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Experiences and illness perceptions of patients with functional symptoms admitted to hyper acute stroke wards: a mixed methods study

Research output: Contribution to journalArticle

Nicola O'Connell, Abbeygail Jones, Trudie Chalder, Antony David

Original languageEnglish
JournalNeuropsychiatric Disease and Treatment
Publication statusAccepted/In press - 7 Jul 2020

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Abstract

Introduction
A proportion of patients admitted to acute stroke settings do not have stroke but have conditions mimicking stroke. Approximately 25% of suspected stroke cases are ‘stroke mimics’ and 2% of all suspected stroke are patients with functional symptoms, ‘functional stroke mimics’ (FSMs). This study aimed to explore experiences and illness perceptions of patients with functional symptoms admitted to hyper acute stroke wards.
Methods
This study used mixed methods. Patients with functional stroke symptoms participated in semi-structured qualitative interviews immediately after admission to one of two acute stroke units in London and again two months after hospital discharge. Qualitative data were assessed using thematic analysis. The Brief Illness Perception Questionnaire (Brief-IPQ) measured illness perceptions at admission and at two-month follow-up.
Results
Thirty-six participants completed baseline interviews and 25 completed follow-ups. Six themes emerged: (1) physical symptom experience; (2) emotional and coping responses; (3) symptom cause; (4) hospital experiences; (5) views on the future; and (6) uncertainty after hospital discharge. The mean Brief-IPQ score at admission was 49.3 (SD: 9.9) indicating a moderate-to-high level of perceived illness threat. Participants presented with a range of functional symptoms. At baseline, participants were highly concerned about their symptoms, but this decreased at two-month follow-up. Two months later, many were confused as to the cause of their admission.

Conclusion
This is the first study to examine functional stroke patients’ experiences of acute stroke admission. At admission, patients expressed confusion regarding their diagnosis and experienced high levels of emotional distress and were concerned they were perceived as time-wasting by stroke clinicians. While most participants experienced symptom recovery, there was a significant sub-group for whom symptoms persisted or worsened. A lack of care guidelines on the management of functional stroke patients may perpetuate functional symptoms.

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