Possible effects of unrealistic expectations of recovery after stroke.

Until recently, the evaluation of medical interventions relied upon measures of morbidity and mortality and clinical tests. However, there is now greater recognition of patients’ subjective points of view in the evaluation of their care (DHSS 1983). Patients and their carers are regarded as vital partners in the decision making process and their role should not be underestimated. The quality of rehabilitation care, ultimately the patient’s health-related quality of life, also depends upon this process of partnership with health professionals. Most research which has sought the views of consumers, has tended to focus upon patient satisfaction with the services provided in hospital and when they are discharged. Studies have shown that patient satisfaction is associated with the differences in care received and better provision of information (Pascoe 1983, Cleary and McNeil 1988). However, satisfaction with services is not necessarily associated with better health functioning (Pound et al 1999). More recently patient expectations and outcomes of their treatment have been investigated in a number of conditions (Borkan and Quirk 1992, Brown et al 1997, Staniszewska 1999). In one study the expectations of older hip fracture patients making a full recovery when treated in a specialist rehabilitation setting were significantly associated with better outcomes in physical recovery (Borkan and Quirk 1992). Stroke is a common cause of mortality in England and Wales and is a significant predictor of significant long-term physical disability. A number of studies have investigated patient satisfaction with stroke services and these have found that greater satisfaction is associated with the provision of better services, patient information and the patient’s personal characteristics (Pound et al 1994, Wellwood et al 1995, Scolte op Reimer et al 1996, Bisset et al 1998, Clarke and Smith 1998, Rao 1998, Pound et al 1999). Depression after stroke is also common and is considered to be a major predictor of poor physical rehabilitation and a prognostic indicator of long-term handicap due to poor psychosocial functioning (Young and Forster 1992, Astrom et al 1993). These patients are also often found to be more dissatisfied with services (Scolte op Reimer et al 1996). Unfulfilled expectations, because of either unrealistic optimism or undue pessimism about recovery, may increase handicap after stroke. The relationship with patient expectation, patient characteristics and their functional recovery post stroke has not received attention. Patient expectation of recovery post stroke may be an important determinant of the overall stroke rehabilitation process. This study aims to explore whether patient expectation of recovery post stroke reflects that of the health professional, and if expectations are not met, whether this results in depressive symptoms.