Deans' stroke musings: unmet needs

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Showing posts with label unmet needs. Show all posts

Wednesday, March 13, 2024

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

Well shit, are you that blitheringly stupid that you don't know that the unmet need is 100% recovery.?

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

Yookyung Lee MD MS1*, Won-Seok Kim MD PhD2*, Won Kee Chang MD MS2, Yun Sun3
Jung MPH PhD2, Sungju Jee MD PhD3, Sung-Hwa Ko MD PhD4, Min Kyun Sohn MD4
PhD3, Yong-Il Shin MD PhD4, Hee-Joon Bae MD PhD5, Beom Joon Kim MD PhD5, Jun Yup5
Kim MD MS5, Dong-Ick Shin MD PhD6, Kyu Sun Yum MD PhD6, Hee-Yun Chae MD MS6,6
Dae-Hyun Kim MD PhD7, Jae-Kwan Cha MD PhD7, Man-Seok Park MD PhD8, Joon-Tae7
Kim MD PhD8, Kang-Ho Choi MD PhD8, Jihoon Kang MD PhD5, Nam-Jong Paik MD PhD2
8
9
1Department of Physical and Rehabilitation Medicine, Chung-Ang University Gwang-10
Myeong Hospital, Gwang-Myeong, Gyeonggi-do, Republic of Korea11
2Department of Rehabilitation Medicine, Seoul National University College of Medicine,12
Seoul National University Bundang Hospital, Republic of Korea13
3Department of Rehabilitation Medicine, Chungnam National University Hospital and14
Chungnam National University College of Medicine, Daejeon, Korea15
4Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan16
National University School of Medicine, Pusan, Korea17
5Department of Neurology, Cerebrovascular Center, Seoul National University Bundang18
Hospital, Seoul National University, Republic of Korea19
6Department of Neurology, Chungbuk National University Hospital, Chungbuk National20
University College of Medicine, Cheongju, Korea21
7Department of Neurology, Dong-A University Hospital, Dong-A University College of22
Medicine, Busan, Korea23
8Department of Neurology, Chonnam National University Medical School and Hospital,24
Gwangju, Korea25All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted March 11, 2024.;https://doi.org/10.1101/2024.03.08.24304010doi:medRxiv preprint
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
*These authors contributed equally to this work.26
27
Short title: Unmet rehabilitation needs in stroke survivors28
29
Corresponding authors30
Nam-Jong Paik, MD, PhD31
Department of Rehabilitation Medicine, Seoul National University College of Medicine,32
Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu,33
Seongnam 13620, Korea34
Tel: +82-31-787-773135
Fax: +82-31-712-391336
E-mail: njpaik@snu.ac.kr37
38
Jihoon Kang, MD, PhD39
Department of Neurology, Cerebrovascular Center, Seoul National University Bundang40
Hospital, Seoul National University, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam41
13620, Korea42
Tel +82-31-787-781843
Fax +82-31-787-405944
E-mail: kangjihoon0913@gmail.com45
46
Word count: 4,80147
48All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted March 11, 2024.;https://doi.org/10.1101/2024.03.08.24304010doi:medRxiv preprint

Abstract

Background

Unmet long-term needs and rehabilitation needs are prevalent among stroke survivors and
affect their quality of life. We aimed to identify the long-term unmet needs and unmet
rehabilitation needs among stroke survivors in South Korea and evaluate their
intercorrelations with health-related quality of life.
Methods

Stroke survivors who were admitted to four Regional Cardiocerebrovascular Disease Centers
between January 1, 2015 and December 31, 2019 were telephonically surveyed using a
computer-assisted telephone interview method. With the aim of surveying approximately
1,000 patients, 9,204 people were recruited through random sampling. Unmet needs were
evaluated on the basis of Longer-term Unmet Needs after Stroke questionnaire items. Quality
of life was evaluated using the EuroQoL 5-dimension, 3-level (EQ-5D-3L) questionnaire and
the EQ-5D index.

Results

Among the participants, 93.6% experienced at least one unmet need and 311 (32.6%)
reported unmet rehabilitation needs. The number of unmet needs, age, modified Rankin Scale
(mRS) score, and previous stroke showed significant negative correlations with the EQ-5D
index (p-value < 0.05). The age-adjusted odds ratio (OR) for reporting unmet rehabilitation
needs significantly increased with problems in mobility (OR, 4.96; 95% confidence interval
[CI], 3.64-6.76), self-care (OR, 4.46; 95% CI, 3.32-5.98), usual activities (OR, 5.78; 95% CI,
4.21-7.93), pain/discomfort (OR, 3.76; 95% CI, 2.76-5.06), anxiety/depression (OR, 3.67;
95% CI, 2.74-4.91), higher mRS score (OR, 3.13; 95% CI, 2.29-4.28), prior hyperlipidemia
(OR, 1.35; 95% CI, 1.00-1.81), and number of unmet needs (OR, 1.30; 95% CI, 1.25-1.36).

Conclusions

Unmet needs were prevalent among stroke survivors and were associated with a lower quality
of life and increased odds of reporting unmet rehabilitation needs. Further research is needed(No further research is needed you idiots! 100% recovery is the only goal in stroke! Since you don't know that; self select yourself and get the hell out of stroke!)
to investigate strategies for addressing these subjective unmet needs with the aim of
improving the long-term quality of life of stroke survivors.

Tuesday, September 5, 2023

Adaptation and validation of the Longer-term Unmet Needs after Stroke (LUNS) monitoring tool in Sri Lanka

The basic unmet need is 100% recovery. SOLVE THAT!

Adaptation and validation of the Longer-term Unmet Needs after Stroke (LUNS) monitoring tool in Sri Lanka

BMC Public Health volume 23, Article number: 1718 (2023) Cite this article

Metrics details

Abstract

Background

Globally, stroke is a leading cause of mortality and morbidity. Unmet needs are defined as expressed needs that are not fulfilled by services provided and are considered an important indicator of the adequacy and quality of stroke follow-up care. This study aimed to culturally adapt, modify, translate and validate, the Longer-term Unmet Needs after Stroke (LUNS) monitoring tool, to Sri Lanka. Currently, there is no validated tool in Sri Lanka to assess unmet needs among stroke survivors and unmet needs are not systematically assessed.

Methods

A phased approach followed to culturally adapt, translate, establish its factorial validity and evaluate the convergent and divergent validity, reliability, and overall acceptability. The process of culturally adapting the tool was carried out using two rounds of the modified Delphi technique. The modified tool was translated to Sinhala and pretested among 10 stroke survivors. A descriptive cross-sectional study was conducted among 119 stroke survivors to establish the factorial validity and convergent and discriminant validity using the GHQ-12 and Barthel Index. The Socio-demographic characteristics of the study participants are presented. Communalities were assessed for 21 items and 2 items were dropped. Factor structure was confirmed with varimax and oblique rotations. The correlation coefficient was calculated to assess convergent and divergent validity. Cronbach’s alpha value was calculated to assess internal reliability.

Results

Following the modified Delphi technique, 5 items of LUNS tool were removed, and 5 items were modified. Three new items were added based on expert recommendation. One item related to driving also removed as it does not fit with the factor structure emerged. In establishing factorial validity 5 factors emerged from the exploratory factor analysis. In assessing the convergent and discriminant validity, test results revealed that both General Health Questionnaire-12 (GHQ-12) and Barthel Index significantly correlated as expected with unmet needs. The results of Cronbach’s alpha showed that all the factors were moderately high confirming the reliability of the tool.

Conclusions

The Sinhala version of the LUNS monitoring tool is a valid and reliable instrument to assess the unmet needs of stroke survivors. Assessment of unmet needs will add new insight into evaluation of the quantity, quality, and effectiveness of healthcare interventions received by stroke survivors in Sri Lanka.

Tuesday, January 4, 2022

Unmet Needs for Rehabilitative Management in Common Health-Related Problems Negatively Impact the Quality of Life of Community-Dwelling Stroke Survivors

The biggest unmet need you totally missed is 100% recovery. Since you can't even see that you are totally worthless in solving stroke.

Unmet Needs for Rehabilitative Management in Common Health-Related Problems Negatively Impact the Quality of Life of Community-Dwelling Stroke Survivors

Kyoung Tae Kim^1,2^†,

Won Kee Chang¹^†,

Yun-Sun Jung¹,

Sungju Jee³,

Min Kyun Sohn³,

Sung-Hwa Ko⁴,

Yong-Il Shin⁴,

Ja-Ho Leigh^5,6,

Won-Seok Kim¹^* and

Nam-Jong Paik¹^*

¹Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
²Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
³Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chugnam National University Hospital, Daejeon, South Korea
⁴Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
⁵Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
⁶National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, South Korea

Purpose: Community-dwelling stroke survivors have various unmet needs for rehabilitative management, but there is a lack of in-depth investigations on common health problems after stroke. Moreover, the association between unmet needs and health-related quality of life (HRQoL) has not been thoroughly investigated. This study aimed to investigate the unmet needs for rehabilitative management in common problems after stroke and their associations with HRQoL among community-dwelling stroke survivors.

Methods: A face-to-face cross-sectional survey was conducted among community-dwelling stroke survivors visiting outpatient clinics of rehabilitation departments between June and October 2020 in three university-affiliated hospitals. Unmet needs for common problems after stroke were assessed across eight domains based on the post-stroke checklist: spasticity, dysphagia, communication, cognition, ambulation, pain/discomfort, anxiety/depression, and self-care. HRQoL was measured using the EuroQoL-5D three level (EQ-5D). The prevalence of unmet needs for rehabilitative management and their associations with the EQ-5D index were analyzed.

Results: Among the 239 participants who responded to the survey, 63% (n = 150) were men. The mean age was 63 ± 13 years, and the mean duration of stroke onset was 55.6 months. Overall, 49% reported at least one unmet need, and the most frequently reported unmet needs were anxiety/depression (20.9%), self-care (20.9%), and pain/discomfort (18.0%). The highest proportion of unmet needs was in the anxiety/depression, communication, and cognition domains. Patients with unmet needs for cognition and pain/discomfort showed a significantly lower EQ-5D index, even after adjusting for age, sex, and modified Rankin scale scores. The total number of unmet needs was significantly correlated with a lower EQ-5D index (Pearson's r = −0.329, p < 0.001) in the multivariate linear regression model.

Conclusions: Unmet rehabilitative needs are prevalent among community-dwelling stroke survivors, and the proportion of unmet needs was high among non-physical domains such as anxiety/depression. The number of unmet needs is an independent negative predictor of HRQoL. Systematic approaches to identify unmet needs and provide appropriate rehabilitative management are required in long-term stroke survivors.

Introduction

Stroke is one of the leading causes of mortality and long-term physical, psychological, and social disabilities (1, 2). Although the incidence of stroke is increasing, its mortality has been decreasing owing to improved acute stroke care. Consequently, the number of stroke survivors living with disabilities who need long-term care is also increasing (2–4) and its socioeconomic burden (5).

Stroke survivors have various long-term health problems, such as reduced physical functioning (6), spasticity (7), memory loss (8), urinary incontinence (9), communication (10), and mood (11), which can lead to increased socioeconomic burden, participation restriction, and worse health-related quality of life (HRQoL) (12). These long-term health problems in stroke survivors are often not properly managed and remain as unmet needs. A national survey of long-term needs of stroke survivors in the UK showed that over half of patients have unmet needs (13). Andrew et al. also demonstrated that 84% of stroke survivors reported having unmet needs at a median 2 years after stroke (14). Accordingly, various studies have investigated a wide range of multidimensional unmet needs after stroke (15–20). However, previous studies did not focus on the unmet need for care in specific health-related problems after stroke.

In this study, we developed a questionnaire based on a post-stroke checklist (PSC) to assess unmet needs for rehabilitation management in common health-related problems after stroke. The PSC is a set of questionnaires developed by the Global Stroke Community Advisory Panel to identify long-term problems in stroke survivors (21). It examines 11 domains of long-term problems, including, secondary prevention, activities of daily living, mobility, spasticity, pain, incontinence, communication, mood, cognition, life after stroke, and relationships with caregivers. It focuses on the areas where intervention can have a large impact on HRQoL and has been recognized as a standardized tool for assessing long-term unmet needs in clinical practice (22).

In addition, although there have been many reports on the prevalence of unmet needs among stroke survivors, only few studies have investigated their association with HRQoL. Im et al. reported that worsening of mobility and communication problems was significantly associated with worse HRQoL in stroke survivors at the 12-month follow-up (23). Andrew et al. (24) also reported that pain and activity limitation were related to long-term unmet needs at 90 and 180 days following stroke. Nonetheless, the prevalence of long-term unmet needs and their impact on HRQoL remains unclear among chronic community-dwelling stroke survivors. Additionally, identifying the prevalence of unmet needs and their relationship with HRQoL using a conveniently administrable questionnaire will help physicians quickly recognize unmet needs and provide proper management in clinical settings.

This study aimed to investigate the unmet needs for rehabilitation services in the domains of common health problems after stroke in community-dwelling stroke survivors and establish the relationship between unmet needs for rehabilitative management and HRQoL. To achieve this goal, we developed a questionnaire based on the PSC for unmet needs, specifically for the rehabilitative management of common health-related problems after stroke.

Wednesday, January 22, 2020

Factors related to met needs for rehabilitation 6 years after stroke

The only question needed was: 'Are you 100% recovered?' THAT is the unmet need.

Factors related to met needs for rehabilitation 6 years after stroke

Ytterberg C^1,^2,³, Kristensen HK^3,⁴, Tistad M^1,⁵, von Koch L^1,².