Table 1.
Study | Source | Intervention | Study population | Outcome | ICC estimate | Number of patients | Number of clusters |
---|---|---|---|---|---|---|---|
1 | Thomas et al. 14 | Systematic voiding programme. | Stroke patients with incontinence (UK). | Absence of incontinence at 12 weeks post-stroke. | 0.00 | 413 | 12 |
2 | Tannenbaum et al. 15 | Three experimental continence interventions: (1) continence education; (2) evidence-based self-management; (3) combined continence education and self-management. | Women aged 60 years and older with untreated incontinence (UK). | Patient’s global impression of improvement in continence questionnaire (PGI-I) measured at 3 months post-intervention. | 0.05 | 259 | 71 |
3 | Sackley et al. 16 | Staff education on continence care and mobility care and mobility training. | UK care home residents. | Rivermead Mobility Index at baseline and 6 weeks post-intervention. | 0.37 | 34 | 6 |
4 | Sackley et al. 17 | Occupational therapy provided to individuals and carer education. | UK care homes residents with moderate to severe stroke-related disability (Barthel Index (BI) score 4–15) except those with acute illness and those admitted for end-of-life care. | BI score at baseline. | 0.26 | 173 | 12 |
BI change to 3 months. | 0.18 | ||||||
BI change to 6 months. | 0.2 | ||||||
Global poor outcome at 3 months. | 0.14 | ||||||
Global poor outcome at 6 months. | 0.09 | ||||||
5 | Weir et al. 18 | Computer-based decision support system to aid selection of long-term antithrombotic therapy. | UK hospital in-patients or out-patients with a clinical diagnosis of acute ischaemic stroke or TIA; first investigation of an event occurring within preceding 4 months. | Change in relative risk of ischaemic and haemorrhagic vascular events relative to the option of ‘no antiplatelet or anticoagulant therapy’. | 0.15 | 1952 | 16 |
6 | De Luca et al. 19 | The intervention group staff (physicians, nurses and drivers) training on and delivery of evidence-based prehospital emergency clinical pathway based on experiential learning approach. The training was focused on teaching the personnel to identify stroke symptoms. | People living in the community aged <80 years (Italy, acute care/ community). | The proportion of eligible acute stroke patients correctly referred to stroke unit. | 0.05 | 4895 | 20 |
7 | Dirks et al. 20 | Intervention to increase thrombolysis rates by creating local stroke teams, identifying barriers to thrombolysis delivery, setting goals and planned actions, and updating acute stroke guidelines. | Patients ≥18 years with acute stroke who were admitted to the hospital within 24 h from onset of symptoms (Netherlands, acute care/community). | Treatment with rtPA (recombinant tissue Plasminogen Activator). | 0.0154 | 5515 | 12 |
8 | Johnston et al. 21 | Quality improvement in ischaemic stroke discharge orders comprising statin prescription; antihypertensive medication for those with hypertension; warfarin for all patients with atrial fibrillation (AF), except those with contraindication. | At least 40 years old, were the Kaiser Permanente Medical Care Plan (KPMCP) members with pharmacy benefits, and had been discharged alive to home or to a facility other than hospice (USA hospitals). | Composite binary variable comprising optimal treatment via all of: (1) documentation of filled statin prescription 6 m post-discharge; (2) achievement of controlled blood pressure 4–8 m post-discharge; (3) for those with AF, either documentation of a filled prescription for warfarin or an International Normalised Ratio blood test 6 m post-discharge or a contraindication to warfarin. | 0.0038 | 3361 | 12 |
9 | Jones et al. 22 | All nurses and health-care assistants on the participating stroke intervention units received a group teaching package to improve their understanding and clinical practice in patient positioning. | Patients on stroke rehabilitation units (UK hospitals): with stroke, dependent on another person to position limbs, with inability to move from sitting to standing without assistance. | Rivermead Mobility Index at 6 months post-stroke. | 0.00 | 120 | 10 |
10 | Lakshminarayan et al. 23 | (1) Audit and written feedback of baseline performance; (2) analysis of structural and knowledge barriers to stroke care identified by provider questionnaires; (3) use of clinical opinion leaders to deliver customised feedback to care providers; (4) use of hospital management leaders to overcome identified barriers to stroke care. | Stroke patients aged 30–84 years admitted through emergency room (US hospitals). | Three outcomes with associated ICCs, each is related to the provision of 3 or 4 indicators of quality of care: | 2305 | 19 | |
acute care indicators. | 0.005 | ||||||
inpatient care indicators. | 0.004 | ||||||
discharge indicators. | 0.0007 | ||||||
11 | McAlister et al. 24 | Educational lecture to patients with nonvalvular AF on reducing stroke risk, with self-administered booklet and individualised audiotape decision aid tailored to their personal stroke risk profile. | Adult patients with nonvalvular AF not living in institutions (Canada, Primary Care Practices). | Change in proportion of patients taking antithrombotic therapy appropriate to their stroke risk 3 months post-intervention. | 0.02 | 434 | 102 |
12 | Forster et al. 25 | Structured training programme for caregivers (the London Stroke Carers Training Course). | Patients at UK stroke units with a diagnosis of stroke, likely to return home with residual disability and with a caregiver providing support. | Self-reported extended activities of daily living at 6 months measured with the Nottingham Extended Activities of Daily Living scale. | 0.027 | 928 | 36 |
13 | Taylor et al. 26 | Structured goal elicitation using the Canadian Occupational Performance Measure. | Stroke patients admitted to inpatient rehabilitation services (New Zealand) with ‘sufficient’ cognition for goal setting and completing outcome assessment. | Quality of life at 12 weeks measured using the following tools: | 41 | 4 | |
Schedule for Individualised Quality of Life (SEIQOL-DW). | 0.40 | ||||||
The Medical Outcomes Study 36-item Short Form Health Survey (SF-36), Physical Component Summary (PCS) score. | 0.24 | ||||||
Functional Independence Measure. | 0.21 | ||||||
The Medical Outcomes Study 36-item Short Form Health Survey (SF-36), Mental Component Summary (MCS) score. | 0.25 | ||||||
14 | Middleton et al. 27 | Treatment protocols to manage fever, hyperglycaemia and swallowing dysfunction with multi-disciplinary team building workshops to address implementation barriers. | Patients aged 18 years or older, who had a diagnosis of ischaemic stroke or intracerebral haemorrhage, and presented within 48 h of onset of symptoms to a participating Acute Stroke Unit (ASU), Australia. | Death and dependency 90 days after hospital admission. | 0.018 | 1696 | 19 |
Functional dependency BI ≥95, 90 days after hospital admission. | 0.015 | ||||||
Functional dependency BI ≥60, 90 days after hospital admission. | 0.009 | ||||||
SF-36 PCS score, 90 days after hospital admission. | 0.026 | ||||||
SF-36 MCS score, 90 days after hospital admission. | 0.011 | ||||||
Mean temp within 72 h in ASU. | 0.084 | ||||||
At least one temperature ≥37.5°C in first 72 h. | 0.009 | ||||||
Mean glucose during first 72 h in ASU. | 0.056 | ||||||
Swallowing screening within 24 h of admission to ASU. | 0.156 | ||||||
15 | Power et al. 28 | Stroke 90/10, a quality improvement collaborative based on the Breakthrough Series model. | Patients admitted to stroke units at NHS hospital Trusts in the Northwest of England. | Compliance with two evidence-based bundles of care: early hours and rehabilitation. | 6592 | 24 | |
Early hours bundle. | 0.066 | ||||||
Rehabilitation bundle. | 0.197 | ||||||
16 | Dregan et al. 29 | Remotely installed electronic decision support tools to promote intensive secondary prevention. | Patients ever diagnosed with acute stroke (Family Practices, UK). | Systolic blood pressure. | 0.032 | 11,391 | 106 |
ICC: intracluster correlation coefficient; TIA: transient ischemic attack; NHS: National Health Service.