International Research Team Examines Cross-cultural Issues in Stroke

The Harvey A. Friedman Center for Aging at the Institute for Public Health is developing a Global Aging Initiative with the McDonnell International Scholars Academy partner institutions. The Friedman Center for Aging has funded ten proposals to support collaborations that will advance cross-national research and education on older adults, later life, and aging societies. Each collaboration team includes one or more faculty from Washington University and one or more faculty from a McDonnell Academy partner institution.

Carolyn Baum, PhD, OTR, FAOTA, is the principal investigator on one of the proposals, Cross-cultural Issues in Stroke: Policy, Population, and Clinical Comparisons. Her co-investigators include Leeanne Carey, PhD, BAppSc (OT), FAOTA, from Australia and Gerald Koh, MBBS, MMed, MGer, PhD, from Singapore. Both traveled to the St. Louis for a week-long collaboration with Dr. Baum and emerging researchers Timothy Wolf, OTD, MSCI, OTR/L, Juan Pablo Saa, OTD ’16 and MPH '16, post-doctorate scholar Cynthia Chen, from the National University of Singapore, and Tamara Tse, OT, PhD, from the Florey Institute, University of Melbourne.

Baum and Koh met at the 20th International Association of Gerontology and Geriatrics (IAGG) World Congress of Gerontology and Geriatrics held in Seoul, Korea, in June 2013. At the congress, the McDonnell International Scholars Academy held a symposium after which Baum and Koh discussed their mutual interest in stroke rehabilitation and identified a research project they could collaborate on.

“We wanted to examine data sets of stroke populations in Australia, Singapore and the United States to describe recovery in acute and post-acute settings,” Koh explains. Baum spearheaded the grant proposal, which she worked on with Koh and Carey. “Once we received funding, we began looking at three data sets – the national stroke registries in Australia and Singapore and a stroke registry built with funds through the James S. McDonnell Foundation and includes nearly 18,000 stroke survivors in southern Illinois and eastern Missouri. The registries have given the research team data on approximately 80,000 stroke survivors over a 15-year period.”

The team also have access to detailed cohort data on stroke survivors over the first 12-18 months after stroke. Through their cohort studies, they have in-depth data on more than 1,250 stroke survivors. Having access to such a broad base of outcomes allows the researchers to examine the survivors’ needs and use of services.

“Looking at the outcomes during acute treatment, three months, and 12 months after stroke will allow us to map out what the time compatibilities are, what the variables are, and what is common across them,” Carey explains. “This gives us new and regional insights into what is happening within the context of our different health care systems, and the in-depth data allows us to look at the life journey of the stroke survivor. Based on both types of data sets, we will be able to formulate and answer questions such as what is the profile of a stroke survivor and how has it changed from 15 years ago. ”

The cross-country comparisons on such an individual level are also enabling the researchers to see common trends emerging. “By having the ability to compare and contrast data across the three countries during an extended time span, we are able to see the differences in our health systems, the effect of having access to stroke rehabilitation services, and how variables like environment, geographical location, and ethnicity factor in,” Koh says.

The team is also committed to viewing the data through a shared lens to determine the quality of life of stroke survivors. “Compared to 15 years ago, people are experiencing more mild strokes and are living longer. The National Stroke Foundation in Australia recently conducted a wide scale survey in which 700 stroke survivors identified their needs. They are reporting issues that do not emerge at the acute care point such as fatigue, memory loss, pain, and cognitive impairments. The stroke survivors are being discharged from the hospital because they can speak and move, but due to these (unrecognized) issues, they may not be able to return to their daily lives. Specific assessments are needed to identify the services the stroke survivors would benefit most from,” Tse explains.

“Assessments can help health care providers look at quality of life based on what the stroke survivor defines as meaningful and valuable to them. Currently, not all providers have access to these assessments to better address the survivor’s unmet needs,” says Saa, who is currently pursuing a dual degree in occupational therapy and public health.

Having insight into the unmet needs through the cohort studies allows the collaborating team to explore new ways to bridge the service gaps for the stroke survivor to return to a productive lifestyle that has value to them while improving health through engagement and participation. The researchers hope evidence from their study will help advocate for policy change and health care reform.

“Stroke rehabilitation needs to come to the forefront of public policy and it’s only through global initiatives such as this that allow researchers to take big steps forward to one day enabling policy change,” Koh says.

Pictured left to right (back row, standing): Cynthia Chen, Gerald Koh, MBBS, MMed, MGer, PhD, Timothy Wolf, OTD, MSCI, OTR/L, Juan Pablo Saa, OTD/S ’16, and Tamara Tse, OT, PhD. Pictured left to right (front row, seated) Carolyn Baum, PhD, OTR, FAOTA,, and Leeanne Carey, PhD, BAppSc (OT), FAOTA.

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