Rehabilitation pathways, satisfaction with functioning and wellbeing, and experienced rehabilitation needs after stroke

Abstract

This international cohort study included 451 Norwegian and 348 Danish patients with first-ever stroke admitted to stroke units from one country region in north Norway and one in Denmark with different organization of rehabilitation services. Data were collected from national stroke registries and questionnaires with 3- and 12-months follow-up. The Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS), assessing satisfaction with functioning and well-being, was first-ever validated for patients of stroke. Two questions from the Norwegian Stroke Registry investigated met, unmet or no needs for help and training. Norwegian participants were older than Danish and had more severe strokes. Rehabilitation pathways for participants from the two country regions differed, with longer stay in stroke units and inpatient rehabilitation services more frequently applied in the north of Norway. At 3 months post-stroke, the participants reported equal levels of satisfaction, but at 12 months the Norwegian participants were more satisfied with function and well-being. Good health-related quality of life was stated by 83% in Norway and 71% in Denmark. There was no change in satisfaction at a group level from 3 to 12 months post stroke, but at an individual level 50 % reported clinical important change in perceived satisfaction with functioning. Patients below 65 years of age were more susceptible to report worsening of outcome in QOLIBRI-OS over time. The patients in the two country cohorts reported equal results for met, unmet or no needs for help and training at 3 months post stroke. However, every fifth patient with stroke conveyed unmet need for help and training with a correspondingly low health-related quality of life. Anxiety and depression were correlated with unmet needs. Optimizing stroke structure and processes and implementing strategies to reduce psychological distress may enable a higher degree of fulfilment of rehabilitation needs and hence increase satisfaction with functioning.