What are the essential questions to ask during a stroke follow‑up visit?

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Last updated: September 29, 2026 • View editorial policy

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Essential Questions for Stroke Follow-Up

During stroke follow-up visits, you must ask three core rehabilitation questions: (1) What could the patient do before the stroke that they cannot do now? (2) What does the patient want to be able to do? (3) Has the patient reached full potential? These questions form the foundation for identifying unmet rehabilitation needs and guide all subsequent management decisions 1.

First Visit Priorities

At the initial post-stroke visit, establish the foundation by addressing:

Understanding the Stroke Event

  • "What is your understanding of what happened to you?" - This reveals the patient's perspective and concerns that will shape ongoing care 1
  • "Why did this stroke happen?" - Confirm stroke pathogenesis was established (carotid stenosis, atrial fibrillation, etc.) 1
  • "Are you still taking dual antiplatelet therapy?" - If yes, discontinue at 21 days for most patients (or 90 days for severe intracranial stenosis) 1
  • "What precursors contributed to your stroke?" - Identify remediable factors like uncontrolled blood pressure or discontinued anticoagulation 1

Functional Assessment Questions

Activities of Daily Living

Ask specific, concrete questions rather than general functional inquiries:

  • "Are you still able to shop for groceries?" 1
  • "Are you able to prepare and eat your favorite meals at home?" 1

These instrumental activities of daily living questions uncover gaps between pre-stroke and current function more effectively than abstract assessments.

Screening for Complications and Unmet Needs

Depression and Mood

  • Use the Patient Health Questionnaire-9 (PHQ-9) to screen for depression 1
  • Depression affects up to 25% of patients at 2 years post-stroke 1

Cognitive Function

  • Screen with Mini-Mental State Examination or Montreal Cognitive Assessment during the first year and when clinically indicated 1

Fall Risk and Mobility

  • "Are you afraid of falling?" 1
  • Consider Berg Balance Scale, Morse Scale, timed up-and-go test, or 10-meter walk test for objective assessment 1

Comprehensive Unmet Needs

Ask directly: "Would you benefit from referral for any services to improve your functional impairments and promote your health and wellbeing?" 1

Common unmet needs to probe include 1:

  • Communication difficulties
  • Pain
  • Spasticity
  • Urinary or bowel incontinence
  • Sexual performance
  • Return to work concerns
  • Independence in mobility

Secondary Prevention Assessment

Risk Factor Control

"Are we doing everything we can to prevent another stroke?" This requires checking 1:

  • Blood pressure control: Target <140/90 mm Hg (only 50-70% of patients achieve this) 1
  • Statin adherence: Verify continued use (79% remain on therapy at 1 year) 1
  • Anticoagulation status: For atrial fibrillation patients
  • Smoking status: Confirm continued abstinence (84% remain nonsmoking) 1
  • Exercise adherence: Only 48% exercise per recommendations 1
  • Medication adherence: Actively monitor for missed doses or premature discontinuation 1

Physical Activity

Use the "Exercise Vital Sign" - two simple questions 1:

  • Number of days per week engaging in moderate to vigorous activity
  • Minutes per week of such activity

Caregiver Involvement

With patient consent, include caregivers to:

  • Identify patient and family needs 1
  • Improve risk factor management and outcomes 1
  • Assess caregiver burden and support needs 1

Clinical Pitfalls to Avoid

Do not assume rehabilitation potential is maximized early. Recovery continues for months to years through brain remodeling, compensatory strategies, and adaptive equipment use 1. Repeat functional assessments at each visit as capabilities change over time.

Do not rely solely on observation. Direct inquiry is essential - functional limitations may not be apparent during brief office encounters 1.

Do not overlook social determinants of health. Poverty, food insecurity, lack of transportation, and limited access to care significantly impact outcomes and require team-based approaches 1.

The 2021 AHA/ASA Primary Care Scientific Statement emphasizes that only 17% of stroke survivors achieve healthy weight, and unmet needs for rehabilitation, mobility, pain control, and communication remain highly prevalent 1. Your systematic questioning at each visit directly addresses these gaps and improves long-term outcomes.

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.