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

Abstract

ObjectivesUnderstanding the unmet needs of community-dwelling stroke survivors is essential for further intervention. This systematic review was performed to summarise their unmet needs from a quantitative viewpoint.DesignSystematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesA comprehensive search of six databases was conducted from inception to February 2020: PubMed, EMBASE, CINAHL, PsycINFO, SCOPUS and CBM. The methodological quality of the studies was assessed. Unmet needs were categorised, and a pooled analysis of the main outcomes was conducted.Eligibility criteria for selecting studiesWe included quantitative studies focused on the unmet needs of stroke survivors who live at homes rather than in any other institutionalised organisation.ResultsIn total, 32 of 2660 studies were included, and 1980 unmet needs were identified. The prevalence of patients with unmet needs ranged from 15.08% to 97.59%, with a median of 67.20%; the median number of unmet needs per patient ranged from 2 to 8 (0–31). The prevalence of unmet needs was high at 6 months post-stroke (62.14%) and 2 years post-stroke (81.37%). After categorisation, the main concerns among these patients were revealed to be information support, physical function and mental health; a few studies reported unmet needs related to leisure exercise, return to work and so on. Additionally, differences in the measurement tools used across studies affect what unmet needs participants report.ConclusionsSufficient, accurate, individualised and dynamic information support is a priority among community-dwelling stroke survivors. Physical function and mental health are also the most significant concerns for re-achieving social participation. It is essential to design and disseminate standard, effective and time-saving tools to assess unmet needs.Trial registration numberCRD42018112181.

A qualitative study exploring the experiences of individuals living with stroke and their caregivers with community-based poststroke services: A critical need for action

“…Overall, it is surprising that a number of the stroke service needs identified from our large sample size resonate with prior stroke literature, suggesting that they persist and remain unaddressed [ 4 , 49 , 51 , 52 ]. Specifically, there is mounting evidence for personalized and tailored services (e.g.…”

“…tailored to age, time since stroke, communication, culture) across the stroke care continuum. Despite a strong knowledge base of the benefits of personalized services, our study revealed that these needs persist due to a lack of personalized/individual stroke services available in the community [ 4 , 49 , 51 , 53 , 54 ]. Future research should investigate organizational considerations for program design to support personalized and tailored services.…”

“…Stroke is a common cause of disability in Canada, with a growing incidence [ 1 ]. A stroke can cause long-term functional and psychosocial impacts, making the resumption of community living a challenge [ 2 – 4 ]. A 2011 American study found that up to 59% of people had unmet long-term clinical and social needs after stroke (e.g.…”

Exploring the poststroke experiences and unmet needs of South Asian communities in high-income countries: a scoping review protocol

“…They can relate to body functioning (eg, emotional, anxiety, communication), activity/participation (eg, social life, exercise, establishing meaningful roles), environmental factors (eg, financial, social, cultural) and education 10–14. Unmet poststroke needs (defined as ‘a need for something or help from someone that is not being met’)15 can interfere with maximising one’s function and participation,16 and are reported by up to 59% of people living in the community with stroke 16. Poststroke experiences and needs are often overlooked,13 but are essential to consider because they can inform priorities for poststroke services 14.…”

Long-term psychological consequences of stroke (OX-CHRONIC): A longitudinal study of cognition in relation to mood and fatigue after stroke: Protocol

“…Furthermore, a recent systematic review of quantitative studies on the unmet care needs of community-dwelling stroke survivors reported that the most frequently reported unmet needs were in the area of cognition (41.92%), followed by mood (40.13%). 20 …”