added_by":"auto","created_at":"2024-02-21 18:09:08","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":269552,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eFunctional outcome at 3-and 12-monthfollow-up assessed with the modified Rankin Scale, ranging from 0 to 5, with higher scores indicating more severe disability.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure25.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3876821/v1/00903b93bd794d09e5aa0f38.jpg"},{"id":51445167,"identity":"c015f9a8-7a98-4c03-a246-48347c4ed3be","added_by":"auto","created_at":"2024-02-21 18:09:08","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":125426,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePie chart presenting the change of stroke-related health problems since 3- month follow-up.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure34.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3876821/v1/c831b820700dc05311146c2b.jpg"},{"id":51445162,"identity":"a66bc906-2b71-4f3d-a132-1b125665d30f","added_by":"auto","created_at":"2024-02-21 18:09:08","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":519087,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe outer layer presents the proportion of patients reporting new (since index stroke) problems at 3 months (A) and new (since 3-month evaluation) problems at 12 months (B), and the inner layer presents the cumulative number of new problems.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure43.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3876821/v1/49be579b527cc4f06de3692b.jpg"},{"id":51445166,"identity":"1dbf6b92-139e-42ae-a512-443d7f7a9c8b","added_by":"auto","created_at":"2024-02-21 18:09:08","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":87435,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e5a. \u003c/strong\u003e\u003cem\u003eProportions of patients in need of interventions in each of the 14 Post-Stroke\u003c/em\u003e\u003cem\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/em\u003e\u003cem\u003eChecklist items.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5b. \u003c/strong\u003e\u003cem\u003eThe outer layer of each circle presents the proportion of patients requiring any intervention at 3 months (A) and 12 months (B), and the inner layers of each circle present the number of interventions.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5c. \u003c/strong\u003e\u003cem\u003eType of intervention\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure5ac.png","url":"https://assets-eu.researchsquare.com/files/rs-3876821/v1/fd6fa0c6d2eca54c57880712.png"},{"id":68207402,"identity":"2da43f31-5bc7-44ee-aad3-e6f610efc8d0","added_by":"auto","created_at":"2024-11-04 16:37:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2572396,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3876821/v1/b9fa5f1c-5bfd-4498-ad61-d6c875458960.pdf"},{"id":51445164,"identity":"d7e8d898-7b65-46b5-a4a3-af493b023d45","added_by":"auto","created_at":"2024-02-21 18:09:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15364,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaltable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-3876821/v1/e937a5c356723ac90ea0b729.docx"},{"id":51446753,"identity":"e61acb86-d65f-44d8-9ee3-68425ecbd551","added_by":"auto","created_at":"2024-02-21 18:17:09","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":20552,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTable2.docx","url":"https://assets-eu.researchsquare.com/files/rs-3876821/v1/5ea5416ea01f2dcb6ee1a67c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Post-Stroke Checklist: longitudinal use in routine clinical practice during first year after stroke","fulltext":[{"header":"Background","content":"\u003cp\u003eAs a result of a growing aging population and improved stroke survival, the absolute number of stroke survivors is predicted to increase.\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e Developing resource-effective and sustainable models for the management and care of stroke survivors in a long-term setting is highly relevant.\u003c/p\u003e \u003cp\u003eThe Stroke Action Plan for Europe, a European collaborative project with an overall aim to reduce the burden of stroke by improving stroke care, has introduced \u003cem\u003eLife after stroke\u003c/em\u003e as a new domain important to address in stroke survivors. The Stroke Action Plan provides a recommendation that stroke survivors should be offered follow-up at 3\u0026ndash;6 months post-stroke based on the Post-Stroke Checklist (PSC).\u003csup\u003e4\u0026ndash;5\u003c/sup\u003e This is in line with recommendations in the Swedish national guidelines for stroke care.\u003csup\u003e6\u003c/sup\u003e Still, structured stroke follow-up is not yet fully established on a national or even regional basis, indicating a major gap between guideline recommendations and long-term management of stroke survivors. According to SSNAPP (The Sentinel Stroke National Audit Programme), which measures quality of stroke care in the U.K, only 35% of patients applicable for follow-up completed a 6-month follow-up.\u003csup\u003e7\u003c/sup\u003e In Sweden, there are no reliable data on the proportion of stroke survivors that receive follow-up visits, confirming the gap. Unfortunately, the transition between in- and outpatient care is an area in which problems often occur. Individuals who are discharged home risk inconsistencies in follow-up care and therefore are an important group to study, especially having in mind that this stroke population represents 75% of all stroke patients in Sweden.\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA systematic review from 2021 summarizes the current knowledge on the organization of post-stroke care by targeting the several crucial aspects (neurological deficit, any post-stroke complications, inadequately treated risk factors, and unmet psychosocial needs) affecting the long-term impairments and quality of life of stroke survivors.\u003csup\u003e9\u003c/sup\u003e The STROKE-CARD care trial showed that a comprehensive post-stroke care program handling the multifaceted stroke-related problems can successfully lower the incidence of recurrent stroke and other cardiovascular events while also improving quality of life and functional outcome of patients with stroke.\u003csup\u003e10\u003c/sup\u003e Other studies are limited by relatively short follow-up periods; however, it is important to evaluate patient needs and benefits over longer periods.\u003csup\u003e11\u0026ndash;15\u003c/sup\u003e Encouragingly, there is an enhanced focus on follow-up care of stroke survivors, as evidenced by a recent review on interventions provided to people with minor stroke. However, the review concluded that follow-up care mainly emphasizes secondary prevention rather than the wide range of other post-stroke consequences.\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe aim of this longitudinal study was to evaluate a comprehensive and structured follow-up model over the first year after stroke using the Post-stroke Checklist (PSC). In a first phase of this study, we evaluated a structured follow-up at 3 months for patients with stroke, using a 14-item PSC to identify and intervene against stroke-related problems.\u003csup\u003e17, 18\u003c/sup\u003e In the present extension of the study, we evaluated the prevalence, cumulative number, and distribution of stroke-related health problems and their targeted healthcare interventions at 12 months after stroke. We also reported changes between 3 and 12 months and evaluated the longitudinal use of the PSC from a feasibility perspective.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThe study population is described in a previous publication\u003csup\u003e17\u003c/sup\u003e and under ClinicalTrials.gov ID: NCT04295226. In short, all patients admitted to Skåne University hospital in Malmö, Sweden, for acute ischemic stroke (ICD-10 I.63) or intracerebral hemorrhage (ICD-10 I.61) and discharged directly to their own homes between February and April 2018 and June 2018 and February 2019 were invited to participate in the study. We excluded patients with dementia, severe comorbidity (severe psychiatric illness, kidney failure on dialysis, active cancer), or pre-stroke assisted living at the time of the index stroke. Home visits were not performed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis longitudinal explorative study included a face-to-face semi-structured nurse interview based on the PSC at 3 months and 12 months post-stroke, while also collecting information on risk factors, comorbidities, medications, and blood pressure. The overall purpose was to examine the feasibility of a comprehensive and structured follow-up program over time in stroke patients. We also recorded whether the PSC could be used in its entirety (\u003cem\u003eyes/no\u003c/em\u003e), time used for screening each patient, and number of stroke-related health problems.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eThe Swedish 14-item Post-Stroke Checklist\u003c/h2\u003e \u003cp\u003eThe Swedish modified PSC consists of 14 items with \u003cem\u003eyes/no\u003c/em\u003e questions identifying patient-reported common stroke-related health problems. Beyond the 11 original items of the checklist, the 14-item version includes \u003cem\u003efatigue\u003c/em\u003e, \u003cem\u003eoral health and nutrition\u003c/em\u003e, and \u003cem\u003eother challenges\u003c/em\u003e related to stroke.\u003csup\u003e18\u003c/sup\u003e To be defined as a stroke-related problem at 12 months, the problem had to be presumably linked to the index stroke, be covered by any of the 14 PSC items, and be new/persistent since 3-month follow-up, e.g., found it more difficult to take care of themselves (activities of daily living), communicating with others (communication), or had increased muscular stiffness (spasticity). At 12 months, items 2–4 in the PSC were defined as follows:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eNew problem\u003c/em\u003e: patient did not report a problem within an item at 3-month follow-up, but experienced a new problem within the item at 12-month follow-up\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003ePersistent problem\u003c/em\u003e: patient reported a problem within an item at 3-month follow-up, and the problem was persistent at 12-month follow-up\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eResolved problem\u003c/em\u003e: patient reported a problem within an item at 3-month follow-up but did not report this at 12-month follow-up.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003ePSC items 2–14 were used in the same manner at 3 and 12 months using the questions “since your stroke…” and “since 3-month follow-up…”, respectively. However, PSC item 1 (secondary prevention) with the question “\u003cem\u003eSince your last visit, have you received any advice on health-related lifestyle changes or medications for preventing another stroke?\u003c/em\u003e” was interpreted differently from items 2–14 at 12 months since absence of no advice since 3-month follow-up did not necessarily equal a problem. Therefore, item 1 in the PSC was defined as follows:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eNew problem\u003c/em\u003e: need of an intervention related to secondary prevention at 12-month follow-up (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eregardless\u003c/span\u003e of the answer at 3-month follow-up)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMultidisciplinary stroke team interventions\u003c/h2\u003e \u003cp\u003eThe nurse-led follow-up was followed by a multidisciplinary team conference where nurse(s), stroke physician(s), and occupational therapist(s) assessed the need of further interventions and tailored recommendations and advice. Other stroke team professions such as physiotherapists, speech therapists, welfare officers, or dietitians were consulted if required. The number of interventions and time used for team discussions and administering interventions were registered for each patient as part of the feasibility evaluation.\u003c/p\u003e \u003cp\u003eInterventions were primarily of two types: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) additional patient-tailored advice and information and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) referrals for rehabilitation, to general practice or to a specialist care clinic. Interventions made by doctors included referrals, changes in medication, and patient information. Interventions provided by other professions were information, tailored advice, referrals, and rehabilitation assessments. Interventions undertaken in the study were given in addition to standard care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics and follow-up data\u003c/h2\u003e \u003cp\u003eBaseline characteristics including sex, age, pre-stroke living conditions, pre-stroke functional dependence (modified Rankin Scale (mRS) score 0–2 vs. 3–5), previous stroke or TIA, smoking status, secondary preventive medication prescribed at discharge, comorbidities diagnosed before or during hospitalization for stroke (hypertension, atrial fibrillation, diabetes), stroke subtype (ischemic stroke or intracerebral hemorrhage) were collected from the Swedish Stroke Register (Riksstroke), a nationwide hospital-based stroke register that covers \u0026gt; 90% of stroke patients admitted to hospital.\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAt the 12-month follow-up visit, we measured blood pressure, collected information about mRS, new stroke or transitory ischemic attack since index stroke, smoking status, and current secondary preventive medication.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistics\u003c/h2\u003e \u003cp\u003eCategorical variables were presented as proportions and quantitative variables as means or medians. Comparisons between groups were performed using the \u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e test for categorical variables and \u003cem\u003et\u003c/em\u003e-test for continuous variables. The association between mRS and stroke-related health problems was evaluated using the Kruskal–Wallis H test, and for comparing the mRS scores at 3 vs. 12 months we used the Wilcoxon signed-ranks test. The significance level was set to \u003cem\u003ep\u003c/em\u003e ≤ 0.05 for all analyses. Statistical analyses were conducted using SPSS 26.0.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Results","content":"\u003ch2\u003eStroke survivors and patients lost to follow-up\u003c/h2\u003e\u003cp\u003eWe included a total of 200 patients at baseline. The follow-up rate at 12 months post-stroke was 77% (154/200): 8 patients died and 146 attended both 3- and 12-month follow-up visits. Reasons for loss to 12-month follow-up are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were no significant differences in age, sex, previous stroke status, stroke subtype, country of birth, or median number of reported stroke-related health problems at 3-month follow-up between those that were followed up and those who discontinued the study between 3 and 12 months.\u003c/p\u003e\u003ch2\u003eDemographics, comorbidity, recurrence, and secondary prevention\u003c/h2\u003e\u003cp\u003eData on patient demographics, comorbidities, and secondary prevention are presented in Table\u0026nbsp;1. The mean age at 12-month follow-up was 72 years (SD 12) and the proportion of women was 39%. Stroke recurrence between index stroke and 3-month evaluation was 1.4% (\u003cem\u003en\u003c/em\u003e = 2), whereas 6.2% (\u003cem\u003en\u003c/em\u003e = 9) had a recurrence beyond 3 months.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;1. \u003cem\u003eDemographics, comorbidities, and secondary prevention in 146 patients followed up at 3 and 12 months post-stroke.\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVariable\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIncluded patients\u003c/b\u003e \u003cb\u003eN\u003c/b\u003e \u003cb\u003e= 146\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDemographics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age (SD) 12-month FU\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e72 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e39%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle household\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e38.4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e53/138\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-stroke living\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOwn home without HCS\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e93.2%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOwn home with HCS\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e5.5%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-stroke function\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependent (mRS 0–2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e93.7%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e134/143\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent (mRS 3–5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e6.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9/143\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest education\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;9 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e32.2%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10–12 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e34.9%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;12 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e32.9%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountry of birth\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSweden\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e77.4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEuropean\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e12.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-European\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e10.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke subtype\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIschemic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e91.8%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemorrhagic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e8.2%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVascular risk factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e78.1%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e24.0%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e11.6%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious TIA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e7.5%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e24.7%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongestive heart failure\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e11.6%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e15.2%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e22/145\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline smoking habit\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e20.5%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther comorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e9.7%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e14/145\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic pain\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e17.8%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e8.9%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e2.7%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep disturbance\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e9.6%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecurrence and secondary prevention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003e12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrent stroke after index stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.2%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean systolic BP (mmHg) (SD)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e140 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean systolic MP (mmHg) (SD)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e82 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension at FU (\u0026gt; 140 SBP / \u0026gt;90 DPB)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e49%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71/145\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.8%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62/145\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntihypertensive treatment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e82.9%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80.1%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntiplatelet treatment (non-cardioembolic IS)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e91.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94/103\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91/103\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatin treatment (all IS)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e94.8%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127/134\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e117/134\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticoagulant treatment (AF and IS)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e96.8%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30/31\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.1%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27/31\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoking habit\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e73.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22/30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.7%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23/30\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking cessation (in smokers)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e26.7%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8/30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7/30\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eSD = standard deviation, HCS = Home care service, mRS = modified Rankin Scale, COPD = Chronic obstructive pulmonary disease,\u003c/p\u003e \u003cp\u003eFU = Follow-up, BP = blood pressure, AF = atrial fibrillation, IS = ischemic stroke, TIA = Transitory ischemic attack\u003c/p\u003e \u003cp\u003eMissing data: 5.5% for single household, ≤ 2% for all variables, the number of observations is stated under each carriable with missing data\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eFunctional outcome\u003c/h2\u003e\u003cp\u003eTwelve months after the index stroke, 78% compared to 83% at 3 months, were functionally independent defined as a mRS score ≤ 2, see Fig.\u0026nbsp;2. We found no significant association between the median number of new stroke-related problems and level of dependency (dependent/independent) at 12 months, as opposed to the 3-month evaluation, where the median number of problems increased with increasing level of dependency. A total of 24% declined in functional status (higher mRS score) between 3 and 12 months, while 19% improved (lower mRS score) and 57% had an unchanged mRS score. Patients with worsened functional status were more likely to have had a new stroke (14.3%, \u003cem\u003en\u003c/em\u003e = 5 vs. 3.6%, \u003cem\u003en\u003c/em\u003e = 4, \u003cem\u003ep\u003c/em\u003e = 0.022) than patients with improved or unchanged functional status based on the mRS score. Furthermore, they had higher prevalence of congestive heart failure (20% vs. 9.0%, \u003cem\u003ep\u003c/em\u003e = 0.039), atrial fibrillation (37.1% vs. 20.7%, \u003cem\u003ep\u003c/em\u003e = 0.049), and anxiety (8.6% vs. 0.9%, \u003cem\u003ep\u003c/em\u003e = 0.015) (Supplemental Table\u0026nbsp;1).\u003c/p\u003e\u003ch2\u003eThe supplemental table 1 should be placed here!\u003c/h2\u003e\u003ch2\u003eChanges in stroke-related health problems over the first year after stroke\u003c/h2\u003e\u003cp\u003ePatients were divided into three groups based on their report of stroke-related health problems at 12 months: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) new problems, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) persistent problems and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) no problems (including resolved problems), see Fig.\u0026nbsp;3. The prevalence of problems for every PSC item at 3 and 12 months is presented separately in Table\u0026nbsp;2. A more detailed presentation of the prevalence of problems can be seen in Supplemental Table\u0026nbsp;2.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;2. \u003cem\u003eStroke-related health problems identified using the Post-Stroke Checklist at 3 and 12 months post-stroke.\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSC item\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3 months N = 146\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003e12 months N = 146\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1. \u003cb\u003eSecondary prevention\u003c/b\u003e\u003c/p\u003e \u003cp\u003eUnmet need of medical advice on health-related lifestyle changes or medications to prevent another stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eHave\u003c/em\u003e \u003cb\u003enot\u003c/b\u003e \u003cem\u003ereceived medical advice on health-related lifestyle changes or medications to prevent another stroke) since index stroke\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003eRequired\u003c/em\u003e \u003cb\u003ea new intervention\u003c/b\u003e \u003cem\u003eof any kind within secondary prevention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.5%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eStroke-related health problem\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(\u003c/em\u003e\u003cb\u003enew since index stroke\u003c/b\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003eStroke-related health problem\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(\u003c/em\u003e\u003cb\u003enew and persistent since 3 months\u003c/b\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. \u003cb\u003eADL (activities of daily living)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDifficulties in ADL\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.6%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.9%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26/145\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. \u003cb\u003eNutrition\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOral health/nutrition problem\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.9%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.5%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18/145\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. \u003cb\u003eMobility\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDifficulties walking or moving safely\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.5%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31/145\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. \u003cb\u003eSpasticity\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIncreased muscular stiffness\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.2%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.2%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12/145\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. \u003cb\u003ePain\u003c/b\u003e\u003c/p\u003e \u003cp\u003eNew pain\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.8%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33/145\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.7%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. \u003cb\u003eIncontinence\u003c/b\u003e\u003c/p\u003e \u003cp\u003eProblems controlling bladder or bowel\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.1%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.1%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22/145\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. \u003cb\u003eCommunication\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDifficulties communicating\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.7%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29/145\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. \u003cb\u003eMood\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAnxiety or depressed mood\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.9%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36/144\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. \u003cb\u003eCognition\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDifficulties to think, concentrate, or remember things\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.0%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.2%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. \u003cb\u003eMental fatigue\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFatigue interfering with ability to do daily activities\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.3%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.1%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52/144\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. \u003cb\u003eLife after stroke\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDifficulties to carry out work, hobbies, sexuality, other activities, driving car\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.8%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62/145\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48/143\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. \u003cb\u003eRelationship with family\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDifficulties in personal relationships\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.1%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.2%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. \u003cb\u003eOther challenges\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOther challenges related to stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.1%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eMissing data: ADL \u003cem\u003en\u003c/em\u003e = 1, nutrition \u003cem\u003en\u003c/em\u003e = 1, mobility \u003cem\u003en\u003c/em\u003e = 1, spasticity \u003cem\u003en\u003c/em\u003e = 1, incontinence \u003cem\u003en\u003c/em\u003e = 1, communication \u003cem\u003en\u003c/em\u003e = 1, mood \u003cem\u003en\u003c/em\u003e = 2, mental fatigue \u003cem\u003en\u003c/em\u003e = 2, life after stroke \u003cem\u003en\u003c/em\u003e = 3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eSupplemental table 2 should be placed here!\u003c/h2\u003e\u003cp\u003ePatients with new problems\u003c/p\u003e\u003cp\u003eThe proportion of patients reporting any \u003cem\u003enew\u003c/em\u003e problem at 12 months was 40% (58/146), compared to 90% (131/146) at 3 months. The highest proportion of new problems at 12 months was seen within \u003cem\u003esecondary prevention\u003c/em\u003e (23%), followed by \u003cem\u003elife after stroke\u003c/em\u003e (10%), \u003cem\u003ecognition\u003c/em\u003e (6%), and \u003cem\u003emood\u003c/em\u003e (4.1%). No patient reported new problems within PSC item 14 – \u003cem\u003eother challenges related to stroke.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe median number of new stroke-related health problems was zero per patient (IQR = 0–1) at 12 months and four (IQR = 2–6) at 3 months. Approximately one-third of patients (34%) reported 1–2 new problems, while only 6% reported three or more problems at 12-month follow-up. A comparison of new stroke-related health problems at 3 vs. 12 months post-stroke can be seen in Fig.\u0026nbsp;4.\u003c/p\u003e\u003cp\u003eRegarding PSC item 1 (secondary prevention) half of the patients (73/146) reported not having received advice on health-related lifestyle changes or medications to prevent new stroke since the 3-month follow-up. Approximately a fourth of patients (23%, 34/146) required an intervention of any kind within secondary prevention at 12-month follow-up, indicating a new problem within secondary prevention.\u003c/p\u003e\u003cp\u003ePatients with persistent problems\u003c/p\u003e\u003cp\u003eThe proportion of patients that reported persistent but no new problems at 12-month follow-up was 24% (35/146). Persistent problems were most commonly reported within \u003cem\u003efatigue\u003c/em\u003e (33%), \u003cem\u003ecognition\u003c/em\u003e (25%), \u003cem\u003elife after stroke\u003c/em\u003e (23%), and \u003cem\u003emood\u003c/em\u003e (21%).\u003c/p\u003e\u003cp\u003ePatients with no problems\u003c/p\u003e\u003cp\u003eApproximately one third (36%, 53/146) of patients reported resolved problems or no new problems at 12 months, compared to 10% (15/146) at 3 months.\u003c/p\u003e\u003ch2\u003eInterventions for stroke-related health problems\u003c/h2\u003e\u003cp\u003eApproximately half (53%, 78/146) of the patients received at least one new intervention at 12 months, compared to 84% (122/146) at 3 months. Specifically, in 49% (71/146) an intervention was prompted by a nurse or other stroke team professional and in 27% (39/146) by a physician. Interventions were mostly required within secondary prevention (23%), mood (17%), fatigue (16%), and cognition (15%), similar to interventions prompted at 3 months. Regarding secondary prevention, the most common areas for intervention were information/advice concerning stroke preventive measures given by a nurse (32%), information/advice concerning medications given by a nurse (21%), and primary care referral/information undertaken by a physician (50%). All new interventions for the individual PSC items at 3 and 12 months are presented in Fig.\u0026nbsp;5a.\u003c/p\u003e\u003cp\u003eThe median number of interventions per patient at 12 months was one (IQR = 0–2): one nurse or other stroke team professional intervention (IQR = 0–2) and zero physicians’ interventions (IQR = 0–1). It should be noted that not all identified stroke-related health problems generated new interventions since some patients already had ongoing interventions within routine healthcare. A comparison of the cumulative number of interventions at the 3- and 12-month follow-ups is shown in Fig.\u0026nbsp;5b. The most common type of intervention was information and tailored advice (49%), primary care referral (19%), and specialist care/rehab/other referral (8%), see Fig.\u0026nbsp;5c.\u003c/p\u003e\u003ch2\u003eFeasibility evaluation\u003c/h2\u003e\u003cp\u003eThe semi-structured PSC interview containing 14 items could be completed in its entirety in all 146 patients. The median time to complete the PSC interview at 12 months was 28 minutes (IQR 18.5–40, range: 6–100) compared to 30 minutes (IQR = 22–45, range: 5–140) at 3 months.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSummary of findings\u003c/h2\u003e \u003cp\u003eWe found that one-third of the patients had completely recovered, reporting no stroke-related health problems during the 12-month evaluation according to the PSC. However, the remaining two-thirds experienced persistent or new problems related to their strokes. Notably, the proportion reporting new problems was 40% at 12 months, compared to the 90% at 3 months. The most commonly reported new problems were within the domains of \u003cem\u003esecondary prevention, life after stroke\u003c/em\u003e, and \u003cem\u003ecognition.\u003c/em\u003e Additionally, at 12 months, half of the patients needed new healthcare interventions, compared to 86% at 3 months. Despite the reduction in stroke-related health problems and their targeted interventions between the 3- and 12-month evaluations, problems were experienced by two-thirds of the patients at 1 year, emphasizing the relevance of continuous follow-up of stroke survivors.\u003c/p\u003e \u003cp\u003eFrom a feasibility perspective, the PSC was completed in all patients at 12 months with a median time of 28 minutes. PSC item 1 (\u003cem\u003esecondary prevention\u003c/em\u003e) had to be modified for the 12-month follow-up, whereas the rest of the PSC items (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) could be used without change at the two timepoints. Item 14 (\u003cem\u003eother challenges related to stroke\u003c/em\u003e) was not reported by any patient at 12 months and by 1.4% at 3 months. Although our findings confirm the comprehensiveness of items 1\u0026ndash;13, the continued clinical use of item 14 could be questioned. Most interventions could be carried out by a nurse, supporting the overall feasibility of the nurse-based model.\u003c/p\u003e \u003cp\u003eWe observed a functional decline in a fourth of the patients between 3 and 12 months, predominantly in patients with recurrent stroke or significant comorbidity. On the other hand, the functional status improved in approximately one-fifth of patients. No significant association between the median number of new stroke-related problems and the level of dependency at 12 months was found. Of note, 64% of patients experienced new or persistent stroke-related problems, while 74% remained functionally independent (mRS\u0026thinsp;\u0026le;\u0026thinsp;2) at 12 months, thereby showing that stroke-related health problems are poorly reflected by the mRS. It has previously been shown that patients with a favorable mRS outcome often experience cognitive impairment, difficulties with social reintegration, and depression.\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eOur research in context of current knowledge\u003c/h2\u003e \u003cp\u003eThe PSC has been validated in several studies, supporting its feasibility in different settings.\u003csup\u003e11, 12, 14\u003c/sup\u003e A study investigating the prevalence of worsening problems using the PSC at 3, 6, and 12 months post-stroke found that mood disturbances were the most frequently and continuously identified worsened problem and that PSC was useful for the detection of worsened problems.\u003csup\u003e15\u003c/sup\u003e A cross-sectional study comparing stroke-related health problems using the PSC across seven countries at 6 months post-stroke implied that the most prevalent problems were cognition, life after stroke, and mood.\u003csup\u003e13\u003c/sup\u003e These results are in line with our findings that stroke-related health problems are often persistent and even worsened beyond the sub-acute phase and are particularly common within the non-motor symptoms of stroke.\u003c/p\u003e \u003cp\u003eLong-term risk factor control and adherence to recommended medications and guidelines are often suboptimal in routine healthcare.\u003csup\u003e21\u0026ndash;24\u003c/sup\u003e Reasons for lack of adherence include insufficient monitoring or treatment modifications/intensification when therapeutic response is not obtained, but also include patients making decisions about medications independently of their general practitioner, or prioritizing other aspects like quality of life rather than striving for treatment targets.\u003csup\u003e25\u0026ndash;28\u003c/sup\u003e Despite our targeted interventions regarding secondary prevention, results were discouraging. The reduction in patients presenting with high blood pressure from 49% at 3 months to 43% at 12 months was modest at best. Eighty percent of all patients were on antihypertensives at 12 months, implying that dose titration or intensification of treatment may be important challenges. Statin use was discontinued by 8% of patients between the two follow-ups, and 77% of baseline smokers still smoked at 12 months. Our intervention, which was an add-on to routine healthcare, did not include a doctor\u0026rsquo;s visit and did not have resources for continuous contact with the patient but served as a tool to identify problems. Thus, we had to rely on primary care to reach secondary prevention treatment targets. The rate of stroke recurrence was 7.5%. Some of these strokes might have been prevented by improved risk factor control. We acknowledge that use of our model alone for follow-up is insufficient for reaching long-term treatment targets. Primary care differs between countries, but patients are severely underserved in Sweden, which may affect patients with chronic diseases and regular follow-up needs. It could be argued that patients with stroke are best managed at a stroke clinic during the first important year post-stroke, but this warrants further study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThe strengths of this study include a consecutive cohort of patients with detailed data and a longitudinal design, allowing for analyses of changes over time. The study has numerous limitations. Firstly, the lack of a control group provides limited ability to analyze the effectiveness of our model compared to standard of care. An additional limitation is that follow-up was limited to patients that were discharged home. However, it should be taken into account that 75% of stroke patients in Sweden are discharged to home.\u003csup\u003e8\u003c/sup\u003e As home discharge represents the majority within the stroke population it is seemingly relevant to conduct a study on this population and the results applicable on a large scale. Another study assessing patients with severe strokes that were discharged to nursing homes found the PSC to be useful in that patient group.\u003csup\u003e29\u003c/sup\u003e Interestingly, the nature of stroke-related health problems differed markedly between patients discharged home and those discharged to nursing homes and ought to be studied separately. The follow-up rate was 77%. Patients lost to follow-up at 3 months were older, and the most common reason for study exclusion was declined function (9/34). Twelve patients were lost between 3 and 12 months, and the most common reason for discontinuing the study was declined need for continued follow-up. Home visits were not offered but might have prevented drop-out due to decline in function.\u003c/p\u003e \u003cp\u003eSingle blood pressure measurements, which are known to be less precise than 24-hour measurements, were used at 3 and 12 months and may have overestimated the prevalence of hypertension.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eStroke-related health problems decreased over time but were still experienced by two-thirds of patients 1 year after the stroke. Continuous stroke follow-up therefore remains highly relevant. The nurse-based follow-up model with stroke team support used in this study was feasible, but its use alone is insufficient to reach secondary prevention targets. With few modifications, we found the PSC to be feasible for longitudinal use and to capture stroke-related health problems during the first year. Further development of PSC-based follow-up models could focus on sustainable and intensified secondary prevention strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePost stroke checklist\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSNAPP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Sentinel Stroke National Audit Programme\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Statistical Classification of Diseases and Related Health Problems\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003emRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eModified Rankin Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAvailability for data and materials\u003c/h2\u003e\n\u003cp\u003eRequests to access an anonymized dataset supporting the conclusions of this article may be\u0026nbsp;sent to the corresponding author after obtaining the appropriate ethics approval.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis work was supported by with research grants from the Kamprad Family Foundation, the Bundy Academy, national ALF research funding, the Swedish Stroke Association, and Sparbanksstiftelsen F\u0026auml;rs och Frosta.\u003c/p\u003e\n\u003ch2\u003eEthical approval and consent to participate\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe ethics committee of Sweden approved this study (REC number: EPN LUND 2020/07148). Clinical studies Sweden managed all collected data. ClinicalTrials.gov ID: NCT04295226\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient(s).\u0026nbsp;Patients who were unable to sign their name due to stroke were allowed to use witness informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGuarantor\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKM\u003c/p\u003e\n\u003ch2\u003eAuthors contributions\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eTU, HPR, and KM researched literature and conceived the study. TU and HPR was involved in protocol development, gaining ethical approval (TU, HPR), patient recruitment (KM, TU, IB) and data analysis (KM, TU, IB, HPR). KM wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe would like to thank all participating patients and their next of kin for offering their time and trust to help us improve care for future patients. We would also like to thank Riksstroke for providing data, and occupational therapist Gerd Andersson for generously sharing her knowledge.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRajsic S, Gothe H, Borba HH, et al. Economic burden of stroke: a systematic review on post-stroke care. 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J Intern Med. 2021;289:355\u0026ndash;68. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/joim.13161\u003c/span\u003e\u003cspan address=\"10.1111/joim.13161\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKj\u0026ouml;rk EK, Gustavsson M, El-Manzalawy N, et al. Stroke-related health problems and associated actions identified with the post-stroke checklist among nursing home residents. BMC Cardiovasc Disord. 2022;22:50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12872-022-02466-3\u003c/span\u003e\u003cspan address=\"10.1186/s12872-022-02466-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"stroke, stroke prevention, stroke rehabilitation, outcome, quality of care, follow-up, modifiable stroke risk factors, complications","lastPublishedDoi":"10.21203/rs.3.rs-3876821/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3876821/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFew studies describe the use of the Post-Stroke Checklist (PSC) as a tool for longitudinal stroke follow-up in clinical practice. We mapped the prevalence of stroke-related health problems and targeted interventions at 3 and 12 months post-stroke by using the PSC.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePatients with acute stroke discharged home in 2018\u0026ndash;2019 at Sk\u0026aring;ne University Hospital, Sweden, were invited to participate in a comprehensive nurse-led follow-up based on a 14-item PSC 3 and 12 months post-stroke. We measured time consumption, screened for stroke-related health problems, compared the findings, and recorded targeted healthcare interventions. Problems at 12 months were grouped into new, persistent, or none compared to the 3-month evaluation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 200 consecutively included patients, 146 (77%) completed both the 3- and 12-month follow-ups. At 12-month follow-up, 36% of patients reported no stroke-related health problems, 24% reported persistent problems, and 40% reported new problems since the 3-month evaluation. New problems at 12 months were most common within the domains: \u003cem\u003esecondary prevention\u003c/em\u003e (23%) and \u003cem\u003elife after stroke\u003c/em\u003e (10%). Stroke recurrence rate was 7.5%, 43% had high blood pressure, and few smokers had quit smoking. At 12 months, 53% received at least one new healthcare intervention, compared to 84% at 3 months.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eStroke-related health problems decreased beyond 3 months but were still present in two-thirds of patients at 1 year. This emphasizes the relevance of continuous structured follow-up using the PCS. However, the follow-up alone was insufficient to adequately achieve treatment targets for secondary prevention, which require intensified focus.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eClinicalTrials.gov ID NCT04295226, (04/03/2020)\u003c/p\u003e","manuscriptTitle":"The Post-Stroke Checklist: longitudinal use in routine clinical practice during first year after stroke","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-21 18:09:02","doi":"10.21203/rs.3.rs-3876821/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvited","content":"","date":"2024-02-19T15:41:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-19T15:36:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2024-01-18T20:25:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4a2a8c22-90c7-4ddd-9522-af577932eb19","owner":[],"postedDate":"February 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-04T16:29:46+00:00","versionOfRecord":{"articleIdentity":"rs-3876821","link":"https://doi.org/10.1186/s12872-024-04239-6","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2024-10-29 16:20:38","publishedOnDateReadable":"October 29th, 2024"},"versionCreatedAt":"2024-02-21 18:09:02","video":"","vorDoi":"10.1186/s12872-024-04239-6","vorDoiUrl":"https://doi.org/10.1186/s12872-024-04239-6","workflowStages":[]},"version":"v1","identity":"rs-3876821","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3876821","identity":"rs-3876821","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}