Factors associated with met and unmet rehabilitation needs after stroke: A multicentre cohort study in Denmark and Norway

Abstract

Objectives To examine patient-reported needs for care and rehabilitation in a cohort following different subacute pathways of rehabilitation, and to explore factors underpinning met and unmet needs. Design Observational multicentre cohort study. Patients and methods A total of 318 Norwegian and 155 Danish patients with first-ever stroke were included. Participants answered questions from the Norwegian Stroke Registry about perceived met, unmet or lack of need for help and training during the first 3 months post stroke. The term “training” in this context was used for all rehabilitative therapy offered by physiotherapists, occupational or speech therapists. The term “help” was used for care and support in daily activities provided by nurses or health assistants. Results Need for training: 15% reported unmet need, 52% reported met need, and 33% reported no need. Need for help: 10% reported unmet need, 58% reported met, and 31% reported no need. Participants from both Norway and Denmark had similar patterns of unmet/met need for help or training. Unmet need for training was associated with lower functioning, (odds ratio (OR) = 0.32, p < 0.05) and more anxiety (OR = 0.36, p < 0.05). Patients reporting unmet needs for help more often lived alone (OR = 0.40, p < 0.05) and were more often depressed (OR = 0.31, p < 0.05). Conclusion Similar levels of met and unmet needs for training and help at 3 months after stroke were reported despite differences in the organization of the rehabilitation services. Functioning and psychological factors were associated with unmet rehabilitation needs. LAY ABSTRACT The aim of this study was to examine patient-reported needs for care and rehabilitation among selected patients with stroke in Norway and Denmark. A total of 318 Norwegian and 155 Danish patients with first-ever stroke were included. Participants answered the following 2 questions from the Norwegian Stroke Registry: Have you received enough help after the stroke? Have you received as much training as you wanted after the stroke? The term “training” in this context was used for all rehabilitative therapy offered by physio-, occupational or speech therapists. The term «help» was used for care and support in daily activities provided by nurses or health assistants. Levels of anxiety and depression were investigated. With regard to training needs, 15% of all participants reported unmet needs, 52% reported that their needs had been met, and 33% reported that they had no need for training. Regarding the need for help, 10%, 58% and 31% reported unmet needs, that needs had been met, and that they had no need for care, respectively. Participants in the 2 countries had similar patterns of unmet/met needs for help or training. Unmet need for training was associated with...

Effects of long-term unmet needs and unmet rehabilitation needs on the quality of life in stroke survivors

“…The observed prevalence of unmet rehabilitation needs was 32.6%, which is consistent with a previously reported range of 15%-33% (7,22–24). In a study by Ullberg et al, female sex, living alone, smoking, atrial fibrillation, diabetes, somnolence, comatose status, prior stroke, and intracranial hemorrhage or unspecified stroke were all associated with an increased OR for unmet rehabilitation needs (7).…”

Healthcare Professionals’ Experiences with Rehabilitation Practices for Patients with Cognitive Impairment after Stroke in North Norway: A Qualitative Study

“…As discussed by Heiberg et al [ 25 ], in the broad geographic rural North Norwegian region, available specialized subacute inpatient rehabilitation services are necessary. Parallel with building systems for improved transitions from stroke units and rehabilitation units to home, improved follow-up of persons with PSCI in the municipalities is further required.…”

“…In Norway, rehabilitation usually takes place in hospitals [ 23 ], where most acute stroke patients (95%) are admitted to stroke units [ 24 ]. A recent study from the northern part of Norway showed that approximately 40% of participants received further inpatient treatment at rehabilitation units, 17% received community-based rehabilitation, and 43% received no rehabilitation after discharge from stroke units [ 25 ]. However, this study revealed little about the content of professional support for community-based services or which kind of patients' needs these services applied to.…”