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. 2023 Sep 22:14:1241391.
doi: 10.3389/fneur.2023.1241391. eCollection 2023.

Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes

Luca Tarantini  1   2   3 , Fatma Merzou  3 , Maxine Luley  3 , Aline Rollmann  3 , Michael Peter Schwindling  3 , Martin Lesmeister  3 , Marietheres Gläss  3 , Jennifer Wollenburg  3 , Lenka Schwindling  3 , Klaus Fassbender  3
Affiliations

Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes

Luca Tarantini et al. Front Neurol. .

Abstract

Background: Until recently, public education campaigns aimed at improving help-seeking behavior by acute stroke patients have achieved only limited or even no effects. Better understanding of psychological factors determining help-seeking behavior may be relevant in the design of more effective future campaigns.

Methods: In this prospective, cross-sectional study, we interviewed 669 acute stroke patients within 72 h after hospital admission. The primary endpoint was the effect of psychological factors on the decision to call emergency medical services (EMS). Secondary endpoints were the effects of such factors on treatment rates and clinical improvement (difference between modified Rankin scale (MRS) scores at admission and at discharge).

Results: Only 48.7% of the study population called the EMS. Multivariate logistic and linear regression analyses revealed that perception of unimpaired performance of activities of daily living (ADL) was the only psychological factor that predicted EMS use and outcomes. Thus, patients who perceived only minor impairment in performing ADL were less likely to use EMS (odds ratio, 0.54 [95% confidence interval, 0.38-0.76]; p = 0.001), had lower treatment rates, and had less improvement in MRS scores (b = 0.40, p = 0.004). Additional serial mediation analyses involving ischemic stroke patients showed that perception of low impairment in ADL decreased the likelihood of EMS notification, thereby increasing prehospital delays, leading to reduced thrombolysis rates and, finally, to reduced clinical improvement.

Conclusion: Perception of unimpaired performance of ADL is a crucial barrier to appropriate help-seeking behavior after acute stroke, leading to undertreatment and less improvement in clinical symptoms. Thus, beyond improving the public's knowledge of stroke symptoms, future public education campaigns should focus on the need for calling the EMS in case of stroke symptoms even if daily activities do not seem to be severely impaired.

Keywords: emergency medical service (EMS); help-seeking; prehospital; psychological; public education; stroke.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CONSORT, Consolidated standards of reporting trials.
Figure 2
Figure 2
Full serial mediation model. The full serial mediation model shows that perceptions of impaired activities of daily living (ADL) lead to a higher likelihood of EMS use, which in turn decreases prehospital delay times and increases the likelihood of thrombolytic treatment leading to higher modified Rankin scale score improvement [indirect path 1, a × b × c × d (solid lines)]. *Indicates confidence interval different from zero. EMS, Emergency Medical Services.
See this image and copyright information in PMC

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