Invisible difficulties are easily missed when visible outcomes are positive: A qualitative study of patient perspectives following acute treatments for ischaemic stroke

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Humphrey, Sam
Pike, Kerryn Elizabeth
Long, Brian
Ma, Henry
Bourke, Robert
Wright, Bradley J
Wong, Dana
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2025
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Abstract

We aimed to explore the perspectives of ischaemic stroke patients treated with endovascular clot retrieval (ECR), intravenous tissue plasminogen activator (t-PA), or conservative management in the early stages of stroke recovery. Thirty-one semi-structured interviews were qualitatively analysed using a reflexive thematic analysis approach. Three themes were generated: (1) Experiencing ongoing impairments after stroke; (2) Coping with life after stroke; and (3) Invisible difficulties are easily missed when visible outcomes are positive. Participants (ECR = 11, t-PA = 10, conservative management = 10; mean age = 62.9 ± 17.5; 20 male, 11 female) experienced ongoing impairments after stroke including physical problems, fatigue and sleep issues, communication difficulties, and cognitive impairment. They described these difficulties as impacting their ability to cope with life after stroke, including reduced participation, loss of independence, adjustment difficulties, and identity changes, which were associated with negative emotions. In participants with positive visible (e.g., physical) outcomes, particularly those in the ECR group, invisible difficulties were underrecognized and untreated due to a lack of services post-discharge, with this causing uncertainty in recovery. Invisible difficulties are common for all stroke survivors regardless of acute medical treatment and rehabilitation services need to place greater emphasis on managing invisible difficulties earlier in the recovery process.

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Neuropsychological Rehabilitation

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© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.

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This publication has been entered in Griffith Research Online as an advance online version.

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Humphrey, S; Pike, KE; Long, B; Ma, H; Bourke, R; Wright, BJ; Wong, D, Invisible difficulties are easily missed when visible outcomes are positive: A qualitative study of patient perspectives following acute treatments for ischaemic stroke, Neuropsychological Rehabilitation, 2025

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