Patient satisfaction with hospital-based outpatient rehabilitation after stroke in Sweden and its association with life satisfaction and health-related quality of life: a longitudinal national register study
DOI:
https://doi.org/10.2340/jrm.v58.43966Keywords:
health, personal satisfaction, quality of life, stroke, outpatient rehabilitationAbstract
Objective: To examine stroke survivors’ satisfaction with hospital-based outpatient rehabilitation and its association with life satisfaction and health-related quality of life (HRQoL), and whether sex and age affect possible associations.
Design: A longitudinal national register study.
Methods: Data from the Swedish national quality register were used and included 1,068 patients with stroke performing outpatient rehabilitation. Self-reported questionnaires collected on admission, discharge, and at 1-year follow-up were analysed. Regression analyses were used to assess possible associations between patient satisfaction and life satisfaction (Life Satisfaction Questionnaire, LiSat-11) and HRQoL (EuroQol Five Dimensions questionnaire, EQ-5D).
Results: Over 71% of the included patients were satisfied with their rehabilitation process on discharge. Satisfied patients also reported higher scores on global LiSat-11 and higher EQ-5D values. Older patients (> 58 years) satisfied with their rehabilitation process were more likely to be satisfied with global LiSat-11. Women dissatisfied with the rehabilitation process had lower EQ-5D values on discharge.
Conclusion: Patient satisfaction with hospital-based outpatient rehabilitation was associated with life satisfaction and HRQoL. Potential differences linked to sex and age support the importance of individually tailored rehabilitation strategies. Evaluating self-reported outcomes and experiences over time is essential for improving long-term recovery and for further development of person-centred stroke rehabilitation.
Downloads
References
Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795–820.
https://doi.org/10.1016/S1474-4422(21)00252-0 DOI: https://doi.org/10.1016/S1474-4422(21)00252-0
National Board of Health and Welfare. National Guidelines for Stroke Care: support for governance and management [cited 2020]. Available from: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2020-1-6545.pdf
Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2016; 47: e98–e169.
https://doi.org/10.1161/STR.0000000000000098 DOI: https://doi.org/10.1161/STR.0000000000000098
National Board of Health and Welfare. Statistics on stroke 2023. [cited 2024; Available from: https://www.socialstyrelsen.se/statistik-och-data/statistik/alla-statistikamnen/stroke/
Shipley J, Luker J, Thijs V, Bernhardt J. How can stroke care be improved for younger service users? A qualitative study on the unmet needs of younger adults in inpatient and outpatient stroke care in Australia. Disabil Rehabil 2020; 42: 1697–1704.
https://doi.org/10.1080/09638288.2018.1534278 DOI: https://doi.org/10.1080/09638288.2018.1534278
Boissonneault M, Mulders JO, Turek K, Carriere Y. A systematic review of causes of recent increases in ages of labor market exit in OECD countries. PLoS One 2020; 15: e0231897.
https://doi.org/10.1371/journal.pone.0231897 DOI: https://doi.org/10.1371/journal.pone.0231897
Martinsen R, Kirkevold M, Sveen U. Young and midlife stroke survivors’ experiences with the health services and long-term follow-up needs. J Neurosci Nurs 2015; 47: 27–35.
https://doi.org/10.1097/JNN.0000000000000107 DOI: https://doi.org/10.1097/JNN.0000000000000107
Harris GM, Prvu Bettger J. Parenting after stroke: a systematic review. Top Stroke Rehabil 2018; 25: 384–392.
https://doi.org/10.1080/10749357.2018.1452366 DOI: https://doi.org/10.1080/10749357.2018.1452366
Ludvigsson JF, Bergman D, Lundgren CI, Sundquist K, Geijerstam J-La, Glenngård AH, et al. The healthcare system in Sweden. Eur J Epidemiol 2025: 1–17. DOI: https://doi.org/10.1007/s10654-025-01226-9
Bråndal A, Eriksson M, Glader EL, Wester P. Effect of early supported discharge after stroke on patient reported outcome based on the Swedish Riksstroke registry. BMC Neurol 2019; 19: 40.
https://doi.org/10.1186/s12883-019-1268-8 DOI: https://doi.org/10.1186/s12883-019-1268-8
Norrving B, Barrick J, Davalos A, Dichgans M, Cordonnier C, Guekht A, et al. Action Plan for Stroke in Europe 2018–2030. Eur Stroke J 2018; 3: 309–336.
https://doi.org/10.1177/2396987318808719 DOI: https://doi.org/10.1177/2396987318808719
Hamza AM, Al-Sadat N, Loh SY, Jahan NK. Predictors of poststroke health-related quality of life in Nigerian stroke survivors: a 1-year follow-up study. Biomed Res Int 2014; 2014: 350281.
https://doi.org/10.1155/2014/350281 DOI: https://doi.org/10.1155/2014/350281
OECD Better Life Index [cited]. Available from: https://www.oecdbetterlifeindex.org/topics/life-satisfaction/
Taylor RM, Gibson F, Franck LS. A concept analysis of health-related quality of life in young people with chronic illness. J Clin Nurs 2008; 17: 1823–1833.
https://doi.org/10.1111/j.1365-2702.2008.02379.x DOI: https://doi.org/10.1111/j.1365-2702.2008.02379.x
Kingsley C, Patel S. Patient-reported outcome measures and patient-reported experience measures. BJA Educ 2017; 17: 137–144.
https://doi.org/10.1093/bjaed/mkw060 DOI: https://doi.org/10.1093/bjaed/mkw060
Abualait TS, Alzahrani MA, Ibrahim AI, Bashir S, Abuoliat ZA. Determinants of life satisfaction among stroke survivors 1 year post stroke. Medicine (Baltimore) 2021; 100: e25550.
https://doi.org/10.1097/MD.0000000000025550 DOI: https://doi.org/10.1097/MD.0000000000025550
Palmcrantz S, Widén Holmqvist L, Sommerfeld DK. Young individuals with stroke: a cross sectional study of long-term disability associated with self-rated global health. BMC Neurol 2014; 14: 20.
https://doi.org/10.1186/1471-2377-14-20 DOI: https://doi.org/10.1186/1471-2377-14-20
Yoon CW, Bushnell CD. Stroke in women: a review focused on epidemiology, risk factors, and outcomes. J Stroke 2023; 25: 2–15.
https://doi.org/10.5853/jos.2022.03468 DOI: https://doi.org/10.5853/jos.2022.03468
Phan HT, Blizzard CL, Reeves MJ, Thrift AG, Cadilhac DA, Sturm J, et al. Sex differences in long-term quality of life among survivors after stroke in the INSTRUCT. Stroke 2019; 50: 2299–2306.
https://doi.org/10.1161/STROKEAHA.118.024437 DOI: https://doi.org/10.1161/STROKEAHA.118.024437
Phan HT, Gall SL, Blizzard CL, Lannin NA, Thrift AG, Anderson CS, et al. Sex differences in quality of life after stroke were explained by patient factors, not clinical care: evidence from the Australian Stroke Clinical Registry. Eur J Neurol 2021; 28: 469–478.
https://doi.org/10.1111/ene.14531 DOI: https://doi.org/10.1111/ene.14531
Laurent K, De Sèze M-P, Delleci C, Koleck M, Dehail P, Orgogozo J-M, et al. Assessment of quality of life in stroke patients with hemiplegia. Ann Phys Rehabil Med 2011; 54: 376–390.
https://doi.org/10.1016/j.rehab.2011.06.002 DOI: https://doi.org/10.1016/j.rehab.2011.06.002
Fugl-Meyer AR, Melin R, Fugl-Meyer KS. Life satisfaction in 18- to 64-year-old Swedes: in relation to gender, age, partner and immigrant status. J Rehabil Med 2002; 34: 239–246.
https://doi.org/10.1080/165019702760279242 DOI: https://doi.org/10.1080/165019702760279242
Ekstrand E, Lexell J, Brogårdh C. Test–retest reliability of the Life Satisfaction Questionnaire (LiSat-11) and association between items in individuals with chronic stroke. J Rehabil Med 2018; 50: 713–718.
https://doi.org/10.2340/16501977-2362 DOI: https://doi.org/10.2340/16501977-2362
Hansson EE, Beckman A, Wihlborg A, Persson S, Troein M. Satisfaction with rehabilitation in relation to self-perceived quality of life and function among patients with stroke: a 12 month follow-up. Scand J Caring Sci 2013; 27: 373–379.
https://doi.org/10.1111/j.1471-6712.2012.01041.x DOI: https://doi.org/10.1111/j.1471-6712.2012.01041.x
Tarihoran DE, Honey M, Slark J. Younger women’s experiences of stroke: a qualitative study. Nurs Prax Aotearoa NZ 2023; 39.
https://doi.org/10.36951/001c.73355 DOI: https://doi.org/10.36951/001c.73355
Gurková E, Štureková L, Mandysová P, Šaňák D. Factors affecting the quality of life after ischemic stroke in young adults: a scoping review. Health Qual Life Outcomes 2023; 21: 4.
https://doi.org/10.1186/s12955-023-02090-5 DOI: https://doi.org/10.1186/s12955-023-02090-5
Segerdahl M, Hansson P-O, Samuelsson CM, Persson CU. Health-related quality of life in stroke survivors: a 5-year follow-up of the Fall Study of Gothenburg (FallsGOT). BMC Geriatr 2023; 23: 584.
https://doi.org/10.1186/s12877-023-04308-z DOI: https://doi.org/10.1186/s12877-023-04308-z
Svenskt Register för Rehabiliteringsmedicin [cited]. Available from: https://svereh.registercentrum.se
Sunnerhagen KS, Flansbjer UB, Lannsjö M, Tölli A, Lundgren-Nilsson A. WebRehab: a Swedish database for quality control in rehabilitation. J Rehabil Med 2014; 46: 958–962.
https://doi.org/10.2340/16501977-1886 DOI: https://doi.org/10.2340/16501977-1886
Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001; 33: 337–343.
https://doi.org/10.3109/07853890109002087 DOI: https://doi.org/10.3109/07853890109002087
Joundi RA, Adekanye J, Leung AA, Ronksley P, Smith EE, Rebchuk AD, et al. Health state utility values in people with stroke: a systematic review and meta-analysis. J Am Heart Assoc 2022; 11: e024296.
https://doi.org/10.1161/JAHA.121.024296 DOI: https://doi.org/10.1161/JAHA.121.024296
Zhou J, Wei Q, Hu H, Liu W, Guan X, Ma A, et al. A systematic review and meta-analysis of health utility values among patients with ischemic stroke. Front Neurol 2023; 14: 1219679.
https://doi.org/10.3389/fneur.2023.1219679 DOI: https://doi.org/10.3389/fneur.2023.1219679
Burström K, Sun S, Gerdtham UG, Henriksson M, Johannesson M, Levin L, et al. Swedish experience-based value sets for EQ-5D health states. Qual Life Res 2014; 23: 431–442.
https://doi.org/10.1007/s11136-013-0496-4 DOI: https://doi.org/10.1007/s11136-013-0496-4
Matérne M, Strandberg T, Lundqvist LO. Change in quality of life in relation to returning to work after acquired brain injury: a population-based register study. Brain Inj 2018; 32: 1731–1739.
https://doi.org/10.1080/02699052.2018.1517224 DOI: https://doi.org/10.1080/02699052.2018.1517224
Ytterberg C, Kristensen HK, Tistad M, von Koch L. Factors related to met needs for rehabilitation 6 years after stroke. Plos One 2020; 15: e0227867.
https://doi.org/10.1371/journal.pone.0227867 DOI: https://doi.org/10.1371/journal.pone.0227867
Cramm JM, Strating MM, Nieboer AP. Satisfaction with care as a quality-of-life predictor for stroke patients and their caregivers. Qual Life Res 2012; 21: 1719–1725.
https://doi.org/10.1007/s11136-011-0107-1 DOI: https://doi.org/10.1007/s11136-011-0107-1
Tistad M, Tham K, von Koch L, Ytterberg C. Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke: an explorative observational study. BMC Neurol 2012; 12: 40.
https://doi.org/10.1186/1471-2377-12-40 DOI: https://doi.org/10.1186/1471-2377-12-40
Håkansson Eklund J, Holmström IK, Kumlin T, Kaminsky E, Skoglund K, Höglander J, et al. “Same same or different?” A review of reviews of person-centered and patient-centered care. Patient Educ Couns 2019; 102: 3–11.
https://doi.org/10.1016/j.pec.2018.08.029 DOI: https://doi.org/10.1016/j.pec.2018.08.029
Forster A, Brown L, Smith J, House A, Knapp P, Wright JJ, et al. Information provision for stroke patients and their caregivers. Cochrane Database Syst Rev 2012; 11: Cd001919.
https://doi.org/10.1002/14651858.CD001919.pub3 DOI: https://doi.org/10.1002/14651858.CD001919.pub3
Davoody N, Koch S, Krakau I, Hägglund M. Post-discharge stroke patients’ information needs as input to proposing patient-centred eHealth services. BMC Med Inform Decis Mak 2016; 16: 66.
https://doi.org/10.1186/s12911-016-0307-2 DOI: https://doi.org/10.1186/s12911-016-0307-2
Gargano JW, Reeves MJ. Sex differences in stroke recovery and stroke-specific quality of life: results from a statewide stroke registry. Stroke 2007; 38: 2541–2548.
https://doi.org/10.1161/STROKEAHA.107.485482 DOI: https://doi.org/10.1161/STROKEAHA.107.485482
Gall SL, Donnan G, Dewey HM, Macdonell R, Sturm J, Gilligan A, et al. Sex differences in presentation, severity, and management of stroke in a population-based study. Neurology 2010; 74: 975–981.
https://doi.org/10.1212/WNL.0b013e3181d5a48f DOI: https://doi.org/10.1212/WNL.0b013e3181d5a48f
Gall SL, Tran PL, Martin K, Blizzard L, Srikanth V. Sex differences in long-term outcomes after stroke: functional outcomes, handicap, and quality of life. Stroke 2012; 43: 1982–1987.
https://doi.org/10.1161/STROKEAHA.111.632547 DOI: https://doi.org/10.1161/STROKEAHA.111.632547
Silva Y, Sánchez-Cirera L, Terceño M, Dorado L, Valls A, Martínez M, et al. Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia. Eur Stroke J 2023; 8: 557–565.
https://doi.org/10.1177/23969873231156260 DOI: https://doi.org/10.1177/23969873231156260
Röding J, Glader E-L, Malm J, Lindström B. Life satisfaction in younger individuals after stroke: different predisposing factors among men and women. J Rehabil Med 2010; 42: 155–161.
https://doi.org/10.2340/16501977-0497 DOI: https://doi.org/10.2340/16501977-0497
Ullberg T, Månsson K, Berhin I, Pessah-Rasmussen H. Comprehensive and structured 3-month stroke follow-up using the post-stroke checklist (The Struct-FU study): a feasibility and explorative study. J Stroke Cerebrovasc Dis 2021; 30: 105482.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105482 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105482
Additional Files
Published
How to Cite
License
Copyright (c) 2026 Anna Bråndal, Britt-Marie Stålnacke, Gudrun M. Johansson
This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
