Focus on Quality of Neurology and Stroke Care for Patients

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Healthcare Quality, Patient Safety, and Self-care Management".

Deadline for manuscript submissions: 15 January 2027 | Viewed by 3795

Editor


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Guest Editor
1. Department of Pharmacology and Toxicology, University of Zielona Gora, 65-001 Zielona Góra, Poland
2. Elderly and Stroke Medicine, Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK
Interests: neurology; stroke; care
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Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to this Special Issue on the topic of the quality of neurology and stroke care. Thanks to ongoing progress in new pharmacotherapy options, more effective treatment is being achieved. We will discuss  a number of neurological conditions, including stroke. Unfortunately, there are still some conditions with limited treatment options. In both groups of ailments, in contrast to medication alone, the quality of care seems to frequently be even more important.

This Special Issue will address the management of neurological conditions in both outpatient and inpatient settings. Many neurological conditions are chronic or lead to long-term psychomotor disabilities. Key issues include access and ability to work, the availability of social care, rehabilitation, psychotherapy, dietary support, speech therapy, medical follow-ups, and specialized treatments such as cardiology or spasticity management.

For hospitalized patients, the quality of care is particularly dependent on access to hospital facilities and specialized services, such as epilepsy centres or advanced Parkinson’s disease treatment units. Special attention must also be given to acute phase treatment in stroke, as the quality of care directly impacts patient outcomes. Proper stroke treatment requires immediate access to stroke centres providing thrombolysis and access to mechanical thrombectomy centres.

This topic also encompasses quality-of-care aspects within hospitals, including proper nutrition, diagnostic procedures, and the prevention of complications such as deep vein thrombosis, pressure sores, deconditioning, delirium, and falls. Quality of care also refers to end-of-life pathways. Multiple factors influence the quality of care in neurological conditions, all of which significantly affect patient outcomes.

This Special Issue will highlight current challenges and promising solutions to enhance the quality of care for this patient group.

For this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

  • Access to stroke centres providing thrombolysis and mechanical thrombectomy;
  • Comprehensive quality care for stroke patients;
  • Additional aspects of hospitalization, such as rehabilitation, feeding, the prevention of complications, delirium, deconditioning, falls, and end-of-life care; 
  • Access to in- and outpatient services, such as rehabilitation, spasticity treatment, psychiatric treatment, a dietitian, and psychological and speech therapy;
  • Post-discharge care for stroke patients;
  • The ability to continue working and access to occupational health support;
  • Access to diagnostic procedures and medical facilities for diagnosing neurological conditions;
  • Access to, and organization of, specialized neurological centres in different countries;
  • Inequalities in access to neurological clinics and hospitals.

I look forward to receiving your contributions.

Dr. Dariusz Kotlȩga
Guest Editor

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Keywords

  • ischemic stroke
  • thrombolysis
  • thrombectomy
  • neurology
  • care
  • rehabilitation
  • nutrition

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Published Papers (3 papers)

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Research

17 pages, 1273 KB  
Article
Depressive and Anxiety Symptoms Predict Health-Related Quality of Life More than Cognitive Impairment After Minor Stroke or Transient Ischemic Attack: A Hierarchical Regression Analysis
by María Rocío Córdova-Infantes and José María Ramírez-Moreno
Healthcare 2026, 14(7), 948; https://doi.org/10.3390/healthcare14070948 - 4 Apr 2026
Viewed by 1013
Abstract
Background: Transient ischemic attack (TIA) and minor stroke often result in excellent functional recovery but are frequently followed by substantial psychological morbidity. It remains unclear whether mood disturbances or cognitive impairment are the primary contributors to reduced health-related quality of life (HRQoL) in [...] Read more.
Background: Transient ischemic attack (TIA) and minor stroke often result in excellent functional recovery but are frequently followed by substantial psychological morbidity. It remains unclear whether mood disturbances or cognitive impairment are the primary contributors to reduced health-related quality of life (HRQoL) in this population. Methods: We conducted a prospective observational case–control study including 90 patients with acute TIA or minor stroke confirmed by diffusion-weighted imaging and 92 age-matched healthy controls. At 90 days, participants completed the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Montreal Cognitive Assessment, and the EQ-5D-5L. Hierarchical multiple regression using standardized z-scores identified independent predictors of HRQoL. Bias-corrected bootstrapped mediation analyses (5000 iterations) assessed whether cognitive impairment mediated the relationship between mood symptoms and HRQoL. Results: Compared with controls, patients exhibited markedly higher rates of depressive symptoms (82.2% vs. 18.5%), anxiety symptoms (81.1% vs. 21.7%), and cognitive impairment (66.7% vs. 13.0%) (all p < 0.001). Psychopathological variables explained an additional 36.6% of HRQoL variance, whereas cognitive and neuroimaging variables contributed only 1.7% (ΔR2 = 0.017; p = 0.523). In the fully adjusted regression model, HAM-A showed the numerically largest standardized coefficient (β = −0.055; p = 0.064), representing a trend toward significance, while HDRS-17 did not individually reach statistical significance (β = −0.043; p = 0.147); cognitive impairment had negligible independent effects (β = −0.001; p = 0.947). Both mood variables collectively accounted for the substantial majority of explained HRQoL variance, far exceeding the contribution of cognitive and neuroimaging predictors. Mediation analyses revealed no significant indirect effects, indicating that mood and cognitive complications are statistically consistent with a model in which mood and cognitive symptoms exert independent effects on HRQoL; temporal ordering cannot be established from these cross-sectional measures. Conclusions: Following TIA or minor stroke, depressive and anxiety symptoms are highly prevalent, persist despite good neurological recovery, and exert a disproportionately negative impact on HRQoL. Anxiety appears particularly influential in determining patient-reported outcomes. The statistical consistency of the mediation models with parallel rather than sequential mood–cognition pathways suggests that these represent independent neurobiological sequelae requiring separate clinical attention, underscoring the need for routine and concurrent assessment of both mood and cognitive function after TIA and minor stroke. Full article
(This article belongs to the Special Issue Focus on Quality of Neurology and Stroke Care for Patients)
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18 pages, 540 KB  
Article
Aphasia Rehabilitation in India: Current Practices and Future Directions
by Sunil Kumar Ravi, Sai Samyuktha Vachavai, Saraswathi Thupakula, Irfana Madathodiyil, Vijaya Kumar Narne, Krishna Yerraguntla, Abdulaziz Almudhi, Deepak Puttanna and Abhishek Budiguppe Panchakshari
Healthcare 2026, 14(4), 434; https://doi.org/10.3390/healthcare14040434 - 9 Feb 2026
Viewed by 971
Abstract
Background/Objectives: The Speech-Language Pathologists (SLP) are an integral part of the multidisciplinary team approach to rehabilitation of persons with aphasia (PWA). However, the efficacy of treatment provided by SLPs can vary due to several factors related to clinicians, patients, and the availability of [...] Read more.
Background/Objectives: The Speech-Language Pathologists (SLP) are an integral part of the multidisciplinary team approach to rehabilitation of persons with aphasia (PWA). However, the efficacy of treatment provided by SLPs can vary due to several factors related to clinicians, patients, and the availability of services. The present study was conducted with the aim of investigating current practices in aphasia rehabilitation, key challenges, and future directions as perceived by the SLPs in the Indian context. Methods: The study was conducted using a web-based survey comprising a 32-item questionnaire to gather information related to demographic and professional details, knowledge and use of aphasia rehabilitation approaches, patient education, counselling, bilingual & multilingual contexts, and challenges faced by SLPs. A total of 142 responses were analyzed after initial screening to assess the knowledge, use, and confidence of aphasia rehabilitation along with challenges faced by SLPs in the Indian context. Results: The results indicated significant challenges in the assessment of aphasia due to a lack of formal screening and diagnostic languages in several languages. Further, the results also indicated variations in the knowledge level and confidence in the use of various approaches to aphasia rehabilitation, which warrants the urgent need for organizing short-term training programs for SLPs. The participants also self-reported significant challenges in managing bilingual and multilingual patients with aphasia due to differences in their knowledge and confidence in the selection of language for treatment. On the other side, major patient-related challenges include inadequate logistics, lack of funding, unavailability of speech and language therapy services, social acceptance, and support from family members. The participants also reported the necessity of improving tele-rehabilitation services and developing materials and mobile apps for rehabilitation in Indian languages as future directions for aphasia rehabilitation. Conclusions: The present study through a self-reported questionnaire identified key challenges in aphasia rehabilitation related to the clinician and PWA in the Indian context. The results of the study warrant the need for immediate action to overcome the challenges to enhance the rehabilitation services to PWAs. Full article
(This article belongs to the Special Issue Focus on Quality of Neurology and Stroke Care for Patients)
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15 pages, 1347 KB  
Article
Use of End-of-Life Care Pathways in Hospitalized Stroke Patients: A Retrospective Study of the AMBER Care and Dying Adults in the Last Days of Life Approaches
by Dariusz Kotlęga
Healthcare 2025, 13(16), 1979; https://doi.org/10.3390/healthcare13161979 - 12 Aug 2025
Cited by 1 | Viewed by 1189
Abstract
Background: Stroke-related deaths often follow rapid deterioration, making end-of-life (EOL) care decisions particularly challenging in acute settings. Although national guidelines support structured approaches to end-of-life care, there is limited evidence of how these pathways are applied in routine stroke practice. Objective: [...] Read more.
Background: Stroke-related deaths often follow rapid deterioration, making end-of-life (EOL) care decisions particularly challenging in acute settings. Although national guidelines support structured approaches to end-of-life care, there is limited evidence of how these pathways are applied in routine stroke practice. Objective: To evaluate the use of structured end-of-life care pathways, including the AMBER Care Bundle and Dying Adults in the Last Days of Life (DALDL), in stroke patients who died during admission at a general hospital stroke center. Methods: This retrospective, single-center cohort study included 123 patients with confirmed stroke (73.2% ischemic, 26.8% hemorrhagic) who died in hospital during 2023. Clinical characteristics, the timing of care pathway decisions, palliative care involvement, withdrawing of medical procedures, and outcomes were analyzed. Descriptive statistics, Mann–Whitney U tests, Spearman correlations, chi-square tests, and a multivariate regression model were performed. Results: Of 123 patients, 101 (82.1%) entered the DALDL pathway a median of 14.8 days after admission, with a subsequent median survival of 2.9 days. Anticipatory medications were prescribed in 100% of DALDL patients versus 0% of non-DALDL. Do Not Attempt Cardiopulmonary Resuscitation orders were documented in 99%, and 67.3% received specialist palliative care input. Nasogastric tube insertion correlated with a higher National Institutes of Health Stroke Scale (NIHSS) and higher rate of infections. Conclusions: Most patients had access to structured EOL care, but variability in timing and interventions highlights the need for earlier palliative engagement and consistent implementation of pathways to improve the quality of EOL care in stroke patients. We detected areas that could be improved, such as access to a palliative care team and the anticipatory medication use in dying stroke patients. Full article
(This article belongs to the Special Issue Focus on Quality of Neurology and Stroke Care for Patients)
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