Life and Leisure Activities following Stroke or Transient Ischaemic Attack (TIA): An Observational, Multi-Centre, 6-Month Follow-Up Study

Abstract

Objective: To examine changes in leisure participation following stroke/transient ischaemic attack (TIA) and explore its relationship to modifiable and non-modifiable participant characteristics. Design: An observational study design with self-report questionnaires collected at two time points (baseline and 6-months). Setting: The study was conducted across 21 hospital sites in England, Wales, and Northern Ireland. Participants: Participants were aged 18+ and had experienced a first or recurrent stroke or TIA and had a post-stroke/TIA modified Rankin score (mRS) of ≤3. Procedure: Research practitioners at each site approached potential participants. Individuals who agreed to participate completed a baseline questionnaire whilst an inpatient or at a first post-stroke/TIA clinic appointment. A follow-up questionnaire was posted to participants with a freepost return envelope. Two questionnaires were developed that collected demographic information, pre-stroke/TIA mRS, social circumstances (e.g., employment situation) and incorporated the shortened Nottingham Leisure Questionnaire (sNLQ). Results: The study recruited eligible participants (N = 3295); 2000 participants returned questionnaires at follow-up. Data showed three participant variables were significant predictors of engagement in leisure activities post-stroke/TIA: age, sex, and deprivation decile. There was an overall decline in the number and variety of leisure activities, with an average loss of 2.2 activities following stroke/TIA. Only one activity, “exercise/fitness” saw an increase in engagement from baseline to follow-up; watching TV remained stable, whilst participation in all other activities reduced between 10% and 40% with an average activity engagement reduction of 22%. Conclusions: Some groups experienced a greater reduction in activities than others—notably older participants, female participants, and those living in a low socioeconomic area. Registration: researchregistry4607. Strengths and limitations of this study: 1. This is the largest-ever study to survey life and leisure activity engagement following stroke/TIA. 2. Survey responses were self-reported retrospectively and, therefore, may have been misreported, or misremembered. 3. Despite the large cohort, there were few participants, and so respondents, from ethnic minority groups.

Returning to Leisure Activity Post-Stroke: Barriers and Facilitators to Engagement

“…In the prior study, [ 16 ] it was identified that those participants who were older, female and living in an area of high socioeconomic deprivation were more likely to experience a reduction in leisure engagement. This sequential analysis identified that the main barriers for these groups were ‘ physical difficulties ’ and ‘lower energy levels ’ (as for all participants) and either loss of independence (older participants) or psychological difficulties (females or living in high socioeconomic deprivation).…”

“…This method enabled a more thorough understanding of specific issues and identified barriers and facilitators to engagement that were common to all participant groups. Building on the previous study’s findings of a 22% loss in activity post-stroke [ 16 ], this study helped to understand why this might happen and what might help to overcome this problem.…”

“…A self-report questionnaire on leisure activity was administered to participants who had a diagnosis of stroke or TIA at baseline and at 6-month follow-up. Full details of the study have been reported elsewhere [ 16 ]. Using a sequential, explanatory, mixed-methodology [ 17 ], qualitative data were identified from the 6-month follow-up questionnaire, analysed and were used to contextualise the findings from the prior study.…”

“…We have previously shown that engagement in leisure activities by six-months post-stroke or TIA, reduces on average by 22% compared to pre-event levels and notably so for older adults, females, and those living in higher socioeconomic deprivation [ 16 ]. To further our understanding of what helps or hinders engagement in leisure activity post-stroke or TIA, we used existing data from this study to undertake a qualitative analysis.…”