Unmet Needs Post Stroke: Level of Unmet Need According to Discharge Destination

Abstract

Abstract Background Stroke survivors often face unmet needs after leaving acute and rehabilitation services (McKevitt et al., 2011). UK and Ireland stroke guidelines (2023) advise a 6-month health and social care review for all patients, yet resource access in hospital and community settings hinder this. Targeting those with the most unmet needs could improve service delivery. Consequently, we examined unmet needs of stroke patients post-rehabilitation, comparing those who were discharged to rehabilitation (RG) to the non-rehabilitation group (NRG). Methods Participants: All patients attending a post-stroke review clinic between March 2023 and April 2024. Groups: RG included patients discharged to Early Supported Discharge or inpatient rehabilitation; NRG included patients not discharged to these services. Data: Collected demographic information and assessed unmet needs using a modified Greater Manchester Stroke Assessment Tool. Analysis: Using Microsoft Excel, group comparisons were made using chi-squared tests and t-tests, with log transformation applied to non-normally distributed data. Results 251 patients attended during the data collection period (69 patients (27%) in RG, 182 patients (73%) in NRG). The average age was 68 in both groups. The RG had a longer mean length of stay (23 days) compared to the NRG (19 days) (p=0.0007). The RG also had a higher mean score on the clinical frailty scale (RG 4, NRG 3, p=0.05). In the RG, 97% reported no follow-up after discharge, compared to 78% in the NRG. A greater proportion of RG patients reported swallow difficulties (12% vs. 3%, p=0.03), mobility difficulties (46% vs. 30%, p=0.02), and falls (41% vs. 30%, p=0.008) compared to NRG patients. Conclusion Data from this exploratory study suggests substantial unmet needs among post-stroke patients with a significantly higher level of unmet needs among patients who were discharged to post-acute rehabilitation. Despite this, the majority of these patients were not seen by community services at the time of 6-month review.