Rural Needs and Gaps in Stroke Rehabilitation: Results of Statewide Healthcare Provider and Patient Survey

Research Objectives: To better inform a robust understanding of stroke rehabilitation needs in Nebraska (NE) among healthcare providers (HCPs) and stroke survivors.

Design: Cross-sectional survey

Setting: Nebraska hospital settings: critical access/community, acute care, inpatient rehabilitation facility, skilled nursing facility and outpatient.

Participants: A total of 260 HCPs were recruited through the Nebraska Stroke Advisory Council to complete a 17-question online survey. HCPs included: physical, occupational and speech therapists, registered nurses, case managers and social workers. Separately, 28 stroke survivors recruited through social media and existing stroke support groups completed a 26-question online survey. Survivors included 12 females, 15 males (1 did not answer) ages 45-75+ years with the majority (35.7%) between 1 to 5 years since stroke.

Interventions: None

Main Outcome Measures: Survey designed to assess perceptions of HCPs and stroke survivors evaluating outpatient therapy, social support, equipment, patient resources, and contextual factors such as transportation and insurance.

Results: HCPs identified the top barrier to providing stroke rehabilitation care as lack of insurance (62%), followed by lack of caregiver support (42%), and lack of specialized services (42%). When asked about survivors’ greatest barrier to receiving care, the majority indicated a lack of insurance (74%), followed by financial burden (64%), and lack of caregiver/social support (50%). Survivors reported the top missing resource as communication about stroke support groups and sources of emotional support. HCPs indicated missing resources primarily include specialized rehab equipment, technology and services (52%), and professional opportunities for staff (37%).

Conclusions: Most stroke rehab HCPs identified specialized equipment and services as a missing resource, and indicated lack of insurance coverage as the top barrier to providing care, suggesting a need to understand where the specialized services are located in the state along with the insurance-related challenges patients face. Only 7% of stroke survivors indicated they learned about mental health resources during stroke recovery, while over a third (35%) reported feeling down or depressed suggesting there is a need for more information about mental health services available for survivors.

Author(s) Disclosures: None