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 Chang^1†, Yun-Sun Jung¹, Sungju Jee³, Min Kyun Sohn³, Sung-Hwa Ko⁴, Yong-Il Shin⁴, Ja-Ho Leigh^5,6, Won-Seok Kim^1* and Nam-Jong Paik^1*

• 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.