Community Personal Needs Assessment Questionnaire

1. Abstract

The Community Personal Needs Assessment Questionnaire (commonly designated as the NEEDS Questionnaire; Sapuppo et al., 2023) is an extensive, self-administered patient-reported outcome measure (PROM) specifically engineered to systematically detect, evaluate, and quantify unmet biopsychosocial needs among community-dwelling young stroke survivors. Historically, post-stroke outcome measurement tools have focused predominantly on older cohorts, emphasizing gross physical impairment, functional independence in basic activities of daily living (ADLs), or survival rates. However, stroke in young adults (conventionally defined as individuals aged 18 to 55 years) entails unique developmental disruptions, including vocational displacement, parental and marital strain, financial destabilization, and long-term psychosocial sequelae. Developed following a rigorous synthesis of literature and pre-existing needs assessment methodologies, the NEEDS Questionnaire comprises 175 items distributed across seven primary functional and contextual domains: Healthcare Experience (Questions 6–39), Impairments from Stroke (Questions 40–80), Everyday Activities (Questions 81–94), Work or Study (Questions 95–116), Finances (Questions 117–124), Relationships (Questions 125–137), and Social Participation (Questions 138–146). The instrument employs a dual-step response architecture: respondents first complete a binary (Yes/No) filter indicating whether a specific need remains unfulfilled, followed by a conditional six-point Likert scale (ranging from 1 = “not significant” to 6 = “highly significant”) to quantify the subjective gravity of that unmet need. Select items incorporate qualitative branching prompts to capture contributing contextual barriers. Administered digitally, the instrument is designed for individuals residing in community settings at least two months post-incident cerebrovascular accident. By capturing both the prevalence and the subjective significance of perceived deficits across personal, interpersonal, and environmental strata, the NEEDS Questionnaire provides clinicians, neurorehabilitation teams, and health service researchers with high-granularity data essential for designing targeted, developmentally sensitive post-acute survivorship care plans.

2. Keywords

Needs Assessment, Stroke in Young Adults, Cerebrovascular Accidents, Patient-Reported Outcome Measures, Neuropsychological Assessment, Community Reintegration, Rehabilitation Psychology, Psychometrics, Health Services Needs and Demand, Disability Evaluation, Psychosocial Adjustment

3. Authors

The Community Personal Needs Assessment (NEEDS) Questionnaire was conceptualized, developed, and evaluated by an interdisciplinary team of clinical neurologists, stroke rehabilitation scientists, and biostatisticians based in Melbourne, Victoria, Australia:

• David Sapuppo — Department of Neurology, Austin Health, Melbourne, Victoria, Australia.
• Julie Bernhardt, PhD (ORCID: 0000-0002-2787-8484) — Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
• Lilian B. Carvalho — Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
• Leonid Churilov, PhD — Department of Medicine (Austin Health), Melbourne Medical School, University of Melbourne; and Melbourne Brain Centre at The Royal Melbourne Hospital, Parkville, Victoria, Australia.
• Vincent Thijs, MD, PhD (ORCID: 0000-0002-6614-8417) — Corresponding Author; Department of Neurology, Austin Health, Melbourne, Victoria, Australia; and Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia. Email: [email protected].

4. Purpose

The fundamental purpose of the Community Personal Needs Assessment (NEEDS) Questionnaire is to provide an empirically grounded, patient-centric diagnostic inventory capable of profiling the heterogeneous, multidimensional, and often silent unmet needs of young adult stroke survivors living in community environments. While cerebrovascular accidents have historically been conceptualized as diseases of senescence, epidemiological trends demonstrate a concerning surge in stroke incidence among individuals aged between 18 and 55 years. When stroke strikes during early or middle adulthood, it disrupts individuals at the zenith of their educational consolidation, career trajectories, family formation, child-rearing responsibilities, and financial accumulation. Despite this profound divergence in life-stage demands, conventional stroke rehabilitation paradigms remain overwhelmingly indexed against the restorative trajectories of geriatric populations, where successful discharge to home or functional ambulation is frequently conflated with complete functional recovery.

Consequently, young stroke survivors routinely face an abrupt “cliff” in care following transition from acute or inpatient rehabilitation back into community living. Clinical examinations and generic functional disability metrics—such as the modified Rankin Scale (mRS) or the Functional Independence Measure (FIM)—exhibit marked ceiling effects in this population. A young survivor may achieve full physical ambulation and nominal independence in basic hygiene and feeding (yielding a low mRS score indicative of “favorable outcome”), yet simultaneously suffer from catastrophic executive dysfunction, post-stroke fatigue, emotional lability, sexual dysfunction, parental inadequacy, workplace alienation, and sudden socioeconomic precarity. Because traditional outcome measures do not interrogate these nuanced domains, these pervasive deficits remain clinically invisible and untreated.

The NEEDS Questionnaire directly bridges this translational gap by serving three core applications across clinical, research, and policy settings:

• Individualized Clinical Case Formulation and Care Planning: By categorizing 175 potential problem areas into distinct operational domains, the instrument functions as an actionable intake inventory for outpatient neurorehabilitation teams, occupational therapists, clinical neuropsychologists, and social workers. Rather than relying on unstructured patient recall during brief clinical encounters, the instrument systematically screens for low-incidence or socially sensitive concerns (such as intimate relationship difficulties, reproductive challenges, cognitive fatigue, or financial navigation) that patients rarely spontaneously articulate.
• Resource Stratification and Triage in Health Services: The inclusion of a conditional six-point significance scale (evaluating the subjective gravity of each endorsed unmet need from 1 = “not significant” to 6 = “highly significant”) allows multidisciplinary teams to differentiate between minor residual deficits that the survivor has successfully accommodated, and acute, highly disruptive unmet needs requiring immediate secondary care intervention, psychological therapy, or community-based social work support.
• Translational Health Services Research and Policy Benchmarking: In epidemiological and health economics research, the NEEDS Questionnaire offers a standardized, granular metric to benchmark the longitudinal long-term efficacy of stroke service delivery models. Researchers can quantify how systemic health service gaps vary as a function of time post-stroke, geographical location, sociodemographic background, and neurological stroke subtype, thereby establishing an empirical foundation for health policy reform and resource allocation directed at younger survivor cohorts.

5. Psychological Construct

The central psychological and behavioral construct operationalized by the NEEDS Questionnaire is the perceived unmet need within a post-acute, community-dwelling neurological survivorship context. In health services psychology, a “need” is conceptualized not merely as the presence of a physiological or cognitive impairment, but rather as the discrepancy between an individual’s actual functional state and their desired functional state, occurring alongside the absence of adequate environmental, clinical, or personal resources to mitigate that gap. The NEEDS Questionnaire explicitly recognizes that impairment does not linearly dictate suffering; instead, subjective distress and maladaptation emerge when contextual environmental barriers prevent an individual from fulfilling socially and developmentally expected life roles.

The architecture of the NEEDS Questionnaire maps this overarching construct across seven interconnected functional, psychological, and environmental domains:

1. Healthcare Experience (Items 6–39)

This domain captures the patient’s interactions with, and navigation through, the health system following acute discharge. It assesses informational needs regarding stroke etiology, secondary prevention, pharmacological side effects, access to specialized Allied Health therapy (e.g., speech pathology, specialized neuro-physiotherapy, vocational rehabilitation), communication quality with healthcare practitioners, continuity of care across transitions, and perceived coordination among primary, secondary, and tertiary clinical services.

2. Impairments from Stroke (Items 40–80)

Encompassing 41 distinct items, this extensive domain measures the subjective burden of sensorimotor, cognitive, somatic, and affective sequelae. Rather than relying solely on objective neurological indices, it queries the patient’s perception of ongoing bodily disturbances. Specific subconstructs include motor weakness, spasticity, sensory loss, chronic pain, post-stroke central fatigue, sleep architecture disruption, communicative deficits (aphasia, dysarthria, cognitive-communication disorders), and higher-order neuropsychological deficits such as executive dysfunction, working memory lapses, divided attention failures, emotional lability, anxiety, and post-stroke depressive symptomology.

3. Everyday Activities (Items 81–94)

Moving beyond basic activities of daily living, this domain probes instrumental activities of daily living (IADLs) and domestic life. Items evaluate the respondent’s perceived autonomy and support in complex tasks necessary for independent community living, including personal transportation, public transit utilization, meal preparation, domestic house maintenance, medication management, child care, and the navigation of digital technologies and complex physical environments.

4. Work or Study (Items 95–116)

Recognizing that vocational and educational continuity is central to identity and developmental progression in young adulthood, this domain systematically evaluates the multi-faceted barriers associated with return-to-work or resumption of academic pursuits. Subconstructs examine physical access barriers, cognitive stamina in workplace settings, access to workplace modifications, employer understanding and stigma, specialized vocational counseling, legal protections, and academic accommodation services.

5. Finances (Items 117–124)

Financial toxicity represents an acute secondary crisis for young survivors who abruptly lose earning capacity while incurring substantial medical and rehabilitation expenditures. This domain measures unmet needs related to navigating disability pensions, welfare support systems, insurance dispute processes, personal debt management, cost of ongoing therapeutic interventions, and long-term financial security for the patient and their dependents.

6. Relationships (Items 125–137)

Neurological illness induces profound structural shifts within interpersonal ecosystems. This domain captures psychological and relational strain across marital, partnership, familial, and parental dyads. Specific constructs include alterations in partner dynamic (e.g., transition from romantic partner to informal caregiver), parenting distress and difficulty managing parental authority, communication breakdowns, loss of intimacy, and sexual dysfunction—topics that are frequently neglected during standard neurological follow-ups.

7. Social Participation (Items 138–146)

The final domain measures alienation, social isolation, and community reintegration. It explores the survivor’s ability to maintain pre-stroke peer networks, engage in recreational and leisure pursuits, join community organizations, and navigate the psychological friction associated with social stigma, invisible cognitive-communicative disability, and altered peer relational expectations.

6. Theoretical Framework

The conceptual underpinning of the NEEDS Questionnaire is situated at the intersection of three foundational paradigms within medical sociology, clinical neuropsychology, and developmental lifespan theory: the International Classification of Functioning, Disability and Health (ICF), Bradshaw’s Taxonomy of Social Need, and Erikson’s Theory of Psychosocial Development.

The World Health Organization’s ICF Model

The structural taxonomy of the NEEDS Questionnaire aligns closely with the biopsychosocial architecture of the World Health Organization’s ICF model (WHO, 2001). The ICF model conceptualizes human functioning not as a purely biological or personal attribute, but as a dynamic, bidirectional interplay between health conditions (disorders or diseases), body functions and structures (impairments), activities (limitations), and participation (restrictions), all contextualized by environmental and personal factors. In the NEEDS Questionnaire:

• The Impairments from Stroke domain directly maps onto the ICF Body Functions and Body Structures component.
• The Everyday Activities domain operationalizes the Activity Limitations dimension.
• The Work or Study, Relationships, and Social Participation domains capture the complex societal domain of Participation Restrictions.
• The Healthcare Experience and Finances domains evaluate environmental barriers, systemic institutional facilitators, and economic resource contexts.

By mapping its assessment across all strata of the ICF framework, the NEEDS Questionnaire avoids the reductionist bio-medical traps of acute stroke assessments, highlighting how personal and environmental deficits intersect to create lived disability.

Bradshaw’s Taxonomy of Social Need

To rigorously assess unmet needs, the instrument relies on the sociological formulation articulated in Bradshaw’s Taxonomy of Social Need (1972). Bradshaw differentiated needs into four operational categories: normative need (defined by clinical experts against an objective standard), comparative need (identified by comparing resource availability across demographic groups), expressed need (demands translated into explicit service utilization, such as seeking clinical appointments), and felt need (the subjective perception of deficit, longing, or inadequacy experienced directly by the individual). Conventional healthcare systems frequently conflate expressed need with actual need; if a patient does not present to a clinic or request speech therapy, the system erroneously assumes no need exists. The NEEDS Questionnaire operationalizes felt need, creating an explicit vehicle for young survivors to identify unvoiced deficits that have never been translated into formal service claims due to systemic friction, cognitive fatigue, emotional distress, or simple ignorance of available community services.

Lifespan Developmental Psychology

Underpinning the age-specific tailoring of the instrument (targeting individuals aged 18 to 55) is Erikson’s lifespan developmental theory. Young and middle adulthood corresponds directly to the critical psychosocial crises of Intimacy vs. Isolation (ages 18–40) and Generativity vs. Stagnation (ages 40–65). During these stages, developmental success is predicated upon establishing romantic and domestic partnerships, raising progeny, attaining vocational mastery, and generating societal contributions. A sudden neurological insult during these developmental windows causes unique developmental disruption. By dedicating extensive subscales to career trajectories, financial security, child-rearing, and intimate partnerships, the NEEDS Questionnaire directly addresses the developmental realities of this younger cohort, recognizing that identity stabilization and role preservation are central to psychological adjustment after neurological injury.

7. Validity

The developmental process and initial psychometric appraisal of the NEEDS Questionnaire, as described by Sapuppo et al. (2023), laid an extensive foundation for content and face validity, while identifying critical methodological avenues for future empirical construct validation across international samples.

Content and Face Validity

Content validity—the degree to which an instrument adequately represents all facets of a given psychological or clinical construct—was rigorously established through a multi-stage qualitative and iterative design protocol:

• Systematic Literature Synthesis: The development group initiated the process with an exhaustive literature review of published unmet needs instruments utilized across stroke, traumatic brain injury (TBI), and chronic neurological disorders. Pre-existing instruments, including the Longer-term Unmet Needs after Stroke (LUNS) tool, the Stroke Survivors Needs Questionnaire (SSNQ), and generic cancer survivorship tools, were scrutinized to identify functional gaps specific to young adult survivorship.
• Multidisciplinary Expert Consultation: The 175 prospective items were formulated, refined, and categorized through iterative panel evaluations involving vascular neurologists, stroke rehabilitation physicians, clinical neuropsychologists, occupational therapists, academic physiotherapists, and biostatisticians. This interdisciplinary scrutiny ensured that item phrasing minimized medical jargon, was comprehensible to individuals with mild cognitive or language deficits, and captured the clinical nuances observed in contemporary post-acute community rehabilitation.
• Target Population Pilot Review: Face validity was appraised by pilot-testing preliminary draft iterations with community-dwelling young stroke survivors. Participant feedback was utilized to refine question syntax, adjust navigational flow in the electronic survey environment, and ensure that sensitive topics (such as sexual dysfunction, cognitive declines, and financial strain) were approached with appropriate clinical framing and psychological safety.

Construct, Convergent, and Discriminant Validity Considerations

In the primary empirical validation cohort evaluated in Australia (Sapuppo et al., 2023), the NEEDS Questionnaire demonstrated significant ecological validity by successfully delineating complex profiles of unmet needs that were completely undetected by standard gross outcome classifications (e.g., mRS). Specifically, respondents who met clinical criteria for “good functional recovery” (mRS scores of 0–2) routinely endorsed high volumes of unmet needs in the Work or Study, Impairments (specifically invisible cognitive fatigue and executive dysfunction), and Relationships domains.

Formal quantitative psychometric indices—such as convergent validity (correlating NEEDS domain scores with validated scales such as the Stroke Impact Scale [SIS], the Hospital Anxiety and Depression Scale [HADS], or the EuroQol 5-Dimension [EQ-5D]) and discriminant validity (demonstrating distinctness from generalized neuroticism or acute somatic distress)—represent ongoing areas of empirical exploration. As noted by the original investigators, the broad epidemiological scope of the 175-item inventory provides unprecedented qualitative granularity, but requires ongoing large-sample psychometric studies to establish standardized convergent and discriminant correlation matrices across diverse health systems.

8. Reliability

Reliability analysis in broad, multi-domain healthcare inventories presents distinct theoretical and methodological considerations. Because the NEEDS Questionnaire functions primarily as an exhaustive clinical and epidemiological profiling checklist across 175 heterogeneous items, its reliability parameters must be understood through the lens of patient-reported health needs indices rather than homogeneous latent trait scales.

Internal Consistency Considerations

In traditional psychometrics, Cronbach’s alpha and McDonald’s omega evaluate the degree to which items within a scale measure the same underlying construct. For highly cohesive clinical subscales within the NEEDS Questionnaire (such as Impairments from Stroke or Healthcare Experience), high internal consistency estimates are expected due to the shared physiological and institutional substrates connecting those items. However, in heterogeneous life-context domains—such as Everyday Activities (spanning child care to personal transport) or Finances (spanning insurance claims to personal loans)—calculating a monolithic internal consistency coefficient can be methodologically misleading. An individual may possess an acute unmet need regarding public transit access while having zero difficulty managing personal banking. Therefore, as highlighted in health services research methodology, the instrument functions partly as a causal-indicator or cumulative inventory where individual items represent distinct, non-redundant challenges rather than parallel manifestations of a single latent trait.

Test-Retest Stability vs. Dynamic State Sensitivity

Evaluating test-retest reliability (Pearson’s r or Intraclass Correlation Coefficients [ICC]) in a post-stroke needs assessment requires careful consideration of temporal stability versus clinical responsiveness. Unmet needs in young stroke survivors are inherently dynamic: they fluctuate in response to spontaneous biological neurological recovery, changes in rehabilitation access, shifts in family support structures, and unpredictable life events (such as termination of employment or changes in national disability funding policies).

Consequently, establishing an optimal re-test window is critical. A test-retest interval that is too brief (e.g., <48 hours) introduces substantial recall bias, whereas an interval that is too lengthy (>2 to 4 weeks) captures genuine therapeutic change or clinical deterioration rather than instrument instability. Methodologists evaluating the NEEDS Questionnaire recommend administering test-retest evaluations within a 7- to 14-day window in stable, chronic cohorts (>6 months post-stroke) to establish baseline stability coefficients for the six-point Likert significance ratings.

9. Factor Analysis

The structural dimensionality of the 175-item NEEDS Questionnaire represents a rich domain for psychometric investigation, combining high-item-volume clinical profiling with multi-tiered structural domains.

Structural Dimensionality and Factor Structure

The conceptual blueprint of the NEEDS Questionnaire proposes seven overarching dimensions: (1) Healthcare Experience, (2) Impairments from Stroke, (3) Everyday Activities, (4) Work or Study, (5) Finances, (6) Relationships, and (7) Social Participation. In initial validation protocols, this structure was derived through rational, content-driven domain allocation guided by clinical expert consensus and ICF alignment rather than unconstrained mathematical data reduction (Sapuppo et al., 2023).

Subsequent psychometric modeling of large-scale needs inventories typically utilizes both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to determine whether these seven conceptual domains conform to empirical latent factors, or whether specific subscales exhibit multi-factorial substructures. For example, the 41-item Impairments from Stroke domain exhibits theoretical sub-dimensions comprising:

• Sensorimotor Physical Dysfunction (items evaluating paresis, gait, spasticity, and coordination)
• Neurocognitive and Executive Impairment (items evaluating memory, concentration, cognitive pacing, and problem-solving)
• Neuro-affective and Somatosensory Disturbance (items evaluating chronic pain, central fatigue, insomnia, affective dysregulation, and emotional lability)

Methodological Challenges: Binary Gating and Polytomous Severity

A notable psychometric feature of the NEEDS Questionnaire is its dual-tiered response structure: a binary presence-absence gating step (Yes/No unmet need) followed by a polytomous continuous-significance rating (1–6 Likert scale). From an advanced psychometric standpoint, running standard linear factor models (such as maximum likelihood CFA) directly on such conditional, zero-inflated data violates classical distributional assumptions.

Contemporary psychometric modeling addresses this architecture via two primary analytical paradigms:

• Item Response Theory (IRT) and Rasch Measurement Models: Utilizing two-parameter logistic (2PL) or three-parameter logistic (3PL) IRT models for the binary gating stage allows researchers to calculate item difficulty ($b_i$) and item discrimination ($a_i$) parameters. This identifies which unmet needs act as common early markers of survivorship distress versus those that signify extreme systemic marginalization.
• Two-Part (Hurdle) Latent Variable Modeling: To analyze the paired binary and polytomous components simultaneously, methodologists utilize hurdle factor models. The first equation models the probability of crossing the threshold into endorsing an unmet need (the binary hurdle), while the second equation models the latent severity or subjective significance among those who endorsed the presence of that need. Applying such models in structural equation modeling (SEM) frameworks provides robust fit indices (RMSEA < .06, CFI > .95, TLI > .95) without introducing distributional distortion.

10. Instrument / Measurement Tool

The Community Personal Needs Assessment (NEEDS) Questionnaire is structured as follows:

• Test Type: Standardized Patient-Reported Outcome Measure (PROM); comprehensive diagnostic clinical checklist and self-assessment needs inventory.
• Administration Format: Electronically administered (web-based survey interface accessible via desktop, tablet, or mobile browser environments) to facilitate adaptive branching and eliminate paper-based routing errors. Clinician-assisted administration is permissible for survivors with severe cognitive, motor, or visual limitations.
• Target Population: Community-dwelling young adult stroke survivors aged 18 to 55 years at the time of stroke occurrence, who are at least two months post-acute cerebrovascular accident.
• Item Inventory: 175 items organized into an initial demographic module followed by seven discrete substantive domains:
• Demographics and Clinical Background: Questions 1 to 5
• Healthcare Experience: Questions 6 to 39 (34 items)
• Impairments from Stroke: Questions 40 to 80 (41 items)
• Everyday Activities: Questions 81 to 94 (14 items)
• Work or Study: Questions 95 to 116 (22 items)
• Finances: Questions 117 to 124 (8 items)
• Relationships: Questions 125 to 137 (13 items)
• Social Participation: Questions 138 to 146 (9 items)
• Additional Branching / Contextual Explorations: Questions 147 to 175 (clarifying items investigating specific contributing etiologies and environmental constraints for endorsed needs)
• Response Architecture: Two-tiered hierarchical conditional branching:
• Tier 1 (Screening Filter): Binary response (Yes / No) to the question: “Do you currently have an unmet need in this area?”
• Tier 2 (Significance Rating): If the respondent answers “Yes”, an automated conditional item appears: “How significant is this unmet need to you?” rated on a 6-point Likert scale:
• 1 = Not significant
• 2 = Slightly significant
• 3 = Somewhat significant
• 4 = Moderately significant
• 5 = Very significant
• 6 = Highly significant
• Scoring and Output Metrics:
• Total Unmet Needs Count: The cumulative sum of binary “Yes” endorsements across all 175 items (possible range: 0–175), reflecting overall unmet need breadth.
• Domain-Specific Needs Count: The count of unmet needs within each of the seven individual domains, allowing for intra-individual profile analysis.
• Domain Significance Score: The arithmetic mean or cumulative sum of Likert severity ratings within each domain, highlighting areas of acute perceived distress.
• High-Significance Needs Index: The total count of items receiving significance ratings of 5 (“Very significant”) or 6 (“Highly significant”), serving as a clinical triage metric for immediate multidisciplinary referral.
• Estimated Completion Time: Approximately 30 to 50 minutes, depending on the survivor’s cognitive processing speed, motor dexterity, and the total volume of conditional branching items triggered. The electronic administration platform allows users to save progress and complete the questionnaire across multiple sessions to mitigate post-stroke cognitive fatigue.

11. Permissions & Fee and Test Year

The Community Personal Needs Assessment (NEEDS) Questionnaire was finalized and published in 2023 by David Sapuppo, Julie Bernhardt, Lilian B. Carvalho, Leonid Churilov, and Vincent Thijs via the Florey Institute of Neuroscience and Mental Health and Austin Health (Sapuppo et al., 2023).

• Commercial Status: Non-commercial instrument developed for clinical practice, academic investigation, and health service quality improvement.
• Usage Fee: There is no royalty or user fee associated with administering the NEEDS Questionnaire for non-profit academic research, clinical rehabilitation triage, or public health benchmarking.
• Permissions and Access Protocol: The complete electronic questionnaire, technical implementation specifications, and licensing terms must be obtained by directly contacting the corresponding author:
• Corresponding Contact: Prof. Vincent Thijs, MD, PhD
• Institutional Address: Department of Neurology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
• Direct Inquiries: [email protected]

12. References

Bradshaw, J. (1972). The concept of social need. New Society, 19(496), 640–643. https://doi.org/10.1177/004711787200100108

Chen, T., Zhang, B., Deng, Y., Fan, J. C., Shen, Q. Y., & Rong, J. K. (2019). Long-term unmet needs and associated factors in stroke survivors: A systematic review. Journal of Clinical Nursing, 28(21-22), 3746–3758. https://doi.org/10.1111/jocn.14972

Erikson, E. H. (1993). Childhood and society. W. W. Norton & Company. (Original work published 1950).

Forster, A., Young, J., & Nixon, J. (2013). Meeting the long-term needs of stroke survivors and their carers. Age and Ageing, 42(5), 554–555. https://doi.org/10.1093/ageing/aft107

Lo, J. W., Crawford, J. D., Desmond, D. W., Godefroy, O., Jokinen, H., Mahinrad, S., Bae, H. J., Lim, J. S., Köhler, S., Staals, J., Chen, C., Pasquier, F., Bordet, R., & Sachdev, P. S. (2019). Profile of and risk factors for poststroke cognitive impairment in diverse ethnocultural groups. Stroke, 50(9), 2247–2253. https://doi.org/10.1161/STROKEAHA.118.024098

Murray, J., Ashworth, R., & Forster, A. (2013). The Longer-term Unmet Needs after Stroke (LUNS) monitoring tool: Development and content validity. Clinical Rehabilitation, 27(11), 1014–1022. https://doi.org/10.1177/0269215513488880

Sapuppo, D., Bernhardt, J., Carvalho, L. B., Churilov, L., & Thijs, V. (2023). Self-evaluation of personal needs by community-living young stroke survivors using an online English language questionnaire. Disability and Rehabilitation: An International, Multidisciplinary Journal, 45(11), 1830–1835. https://doi.org/10.1080/09638288.2022.2076935

Synn, A. J., Jones, S. B., Rosamond, W. D., & Thijs, V. (2020). Stroke in the young: Current trends and future directions. Neurology, 95(16), 711–720. https://doi.org/10.1212/WNL.0000000000010729

World Health Organization. (2001). International Classification of Functioning, Disability and Health: ICF. World Health Organization. https://apps.who.int/iris/handle/10665/42407

13. Items of the Scale