Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke: an explorative observational study.
BACKGROUND
People who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation or dissatisfaction with health care services at 12 months after stroke.


METHODS
The participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables "unfulfilled needs for rehabilitation" and "dissatisfaction with care" were collected using a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses.


RESULTS
Unfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds ratio (OR) 7.05) at three months, and associated with hand function (SIS) (OR 4.38) and poor self-rated recovery (SIS) (OR 2.46) at 12 months. Dissatisfaction with care was predicted by SOC (OR 4.18) and participation (SIS) (OR 3.78), and associated with SOC (OR 3.63) and strength (SIS) (OR 3.08).


CONCLUSIONS
Thirty-three percent of the participants reported unmet needs for rehabilitation and fourteen percent were dissatisfied with the care received. In order to attend to rehabilitation needs when they arise, rehabilitation services may need to be more flexible in terms of when rehabilitation is provided. Long term services with scheduled re-assessments and with more emphasis on understanding the experiences of both the patients and their social networks might better be able to provide services that attend to patients' needs and aid peoples' reorientation; this would apply particularly to those with poor coping capacity.
Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Fack 23 200, S 141 83, Huddinge, Sweden. malin.tistad@ki.se
Malin
M
Tistad
Kerstin
K
Tham
Lena
L
von Koch
Charlotte
C
Ytterberg
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D015995:Prevalence; D020521:Stroke / Q000453:epidemiology*; D000071939:Stroke Rehabilitation; D013548:Sweden / Q000453:epidemiology; D017211:Treatment Failure