Date Presented 03/23/24
Gold-standard poststroke rehabilitation interventions focus on impairment reduction with assumed carry-over to participation. Long-term participation in meaningful activities for stroke survivors should be addressed during rehabilitation.
Primary Author and Speaker: Sarah Humphrey
Contributing Authors: Patricia Finetto, Julianne Laura, Kelly C. Rishe, Stephanie Garner, Michelle L. Woodbury
OBJECTIVE: To describe chronic stroke survivors’ current level of Participation.
BACKGROUND: Current ‘gold standard’ stroke rehabilitation interventions focus on impairment-reduction and assume carry-over to Participation. Participation has three dimensions: social connectedness, adaptation, and active involvement in meaningful activities. Little is known about stroke survivors’ level of Participation in the chronic stage.
METHOD: We analyzed existing data from 2 IRB-approved stroke rehabilitation studies. All subjects were >3 mo. post-stroke and no longer received OT. An anonymous Needs Assessment survey documented survivor-reported factors contributing to Participation. The survey was emailed to stroke survivors in an IRB-approved stroke registry. Subjects in one study completed the World Health Organization Quality of Life (WHOQoL-BREF), a 26-item self-report questionnaire using 4-point scale (1=low, 5=high). WHOQoL items were arranged into 3 Participation dimensions and average ratings per dimension was reported. Subjects in another study completed the Patient Specific Functional Scale (PSFS), a 5-item self-report questionnaire of the ability to accomplish self-selected meaningful activities on a 10-point scale (0=unable, 10=at pre-stroke levels). Data were tallied and the frequency of responses were reported.
RESULTS: The majority (58.8%) of the N=17 Needs Assessment respondents indicated no community activity. N=22 participants completed the WHOQoL-BREF. Average ratings for each Participation dimension ranged from 3.36–3.86/5 points. N=20 participants completed the PSFS, with the average rating =4.00.
CONCLUSION: The majority of these chronic stroke survivors are experiencing reduced Participation including limited community-integration, isolation, moderate quality of life, and low satisfaction with occupational performance. The results suggest that impairment-reduction focused OT may not adequately prepare survivors for long-term Participation.
References
Foley, E. L., Nicholas, M. L., Baum, C. M., & Connor, L. T. (2019). Influence of Environmental Factors on Social Participation Post-Stroke. Behavioral neurology, 2019, 2606039. https://doi.org/10.1155/2019/2606039
Woodman, P., Riazi, A., Pereira, C., & Jones, F. (2014). Social participation post stroke: meta- ethnographic review of the experiences and views of community-dwelling stroke survivors. Disability and rehabilitation, 36(24), 2031–2043. https://doi.org/10.3109/09638288.2014.887796
Ashaie, S. A., & Castro, N. (2022). Complexity of Participation Post-Stroke: Longitudinal Assessment of Community Participation, Positive Affect, Social Support, and Functional Independence. Journal of rehabilitation medicine, 54, jrm00335. https://doi.org/10.2340/jrm.v54.2238
