Acute assessments in stroke care: clinical guidance on cognitive testing, patients’ perceptions, and accuracy of diagnostic scoring systems

McMahon, David J. (2024) Acute assessments in stroke care: clinical guidance on cognitive testing, patients’ perceptions, and accuracy of diagnostic scoring systems. MD thesis, University of Glasgow.

Abstract

The thesis describes three complementary projects each of which were designed to allow me to develop differing research skills, comprising evidence synthesis, qualitative and quantitative techniques.

In the first project, I performed an analysis of clinical practice guidelines (CPGs) describing recommendations around cognitive assessment in stroke. I compared the content and strength of CPG recommendations. I found there to be limited guidance for clinicians around assessing cognition in stroke.

In the second project, I used qualitative techniques to assess interviews with thirteen stroke survivors. I considered the factors that influenced acceptability of cognitive assessments through the lens of the theory of acceptability (TFA). Using the TFA as a framework, this process yielded five themes that described the factors that influence acceptability of cognitive screening from the patient perspective. These were 1) participation motives; 2) trust in health professionals; 3) perceived risks of harm; 4) information provision; & 5) burden of testing.

In the final project, I assessed the diagnostic test accuracy of clinical scoring systems used to identify stroke. The scoring systems assessed were: ROSIER (Recognition of Stroke in the Emergency Room score) score, ABCD2 score, Dawson score and the DOT (Diagnosis of TIA) score. I described and compared sensitivity, specificity, area under the curve; and positive and negative predictive values for each of these assessment tools. I found that no tool was perfectly suited to stroke assessment, albeit the Dawson score had higher accuracy metrics than other tools.

In the discussion section I summarise the main issues and points arising from these three projects and consider overall conclusions and implications for future research. In particular, I explore how CPG development and validation of tests need to consider issues such as acceptability of the tool to the patients in whom the guidance or assessment is intended to be used. Finally, I offer a biography of myself, to explain why I chose the themes explored in this thesis; as well as providing context and clarity for the later areas of discussion. I will describe my progression into homelessness health care, and the relevant and inter-related issues of stroke and cognitive impairment within homeless people.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Subjects: Q Science > QP Physiology; R Medicine > R Medicine (General)
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Supervisor's Name: Quinn, Professor Terry, Dawson, Professor Jesse and Gallacher, Dr. Katie
• Date of Award: 2024
• Depositing User: Theses Team
• Unique ID: glathesis:2024-84198
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 03 Apr 2024 12:08
• Last Modified: 03 Apr 2024 12:11
• Thesis DOI: 10.5525/gla.thesis.84198
• URI: https://theses.gla.ac.uk/id/eprint/84198

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