Ebbesen Birgitte Hede, Modrau Boris, Rathleff Michael Skovdal, Johnsen Søren Paaske, Andreasen Jane
Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.
Department of Neurology, Aalborg University Hospital, Aalborg, Denmark.
J Clin Nurs. 2025 Apr;34(4):1420-1431. doi: 10.1111/jocn.17399. Epub 2024 Aug 11.
Fatigue, depression, anxiety and cognitive difficulties are reported by 1/3 of patients following transient ischemic attack (TIA).
To explore the timeline and how the diagnosis impacts individuals experiencing lasting challenges after TIA. Furthermore, to identify what they believed facilitated return to everyday life.
Qualitative exploratory study with a phenomenological-hermeneutic approach.
Individual semi-structured interviews and thematic analysis.
Fifteen patients were included. Four themes were identified; (1) 'They say it is transient - no, not for me' where all participants described lasting challenges emphasizing invalidating fatigue and impaired social participation, (2) 'I am a changed person; how does this impact my future?' which reflects altered identity and elevated alertness to symptoms, (3) 'Time has been my ally and new perspectives have evolved' where most participants described improvement over time and a few considered the diagnosis a wake-up call to change lifestyle. Lastly (4) 'What would have helped me recover?' which unfolds that close, trustful relations influence positively. In addition, the system often failed to support. Participants described pressure to return to work and lack of trust and negative experiences when involving their general practitioner.
During the 4 months since diagnosis, participants experienced limitations impacting physical, psychological and social domains. They felt uninformed that lasting challenges could affect them. Different coping strategies were activated, and participants with close, supportive relations managed better. A pressure to return to work and a lack of trust in the general practitioner affected their recovery negatively. Overall, return to everyday life after TIA was considered stressful and appropriate support lacking.
To be able to support patients with challenges following TIA, we as healthcare professionals need to understand the identified impact and life changing circumstances. Currently the system seemingly is not able to provide timely, sufficient and competent support.
IMPACT (ADDRESSING): WHAT PROBLEM DID THE STUDY ADDRESS?: We know from the literature that up to 1/3 of patients following transient ischemic attack experience lasting challenges measured on a variety of questionnaires. This is paradoxical to a diagnosis defined by focal neurological symptoms that resolve within 24 h. It is unknown how patients with lasting challenges experience the timeline from diagnosis and until 4 months after, how the diagnosis impacts the lives of these individuals, and what they believe as beneficial in returning to their everyday life. WHAT WERE THE MAIN FINDINGS?: These participants with self-reported lasting challenges experienced substantial impacts on physical, psychological and social domains. Further, they felt alone with their struggles and when in need of support from the healthcare system, it failed to provide this. A pressure to return to work and a lack of trust in the general practitioner affected return to everyday life negatively, whereas close and supportive relations facilitated positively. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This study will have an impact on the healthcare professionals that provide support and the (limited) follow-up services to patients after TIA. These healthcare professionals are often specialized nurses who need to know what these patients experience and need in order to act upon their struggles and provide timely support.
The Standards of Reporting Qualitative Research (SRQR).
Patients with TIA was involved in planning this study. They participated in a panel to plan a prospective observational cohort study and emphasized the importance of exploring the subjective perspectives of impact and prognosis for those patients struggling in a longer term (through qualitative interviews).
据报道，三分之一的短暂性脑缺血发作（TIA）患者会出现疲劳、抑郁、焦虑和认知困难。
探讨时间线以及诊断对经历TIA后长期面临挑战的个体的影响。此外，确定他们认为有助于回归日常生活的因素。
采用现象学诠释学方法的定性探索性研究。
个体半结构化访谈和主题分析。
纳入了15名患者。确定了四个主题；（1）“他们说这是短暂的——不，对我来说不是”，所有参与者都描述了长期面临的挑战，强调了使人无效的疲劳和社会参与受损，（2）“我变成了一个不同的人；这对我的未来有何影响？”，这反映了身份的改变和对症状的更高警觉，（3）“时间是我的盟友，新的观点已经形成”，大多数参与者描述随着时间推移有所改善，少数人认为诊断是改变生活方式的警钟。最后（4）“什么能帮助我康复？”，这表明亲密、信任的关系有积极影响。此外，系统常常未能提供支持。参与者描述了重返工作岗位的压力以及在联系全科医生时缺乏信任和负面经历。
在诊断后的4个月里参与者经历了影响身体、心理和社会领域的限制。他们觉得未被告知长期挑战可能会影响他们。他们启动了不同的应对策略，有亲密支持关系的参与者应对得更好。重返工作岗位的压力和对全科医生缺乏信任对他们的康复产生了负面影响。总体而言，TIA后回归日常生活被认为压力很大且缺乏适当支持。
为了能够支持TIA后面临挑战的患者，作为医疗保健专业人员，我们需要了解已确定的影响和改变生活的情况。目前，该系统似乎无法提供及时、充分和有效的支持。
影响（解决的问题）：该研究解决了什么问题？：我们从文献中了解到，高达三分之一的短暂性脑缺血发作患者在各种问卷调查中存在长期挑战。这与由在24小时内缓解的局灶性神经症状所定义的诊断相矛盾。尚不清楚长期面临挑战的患者如何体验从诊断到之后4个月的时间线，诊断如何影响这些个体的生活，以及他们认为在回归日常生活中哪些因素有益。主要发现是什么？：这些自我报告存在长期挑战的参与者在身体、心理和社会领域受到了重大影响。此外，他们在挣扎中感到孤独，当需要医疗保健系统的支持时，该系统未能提供。重返工作岗位的压力和对全科医生缺乏信任对回归日常生活产生了负面影响，而亲密和支持性的关系则有积极促进作用。该研究将对哪些人产生影响？：这项研究将对为TIA后患者提供支持和（有限的）后续服务的医疗保健专业人员产生影响。这些医疗保健专业人员通常是专科护士，他们需要了解这些患者的经历和需求，以便应对他们的挣扎并提供及时支持。
定性研究报告标准（SRQR）。
TIA患者参与了本研究的规划。他们参加了一个小组，以规划一项前瞻性观察队列研究，并强调了探索那些长期挣扎的患者的主观影响和预后观点（通过定性访谈）的重要性。
