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

Abstract

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.

Unmet care needs of community-dwelling stroke survivors: a systematic review of quantitative studies

“…The details were listed in table 1 (detailed unmet needs were shown in online supplemental file 3 ). The data from one paper 43 containing findings from two countries were analysed separately but as one record; two records 44 45 that reported different types of unmet needs from one study were included as two records.…”

“…In total, more than 1980 unmet needs were reported in 23 articles 44 46 47 ; precise data from two studies were obtained by emailing the authors. 45 48 The weighted mean of unmet needs was 25.31%.…”

Determinants of complications in first ever acute stroke patients: a prospective observational study from India

“…Stroke itself can result in minor to major, short and longterm physical disabilities [1], cognitive impairments [2,3], emotional disturbances [4,5], decreased social interactions [6] and excessive economic burden [7]. In addition to neurological problems appearing in the immediate post-stroke period [8], often there are multiple late complications [9] which should not to be neglected.…”

Head-to-Head Comparison of Social Network Assessments in Stroke Survivors

“…3,10 It has further been shown that stroke survivors are likely to have unmet social support needs in the years following their stroke. 11 Understanding the structure and health characteristics of patient’s social network is, therefore, likely to inform predictions of long-term outcomes and may help providers identify vulnerable patients who would benefit from additional social and community supports during the active phase of recovery.…”