Abstract
This poster describes a completed research study that examined to what extent the built environment, physical functioning, and fatigue impact community participation for individuals poststroke.
Primary Author and Speaker: Emily McManus
Additional Authors and Speakers: Lisa Tabor Connor
Contributing Authors: Marjorie Nichols
After a stroke, individuals often find themselves unprepared to resume their previous lives within their community once discharged from rehabilitation services (Eriksson et al., 2015). The majority of rehabilitation services focus on ADLs and less on community reintegration (Wolf et al., 2015). Post-stroke fatigue is a common consequence of stroke and is reported to be the most distressing symptom. Additionally, individuals have reported aspects of the built environment as acting as a facilitator or barrier to community participation. The purpose of this research was 1) to examine the extent to which the built environment, physical functioning, and fatigue predicted community participation after stroke and 2) to determine if there were group differences between persons with and without aphasia. Fatigue was measured using the Multidimensional Assessment of Fatigue (MAF). The built environment was measured using the Measure of the Stroke Environment (MOSE) Built Environment subscale score. Physical functioning was measured using the Stroke Impact Scale (SIS) physical and motor subscale and the NIHSS motor score. Community reintegration was measured using the Reintegration to Normal Living Index (RNL). All assessments were adapted using a hierarchy of support to enable individuals with and without aphasia to participate in this study. This study utilized a quasi-experimental prospective, cross sectional design with 54 participants who experienced stroke at least 6 months prior. The inclusion criteria: age of 18 years or older, at least six months post stroke, ability to tolerate five hours of testing over two sessions, and a physical ability to get to the testing site. The exclusion criteria: a history of multiple strokes, traumatic brain injury, or seizure disorder, a pre-existing neurological condition, or concurrent severe medical or psychiatric illnesses. There were no group differences between individuals with and without aphasia for community reintegration on the RNL. Multiple regression revealed that 64% of the variance in RNL score could be explained by the predictor variables. The SIS Motor and Physical self-perception score was the strongest predictor of overall community participation, more so than the extent of motor impairment as measured by the NIHSS motor item total score; fatigue was not a mediating factor as initially predicted. Occupational therapists exert a vital role in working with the client, family and other team members to improve individuals’ perceptions of abilities by improving strength and mobility through compensatory strategies and demonstrating to clients how this translates to enhanced community participation.
Centers for Disease Control and Prevention. (2017). Stroke facts. Retrieved from http://www.cdc.gov/stroke/facts.htm
Eriksson, G., Baum, M.C., Wolf, T.J., Connor, L.T. (2013). Perceived participation after stroke: The influence of activity retention, reintegration, and perceived recovery. The American Journal of Occupational Therapy. 67, 131-138.
Tucker, F. M., Edwards, D. R., Kirchner Matthews, L., Baum, C. M., & Connor, L. T. (2012). Modifying outcome measures for people with aphasia. The American Journal of Occupational Therapy, 66(1), 42-50. doi:10.5014/ajot.2012.001255
Wolf, T. J., Chuh, A., Floyd, T., McInnis, K., & Williams, E. (2015). Effectiveness of occupation-based interventions to improve areas of occupation and social participation after stroke: An evidence-based review. The American Journal of Occupational Therapy, 69(1), 1-11. doi:10.5014/ajot.2015.012195