title: Development of a patient-centred, patient-reported outcome measure (PROM) for post-stroke cognitive rehabilitation: qualitative interviews with stroke survivors to inform design and content.
abstract: BACKGROUND
  Improving cognition is service users' top research priority for life after stroke, and future research should include outcomes that they deem important. Patient perspectives on outcomes are collected using patient-reported outcome measures (PROMs). There is currently no patient-centred PROM specific for cognitive rehabilitation trials.
  
  
  OBJECTIVE
  Inform PROM development by exploring stroke survivor perspectives on the important, measurable impacts of persisting post-stroke cognitive problems.
  
  
  METHODS
  Qualitative semi-structured interviews in participants' homes.
  
  
  METHODS
  Purposive sample of 16 cognitively impaired stroke survivors at least six months post-stroke.
  
  
  METHODS
  Interviews used a schedule and communication aids developed through patient consultation. Interviews were transcribed verbatim with non-verbal communication recorded using field notes. Data were analysed using a framework approach to find commonalities to shape the focus and content of an outcome measure.
  
  
  RESULTS
  Participants identified important impacts of their 'invisible' cognitive problems, outside of other stroke-related impairments. Cognitive problems exacerbated emotional issues and vice versa. Changes in self-identity and social participation were prominent. Impact was not spoken about in terms of frequency but rather in terms of the negative affect associated with problems; terms like 'bothered' and 'frustration' were often used.
  
  
  CONCLUSIONS
  The results support the development of a PROM specifically designed to address the impact of cognitive problems. It should: include items addressing a comprehensive range of cognitive skills; ask questions about mood, self-identity and social participation; use accessible wording that respondents understand and endorse; measure impact rather than frequency; and explore perceived impact on carers.
authors.affiliation: School of Psychological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Patchick
authors.affiliation: School of Nursing, Faculty of Health Studies, University of Bradford, Bradford, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Horne
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Woodward-Nutt
authors.affiliation: Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Vail
authors.affiliation: Stroke Research, School of Psychological Sciences, University of Manchester, Manchester Academic Health Science Centre, CSB, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Audrey
authors.initials: A
authors.lastname: Bowen
mesh_terms: D000328:Adult; D003072:Cognition Disorders; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D018802:Patient-Centered Care; D036301:Qualitative Research; D020521:Stroke / Q000523:psychology; D000071939:Stroke Rehabilitation; D017741:Survivors
keywords: cognition; patient-centred; patient-reported outcome measure; psychometrics; qualitative; stroke