Factors associated with met and unmet rehabilitation needs after stroke: A multicentre cohort study in Denmark and Norway.
Guri Heiberg, Cecilie Røe, Oddgeir Friborg and 4 others
PMID 33846761WHAT IT FOUND
Three months after stroke, 67% reported needing training and 69% needed help, with similar rates in Norway and Denmark despite different rehabilitation pathways.
Unmet needs for training were linked to lower function and anxiety, while unmet needs for help were linked to living alone and depression.
Key findings
01At 3 months, 67% of participants reported a need for training and 69% for help, with no significant difference in perceived need between the two countries.
02Unmet need for training was significantly associated with lower functional ability (mRS 3-5) and higher anxiety scores at 3 months.
03Unmet need for help was significantly associated with living alone pre-stroke and depression at 3 months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Response rates varied significantly (76% in Norway vs 45% in Denmark), introducing potential selection bias, particularly in the Danish cohort. Needs were assessed using only two single-item questions (yes/no/unknown), which cannot distinguish between partially met needs or identify the specific type of rehabilitation required. The study was exploratory; variables were removed if p > 0.05, which may inflate the significance of the remaining findings. Mental health data (HADS) was missing for a large portion of the sample (available for 308 of 473 patients). The definition of 'rehabilitation' was broad, combining physiotherapy, occupational therapy, and speech therapy into 'training', and general care into 'help', limiting specificity for individual disciplines.
Declared interests
The authors declare no conflicts of interest. The study was approved by ethics committees in both countries.
The easy way to misread this
Do not assume that because unmet needs were low (15-22%), the rehabilitation provided was adequate. The study used a binary yes/no question, so patients with partially met needs may have reported them as 'met', and the high rate of unmet needs in patients with good physical function (mRS 0-1) suggests that standard disability scales may miss specific therapy needs.