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

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) <i>Experiencing ongoing impairments after stroke</i>; (2) <i>Coping with life after stroke</i>; and (3) <i>Invisible difficulties are easily missed when visible outcomes are positive</i>. 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.