Date Presented 04/05/19
Primary Author and Speaker: Kimberly Erler
Additional Authors and Speakers: Sarah McKinnon, Virginia Sullivan
Contributing Authors: Rebecca Inzana
PURPOSE: Participation is the overarching goal of neurorehabilitation; however, most individuals post stroke experience significant restrictions in participation as they attempt to resume their everyday roles and routines. Occupational therapy practitioners play a key role in facilitating participation for clients and recognize the impact of participation on overall health (Smallfield & Molitor, 2018). Despite this emphasis on participation, evidence suggests that inpatient stroke rehabilitation interventions focus more on upper extremity control and activities of daily living (Latham et al., 2006). Caregiver support at discharge from inpatient rehabilitation positively influences functional outcomes but more research is needed to understand the association between social support and participation. Therefore, this study aimed to examine the independent contribution of social support to participation 3 months post discharge from inpatient rehabilitation for ischemic stroke.
DESIGN: A secondary analysis of the Stroke Recovery in Underserved Populations 2005–2006 data was performed (Ostir, Ottenbacher & Kuo, 2016). Participants in this study were adults (mean age 68.15 years old) living in the community 3 months post discharge from inpatient rehabilitation for ischemic stroke with complete participation data (n=442).
METHOD: Multiple Linear Regression Analyses were performed with the primary variables of interest as the PAR-PRO Measure of Home and Community Participation and the Duke-UNC Functional Support Questionnaire.
RESULTS: Social support at discharge from inpatient rehabilitation for ischemic stroke was found to contribute uniquely to the variance in participation at 3 months post discharge (β=.396, P<.001) after controlling for race, sex, age, years of education, sum of comorbidities, sum of stroke symptoms, depression at discharge, FIM Motor at discharge, and FIM Cognitive at discharge. The overall model was significant (F(10, 405) = 17.546, p < .001) explaining 28.5% of the variance in participation at 3 months post discharge from inpatient rehabilitation for ischemic stroke. Social support alone accounted for 12.2% of the variance in participation (F(1, 405) Δ = 70.977, p < .001), and based on standardized betas was the strongest predictor of participation at 3 months relative to the other significant predictors in the model including FIM Motor (β=.243, P<.001) and depression (β=-.127, P<.007).
CONCLUSION: These findings suggest the need for occupational therapy practitioners to address social support during discharge planning from inpatient rehabilitation in the context of promoting participation. Results differ from previous work which found that participation was moderated by social support but was more related to independence (Beckley, 2006). Given that more than 70% of the variance remains unexplained, further research is needed to determine factors associated with participation after stroke.
IMPACT STATEMENT: In the complex United States health care system where there is a move towards shorter inpatient hospital stays, caregivers are often called upon to assist with basic self-care and medical management. Since social support is associated with valued outcomes after neurological injury including the overarching goal of participation, this research supports the expansion of community-based programs targeting caregivers well-being and education.
References
Beckley, M. N. (2006). Community participation following cerebrovascular accident: Impact of the buffering model of social support. American Journal of Occupational Therapy, 60(2), 129-135. http://dx.doi.org/10.5014/ajot.60.2.129
Latham, N. K., Jette, D. U., Coster, W., Richards, L., Smout, R. J., James, R. A., Gassaway, J., & Horn, S. D. (2006). Occupational therapy activities and intervention techniques for clients with stroke in six rehabilitation hospitals. American Journal of Occupational Therapy, 60, 369–378. http://dx.doi.org/10.5014/ajot.60.4.369
Ostir, Glenn, Ottenbacher, Kenneth, and Kuo, Yong Fang. Stroke Recovery in Underserved Populations 2005-2006 [United States]. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2016-05-03. https://doi.org/10.3886/ICPSR36422.v1
Smallfield, S., & Lucas Molitor, W. (2018). Occupational therapy interventions supporting social participation and leisure engagement for community-dwelling older adults: A systematic review. American Journal of Occupational Therapy, 72, 7204190020. https://doi.org/10.5014/ajot.2018.030627
