Participation in Younger and Older Adults Post-stroke: Frequency, Importance, and Desirability of Engagement in Activities

Abstract

Purpose: To characterize and compare frequency and subjective dimensions of post-stroke participation in younger (<65) and older adults (>age 65), in social, productivity and leisure activities, 6 months post-inpatient rehabilitation. Secondary aims included exploration of demographic and clinical factors influencing desire for increased participation and comparison of two measures of participation.Methods: A prospective cohort study of people with stroke (n = 99) who were identified during their inpatient rehabilitation stay and followed-up 6 months post-discharge with telephone interviews using two self-report participation measures. The Stroke Impact Participation subscale (SIS-P) measured the frequency of perceived limitations in social, leisure, productive activities and extent of stroke recovery. The Community Participation Indicators (CPI) examined activity frequency, importance, and desire for increased activity engagement. Descriptive statistics were used to summarize demographic variables and characterize SIS-P and CPI items. Differences between age groups on individual items were examined. Associations between measures and demographic variables were explored.Results: Both groups reported a wide variation in participation restrictions that was not associated with stroke severity and weakly associated with discharge functional status (rho = 0.20–0.35). There were no significant differences between age groups in CPI frequency (for 18/19 items), or the SIS-P. However, there was a trend toward more participation restrictions on the SIS-P among those <65 (p = 0.07). Younger adults (n = 46; median age = 53) were significantly more likely to indicate that they were not doing selected activities enough on the CPI, compared with older adults (n = 56; median age = 76). While age and ethnicity were independently associated with some activities, it was not associated with other activities. The CPI and SIS-P were moderately related at a correlation of rho = 0.54, p < 0.001.Conclusion: The CPI demonstrated value and utility in examining subjective perspectives of activity importance and desire for change for people who are 6 months post-stroke. Although the CPI and SIS-P are moderately related, subjective appraisal of participation in selected individual activities (CPI) better distinguished between age groups and provided unique and distinct information from the SIS-P.

Detecting change in community participation with the Enfranchisement scale of the community participation indicators

“…One study was a wait-list randomized controlled trial of a self-management intervention for adults with stroke ( n = 97). 15 Participants were recruited from the community using stroke registries across multiple midwestern sites and were included if they were community-dwelling adults who had mild-moderate strokes more than 3 months prior and had completed their acute and inpatient rehabilitation. The dataset was selected because all participants received an intervention between testing time points and would be expected to improve.…”

Perceived Community Participation and Associated Factors in People With Stroke

“…Previous reports often state that increased age correlates with reduced participation performance. 27 , 28 Additionally, reaching a stage of acceptance or content with participation after stroke takes about 7-8 years. 29 This incongruity in results could be because our sample was relatively younger in age and less time had passed since their stroke (median=23 months, table 1 ) compared to the other studies.…”

The WeReha Project for an Innovative Home-Based Exercise Training in Chronic Stroke Patients: A Clinical Study

“…After a stroke, restricted participation in social and work activities (mainly in younger patients aged <65 with social and economic repercussions) was observed. 3 …”

“…The reduction of disability should be developed so as to improve the quality of life. 3 , 4 Moreover, rehabilitation is one of the most important aspects of patient care after a stroke and has proven to be fundamental to the degree of recovery and level of independence after hospitalization. 4 Consequently, the provision of comprehensive rehabilitation programs with adequate duration and resources is essential in stroke care rehabilitation and should be prioritized in the acute and chronic phases.…”

“…1,2 After a stroke, restricted participation in social and work activities (mainly in younger patients aged <65 with social and economic repercussions) was observed. 3 Additionally, stroke-related sequelae range from associated motor deficit, often to cognitive impairment, which contributes to a reduction in daily activities with a low level of participation and a poor quality of life. Rehabilitation strategies focus on the recovery of autonomy in both simple and complex daily activities.…”