Participation in Complex and Social Everyday Activities Six Years after Stroke: Predictors for Return to Pre-Stroke Level

Abstract

BackgroundLong-term disability following stroke can lead to participation restrictions in complex and social everyday activities, yet information is lacking on to what extent stroke survivors return to their pre-stroke levels of participation.ObjectivesThe objectives of this study were to investigate the level of participation in complex and social everyday activities 6 years after stroke, to compare this with pre-stroke participation and to identify predictors of returning to pre-stroke levels of participation.MethodAll patients admitted to Karolinska University Hospital's stroke units during a 1-year period were eligible to participate and 349 patients were recruited. Assessments were made at base-line, 3 months and 6 years using self-reported outcome measures. Participation was assessed using the Frenchay Activities Index (FAI). The 6-year score for each participant was compared to the pre-stroke score, both for the total score and for each domain (domestic chores, leisure/work and outdoor activities). Predictors of having the same or better level of participation at 6 years were identified using logistic regression.ResultsAt 6 years, 121 participants were followed up, 166 were deceased, 44 declined to take part and 18 could not be traced. At 6 years 84% could be described as active (FAI≥15). The same level of participation or better than pre-stroke was found in 35% of participants, in 65% the level was lower. Similar predictors were identified for achieving the same or better level of participation at 6 years for FAI total and the three domains; ability to walk without aids and a lower age at stroke onset, and perceived mobility, participation and recovery at 3 months.ConclusionSix years after stroke, 35% of participants had the same or better level of participation as pre-stroke. Rehabilitation after stroke to improve walking ability and participation might improve long-term participation in complex and social everyday activities.

Occupational gaps 5 years after stroke

“…Few studies have investigated predictors for occupational gaps, but one study (Bergstrom et al., ) showed that stroke severity, activities of daily living abilities, social participation, and not being born in Sweden as predictors for occupational gaps, whereas age at stroke onset was not found to be a significant predictor. Furthermore, age and physical capability have previously been identified as predictors for a reduced subjective participation 2–4 (Desrosiers et al., ) and 6 (Singam et al., ) years after stroke, indicating generalizability of the identified predictors in the present study since the previous study populations were older and had different sex distribution compared to the present study.…”

Return to Work after a Stroke in Working Age Persons; A Six-Year Follow Up

“…An Australian study [13] showed a RTW rate of 75% within the first year after stroke, while 48% had returned to the same level of work as before the stroke in a 6 year follow up of participation in everyday activities, conducted in Sweden [14]. Further, in a one-year follow-up study, 45% had returned to paid work (30% in the same extent as before the stroke and 15% less than before) [15].…”

Social Participation as a goal of the post-stroke rehabilitation program: a literature review

“…Singam et al (10) presented in their study that the post-stroke individuals, six years after the event, returned to their level of (6) A multicenter study, conducted in Nigeria with 96 stroke survivors. The social participation was assessed by the Multidimensional Scale Perceived Social Support (MSPSS) and London Handicap Scale (LHS).…”

“…The knowledge regarding the treatments which promote the best results may help optimize its effects and provide a better functionality for these patients (2) . The successful recovery of a stroke should result in a quality of life and degree of participation in the community similar to the previous injury, however, not all patients have access to care and rehabilitation that they need (9,10) . The provision of rehabilitation services after discharge is essential to promote independence and reintegration of patients in the community (10) .…”

“…The successful recovery of a stroke should result in a quality of life and degree of participation in the community similar to the previous injury, however, not all patients have access to care and rehabilitation that they need (9,10) . The provision of rehabilitation services after discharge is essential to promote independence and reintegration of patients in the community (10) . Although many interventions and measurements are not aimed at social participation, even though it is considered one of the most important and fundamental factors for a successful recovery, there is the necessity to measure what the studies have been using to assess the social participation of people who had stroke, in order to suggest a standardization of the use of more sensitive tools to classify the social participation in this population.…”