LUNS - Longer-term Unmet Needs after Stroke.
Introduction
Stroke patients may experience a range of longer-term problems affecting physical, social and mental well-being. There is currently no available measure that provides a ‘good fit’ across all of these outcome domains in the special context of longer-term stroke care. Through literature reviews, preliminary psychometric testing, expert peer review and consumer feedback we have developed a patient-centred, clinical monitoring tool to measure longer-term unmet needs after stroke (LUNS). In a pilot study, the 21-item LUNS was shown to have adequate postal reliability and validity against the Nottingham extended activities of daily living scale (NEADL) and the hospital anxiety and depression scale (HADS). Qualitative semi-structured interviews were then used to further refine five items and add an extra item. The reliability, validity and acceptability of the resulting 22-item LUNS has now been evaluated in a larger multi-centre study. The LUNS questionnaire is also included in the questionnaire pack of the system of care trial.
Methods
The study recruited patients in two phases in approximately 40 stroke units across England.
First Phase (n=350): Patients who have suffered a new stroke event, do not have cognitive impairment or aphasia, are able to read and understand English, likely to be discharged to their own homes, and able to provide written informed consent, were recruited to the study. An assessment pack containing the LUNS, General Health Questionnaire-12, the Frenchay Activities Index and the Short Form-12 (v2) was posted to the participating patients between three and six months post-stroke. A second identical assessment pack was administered approximately one week after completion of the first. The psychometric properties of the LUNS tool were assessed and shown to be acceptable in this group of patients before proceeding to the second phase.
Second phase (n=500): Study procedures and entry criteria were as above with the exception that the following patients were also included and proxy responses were allowed: patients who have cognitive impairment or aphasia, cannot read and understand English but have a carer who can read and understand English, or lack capacity to provide informed consent but have a carer who can provide assent.
Current Progress
Recruitment for Phase 1 took place from December 2008 to May 2009 and for Phase 2 from February 2010 to January 2011. In total 850 patients were recruited; 651 with normal cognition and communication and English speaking (“normal communication” group) and 199 with impaired cognition or communication or non-English speaking (“impaired communication” group). Acceptability, validity and test-retest reliability of LUNS22 has been assessed to determine its suitability as a monitoring tool for identifying the number and types of longer-term unmet needs after stroke.
Provisional results of the LUNS study were presented at UK Stroke Forum 2011 (International Journal of Stroke, 2011, 6 (suppl 2), 3), and the publication is in preparation.
We are currently carrying out further analyses of the data to investigate whether LUNS is suitable to be used as an outcome measure of longer term unmet need, for example to measure the level of longer term unmet need before and after an intervention.
If you are interested in using LUNS22 or would like more information on the LUNS study, please send us an e-mail at lunsadmin@bthft.nhs.uk or alternatively our address and telephone number are available here. |