Social Support as a Predictor of Community Participation After Stroke

Abstract

Participation is a primary goal of neurorehabilitation; however, most individuals post stroke experience significant restrictions in participation as they attempt to resume their everyday roles and routines. Despite this emphasis on participation, there is a paucity of evidence-based interventions for optimizing this outcome and a limited understanding of factors that contribute to poor participation outcomes. Caregiver support at discharge from inpatient rehabilitation positively influences physical and psychological outcomes after stroke but more research is needed to understand the association between social support and participation. This study aimed to examine the independent contribution of perceived social support to participation 3 months post discharge from inpatient stroke rehabilitation. This study was a secondary analysis of the Stroke Recovery in Underserved Populations 2005–2006 data. Participants were adults ≥55 years old, living in the community 3 months post discharge from inpatient rehabilitation for ischemic stroke (n = 422). Hierarchical linear regressions were performed. The primary variables of interest were the PAR-PRO Measure of Home and Community Participation and the Duke–University of North Carolina Functional Social Support Questionnaire. Perceived social support at discharge from inpatient rehabilitation for ischemic stroke contributed uniquely to the variance in participation 3 months later (β = 0.396, P < 0.001) after controlling for race, sex, age, years of education, comorbidities, stroke symptoms, depression, FIM Motor, and FIM Cognitive. Social support accounted for 12.2% of the variance in participation and was the strongest predictor of participation relative to the other independently significant predictors in the model including FIM Motor and depression. There is already a focus on caregiver training during inpatient rehabilitation related to basic self-care, transfers, and medical management. These findings suggest the need for rehabilitation professionals to also address social support during discharge planning in the context of promoting participation. Given the findings, expanding caregiver training is necessary but novel interventions and programs must be carefully developed to avoid increasing caregiver burden.

The Impact of Home-Based Exercise Rehabilitation on Functional Capacity in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial

“…24 Caregiver burden, access to specialized neurorehabilitation centers, cost, time, and transportation are a few of the obstacles to delivering time intensive, prolonged center-based rehabilitation. 25 Therefore, designing a comprehensive home-based rehabilitation programs is essential to overcome these briers.…”

Social Determinants of Health in Physiatry: Challenges and Opportunities for Clinical Decision Making and Improving Treatment Precision

“…Successful community reengagement includes social, leisure, instrumental, vocational, school or volunteer participation. For some diagnoses like stroke, reengagement in community activities and self-care is best predicted by a supportive living situation ( 49 , 50 ). In patients with TBI, community reintegration is complex, and strength of associations between SDH and outcomes vary widely.…”

The role of the social network during inpatient rehabilitation: A qualitative study exploring the views of older stroke survivors and their informal caregivers

“…[20][21][22] Since engagement in valued activities and social relationships are predictors of better (mental) health and wellbeing, [23][24][25][26][27] it seems important that rehabilitation professionals help stroke survivors and primary caregivers resume their valued activities and inform them about the importance of maintaining social relationships. 8,[28][29][30] Additionally, because an understanding and supportive social network is a prerequisite for activity resumption, 8,10,28,29,[31][32][33][34] several authors suggest that rehabilitation professionals should invite family members, friends and acquaintances to play an active role during inpatient rehabilitation. 28,29,32,[35][36][37] Professionals should inform and educate these social network members about how to support stroke survivors' and caregivers' activity resumption so that adequate support will be available once the stroke survivor returns home.…”

“…8,[28][29][30] Additionally, because an understanding and supportive social network is a prerequisite for activity resumption, 8,10,28,29,[31][32][33][34] several authors suggest that rehabilitation professionals should invite family members, friends and acquaintances to play an active role during inpatient rehabilitation. 28,29,32,[35][36][37] Professionals should inform and educate these social network members about how to support stroke survivors' and caregivers' activity resumption so that adequate support will be available once the stroke survivor returns home. Involving and educating social network members seems especially important in case of older stroke survivors because they generally suffer from more initial impairments and more severe strokes, 38,39 resulting in a less favourable functional status and fewer possibilities to return to previously valued activities.…”