Agreement between patients and nurses of neurobehavioral disability following stroke in an inpatient rehabilitation setting

Abstract

Purpose: To investigate the level of agreement of neurobehavioral disability following stroke.

Methods: Stroke patients and nurses were recruited from an inpatient neurorehabilitation facility. In total, 58 stroke patient–nurse pairs completed the St Andrew’s–Swansea Neurobehavioral Outcome Scale questionnaire.

Results: Agreement levels of neurobehavioral disability varied across five behavior subdomains. Cognition and Interpersonal behaviors were reported as more prevalent according to nurses (39% and 36%) versus patients (14% and 7%). Agreement levels between the two groups was fair for these domains (ICC <0.60). Percentage category agreement methods revealed high patient–nurse agreement for Communication, Inhibition, and Aggression behaviors but overall reporting of these problems was very low or absent. Patient demographics and stroke variables did not predict the pattern of results. Lower patient–nurse agreement was moderately associated with older age (r_s = 0.37, p = 0.01) and increased experience of nurse (r_s = 0.38, p = 0.01) but only for the Cognition-related domain. Agreement of impact of neurobehavioral disability was none to slight for both groups across all neurobehavioral domains (κ <0.20).

Conclusions: Neurobehavioral disability is common in the early recovery phase after stroke and is viewed differently with regards to frequency, type, and impact between patients and their nurses. Research and clinical training in the management of stroke-related neurobehavioral disability is required.

Implications for rehabilitation

• Neurobehavioral disability (NBD) following stroke is commonly seen in the early stages of recovery and requires careful evaluation by stroke survivors and rehabilitation staff.

• Many patients may disagree with their clinician that they are exhibiting NBD, which may compromise the therapeutic relationship.

• We need to better understand factors underlying lower reporting of NBD by patients (denial or reduced self-awareness) to help guide management in stroke rehabilitation settings.

Keywords:

• Stroke
• rehabilitation
• behavior
• cognition
• inpatients

Acknowledgments

The authors thank the contributions of the following research assistants and students who assisted with data collection: Cameron Redpath, Holly McManus, Jamie Byrne, Megan O’Neill, and Tiffany Low. The authors also thank Katrina Hidalgo (Nurse Unit Manager) for her support for this project, and all the nursing staff who completed the SASNOS.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Lions John Cockayne Memorial Fellowship Trust Fund.