Health Services for Young Adults with Stroke: A Service Mapping Study over Two Australian States

Despite increased incidence of stroke in young adulthood across the world, young adults report significant difficulties finding services with the expertise and experience to meet their needs. This service mapping study sought to identify and characterise the availability, accessibility, and accommodation of services to meet the needs of young adults (aged 18-44 years) with stroke in two Australian states. 

Methods: Relevant clinical, rehabilitation, and allied health services were systematically identified from previous publications; the National Health Service Directory; professional association "find a provider" listings; and Stroke Foundation service lists. Desktop audit (n = 465 services) and key informant interviews (n = 321 services) were used to collect service design and delivery characteristics; level of experience, confidence, and willingness to work with young adults with stroke; and accommodation of communication impairments. 

Results: Most services (85%) were in major cities or inner regional areas. No services worked solely with young adults with stroke; however, several reported having relevant expertise, training, experience, and programmes to provide neurological rehabilitation to meet the needs of young adults with stroke. Reported willingness (91.0%) to work with young adults with stroke was high, but only 57.0% were very confident to do so. Most services with neurorehabilitation expertise addressed psychosocial recovery needs (e.g., emotional adjustment and relationships) as well as functional recovery, but few supported return-to-driving, peer support, and sensory processing disturbances. Further gaps were the use of accessible communication materials in only 50.2% of services, and staff had completed communication training at only 60.4% of services. 

Conclusion: Findings highlight that while expert neurorehabilitation services exist, they are not sufficiently available, accessible, or accommodating of the needs of young adults with stroke. There remains a need to improve access to services where clinicians have the skills to meet the rehabilitation needs of young adults with stroke in Australia.