Impact of quality improvement strategies on the quality of life of individuals post-stroke: a systematic review

Abstract

Purpose: The purpose of this systematic review was to synthesize and appraise the evidence regarding the impact of quality improvement strategies on quality of life as well as physical and psychological well-being of individuals with stroke.

Materials and methods: Studies were identified by searching MEDLINE (OVID interface, 2000 onwards), CINAHL (EBSCO interface, 2000 onwards), EMBASE (OVID interface, 2000 to present), and PsycINFO (OVID interface, 2000 onwards). The Effective Practice and Organization of Care Risk of Bias Tool was applied. Extracted data from the publications included: study characteristics, participant characteristics, the strategy characteristics, the outcomes, and quality appraisal.

Results: Our review identified 12 trials that utilized only 4 of the 10 quality improvement strategies included in this review. The most common quality improvement strategy was self-management. Other studies included patient education, team changes, and case management. Only 5 of the 12 studies reported statistically significant improvements in some component of quality of life.

Conclusions: There is a lack of evidence to demonstrate efficacy/effectiveness of patient education, self-management, team changes, and case management approaches on improving the quality of life of stroke survivors. Identifying the essential features of effective and ineffective strategies, especially in the area of self-management strategies would be beneficial.

Implications for rehabilitation

• There is a lack of evidence to demonstrate efficacy/effectiveness of patient education, self-management, team changes, and case management approaches on improving the quality of life of stroke survivors.

• To improve these outcomes, there may be a need to co-create/tailor quality improvement interventions with patients, their caregivers, and providers.

• The impact of a broader range of quality improvement interventions, including clinician education and patient reminder systems, on quality of life post-stroke should be considered.

Keywords:

• Stroke
• quality improvement
• knowledge translation
• quality of life
• systematic review

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The first author (concealed for review) has previously received support from a Heart and Stroke Foundation of Canada Focus on Stroke Fellowship, the Toronto Rehabilitation Institute-University Health Network, a Canadian Institutes of Health Research Fellowship and a European Stroke Research Foundation Investigator Award, and Systematic Review Registration: PROSPERO database (CRD42017064141).