Introduction: Management of cognition is an essential component of post-stroke rehabilitation; however, adherence to best-practice clinical guidelines remains inconsistent and stroke survivors continue to identify cognition as a longstanding unmet need. The aim of the current study was to better understand how health professionals address cognition with people post-stroke across the spectrum of care, the barriers and facilitators to following perceived best practice, and proposed strategies to better address cognition across contexts and the recovery journey.
Methods: 20 Australian health professionals from various disciplines and settings were purposively recruited. Semi-structured interviews were conducted individually, and transcripts were analysed using framework analysis. Identified barriers and facilitators were organised according to the COM-B model of behaviour change.
Results: Addressing cognition was identified as a process involving five stages: 1) ‘Inform’ staff and services on addressing post-stroke cognition, 2) ‘Initiate’ relevant stage(s) to address cognition, 3) ‘Identify’ cognitive changes, 4) ‘Investigate’ cognitive changes, and 5) ‘Intervene’ with cognitive changes. Each stage was composed of distinct behaviours, but current practice varied depending on health professional skills and awareness (Capability), confidence to address cognitive difficulties (Motivation), and the availability of resources to do so (Opportunity).
Conclusions: Significant variability and unique enablers and barriers to best-practice cognitive management were identified across settings. Opportunities to improve cognitive management practices were identified including dedicated training and procedures, stepped-care models, strategic access to cognitive expertise, and interdisciplinary practice models. Further research is required to understand the feasibility and effectiveness of these approaches to improve outcomes for people with stroke.
Relevance to clinical practice: Health professionals can use these findings to identify gaps in care and create and integrate relevant training, assessment, and intervention procedures to improve how cognition is addressed within their unique settings, with the goal of enhancing patient outcomes.