Long term weight gain following stroke : exploring incidence and explanations

Stroke is the leading cause of long term disability and third leading cause of death (Curioni et al, 2009). Survival rates are increasing. Approximately 900,000 people in England live with the effects of a stroke (NICE 2010). Health behaviour modification can be crucial in stroke rehabilitation and in avoiding long term impairment. Consultation with stakeholders identified increased numbers of patients experiencing long term weight gain following a stroke.

This study aims to explore i) the existence of weight gain following a stroke ii) factors contributing to weight gain and iii) implications for the stroke rehabilitation pathway.

A mixed method study incorporating i) a survey of South Yorkshire Health Cohort participants (n=87); ii) interviews with staff (n=18) and stroke patients (n=10). Data were analysed using framework analysis methods.

Across the care pathway inconsistencies exist in the recognition that weight gain is an issue for patients post stroke. The findings draw on components of the Theory of Integrated Care (Kodner & Spreeuwenberg, 2002). Applying the theory to the findings provides a means to explain how patients may become lost across the different aspects of the stroke care pathway. Fragmented communication between health care professionals across the pathway limits opportunities to address the risks and realities of weight gain. Ambiguity arises for patients because weight gain following a stroke can be both a sign of progress and of a problem.

Individualising care and integration of weight management advice across the whole pathway (acute, community and primary care settings) may prevent weight gain in stroke survivors.