Abstract
Participation is a primary goal of neurorehabilitation; however, most individuals post stroke experience significant restrictions in participation as they attempt to resume their everyday roles and routines. Despite this emphasis on participation, there is a paucity of evidence-based interventions for optimizing this outcome and a limited understanding of factors that contribute to poor participation outcomes. Caregiver support at discharge from inpatient rehabilitation positively influences physical and psychological outcomes after stroke but more research is needed to understand the association between social support and participation. This study aimed to examine the independent contribution of perceived social support to participation 3 months post discharge from inpatient stroke rehabilitation. This study was a secondary analysis of the Stroke Recovery in Underserved Populations 2005–2006 data. Participants were adults ≥55 years old, living in the community 3 months post discharge from inpatient rehabilitation for ischemic stroke (n = 422). Hierarchical linear regressions were performed. The primary variables of interest were the PAR-PRO Measure of Home and Community Participation and the Duke–University of North Carolina Functional Social Support Questionnaire. Perceived social support at discharge from inpatient rehabilitation for ischemic stroke contributed uniquely to the variance in participation 3 months later (β = 0.396, P < 0.001) after controlling for race, sex, age, years of education, comorbidities, stroke symptoms, depression, FIM Motor, and FIM Cognitive. Social support accounted for 12.2% of the variance in participation and was the strongest predictor of participation relative to the other independently significant predictors in the model including FIM Motor and depression. There is already a focus on caregiver training during inpatient rehabilitation related to basic self-care, transfers, and medical management. These findings suggest the need for rehabilitation professionals to also address social support during discharge planning in the context of promoting participation. Given the findings, expanding caregiver training is necessary but novel interventions and programs must be carefully developed to avoid increasing caregiver burden.
Highlights
Stroke is the leading cause of disability in the United States with almost 800,000 people experiencing a new or recurrent stroke each year [1]
The original publicly available dataset included 1,219 participants, 891 participants of whom had a primary diagnosis of ischemic stroke
The purpose of this study was to determine the unique contribution of perceived social support at discharge from inpatient rehabilitation for first time ischemic stroke to the participation among community dwelling adults 3 months later
Summary
Stroke is the leading cause of disability in the United States with almost 800,000 people experiencing a new or recurrent stroke each year [1]. Stroke can result in a complex matrix of physical, communication, cognitive, and emotional impairments that limit a person’s ability to perform basic activities of daily living or participate in the community. The ICF describes three domains impacted by a health condition: body structures and functions (impairments) which capture functioning at the level of the body, activities which capture functioning at the level of the individual, and participation which captures functioning at the societal level. Neurorehabilitation aims to minimize disability and restore function after stroke, primarily focusing on the restitution of impairments and compensation for activities of daily living [3]. Many rehabilitation professionals expect that an impairmentbased or activity-based approach will lead to improvements in community participation [4]; research indicates that this secondary gain in participation may not always occur. Determining modifiable factors that contribute to successful community participation after stroke has the potential to advance clinical practice by informing novel interventions and program development
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