The application of a stroke cognitive pathway across a county: An exploration of current clinical practice
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Introduction: The 'Accelerating Stroke Improvement Programme' calls for specialist expertise and competence in the assessment, treatment and monitoring of patients with cognitive disturbance. Occupational therapists and clinical psychologists from Nottinghamshire collaborated with a regional special interest group to develop a cognitive pathway for use across acute and community settings. The standardised pathway identifies a toolkit of appropriate assessments and suggests at what point they should be administered. Method: To explore local current practice in the assessment and treatment of cognition, an online survey (developed and supported by National Institute of Health Research, Collaboration for Leadership in Applied Health Research and Care -Nottinghamshire, Derbyshire and Lincolnshire, NIHR CLAHRC-NDL) was distributed to 58 practitioners across Nottinghamshire. The survey was live for six weeks, and required respondents to complete an online questionnaire (www.surveymonkey. com), using open and closed questions. Results: Out of 28 respondents, the preferred cognitive assessment mechanisms were function (96.1%), standardised assessment (88.5%) and observation (84.6%). 22 standardised and non-standardised assessments were identified, with 75% of respondents choosing the Montreal Cognitive Assessment as their local favoured assessment. Less than half (42.9%) of the respondents had had formal training in the use and interpretation of cognitive assessments. Conclusion: Despite there being locally preferred cognitive assessments, practitioners rely on using a wide range and type of assessments, selected on their perceived appropriateness and their own clinical experience. Indicators for use of a formal assessment were diverse and often arbitrary. Further training is required to support the recommendations and implementation of the cognitive pathway.