Factors associated with post-stroke social participation: A quantitative study based on the ICF framework.

Abstract

Post-stroke social participation is a major determinant of quality of life and life satisfaction. However, few data relating to participation determinants are available, especially the influence of psychological factors and factors related to the living environment. This study investigated determinants of post-stroke social participation within the International Classification of Functioning, Disability and Health framework. We contacted people with stroke who had been hospitalized in the Rhône County, included in a previous cohort study, were aged ≥18 years and were not institutionalized. The primary outcome was social participation measured with the Stroke Impact Scale (SIS) 2.0. We performed multiple hierarchical linear regressions to test the following predictors: clinical factors (stroke-related variables, limitations in Activities of Daily Living [ADL]/Instrumental ADL), personal factors (sociodemographic factors, coping strategies) and environmental factors (satisfaction with social relationships and living environment). Among the 352 participants, 63% were men, and mean age was 68.7(SD 14.5) years. In the last multivariate model, variables associated with higher levels of social participation were the use of the positive thinking coping strategy (B (SD)=1.17(0.52), p=0.03), higher perceived satisfaction with the living environment (B (SD)=0.17(0.07), p=0.03) and fewer perceived activity limitations (B (SD)=0.55 (0.06), p<0.001). Conversely, the seeking social support coping style (B (SD)= -1.98 (0.60), p=0.001), and a higher number of stroke-related sequelae (B (SD)= -1.93(0.53), p=0.001) were associated with lower social participation. The identification of potentially modifiable personal and environmental factors that influence social participation provides elements to strengthen existing rehabilitation programs and opens the way for possible psychosocial interventions.