title: Perceived Unmet Rehabilitation Needs 1 Year After Stroke: An Observational Study From the Swedish Stroke Register.
abstract: OBJECTIVE
  Met care demands are key aspects in poststroke quality of care. This study aimed to identify baseline predictors and 12-month factors that were associated with perceived unmet rehabilitation needs 1 year poststroke.
  
  
  METHODS
  Data on patients who were independent in activities of daily living, hospitalized for acute stroke during 2008 to 2010, and followed up 1 year poststroke through a postal questionnaire were obtained from the Swedish stroke register. Patients reporting fulfilled rehabilitation needs were compared with those with unmet needs (Chi square test).
  
  
  RESULTS
  The study included 37 383 patients, 46% female. At 12 months, 8019 (21.5%) patients reported unmet rehabilitation needs. Compared with those with met rehabilitation needs, patients reporting unmet rehabilitation needs were older (75.4 versus 72.4 years; P<0.0001); a higher proportion was activities of daily living-dependent (59% versus 31.9%; P<0.0001) and institutionalized (24.3% versus 11.5%; P<0.0001) at 12 months. Poststroke depression (32.3% versus 24.9%; P<0.0001) and insufficient pain medication were more common in patients with unmet needs (54.5% versus 32.3%; P<0.0001). Baseline predictors of unmet rehabilitation needs at 12 months in an age-adjusted model were severe stroke (odds ratio [OR]=3.04; confidence interval [CI]: 2.39-3.87), prior stroke (OR=1.63; CI: 1.53-1.75), female sex (OR=1.14; CI: 1.07-1.20), diabetes mellitus (OR=1.24; CI: 1.15-1.32), stroke other than ischemic (OR=1.26; CI: 1.20-1.32), and atrial fibrillation (OR=1.19; CI: 1.12-1.27).
  
  
  CONCLUSIONS
  Unfulfilled rehabilitation needs 1 year poststroke are common and associated with high age, dependency, pain, and depression. Long-term follow-up systems should, therefore, be comprehensive and address multiple domains of poststroke problems, rather than having a single-domain focus.
authors.affiliation: From the Department of Neurology, Skåne University Hospital in Malmö/Lund, Sweden (T.U., J.P., B.N.); and Institution of Clinical Sciences, Neurology, Lund University, Sweden (T.U., E.Z., J.P., B.N.). Teresa.Ullberg@med.lu.se.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ullberg
authors.affiliation: From the Department of Neurology, Skåne University Hospital in Malmö/Lund, Sweden (T.U., J.P., B.N.); and Institution of Clinical Sciences, Neurology, Lund University, Sweden (T.U., E.Z., J.P., B.N.).
authors.forename: Elisabet
authors.initials: E
authors.lastname: Zia
authors.affiliation: From the Department of Neurology, Skåne University Hospital in Malmö/Lund, Sweden (T.U., J.P., B.N.); and Institution of Clinical Sciences, Neurology, Lund University, Sweden (T.U., E.Z., J.P., B.N.).
authors.forename: Jesper
authors.initials: J
authors.lastname: Petersson
authors.affiliation: From the Department of Neurology, Skåne University Hospital in Malmö/Lund, Sweden (T.U., J.P., B.N.); and Institution of Clinical Sciences, Neurology, Lund University, Sweden (T.U., E.Z., J.P., B.N.).
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006301:Health Services Needs and Demand; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D000066530:Neurological Rehabilitation / Q000706:statistics & numerical data*; D016017:Odds Ratio; D059408:Pain Management / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010465:Perception; D012042:Registries; D012047:Rehabilitation Centers; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
keywords: follow-up study; quality of care; rehabilitation; stroke care; unmet needs