Early screening for emotional and cognitive issues may improve psychiatric outcomes for stroke patients

1. Routine single-session screening for emotional and cognitive issues post-stroke does not improve long-term societal participation but may offer modest early benefits in anxiety and quality of life

Evidence Rating Level: 1 (Excellent) 

The ECO-stroke trial, a multicenter, cluster-randomized controlled study, evaluated whether structured screening and care for emotional and cognitive problems at 6 weeks post-ischemic stroke improves societal participation at one year. Conducted across 12 Dutch hospitals, 531 patients discharged home without inpatient rehabilitation were enrolled. Intervention patients received a 1-hour nurse-led consultation including standardized screening tools (CLCE-24, MoCA, HADS), self-management support, and referrals as needed. The primary outcome—societal participation at one year measured via USER-P-R—did not significantly differ between intervention and usual care groups (mean difference [MD] 0.77; 95% CI −2.47 to 4.06; p=0.652). However, secondary outcomes at 3 months showed modest improvements favoring the intervention group: reduced anxiety symptoms (HADS-A MD −0.86), improved quality of life (EQ-5D-5L MD 0.044; EQ-VAS MD 2.9), and greater self-efficacy (GSES MD 0.97). These effects persisted to a lesser extent at 1 year. No significant differences were observed in cognitive or depressive symptoms, disability (mRS), or societal participation at either follow-up point. The study suggests that a single screening session may be insufficient to meaningfully impact complex outcomes like participation. Strengths include the large sample and pragmatic design; limitations include low referral rates and potential underpowering for secondary endpoints. Future analysis will assess cost-effectiveness.

Click to read the study in Neurology

Image: PD

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