Understanding long-term unmet needs in Australian survivors of stroke

Abstract

Background: Limited data exist on the long-term needs of community-dwelling stroke survivors. We aimed to describe factors associated with the extent to which needs were met in Australian survivors of stroke.

Method: Multifaceted strategies were used to obtain a national sample. Adults 12+ months poststroke and living in the community participated. Needs were assessed over the domains of health, everyday living, work, leisure, social support, and finances. Multivariable negative-binomial and logistic regression were used.

Results: Seven hundred sixty-five survivors completed surveys. Most (84%) reported having needs that were not being fully met (median 4 of 20, Q1, Q3: 1, 9). Variations occurred based on age, residential location, time since stroke, and disability level. Multivariable results showed that having fatigue, cognition or emotional problems, decreasing age, and increased disability were associated with increasing numbers of needs not being fully met (P < 0·001). Factors associated with needs not being fully met were as follows: (1) greater disability (adjusted odds ratio: 3·4, 95% confidence interval: 1·9, 6·0) and fatigue problems (adjusted odds ratio: 2·0, 95% confidence interval: 1·1, 3·4) (health domain); (2) greater disability (adjusted odds ratio: 7·0, 95% confidence interval: 3·0, 17·0) and being one to two-years poststroke (adjusted odds ratio: 3·4, 95% confidence interval: 1·5, 7·8) (work domain); and (3) increased disability (adjusted odds ratio: 3·8, 95% confidence interval: 2·2, 6·5) and memory problems (adjusted odds ratio: 2·1, 95% confidence interval: 1·0, 4·2) (leisure domain).

Conclusion: The extent to which long-term needs were met was influenced by a variety of factors, particularly age, disability levels, and residential location. Changes need to be made to the way and extent to which survivors are supported following stroke.

Keywords: community care; outcomes; stroke; stroke care; treatment; unmet needs.