Reviews in Clinical Gerontology 2007 17; 277–292 C  2008 Cambridge University Press Printed in the United Kingdom doi:10.1017/S0959259808002608 Review of longer-term problems after a disabling stroke Jenni Murray, John Young and Anne Forster Bradford Institute for Health Research, Bradford, UK. Introduction Over the last three decades there has been a change in attitude to the care of patients after stroke from a somewhat nihilistic stance to a predominantly acute focus with potential for rehabilitation. More recently there has been a widening of perspective, with recognition that stroke is a long- term condition. 1 Aligned with this has been a gradual shift in focus from a primarily biomedical approach to stroke care, to one that considers the psychological and social elements of the poststroke experience. However, the evidence base for stroke is still dominated by prevention and early-care treatments: only eight of the 238 recommendations reported in the UK national clinical guidelines for stroke 2 specifically address longer-term manage- ment. The Australian clinical guidelines for stroke offer a similar pattern: 22 (14%) of 162 recom- mendations relate to community participation and organization of longer-term support. 3 However, ongoing research efforts to develop and evaluate interventions for longer-term stroke care are beginning to address the imbalance in the evidence base. In our previous review, 4 surveys reporting the types and prevalence of longer-term problems experienced after stroke were summarized and synthesized within a structured framework. The review demonstrated the complexity and diversity of the longer-term stroke experience, and highlighted the challenges that support services face in meeting the needs of patients and carers living with the aftermath of stroke. Keeping abreast with this challenging subject area is key to promoting the continued development of stroke services. This review is an update of our previous work, 4 presenting the most recently published data Address for correspondence: Jenni Murray, Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK. on the prevalence of longer-term stroke-related problems. Methods We sought to identify all community-based obser- vational surveys and reviews reporting the types and prevalence of longer-term stroke-related prob- lems. Here, ‘longer-term’ refers to the post-acute period of illness, during which the patient is either living at home, or is in the process of returning home from hospital. Published literature was iden- tified using a combination of methods, including electronic database-searching, cross-referencing and hand-searching. An electronic search strategy was designed and run in Medline, Amed, Embase, Cinahl and Psycinfo (all 2001–December 2007). Subject headings, including cerebrovascular disorder, were searched in combination with key words to capture data incorporating community- service provision, and patient and caregiver iden- tified longer-term stroke problems in quantitative surveys and prevalence studies. The journals hand- searched (from 2001 onwards) were: Stroke; Clin- ical Rehabilitation; Disability and Rehabilitation; Age and Ageing; and the British Journal of General Practice. Additional references were sought from citations of the identified reports. Abstracts of prevalence studies from the most recent European Stroke Conference 5 were also reviewed. Where recently published systematic reviews (2007/8) reporting prevalence estimates were identified, individual studies addressing the same issue were not reviewed. The following types of studies were excluded: those set in a hospital, nursing or resid- ential home; qualitative, pilot, case or intervention studies; those reporting data on physical function, mortality or predictive modelling and correlation analysis; and studies focusing on specific stroke subtypes. Some studies that were included in the previous review 4 are cross-referenced briefly here.