Post-stroke care after medical rehabilitation in Germany: a systematic literature review of the current provision of stroke patients

Hempler, Isabelle; Woitha, Kathrin; Thielhorn, Ulrike; Farin, Erik

doi:10.1186/s12913-018-3235-2

Cited by 27 publications

(23 citation statements)

References 16 publications

(38 reference statements)

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“…In the MAS-I study 24% of the caregivers reported moderate to high levels of stroke-related caregiver burden [11]. Several approaches have been suggested to close the gap between inpatient and outpatient care [52][53][54], however, social care has been understudied. An effective primary care-based stroke aftercare service must have a broad focus and must be based on an individual record of unmet needs including social needs [55].…”

Section: Discussionmentioning

confidence: 99%

Social work support and unmet social needs in life after stroke: a cross-sectional exploratory study

Lehnerer

Hotter

Padberg

et al. 2019

Preprint

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Background: Stroke patients are often affected by long-term disabilities with needs concerning social issues. There is relatively little consideration of social recovery of patients and the support required to return to work, receive social benefits, participate in daily life activities, maintain contact with family and friends and to organize financial affairs. In our study we aimed to investigate if existing tools record social needs adequately. We analyzed the current provision of social support provided in long-term care after stroke and whether unmet social needs were associated with quality of life, caregiver burden, overall function and degree of disability. Methods: Our analysis is part of the Managing Aftercare of Stroke study (MAS-I), a cross-sectional exploratory study of patient needs 2-3 years after initial stroke. Assessment tools included the Nikolaus-score (social situation), the EuroQoL (quality of life), the German Burden Scale for Family Caregivers (caregiver burden), the modified Rankin Scale (disability / dependence), Stroke Impact Scale (function and degree of disability) and the Stroke Survivor Needs Questionnaire (unmet needs). Results: Overall 57 patients were included in MAS-I, with ten patients classified in urgent need of socio-economic support according to the Nikolaus-score. Patients with lower than normal Nikolaus-score had a higher degree of disability. Thirty percent of all patients had never received professional social support. Social worker contact happened mostly during the stay in acute hospital or rehabilitation institution. Only four patients (11%) reported long-term support after discharge. Apart from social worker contact during acute care, 43% of patients had unmet needs in the long-term aftercare. Forty percent of all patients included in MAS-I were recommended for social work intervention after an in-depth analysis of their situation. Finally, we saw that unmet social needs were associated with lower quality of life and higher caregiver burden. Conclusions: Our data suggest significant unmet needs in social care in long-term stroke patients. Screening tools for unmet social needs such as the Nikolaus-score do not holistically report patients’ needs.

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Section: Discussionmentioning

confidence: 99%

Social work support and unmet social needs in life after stroke: a cross-sectional exploratory study

Lehnerer

Hotter

Padberg

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Several approaches have been suggested to close the gap between inpatient and outpatient care [52–54], however, social care has been understudied. An effective primary care-based stroke aftercare service must have a broad focus and must be based on an individual record of unmet needs including social needs [55].…”

Section: Discussionmentioning

confidence: 99%

Social work support and unmet social needs in life after stroke: a cross-sectional exploratory study

et al. 2019

View full text Add to dashboard Cite

Background Stroke patients are often affected by long-term disabilities with needs concerning social issues. There is relatively little consideration of social recovery of patients and the support required to return to work, receive social benefits, participate in daily life activities, maintain contact with family and friends and to organize financial affairs. In our study we aimed to investigate if existing tools record social needs adequately. We analyzed the current provision of social support provided in long-term care after stroke and whether unmet social needs were associated with quality of life, caregiver burden, overall function and degree of disability. Methods Our analysis is part of the Managing Aftercare of Stroke study (MAS-I), a cross-sectional exploratory study of patient needs 2–3 years after initial stroke. Assessment tools included the Nikolaus-score (social situation), the EuroQoL (quality of life), the German Burden Scale for Family Caregivers (caregiver burden), the modified Rankin Scale (disability / dependence), Stroke Impact Scale (function and degree of disability) and the Stroke Survivor Needs Questionnaire (unmet needs). Results Overall 57 patients were included in MAS-I, with ten patients classified in urgent need of socio-economic support according to the Nikolaus-score. Patients with lower than normal Nikolaus-score had a higher degree of disability. Thirty percent of all patients had never received professional social support. Social worker contact happened mostly during the stay in acute hospital or rehabilitation institution. Only four patients (11%) reported long-term support after discharge. Apart from social worker contact during acute care, 43% of patients had unmet needs in the long-term aftercare. Forty percent of all patients included in MAS-I were recommended for social work intervention after an in-depth analysis of their situation. Finally, we saw that unmet social needs were associated with lower quality of life and higher caregiver burden. Conclusions Our data suggest significant unmet needs in social care in long-term stroke patients. Screening tools for unmet social needs such as the Nikolaus-score do not holistically report patients’ needs. Trial registration Clinicaltrials.Gov NCT02320994 . Registered 19 December 2014 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12883-019-1451-y) contains supplementary material, which is available to authorized users.

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“…Alter ( [31]. In Deutschland gibt es aktuell kein empfohlenes standardisiertes Vorgehen bei der Rehabilitation von Personen mit Schlaganfall, und die strikte Trennung von ambulanten und stationären Settings erschwert eine kontinuierliche Nachsorge [32]. Dadurch resultieren auch in der untersuchten Personengruppe Unterschiede hinsichtlich ihres bisherigen Zugangs zu rehabilitativen Maßnahmen, der nicht nur von der Zeit seit dem neurologischen Ereignis, sondern auch von anderen Faktoren wie Alter, sozioökonomischem Status und Komorbiditäten abhängen kann [33].…”

Section: Signifikanzunclassified

Messung von Mobilität und Funktion der unteren Extremität in einem ambulanten neurorehabilitativen Setting

Klotz

Ketels

Pichler³

et al. 2019

physioscience

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Zusammenfassung Hintergrund Erworbene neurologische Erkrankungen mit zerebraler Beteiligung führen häufig zu Einschränkungen der Mobilität und damit auch zu einer erschwerten Teilhabe am gesellschaftlichen Leben. Daher ist die Ermöglichung und Verbesserung von Teilhabe eines der wichtigsten Ziele individuell abgestimmter Rehabilitationsmaßnahmen. Die Wiederherstellung der motorischen Funktionen hängt im Rehabilitationsverlauf nicht zuletzt von der vergangenen Zeit seit dem neurologischen Ereignis ab. Ziel Die vorliegende Untersuchung ging der Frage nach, ob die zu Beginn und am Ende einer komplexen interdisziplinären ambulanten neurologischen Rehabilitation routinemäßig eingesetzten Messinstrumente Veränderungen im Verlauf erfassen können und sich diese bei Personen mit akuten/subakuten und chronischen Geschehen unterscheiden. Methode Retrospektiv wurden die Daten im Zeitraum Januar 2004 bis Dezember 2014 aus dem Neuro Reha Team Pasing, München, ausgewertet. Neben demografischen Daten und der Diagnose wurden die Messergebnisse der Instrumente zur Einschätzung der Funktion der unteren Extremität erhoben. Die Berechnung der intra- und intergruppalen Mittelwertunterschiede in den Messergebnissen erfolgten mittels t-Tests für unabhängige Stichproben und Chi2-Tests. Ergebnisse Die Personen mit neurologischen Geschehen wurden im Mittel 82 ± 36 Tage behandelt. Bei allen eingesetzten Messinstrumenten zeigte sich eine signifikante Veränderung von Ausgangs- zu Endbefund. Bis auf den 10-Meter-Gehtest ergaben sich bei allen Messinstrumenten zwischen der akuten/subakuten und der chronischen Gruppe signifikante Unterschiede im Endbefund zugunsten der akuten/subakuten Gruppe. Schlussfolgerung Der routinemäßige Einsatz von Messinstrumenten in einem neurorehabilitativen Setting erlaubt zuverlässig das schnelle Erfassen von Veränderungen im Therapieverlauf sowohl bei Personen mit akutem/subakutem als auch chronischem neurologischen Geschehen.

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Post-stroke care after medical rehabilitation in Germany: a systematic literature review of the current provision of stroke patients

Cited by 27 publications

References 16 publications

Social work support and unmet social needs in life after stroke: a cross-sectional exploratory study

Social work support and unmet social needs in life after stroke: a cross-sectional exploratory study

Social work support and unmet social needs in life after stroke: a cross-sectional exploratory study

Messung von Mobilität und Funktion der unteren Extremität in einem ambulanten neurorehabilitativen Setting

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