卒中后生活中的社会工作支持和未满足的社会需求：一项横断面探索性研究。
Social work support and unmet social needs in life after stroke: a cross-sectional exploratory study.
机构信息
Center for Stroke Research Berlin, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Department of Neurology, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
出版信息
BMC Neurol. 2019 Sep 6;19(1):220. doi: 10.1186/s12883-019-1451-y.
BACKGROUND
Stroke patients are often affected by long-term disabilities with needs concerning social issues. There is relatively little consideration of social recovery of patients and the support required to return to work, receive social benefits, participate in daily life activities, maintain contact with family and friends and to organize financial affairs. In our study we aimed to investigate if existing tools record social needs adequately. We analyzed the current provision of social support provided in long-term care after stroke and whether unmet social needs were associated with quality of life, caregiver burden, overall function and degree of disability.
METHODS
Our analysis is part of the Managing Aftercare of Stroke study (MAS-I), a cross-sectional exploratory study of patient needs 2-3 years after initial stroke. Assessment tools included the Nikolaus-score (social situation), the EuroQoL (quality of life), the German Burden Scale for Family Caregivers (caregiver burden), the modified Rankin Scale (disability / dependence), Stroke Impact Scale (function and degree of disability) and the Stroke Survivor Needs Questionnaire (unmet needs).
RESULTS
Overall 57 patients were included in MAS-I, with ten patients classified in urgent need of socio-economic support according to the Nikolaus-score. Patients with lower than normal Nikolaus-score had a higher degree of disability. Thirty percent of all patients had never received professional social support. Social worker contact happened mostly during the stay in acute hospital or rehabilitation institution. Only four patients (11%) reported long-term support after discharge. Apart from social worker contact during acute care, 43% of patients had unmet needs in the long-term aftercare. Forty percent of all patients included in MAS-I were recommended for social work intervention after an in-depth analysis of their situation. Finally, we saw that unmet social needs were associated with lower quality of life and higher caregiver burden.
CONCLUSIONS
Our data suggest significant unmet needs in social care in long-term stroke patients. Screening tools for unmet social needs such as the Nikolaus-score do not holistically report patients' needs.
TRIAL REGISTRATION
Clinicaltrials.Gov NCT02320994 . Registered 19 December 2014 (retrospectively registered).
背景
脑卒中患者常伴有长期残疾，需要解决社会问题。目前，对于患者的社会康复以及重返工作岗位、获得社会福利、参与日常生活活动、与家人和朋友保持联系以及组织财务事务所需的支持，关注较少。在我们的研究中，我们旨在调查现有的工具是否能充分记录社会需求。我们分析了脑卒中后长期护理中提供的社会支持现状，以及未满足的社会需求是否与生活质量、照顾者负担、总体功能和残疾程度有关。
方法
我们的分析是 Managing Aftercare of Stroke 研究（MAS-I）的一部分，这是一项脑卒中后 2-3 年患者需求的横断面探索性研究。评估工具包括 Nikolaus 评分（社会状况）、EuroQoL（生活质量）、德国家庭照顾者负担量表（照顾者负担）、改良 Rankin 量表（残疾/依赖）、脑卒中影响量表（功能和残疾程度）和脑卒中幸存者需求问卷（未满足的需求）。
结果
MAS-I 共纳入 57 例患者，根据 Nikolaus 评分，10 例患者被归类为急需社会经济支持。Nikolaus 评分较低的患者残疾程度较高。所有患者中有 30%从未接受过专业社会支持。社工联系主要发生在急性医院或康复机构住院期间。只有 4 名患者（11%）在出院后得到长期支持。除急性护理期间的社工联系外，43%的患者在长期康复后仍有未满足的需求。MAS-I 中所有患者中有 40%在对其情况进行深入分析后被建议接受社会工作干预。最后，我们发现未满足的社会需求与生活质量较低和照顾者负担较高有关。
结论
我们的数据表明，长期脑卒中患者的社会护理存在显著的未满足需求。用于评估未满足社会需求的筛查工具（如 Nikolaus 评分）并不能全面报告患者的需求。
试验注册
Clinicaltrials.Gov NCT02320994。于 2014 年 12 月 19 日注册（追溯注册）。
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